Covid-19, our biggest health crisis in a century, has thrust healthcare into the spotlight. Over the next five days, the Northern Advocate will explore the role the health system plays in communities across Northland. Today, Adam Pearse looks at the impact of Covid-19 in an exclusive interview with two people who caught the virus. He will also investigate the effects of the illness on the community and how it changed our region's largest hospital.
When Keith* fell ill in late March, he thought it was his usual annual bout of the flu.
Instead he, and later his wife Diana*, became two of 28 Northlanders to contract Covid-19, thrusting them along a journey of recovery from a virus ravaging the world.
Keith, who has regular battles with the flu due to his reduced lung capacity, started showing symptoms on March 29. Under direction from Diana, he sought a Covid-19 test the next day, but was turned away as he had not had contact with anyone from overseas.
However, the test guidelines soon changed to include anyone with symptoms and Keith was tested on April 1. Two days later, he was told by the Northland District Health Board he was Covid-19 positive - source unknown.
"To be honest, I just thought it was another bout of flu coming on," he said.
"[When the DHB called], it was like, 'oh s***'."
Given the condition of his lungs, Keith's symptoms became worse and Diana - who tested positive on April 28 - made the decision to rush him to Bay of Islands Hospital in Kawakawa.
During the trip, Diana said the reaction they received at a service station while trying to refuel their car was very unsettling.
"I jumped out of the car, I said, 'I've got a positive Covid patient here, I don't want to touch anything, can someone just fill up for me' ... no one would serve us," she said.
"It was like you were a zombie, a leper," Keith said.
Fortunately, a woman equipped with gloves and a mask helped them refuel but not before the police were called. Police rung the couple's house days later to ask Keith and Diana to stay home and to contact them if they needed any transport assistance.
From April 4, the pair were confined to their home, plagued by fevers, headaches, extreme fatigue, breathlessness, sore joints, coughing, heart palpitations, and loss of taste and smell.
With several horses to care for, the toll the virus took on them was severe.
"As sick as we were, we still had to get up and feed the horses, but it was really hard because we couldn't breathe," Diana said.
"The days you felt good, you went out and did stuff but come the afternoon, it was like someone flicked a switch and you'd have no energy at all," Keith said.
Under close monitoring from the DHB, the couple anxiously waited for their symptoms to clear. Towards the end of April, Keith started showing signs of recovery and when he went 48 hours without symptoms, he was given the all clear by the DHB to return to work without a test to confirm.
However, Keith insisted taking another test to be absolutely sure. It returned a positive result.
"[The DHB] were quite adamant that I didn't need a test until I said I couldn't go back to work unless I had got a negative test, and then I was quite overwhelmed when it came back positive.
"To be honest, that was the only bit where I felt a little bit let down [by the DHB]. All other aspects were really good."
The couple registered their second and final negative test results on May 12 at a GP clinic, 40 days after Keith first tested positive. Diana was Northland's final case of Covid-19 to recover.
However, even in the final stages, Diana could still feel the stigma of having the virus.
"[The staff at the clinic] were all really good, but you felt ashamed going to these separate areas and everyone's reactions, coming in in full personal protective equipment (PPE).
"It felt like you were lepers. You understood it but it felt really weird."
To this day, the pair don't know how they caught the virus. However, the experience has significantly changed their outlook on life. Their diet now heavily features vegetables with very little red meat and they've reduced their already limited alcohol consumption.
"We are not taking our health for granted anymore, we're not getting any younger and I think we've dodged a bullet with this," Diana said.
"To be honest, I think we were very, very lucky," Keith said.
"I've got a weak chest so for me to get what I got and still be walking around, I'm very grateful."
Still feeling the after-effects of the virus, the couple advised anyone who caught it in the future to remain calm and trust in what they felt was a reliable public health system.
Keith, whose mother passed away overseas about six weeks ago, said he knew as well as anyone the desire to ignore isolation restrictions, but he implored people to abide by the rules to ensure the virus couldn't spread.
"I've got people I don't like but I wouldn't wish this on them at all."
As at 3pm on Wednesday, a total of 24,265 tests had been conducted across Northland at eight community-based testing centres (CBTC), nine mobile testing clinics, Northland's five DHB hospitals, all aged residential care facilities and GP practices.
The majority, 14128, were done at the CBTCs while 5727 tests were done across GP practices.
Over half (55.1 per cent) of people tested in Northland were European, 39.6 per cent were Māori, and tests for Asian and Pacific peoples made up just over two per cent each.
People aged between 50-59 were the highest age group tested (17 per cent), with people between 60-69 making up 16 per cent. Females were more tested than males at 57 per cent.
Nikola Springford was one of many DHB public health nurses on the frontline of Northland Covid-19 response. The 45-year-old was stationed across the region's CBTCs in Kerikeri, Bay of Islands, Kaikohe and Whangārei.
Despite knowing she was needed on the frontline, Springford said anxiety was high both for staff and the public.
"We know that we had to step up and do our job, but you've also got that anxiety for your family at home and the unknown," she said.
"It was more about how the public were going to be because the whole country was full of anxiety."
While she said there were a few incidents when members of the public became frustrated, Springford said people's patience at testing centres was commendable.
