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COVID-19 Guide

Essential COVID-19 clinical reference: latest vaccine schedules, antiviral protocols, risk stratification & treatment guidelines for healthcare professionals.

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Key Summary

  • What it is: COVID-19 is caused by SARS-CoV-2 virus, spreads through respiratory droplets and close contact
  • Symptoms: Range from mild (fever, cough, sore throat) to severe complications; 5-10% develop long COVID lasting 3+ months
  • High risk groups: Adults 65+, people with underlying conditions (diabetes, heart disease, obesity), pregnant women, immunocompromised individuals
  • Current vaccines: Comirnaty JN.1 and Omicron XBB.1.5 formulations available; recommended every 6-12 months depending on age and risk factors
  • Vaccine effectiveness: Booster doses provide 65% greater protection against hospitalization/death; effectiveness decreases over time
  • Treatment options: Antiviral medications (Paxlovid, Lagevrio, Veklury) available for high-risk patients if taken within 5 days of symptoms
  • Prevention: Combination approach including vaccination, masks, hygiene, social distancing recommended; Evusheld available for severely immunocompromised

About COVID-19

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus.[1]

The original COVID-19 virus, which is caused by the SARS-CoV-2 virus, was first identified in December 2019. It belongs to the coronavirus family which also includes viruses that cause illnesses like the common cold, MERS (Middle East Respiratory Syndrome), and SARS (Severe Acute Respiratory Syndrome). The virus is characterised by its spike proteins which it uses to enter human cells. 

There have been many identified SARS-CoV-2 virus strains, variants, and sub-variants as the virus mutates and evolves over time. Omicron, a variant of the SARS-CoV-2 virus, was first identified in November 2021 and was officially designated as a variant of concern by the World Health Organization (WHO) shortly thereafter. Omicron is notable for having a large number of mutations in the spike protein of the virus which is the part of the virus that binds to human cells.

Each variant and subvariant is associated with varying levels of transmissibility, immune escape, and disease severity. Each of these is given a name and an abbreviated classification, the latest in Australia being the NB.1.8.1variant. The epidemiology of each variant varies widely, with some strains dominating more than others as they evolve or phase out.

What’s important is for people to stay vigilant, ensure they are vaccinated against the virus (particularly for at-risk individuals with underlying medical conditions), and continue to apply non-pharmaceutical practices during outbreaks.

COVID-19 Cause And Transmission

COVID-19 is a disease caused by a new form of coronavirus, first reported in December 2019. Coronaviruses are a large family of viruses that cause respiratory infections ranging from the common cold to more serious diseases.[2]

The virus can spread from person to person through:

  • Close contact with an infectious person (including in the 48 hours before they had symptoms)
  • Contact with droplets from an infected person’s cough or sneeze
  • Touching objects or surfaces (like doorknobs or tables) that have droplets from an infected person, and then touching your mouth or face.

Current evidence suggests that the most likely spread is from respiratory droplets between people from close contact with each other.[3][4]

People are believed to be most infectious two days before they start showing symptoms.[5] However, even if people do not show any symptoms, they can still spread the virus to other people.

COVID-19 Symptoms

Symptoms of COVID-19 can range from mild illness to pneumonia. Some people may get very sick very quickly, and most people will recover easily. People with coronavirus may experience symptoms such as:[6]

  • Fever
  • Coughing
  • Sore throat
  • Shortness of breath

Other symptoms can include runny nose, acute blocked nose (congestion), headache, muscle or joint pains, nausea, diarrhoea, vomiting, loss of sense of smell, altered sense of taste, loss of appetite and lethargy.[7]

COVID-19 Complications

Most people will recover from COVID-19 within a few weeks, however it can cause serious complications.

Older people and those with underlying medical conditions e.g. heart disease, diabetes, obesity, chronic liver disease, severe asthma and cystic fibrosis may be more likely to develop a more serious illness.[8] 

What causes COVID-19 complications?

