(Image: AP/Mary Altaffer)

When reporting COVID fatalities, Australian governments almost always include the disclaimer that the victim had pre-existing health conditions. Some argue that has an unfortunate side effect of inadvertent victim-blaming, but there are two genuine reasons why noting pre-conditions is crucial.

First, COVID-19 is a very targeted killer. The recent Australian Institute of Health and Welfare report into the virus found that 73% of deaths were among people who had pre-existing chronic conditions (not to be confused with causal events listed in their death which could include pneumonia, respiratory or renal failure).

Someone with chronic pre-existing health conditions has a vastly higher risk profile than a healthy person. Someone who is over 70 and has pre-existing conditions has higher risk still. Reinforcing the risk around pre-conditions acts as a constant reminder to anyone with any to urgently get vaccinated if they are able to.

Second, by noting that most deaths occur for those with comorbidities, it also puts the actual risk for everyone else into much better perspective.

Although the death rate for an unvaccinated, unhealthy 80-year-old in aged care who contracts COVID is upwards of 50%, the death rate for those under 30 is low. In Australia, just five of the more than 1100 COVID deaths have been in people aged under 30. South Korea has recorded even fewer deaths among the young.

Remarkably, in the UK during the first six months of this year, of the 51,281 COVID-19 related deaths, only 63 were in vaccinated people who weren’t classified as “extremely vulnerable”.

This is highlighted by the difficulty in determining when someone dies of COVID or dies with COVID. As AFR journalist John Kehoe pointed out: “In Sweden, doctors in the county of Östergötland analysed all their COVID-19 deaths. COVID-19 was the chief underlying cause of death in just 15% of cases. In 70% cent of cases, COVID-19 was an associated cause of death. In the remaining 15% of the deaths, it was irrelevant.”

Similarly, one preprint study found almost all the instances of children dying with COVID in the UK occurred in children who had multiple pre-existing conditions or complex disabilities such as rare inflammatory syndromes. This does not make those deaths any less tragic but rather indicates that the risk of healthy children dying due to COVID is extremely low.

Given the relevance of pre-existing conditions, those favouring strict elimination policies made another argument: “Sure, COVID-19 tends to mostly kill people who are already sick, but really, lots of people are sick, so we can’t be too careful.” 

Grattan Institute head and leading COVID-zero advocate Stephen Duckett claimed 40% of Australians have conditions that put them at risk. He sourced his data from the ABS national health survey.

But this claim isn’t quite true: 47% of Australians have chronic conditions, but almost half are attributed to mental and behavioural conditions. Genuine COVID risk factors such as diabetes, cancers, vascular disease and chronic obstructive pulmonary disease affects about 15% of Australians (and many have multiple of those pre-existing conditions, so the unique number of at-risk people is likely to be far less).

Obesity, which affects 31% of Australians, is also a risk factor but is categorised as a health risk factor instead of a chronic disease, and cause risk-factor illnesses like diabetes and heart disease.

To claim 40% of the population is at risk would require including other chronic conditions like back problems, arthritis, asthma or mental health, which do not contribute to COVID’s fatality risk. Knowing which conditions increase risk is also important and easy to get wrong.

Pointing out that a COVID victim has a pre-existing condition does not diminish the tragedy of their death. It does, however, put into perspective the restrictions being placed on the healthy.

We must protect the vulnerable, in particular, through vaccination. But if someone with pre-existing conditions chooses not to get vaccinated, using their death as a reason to deprive children of an education, lock domestic violence victims in with their abusers, or separate kids from their parents becomes a far tougher sell.