Since March, the community has become accustomed to seeing markings on the ground indicating places to stand, 1.5 metres apart. Hand sanitiser on entry to shops, workplaces, gyms, cafes and restaurants has become the norm, as we have come to terms with Zoom meetings, masks, not shaking hands or hugging.

Despite outbreaks and clusters, the region has remained relatively unscathed when compared to the widespread devastation predicted at the beginning of the pandemic. At least so far.

Six months on, there are no active cases in the Hunter, but public health physician, Dr David Durrheim, said we are "not out of the woods yet".

Outbreaks could, and would, continue to happen until a safe and effective vaccine was available.

"There is still plenty more skirmishes and battles to be won before we can call it a day on this virus, I'm afraid," Dr Durrheim said. "The community has responded brilliantly, and we really have - again - dodged a bullet.

"We've done that a few times with introduction of the virus and then a rapid community and public health response. We know there is ongoing transmission in Sydney - fortunately at relatively low levels, but with lots of surprises and many unknown source cases.

"So with the free flow of people between Sydney and here, it's just a question of time before we have another introduction unfortunately.

"I'd love to say we don't expect it, but we do."

In greater Newcastle, Lake Macquarie, and the Hunter regions, there have been 229 confirmed cases of the virus to date, and two deaths.

More than 160,000 tests have been analysed.

In Hunter New England, there have been 37 hospitalisations. Of those,13 patients required intensive care, and five needed ventilation.

COVID-19 had proven to be "highly infectious".

On average, it spreads to 2.5 people. But crowded, indoor settings easily became "super spreading" environments.

Unlike influenza, COVID-19 is not just a respiratory virus. The heart, lungs, blood vessel systems and kidneys can all be targeted. The long term impacts are still unknown. And, it can be deadly.

"The virus is clearly more deadly in the elderly, but we have had deaths in people in their 20s and 30s," he said. "The youngest death in Hunter New England was a lady in her 50s."

Even Dr Durrheim, who has previously worked on public health responses for Ebola and Crimean-Congo hemorrhagic fever, was surprised by how much life had changed for everyone in the past six months.

"If you'd have said to people a year ago whether they would expect to see people standing back in the community, wearing masks, not shaking hands or hugging, I think we would have all thought, no, that's not the Australia we know," he said.

"And yet we have all adapted, which I think is a credit to our community. We have been able make these adjustments, which are very foreign to us, but we've made them well and we have seen the benefits of that."

Dr Durrheim said COVID-19 was a "true pandemic".

"This is, as people have been saying, a once in a century pandemic - very similar to the terrible 1918-1919 pandemic which created global mayhem and really disrupted health, well-being and society in an incredible way," he said.

"I haven't seen anything quite like this in my lifetime. I have worked on some interesting infectious diseases, but nothing on the scale of this COVID-19 pandemic."

Dr Durrheim said it was "pleasing" to see old public health measures such as quarantine - which effectively stemmed from biblical times - had still proven effective.

"While we are waiting on a vaccine, things like closing borders and using hotel quarantine - which NSW has done a very effectively - has allowed the public health teams to trace cases and make sure cases and contacts were able to effectively isolate while potentially infectious. Because we have had to rely on non-pharmaceutical measures it has been very pleasing to see that a virus that is this infectious, and potentially this deadly, can actually be contained - but it takes a huge investment - not only from public health teams but really from the community.

"Without the community of the Hunter working so hard to put in place those distancing measures, the increased hand hygiene, and testing in incredible numbers to really help us hunt down the virus, we could never have had the success we have had thus far."

The biggest challenges of the past six months locally had been returning international travellers, particularly from cruise ships where there were infections on board.

"The demographic of those groups was an older demographic, so many of those people got really quite severe disease, and there were relatively high hospitalisation rates," Dr Durrheim said.

"We have seen a second challenge with this new wave.

"The age of people affected is on average much younger - young families, or young adults - and because of their social behaviour, it means there are potentially many more people who are exposed. The folks who came off cruise ships had on average maybe four or five people that were close contacts. Now, with the younger demographic, we are talking about dozens of people that are close contacts. It does make it much more challenging to make sure no one is missed, and that everybody safely isolates for the full period."

Dr Durrheim said multiple school outbreaks in Sydney had shown that older teens, in particular, transmitted the virus just as effectively as adults. So far in the Hunter, two high schools, a primary school and a childcare centre had been closed.

But Dr Durrheim is feeling much more optimistic now than he was six months ago.

"I am seeing a light at the end of this tunnel, and that light is an effective vaccine," he said. "The only way out of this pandemic is a vaccine, and it is likely there'll be more than one effective vaccine that comes out.

"There are 234 candidate vaccines, seven in phase three trials. This is unprecedented - we have never seen a response from the vaccine community like this before.

"We are probably going to find there will be a number of vaccines that provide us with the remedy for the virus, and some will be more appropriate to use in people who are immunosuppressed or the elderly or pregnant people."

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