COVID-19 complications may be caused by a cytokine storm. Cytokines are inflammatory proteins that can flood the bloodstream after an infection such as COVID-19 triggers the immune system. The large influx of cytokines can cause damage to many organs of the body like the heart, lungs, liver and kidneys.[9]

The most common complications affect the lungs and respiratory system:

  • Pneumonia: an infection that affects one or both lungs.[9]
  • Acute Respiratory Distress Syndrome: the lungs become so severely damaged that fluid flows into them which inhibits the body getting oxygen into the bloodstream.[9]

Other complications include:

  • Acute liver injury[10]
  • Acute cardiac injury[11] 
  • Secondary infection: the body may develop another infection unrelated to COVID-19[12]
  • Acute kidney injury[13]
  • Septic shock[14]
  • Disseminated intravascular coagulation: abnormal clotting can lead to internal bleeding and organ failure[15]
  • Blood clots including those causing pulmonary embolism[16]
  • Multi-system inflammatory syndrome in children: some organs in the body become severely inflamed. Symptoms include fever, belly pain, vomiting, diarrhoea, headache, rash and confusion[17]
  • Chronic fatigue: Symptoms may include brain fog, severe fatigue, pain, trouble thinking or dizziness[18]
  • Rhabdomyolysis[19]
  • Damage to the brain: even in young people, COVID-19 can cause strokes and Guillain Barre Syndrome.[20][21]

People with severe symptoms may be hospitalised and treated in the Intensive Care Unit with mechanical devices such as ventilators. Surviving these experiences can make them more likely to suffer from post-traumatic stress disorder, depression and anxiety.[22][23][24]

Long COVID

WHO defines Long COVID as the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection with these symptoms lasting for at least 2 months with no other explanation.[25]

The symptoms may include fatigue, shortness of breath and cognitive dysfunction.

10–20% of people with over 17 million people across the WHO European Region have experienced Long Covid during the first two years of the pandemic (2020/21).[25] 

In Australia, an AIHW review found that 5–10% of COVID-19 cases reported symptoms persisting for more than 3 months with the vast majority resolving within 12 months.[26]

The key risk factors include: severe COVID-19 illness, comorbidities, female, mid-adult age groups[26]

Two COVID-19 vaccination doses are associated with a 13% to 47% lower risk of symptoms persisting beyond 4 weeks.[27]

The Immunisation Coalition has supported the development of the CoRiCal Long-COVID Calculator which provides a personalised risk assessment of developing long COVID 6 months after infection.

Who is Most at Risk?

You are at a high risk of becoming very sick from COVID-19 and needing hospital treatment, if you:[28]

  • are aged 65 years or older
  • have certain health conditions, including:
    • weakened immune system
    • neurological disease, such as stroke or dementia
    • chronic lung disease, such as severe asthma or chronic obstructive pulmonary disease
    • heart disease
    • obesity
    • diabetes
    • chronic kidney disease
  • are pregnant.

High risk settings include:[28]

  • residential aged care facilities
  • disability care services
  • in-home aged, health and disability care
  • hospitals and other healthcare settings

Among patients with vaccine breakthrough COVID-19 hospitalisations, 40-44% had immunosuppression.[29][30]

COVID-19 Prevention

COVID-19 cannot be controlled by one approach alone: a combination of wearing a mask, education, hygiene (particularly washing hands), social distancing, vaccination and antiviral treatments continue to be recommended.[30]

Vaccination recommendations:

ATAGI recommends a COVID-19 vaccine dose every 6 months for:[32]

  • Adults aged ≥75 years.

ATAGI recommends a COVID-19 vaccine dose every 12 months for:[32]

  • Adults aged 65—74 years
  • Adults aged 18—64 years with severe immunocompromise

These groups are also eligible for a dose every 6 months, based on a benefit-risk assessment. A dose every six months is most likely to benefit people with medical risk conditions and/or those living in residential aged care homes.[32].

The following groups are eligible to receive a COVID-19 vaccine every 12 months, based on a benefit-risk assessment:[32]

  • All other adults aged 18—64 years
  • Children and adolescents aged 5—<18 years with severe immunocompromise

Vaccination during pregnancy/breastfeeding: 

  • Unvaccinated pregnant women are recommended to receive a primary dose of COVID-19 vaccine, which can be given at any time during pregnancy.[50]

Comirnaty JN.1 and Omicron XBB.1.5-based vaccines can be used in pregnancy. Although the latest mRNA COVID-19 vaccines (Comirnaty JN.1 and Omicron XBB.1.5-based vaccines) have not been formally studied in pregnant women, ATAGI considers them suitable and safe for use.[50] 

