Through three years of the pandemic, Bianca Spooner didn't get COVID-19 once — until a few days before Christmas.
"The first three to four days were absolute hell," she said.
"I was close to calling an ambulance on the third day because of breathlessness."
The Melbourne woman, 47, spent Christmas alone, and has been doing her best to isolate herself from her teenage son.
More than a week since testing positive, Ms Spooner has been careful to avoid spreading the disease.
"While there aren't any isolation rules, I've been very diligent in self-isolating and wearing masks if I go out, and using high-level hygiene," she said.
To get a doctor's certificate for work, the single mother had to fork out $100 for a telehealth appointment which was not covered by Medicare.
"I've got severe mortgage stress and a $100 doctor's bill was a really significant cost for me," she said.
As Australia battles its latest COVID-19 wave, many will be hoping 2023 is the year the pandemic "ends", the year that weighing-up exposure risks, mask use, skipping social events due to that tickle in the throat, can all be put behind us.
Experts say it's important the community understands that isn't the case — but there are some things that could make the next year a little easier than the past three.
Omicron's spread saw COVID-19 deaths soar in 2022
As we welcomed in 2022, the highly infectious Omicron variant made its arrival felt in Australia's pandemic, sending cases skyrocketing.
The nation has seen thousands of COVID-19 deaths since then, dwarfing the tolls from 2020 and 2021.
Surging cases put immense pressure on the nation's health systems, with rising COVID-19 cases in hospitals and valuable healthcare workers being sent into isolation as they became infected.
In the final two months of the year, new variants have emerged, sending infections up and hospital admissions with them.
Michael Lydeamore — an infectious diseases modeller from Monash University — said while there had been more COVID-19 deaths than anyone in the community would want in 2022, excess mortality estimates from the Australian Bureau of Statistics were starting to come down again.
"No one wants to see [large numbers of COVID-19 deaths] happen but, from a population point of view, we're in an OK place at the moment," Dr Lydeamore said.
We'll still need 'the basics' in place to reduce the spread of the virus
One of the key changes in 2022 was a shift from government-imposed restrictions to personal responsibility.
That's an approach that will continue in 2023, with a national COVID-19 plan outlining an approach based on an informed community taking the lead on protection, alongside vaccine supply certainty and a focus on taking the pressure off hospitals.
Paul Griffin — an infectious diseases physician and associate professor at the University of Queensland — said communicating risk so that Australians could make informed choices remained a challenge.
"I think we've had a strategy of extremes," Dr Griffin said. "We perhaps overdid it early on, so the risk perception was too high.
"And then, perhaps, we underdid it almost … to the point now where I think a number of people are complacent and under-appreciating the risk that still exists in our community."
Dr Griffin said fatigue with the pandemic was a big part of that, which meant there was a need for balanced commentary to reinforce the measures Australians should still be taking to reduce risk.
"We're not trying to propagate fear, [nor] talk about things like lockdowns … we just want people to understand the basics," the clinical microbiologist said.
He said this might involve choosing to meet up outdoors if you can, thinking about ventilation, masking up in high-risk settings, staying up-to-date with vaccines and staying home if you're unwell.
"Those simple things, if we get that right, then the impact of this virus that isn't going to go away will be significantly reduced," he said.
Virus is evolving, but so are our vaccines and antivirals
As we enter the new year, Dr Lydeamore said, there was something of a COVID-19 "variant soup" in circulation.
Omicron subvariants — such as BA.5, BA.2.75, BQ.1 and XBB — are among those moving through the community.
Dr Lydeamore said the fact that multiple branches of evolution of the virus were ending up in a similar position was a sign of "convergent evolution", and could be a good thing.
"If this sort of trend continues, then that's good news for us, in that it's just becoming more transmissible, it's not becoming any more severe," he said.
"The danger will be that, if a variant emerges somewhere — that can be anywhere in the world — that is more severe, starts to put more people in hospital or increase mortality, that's when the real risk comes in for the next 12 months."
Both Dr Lydeamore and Dr Griffin said the introduction of bivalent vaccines, which can target two strains of the virus, was a helpful addition heading into 2023.
Dr Griffin said other new tools being developed — such as intra-nasal vaccines that could reduce the chance of infection and passing the virus on — could also represent a "big step forward".
