Three years into the pandemic, it's clear COVID won't fix itself. Here's what we need to focus on next

On March 11 2020 the World Health Organization classified COVID as a pandemic. Three years on, it remains just that.

As much as we don’t want it to be, and as much as it is off the front pages, COVID is still very much with us.

But how bad has it really been? And, more importantly, what have we learned that could help us accelerate a real and sustained exit?

Read more: Friday essay: COVID in ten photos

COVID has hit us hard

There was a slow initial global response to what we now call SARS-CoV-2, the virus that causes COVID. This allowed the virus to get a foothold, contributing to unexpectedly rapid viral evolution.

Three years into the pandemic, with the removal of almost all mitigation measures in most countries, it’s clear the virus has hit the world very hard. So far, almost 681 million infections and more than 6.8 million deaths have been reported.

This is perhaps best visualised by its impact on life expectancy. There were sharp declines seen across the world in 2020 and 2021, reversing 70 years of largely uninterrupted progress.

The excess mortality driving this drop in life expectancy has continued. This includes in Australia, where over 20,000 more lives than the historical average are estimated to have been lost in 2022.

Read more: Thousands more Australians died in 2022 than expected. COVID was behind the majority of them

Not just COVID deaths

The indirect impacts on the health systems in rich and poor countries alike continue to be substantial. Disruptions to health services have led to increases in stillbirths, maternal mortality and postnatal depression.

Routine child immunisation coverage has decreased. Crucial malaria, tuberculosis and HIV programs have been disrupted.

A paper out this week highlights the severe impact of the pandemic on mental health globally.

Read more: My kids are behind with their vaccines. How do they catch up?

Then there’s long COVID

Meanwhile, more evidence of long COVID has emerged around the world. At least 65 million people were estimated to be experiencing this debilitating syndrome by the end of 2022.

The Australian Institute of Health and Welfare estimates 5-10% of people who are infected with SARS-CoV-2 will develop long COVID, with symptoms persisting more than three months. That’s between 550,000 and 1.1 million Australians, based on the more than 11 million cases reported so far.

Read more: We got some key things wrong about long COVID. Here are 5 things we've learnt

COVID highlighted inequalities

The pandemic has also had a huge economic impact, both directly and indirectly.

The United States alone spent US$4 trillion on its response. Economists have estimated the pandemic will contribute an average 0.75% reduction in GDP in countries with high infection rates and high productivity in 2025.

Studies in the United Kingdom, US and Australia show COVID has had a disproportionate impact – including higher death rates – in disadvantaged communities and ethnic minorities.

The causes range from high exposure in low-paid jobs to inadequate access to health care. And poorer countries have fared terribly on all fronts from COVID, including inequitable access to vaccines.

Read more: Wealthy nations starved the developing world of vaccines. Omicron shows the cost of this greed

There’s no end in sight

We cannot assume there will be a natural exit to the pandemic, where the virus reaches some benign endemicity, a harmless presence in the background.

In fact, there is little indication anything like that is imminent.

In Australia, since the beginning of January, more than 235,000 COVID cases have been reported, almost as many as in 2020 and 2021 combined. Since the start of January, there have been 2,351 COVID-related deaths, more than twice as many as in the whole of 2020 and around the same as in the whole of 2021.