  • Pregnant women who have previously been vaccinated are not routinely recommended to have a further dose of COVID-19 vaccine. However, they can consider a further dose of COVID-19 vaccine based on presence of underlying risk conditions and/or personal preference.[50] 

Table 1: Timing of further COVID-19 vaccine doses by age group and risk status[32]

AgeWith Severe Immunocompromise#Without Severe Immunocompromise#
≥ 75 yearsRecommended every 6 monthsRecommended every 6 months
65-74 yearsRecommended every 12 months and are eligible for a dose every 6 monthsRecommended every 12 months and are eligible for a dose every 6 months
18-64 yearsRecommended every 12 months and are eligible for a dose every 6 monthsEligible for a dose every 12 months
5-17 yearsEligible for a dose every 12 monthsNot recommended
<5 yearsNot recommendedNot recommended

#See the Australian Immunisation Handbook for definitions and examples of severe immunocompromise

Table 2. COVID-19 vaccines registered and available for use in Australia in March 2025, by age groups[32]

Vaccines Recommended age groupsComirnaty JN.1 vaccinesComirnaty Omicron XBB.1.5 vaccines
6 month – <5 years formulation (yellow cap)5 – <12 years formulation (light blue cap)≥12 years formulation (dark grey cap)≥12 years formulation (pre-filled syringe)6 month – <5 years formulation (maroon cap)5 – <12 years formulation (light blue cap) ≥12 years formulation (dark grey cap)
≥12 yearsXX✓✓X X 
✓
5 – 11 yearsX✓XXX 
✓		X 
6 months – <5 years✓XXX✓X X 

✓ Ages at which a vaccine is registered and available
X Vaccine is not available for that age group

Table 2a. Comirnaty JN.1 vaccines registered and available for use in Australia in March 2025, by age groups[32]

Vaccines
Recommended age
groups		6 month – <5 years
formulation (yellow cap)		5 – <12 years formulation (light blue cap)≥12 years formulation (dark grey cap)≥12 years formulation (pre-filled syringe)
12 years of age and olderXX✓✓
5 to 11 yearsXX✓X
6 months to 5 years ✓XXX

✓ Ages at which a vaccine is registered and available
X Vaccine is not available for that age group

Table 2b. Comirnaty Omicron XBB.1.5 vaccines registered and available for use in Australia in March 2025, by age groups[32]

Vaccines
Recommended age
groups		6 month –
<5 years
formulation
(maroon
cap)		5 – <12
years
formulation
(light blue
cap)		≥12 years
formulation
(dark grey
cap)
12 years of age and olderXX✓
5 to 11 yearsX✓X
6 months to 5 years
✓		XX

✓ Ages at which a vaccine is registered and available
X Vaccine is not available for that age group

COVID-19 Vaccine Efficacy

Adults

As of 2025, Comirnaty JN.1 and Omicron XBB.1.5 vaccines are the preferred formulations available in Australia, replacing earlier Omicron-specific or ancestral versions.[32]

The TGA’s AusPAR states that Comirnaty JN.1 was specifically developed due to antigenic differences between JN.1 sub-lineages and earlier Omicron strains. It’s intended to “improve immune responses to currently circulating variants” like JN.1.[42]

Published preclinical data (mouse model) show that a JN.1-based mRNA vaccine elicited strong neutralising antibody responses not only to JN.1 but also to multiple related subvariants, supporting its potential breadth of immunity.[43]

While formal vaccine effectiveness (VE) studies for JN.1 in Australia are not yet complete, monitoring programs note that new variant–matched vaccines have been highly effective in reducing mortality in older adults.[44]

International modeling and WHO analyses suggest that updating vaccines to match dominant strains (like JN.1) is expected to enhance protection, even as full clinical trials are pending.[45]

There is strong evidence that COVID-19 booster doses have been effective in reducing severe outcomes from earlier Omicron variants.[33]

An Australian-first COVID-19 vaccine effectiveness study has shown that receipt of a booster (third) COVID-19 vaccine dose provided 65% greater protection against hospitalisation/death from Omicron than 2 vaccine doses.

The study findings confirm that the COVID-19 vaccine schedule used in Australia protects against severe disease from Omicron SARS-CoV-2 infection. For adults aged 70 years and older, the benefits were especially great with a significant reduction in hospitalisation or death from COVID-19. For every 192 adults aged 70 years and older who received a 3rd dose, at least one hospitalisation or death was prevented. The benefits of a 3rd dose were also significant in adults aged 40–69 years.