He said improving antivirals — which are most effective at reducing severe illness when taken shortly after an infection begins — would also help.
"The ones we've used so far have been tremendous in reducing high-risk people progressing to severe disease," Dr Griffin said.
"But better antivirals, better access to antivirals, will also make a huge difference."
Re-engaging the community with vaccination messages will also be important next year.
While 96 per cent of Australians aged 16 years or older have had the recommended two vaccine doses, only just over 70 per cent have had a third dose to boost their protection against severe illness.
Dr Lydeamore said he was concerned that, as we entered a new year, vaccine coverage across the nation was "dropping rapidly".
"People should expect, if they're not recently vaccinated, they are fully susceptible as they were in 2020 to catching COVID, and that's probably going to be the biggest driver of the waves that we see over the next 12 months or so," he said.
He said vaccines would remain Australia's "main defence" against the virus and the community should expect regular COVID-19 vaccinations into the new year.
Some of Australia's neighbours are facing serious challenges
Dr Lydeamore also said while next year would likely be an easier pandemic year for Australia, some of its neighbours in the Asia-Pacific region could be facing a year similar to Australia's 2022: marked by enormous strain on their health systems.
"Australia, as a neighbour there, really has a responsibility to help with the infrastructure and with the messaging and to try [to] get those populations vaccinated," he said.
Another big shift in the region as we enter 2023 is China's move away from its aggressive suppression strategy.
Dr Griffin said it demonstrated that continuing to try to suppress the virus indefinitely "isn't really feasible, with these new sub-variants, in particular".
He said he did not agree with the move from some countries to place entry restrictions on people travelling from China after the powerful nation's decision to open its borders.
"I think that the practicality and the feasibility … outweighs any potential benefit of implementing those sort of measures," Dr Griffin said.
"And I would have liked to think we've learned from that by now and we just focus, once again, on those basics to minimise the impact of this virus, wherever it is."
COVID-19 testing is being scaled back
As part of Australia's COVID-19 plan for 2023, PCR testing will be prioritised for the most vulnerable, in a bid to ensure their access to antivirals is fast-tracked.
It's a big shift from the first few years of the pandemic, where the gold-standard PCR testing was available to everyone in the community in an attempt to identify every case and send rings of contacts into quarantine.
In a phase where vaccines are freely available, the government is encouraging lower-risk individuals to instead use rapid antigen tests and stay home if they feel unwell.
Dr Lydeamore said the retreat of COVID-19 data, gained from testing and reporting, was probably necessary, given the expense.
However, he said, it would pose a big challenge for epidemiologists.
"We don't have people reporting their rapid tests and testing all the time," he said.
"If you don't know where you are now, that can make it very hard to know what's coming next.
"So, I expect a lot of the decisions to be slightly further behind, rather than really proactive like they were over the past 18 months."
Experts estimate only 10 to 25 per cent of positive cases are being reported in Australia.
Dr Griffin said he believed Australia was "heading in the wrong direction" on testing.
"Finding cases is the backbone of a public health response that really isn't over," he said.
"So, I still think we should have ready access to testing so we can find cases and link high-risk people with antivirals more readily than perhaps we are at the moment."
When Ms Spooner contracted COVID-19, she said she was unsure of her reporting requirements. She said her doctor was flippant when she asked about it.
"He said: 'Look, half of Australia's got COVID at the moment — there's nothing to report really,'" she said.
"I now feel really strongly, it's really important for the government to at least have that data, in case they do need to do something with it."
Long COVID is likely to remain an issue for years to come
While vaccinations have been reducing the risk of severe illness, research is still unfolding into long COVID.
"It's hard because it doesn't have an enormously robust diagnosis," Dr Lydeamore said.
While there is no strict definition, it usually refers to an illness following COVID-19 infection that lasts for at least two or three months.
Clinics have been set up around Australia dedicated to supporting patients suffering from the condition, but funding for many of them is not certain.
In December, Federal Health Minister Mark Butler said the national plan involved funding for research to help better understand long COVID.
Some health authorities have indicated most long-COVID patients will be best cared for by GPs and allied health professionals in the community.
"I think a lot of this work is going to have to be done retrospectively, to understand from various hospital diagnoses and GP diagnoses around how much long COVID is around," Dr Lydeamore said.
"It is a concern … and, I think, that will be an issue for us over the next few years to five years."
