Since the start of the pandemic, sceptics of the severity of COVID-19 have likened it to the flu.
Two years in, with the milder Omicron variant now dominant, most of the developed world vaccinated, and much of it boosted, that assertion may bear some truth.
That is the view of JP Morgan economist David Mackie, who has been doing statistical analysis of the pandemic since soon after it began.
"Our analysis of the Danish data suggests that the properties of the now dominant BA.2 sub-lineage of Omicron (high transmissibility but low virulence), high vaccination and booster rates and the use of anti-viral therapeutics have together pushed the case fatality rate (CFR) of COVID-19 to below the CFR of influenza," he said.
He believes Denmark, which last week removed most restrictions, could offer an insight into what the COVID endemic that is likely to follow the pandemic might look like.
He says that in Denmark, the CFR (death rate) from the dominant BA.2 strain is less than 0.05 per cent — or 1 in 2,000.
Mr Mackie says this is similar to the global death rate from influenza, which is estimated to kill between 0.05 and 0.1 per cent of those infected.
However, he adds that it is likely the fatality rate from Omicron BA.2 is lower still, because all people who die within 30 days of a positive test are recorded as a COVID-19 death.
"A University of Copenhagen study calculated that up to 40 per cent of the deaths recorded in the latest week in Denmark were people who died with COVID-19 rather than people who died because of COVID-19," he noted.
"If we make this adjustment, the CFR for BA.2 falls from 0.045 per cent to 0.027 per cent."
At this level, while Mr Mackie believes COVID-19 will still result in millions of extra hospitalisations around the world each year, he thinks governments are more likely to invest in their healthcare systems to respond than to impose restrictions on individual behaviour.
'We may get unlucky'
However, three of Australia's leading epidemiologists have varying degrees of doubt about the bank economist's analysis.
Overall, Professor Tony Blakely from the University of Melbourne believes the analysis of the fatality rates from Omicron BA.2 relative to influenza is "most reasonable".
His main doubt rests with the idea that the pandemic might soon be over once and for all.
He says this conclusion rests on a "big assumption" that any further variants are "Omicron-like with decreasing virulence."
"There will be new variants," he warned.
"It is, however, random whether it will be less or more virulent. There is no selection pressure based on this virulence."
This is an issue that Mr Mackie himself acknowledged in his report.
"If we define variant dominance as the situation when a variant accounts for more than 50 per cent of global new infections, the Alpha variant was dominant for three months while the Delta variant was dominant for six months," he observed.
"We will have to wait and see how long Omicron can sustain its dominance, and what new variant might follow."
However, Professor Blakely added that there was good reason to be optimistic that new variants were likely to result in less severe disease than we have seen in past waves.
"Because each time a new variant arises, we [as a population] have had more vaccinations and more natural infections, we make its effective virulence less," he explained.
"For example, had Omicron happened 18 months ago, it would have looked more virulent (but still not as bad as Delta).
"However, this is not guaranteed. We may get unlucky, and a new variant comes along with large immune escape and high virulence, and we are back to needing strong PHSMs (public health and social measures) and lockdowns and masks and eventually better vaccines."
We need more than 'a plan to do nothing'
Aside from the risk posed by new variants, Adrian Esterman from the University of South Australia says the JP Morgan analysis ignores the longer-term health effects on many of those who survive COVID.
"The author is forgetting long COVID. Approximately 30 per cent of infected people end up with long-term health problems," Professor Esterman said.
Even if Omicron or future variants result in much lower rates of severe disease, fatality and long-term illness, their infectiousness may still require some public health measures like masks and social distancing, said Nancy Baxter, who heads the University of Melbourne's School of Population and Global Health.
"These waves both have an impact on hospitalisation but also have an impact on social function," Professor Baxter said, pointing to the disruptions to essential goods and services due to staff absences during the Omicron wave.
"Instead of going forward with a plan to do nothing, developing an approach for how we will manage new variants and maintaining non-restrictive measures such as mask wearing and improving ventilation to keep numbers down, to me, are more sensible ways to approach living with COVID."
Her colleague, Professor Blakely, appears a little more relaxed about the short term.
"On the east coast of Australia we have peaked and are coming down in infection rates. We can relax, and follow Denmark," he said.
"In so doing, there will be more infections to come – but that will reduce the pool of susceptibles going into winter.
"And we must still protect the vulnerable, elderly and those with comorbidity. If I was 75, I would keep hunkering down until daily infections rates were down to less than 500 to 1,000 a day, then emerge with good quality N95 masks."
But, like Professor Baxter, Professor Blakely also believes Australia must be much more prepared for a wave of the next COVID variant than it was for Omicron.
His proposed six-point, six-month plan would see Australian governments stockpile rapid antigen tests (RATs) and N95 face masks; ensure a high uptake of the current vaccine booster rollout; look towards new vaccines with wider coverage against variants; continue improving ventilation in public spaces; introduce a clear system to escalate public health and social measures early in a fresh outbreak; and establish a national disease surveillance and data analysis system.
While professors Blakely and Baxter acknowledge Australia's health outcomes have remained comparatively good during the pandemic, they both argue there is much room for improvement.
"That we're going to muddle through this doesn't mean we should pat ourselves on the back for a good job," Professor Baxter said.