A data linkage study conducted in Victoria, Australia, assessed the relative effectiveness of 3 and 4 doses of the COVID-19 vaccine in preventing severe outcomes, such as hospitalisation and death, during an Omicron-dominant period from 1 June 2022 – 1 March 2023.[34] The study included 1,070,113 individuals aged 65 and older who had received at least 2 doses of the vaccine. Key findings include:

  • Third dose: within 2 weeks of administration, the relative vaccine effectiveness (rVE) of a 3rd dose was 40% (95% CI: 0% to 64%) against severe outcomes compared to 2 doses.
  • Fourth dose: within 2 weeks of administration, the rVE of a 4th dose was 66% (95% CI: 60% to 71%) against severe outcomes compared to 2 doses.

The study found that the additional protection provided by the 3rd and 4th doses waned over time. The highest level of protection was observed within the first 2 weeks following administration, with the effectiveness decreasing gradually over subsequent months. 

Children

As of 2025, ATAGI has approved Comirnaty JN.1 for children aged ≥6 months, designed to better match circulating variants, though formal effectiveness studies in paediatric populations are not yet completed. The safety of JN.1 boosters in children is being actively monitored via AusVaxSafety, and early patterns suggest a safety profile consistent with earlier variant vaccines. Continued surveillance will inform future recommendations.

Evidence from earlier Omicron waves provides important context: A 2023 systemic review and meta-analysis on safety and efficacy of vaccines against COVID-19 in children aged 5–11 years found that after 2 doses, vaccine effectiveness against omicron infections was 41.6%, against symptomatic COVID-19 was 36.2%, and against COVID-19-related hospitalisations was 70.8%. A 3rd booster dose increased effectiveness against omicron infections to 55% and against symptomatic COVID-19 to 61%. The safety data showed no significant increase in the risk of serious adverse events or myocarditis, although some uncertainties remain due to limited data.[35] These findings support the continued use of mRNA vaccines in children and provide a baseline for understanding the potential impact of updated formulations like Comirnaty JN.1.

Pre-exposure prevention 

Evusheld (tixagevimab and cilgavimab) received provisional approval on 24 February 2022 for the prophylactic pre-exposure prevention of COVID-19 in adults and adolescents aged ≥12 years, weighing at least 40kg,

  • Who have moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments that make it likely that they will not mount an adequate immune response to COVID-19 vaccination
  • Or for whom vaccination with any approved COVID-19 vaccine is not recommended due to a history of severe adverse reaction (for example., severe allergic reaction) to a COVID 19 vaccine(s) and/or COVID‐19 vaccine component(s).[31]

Tixagevimab and cilgavimab are monoclonal antibodies that stick to the spike protein on the COVID 19 virus and stop it from getting into the lungs. 

A June 2025 meta‑analysis involving 28,950 immunocompromised and transplant patients demonstrated that tixagevimab‑cilgavimab prophylaxis significantly reduced:[46]

  • SARS‑CoV‑2 infection (OR 0.33),
  • Hospitalisation (OR 0.24),
  • Mortality (OR 0.33)
  • with a favourable safety profile during the Omicron surge

Further cohort data in haematology-oncology patients showed reduced COVID‑19 severity and hospitalisation, including during Omicron variant circulation.[47]

Evusheld is available on private script.

COVID-19 Vaccine Safety

AusVaxSafety

As of 11 November 2024[36] 6,859,046 safety surveys completed:

  • 106,566 surveys completed by Aboriginal and/or Torres Strait Islander people
  • 43.6% reported at least one adverse event
  • 0.9% reported visiting a GP or emergency department 

Pfizer JN.1 COVID-19 vaccine safety data – all participants (as of 7 July 2025):[37]

  • 64,592 vaccine safety surveys completed
  • 26% reported at least one adverse event after vaccination
  • Most common adverse event reported (21%) was a local reaction (pain, redness, swelling, itching), the second most common (15%) was fatigue 
  • Fewer than 0.5% of people reported seeing a doctor or going to the emergency department

Myocarditis and Pericarditis after COVID-19 vaccines

mRNA vaccines[38]

