Health authorities fear north Queensland could be at risk of dual emergencies as the region braces for an influx of COVID-19 cases ahead of an active summer disaster season.
The Bureau of Meteorology (BOM) is forecasting a heightened risk of cyclones, bushfires and flooding for the state over the coming months.
On average, four cyclones form in the Coral Sea each year, but climate indicators suggest that number could be higher this season.
The outlook has compounded concerns for local authorities, who are also grappling with a looming COVID-19 health threat.
"We are seeing a cyclone off the coast already, and that cyclone is called COVID-19," Townsville Hospital and Health Service CEO Kieran Keyes said.
Vaccination rates in some parts of regional Queensland remain stubbornly low.
With the state's borders set to reopen to interstate travel on December 17, residents have been warned to prepare for an influx of cases in previously COVID-free locations.
James Cook University infectious diseases physician Professor Emma McBryde said the state certainly could be on the cusp of significant COVID-19 transmission.
"In some places that could lead to a public health emergency," she said.
As disaster season approaches, Professor McBryde warned some areas could face "a potential dual crisis".
"The worst case is communities are cut off from major centres and people get sick with COVID and they have to manage that ? maybe not even in their own home ? maybe in a makeshift centre of some kind," she said.
"The expectation that all Australians have that they'll be looked after with the best possible modern care may have to be compromised considerably."
'Can't guarantee safety' of unvaccinated people
Townsville Mayor Jenny Hill said the prospect of a COVID-19 outbreak on top of a natural disaster was "a horror story".
Despite her fears about the transmission risk in cramped evacuation centres, Cr Hill said unvaccinated residents would not be turned away during a crisis.
"In the end, we've got to ensure that people are safe if there's a storm surge or cyclone," Cr Hill said.
"But the reality is that we can't guarantee your safety if someone's in there with COVID and you're unvaccinated."
Professor McBryde said one possible strategy could be to set up different centres for vaccinated and unvaccinated people.
"It's a very difficult time for people and the chances that they're all going to be carefully physically distancing and wearing masks I think is pretty slim," she said.
Hospital networks already under strain
Last month, public hospitals in Cairns, Townsville, Mackay and Mount Isa simultaneously sounded code yellow alarms, signalling major capacity issues.
"We know that the system is under strain already ? this is without COVID and without natural disasters," Professor McBryde said.
"We could see the systems tested very strongly in the next few months."
Mr Keyes said significant preparations were underway within the Townsville Hospital and Health Service to ensure it could cope with a potential influx in demand once the borders reopen.
"There's no doubt that with the looming deadline of 17th of December, that we are focusing on that with a renewed degree of vigour," he said.
"We absolutely have the planning in place and the capacity to respond to dual surges in demand.
"That's not to say it will be easy or will be without pressure."
Local authorities say getting vaccinated against COVID-19 has become a key element of disaster preparedness.
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© ABC 2021
13:12 AEDT Goondiwindi's 65-year-old levee has once again saved homes from major flooding, but the town is now surrounded by water and there are fears some rural communities could cut off for days, if not weeks.