  • A small increased risk of myocarditis and/or pericarditis has been observed in people following vaccination with an mRNA vaccine compared with unvaccinated people.
  • The risk was higher with Moderna original than with Pfizer original. There is no suggestion that rates are higher following the latest vaccine formulations compared with the original vaccines.
  • Pericarditis and myocarditis after COVID-19 vaccines have been mostly reported in males under 40 years of age, and mostly after the 2nd dose. However, these conditions do occur in people of all genders, at any age, and after any dose.
  • The recommended interval of 8 weeks between dose 1 and dose 2 of an mRNA vaccine may reduce the risk of these conditions, compared with a shorter interval.

Non-mRNA vaccines[38]

  • Myocarditis and/or pericarditis can occur after Novavax at a similar rate to the mRNA vaccine, according to global reports. Myocarditis has been reported in approximately 4 in every 100,000 doses in Australia. Pericarditis has been reported in 13 in every 100,000 doses but is more common in men aged 18-49 years with a rate of 270 per million doses.
  • AstraZeneca was associated with a small increased risk of myocarditis and pericarditis, though this risk appeared lower than with Moderna or Pfizer.

How is COVID-19 Treated?

Doctors will need to review patients’ medications and their current medical conditions to decide if a COVID-19 treatment is suitable for them. The types of COVID-19 treatments that are suitable will also depend on the severity of their COVID-19 illness.

Basic in-hospital treatment options include oxygen for severely ill patients, ventilation for patients who are critically ill and the use of Dexamethasone or other corticosteroids. Antivirals, immune modulators and monoclonal antibodies have also been used.

COVID-19 Antiviral Medication

Antiviral medications can help prevent severe COVID-19 if taken within five days of symptom onset.[39]

There are 3 COVID-19 oral antiviral treatments available for the treatment of COVID-19:[49]

  • Nirmatrelvir and Ritonavir (Paxlovid)
  • Molnupiravir (Lagevrio)
  • Remdesivir (Veklury) 

These are available for eligible people who are vulnerable to severe disease such as older people, those with comorbidities, people who are immunosuppressed with a script from a GP.

Paxlovid

Paxlovid has provisional approval for the treatment of coronavirus disease 2019 (COVID-19) in adults 18 years of age and older, who do not require initiation of supplemental oxygen due to COVID-19 and are at increased risk of progression to hospitalisation or death.[40] 

Lagevrio

Lagevrio (molnupiravir) has provisional approval for the treatment of adults with COVID-19 who do not require initiation of oxygen due to COVID-19 and who are at increased risk for hospitalisation or death.[41]

Veklury

Remdesivir (Veklury) has provisional approval for the treatment of COVID-19 in adults and adolescents (aged 12 years and older, weighing at least 40 kg) with pneumonia, requiring supplemental oxygen.[48]

Available on Pharmaceutical Benefits Scheme (PBS):

COVID-19 oral antiviral treatments are available through the PBS for eligible patients.

References

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2. Australian Government Department of Health and Aged Care. COVID-19 disease and symptoms Last updated 14 October 2022

3. World Health Organization. Coronavirus disease (COVID-19): How is it transmitted? Accessed 19 October 2022

4. Brooks JT, Butler JC. Effectiveness of Mask Wearing to Control Community Spread of SARS-CoV-2. JAMA. 2021;325(10):998–999. doi:10.1001/jama.2021.1505

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33. Liu B et al. Relative Effectiveness of COVID-19 Vaccination with 3 Compared to 2 Doses Against SARS-CoV-2 B.1.1.529 (Omicron) Among an Australian Population with Low Prior Rates of SARS-CoV-2 Infection The Lancet Preprint. June 2022

34. Canevari JT, Cheng AC, Wu L, Rowe SL, Wollersheim DE, West D, et al. The relative effectiveness of three and four doses of COVID-19 vaccine in Victoria, Australia: A data linkage study. Vaccine. 2024;42(1):53-58.

35.Piechotta V, Siemens W, Thielemann I, Toews M, Koch J, Vygen-Bonnet S, et al. Safety and effectiveness of vaccines against COVID-19 in children aged 5–11 years: a systematic review and meta-analysis. Lancet Child Adolesc Health. 2023;7(6):379-91. doi:10.1016/S2352-4642(23)00078-0.

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