Living away from her family, Springford said it was both a blessing and a curse.
"It was definitely hard being away from family and not going home every night to them, but at the same time, I knew I could go to work ... knowing that they were away from me and safe."
Springford she was grateful to have committed staff around her and a supportive management team which ensured the DHB's response was efficient and adaptive.
Going forward, Springford hoped people would remain empathetic to staff if testing need ramped up again.
"I know the public get frustrated but it frustrates us [as well] because we'd love to be going faster, but the reality is we are only human and we just ask them to be patient and kind."
While some people were rushing to Northland's health services, many stayed away from hospitals and general practice clinics in fear of catching the virus.
Far North GP Kath Rollo said this was quite common during the first outbreak, which potentially compromised people's health.
"There were cases where people were just scared of Covid and certainly in the older age group, which is totally understandable," she said.
"One patient in particular stayed at home with her chest pain a couple of days before she came in. She rang for a [phone consultation] and I said, 'hang up and come in right now', and she got admitted to hospital."
Given Māori were found to have a 50 per cent higher likelihood of dying from Covid, there was serious concern for the region's kaumātua and kuia.
Kaikohe's Materoa Mokaraka, 79, was one of many kaumātua and kuia who lived alone. With her tamariki scattered across New Zealand and Australia, Mokaraka found the isolation tough.
"It was hard, really hard, particularly for a Māori women that's been brought up around whānau," she said softly.
"At night, I had nobody to talk to but the photos."
Many iwi organisations, including Te Runanga A Iwi Ō Ngāpuhi in Kaikohe, started work early to identify isolated kaumātua and kuia, providing them with regular communication and kai packages, for which Mokaraka was deeply grateful for.
Brother and sister Clarence, 84, and Nina, 93, Richards said they had no complaints from their time in lockdown, having been well supported by the runanga.
"With the kindness of Ngāpuhi and other people who were supplying us with food, we got through it," Clarence said.
"I wouldn't like to be anywhere else, Nina said.
"It's beautiful here, full of love and sharing."
Much of the change to Northland's healthcare was made to its hospitals. In a matter of weeks, hospitals were required to be split red and green zones - red for Covid-related patients and green for patients of its usual services.
It presented a significant problem for Whangārei Hospital, which was desperately in need of replacement due to ageing and inadequate facilities.
A total of 665 elective surgeries were deferred due to Covid-19. Through the use of private facilities and operating on the weekends and in the evenings, just 26 patients were still waiting for treatment.
While the deficit of people coming to hospital presented a health issue, it became an opportunity to use a largely empty outpatient unit, which added 22 beds to the hospital's red zone capacity.
Outpatient rooms, normally used for check-ups post treatment, were promptly fitted with oxygen and suction capabilities as well as extractor fans to ensure the rooms' air flow complied with national guidelines for housing Covid-19 positive patients.
Wooden framing covered by plastic sheeting was used to divide sections of the hospital into red and green zones.
Associate chief medical officer Jenny Walker, also a renal physician, was pulled into the hospital's planning team in mid-March to assist with splitting the hospital into red and green zones.
Erecting the two zones in a matter of days, Walker said much of the work was done on the fly using plenty of Kiwi DIY.
"We just had to get on and do it," she said.
"We didn't ask for sign off and the good thing was clinicians were speaking directly to facilities staff, we cut through the middle and our staff were great."
Walker said the degraded state of the hospital actually worked in their favour as it allowed staff to erect makeshift solutions without the fear of destroying existing facilities.
However, Whangārei Hospital's limited capacity presented a dire problem should the number of Covid-positive patients in Northland reach into the hundreds, if not thousands.
"We were preparing to be overwhelmed, because that's what the reports were out of the United States," she said.
"It was quite terrifying to the point that when I was supposed to have days off, I didn't take them because I thought the virus isn't sleeping and that speaks for everyone, everyone was working long hours."
Nevertheless, Walker said she had a secret 'Armageddon Plan' had Northland cases spiked. Using a currently vacant floor in the maternity unit, Walker speculated they could have housed up to 100 people on stretchers in the facility, using creative engineering solutions to enable safe access.
Looking forward, Walker said plans were being analysed and altered to ensure any future outbreak was contained more efficiently.
However, she said one necessary difference for any future outbreak had to be the continuation of planned care, including outpatient clinics and surgery.
"We have had people who were harmed by either them waiting at home or procedures being cancelled and not being able to get in, so I don't think we would ever shut down in the way that we did."
While she couldn't be more proud of DHB staff, Walker said it was important to take breaks now while they could.
"I think a lot of people are really tired now and it's tempting not to take holidays because they keep being cancelled, but it's important that you take them because we are not out of this yet."
With people avoiding healthcare facilities and many confined to their homes, healthcare provision had to go through a major evolution by increasing the use of technology, described as telehealth.
Zoom was the primary video tool used by the Northland DHB to communicate with staff and patients. From January to April, the number of minutes staff spent on Zoom increased by over 3000 per cent from 19,849 to 669,756, not including time staff spent in meeting started outside the DHB.
A total of 12,302 outpatient sessions were held over phone or video. Pre-Covid, almost all of these appointments would be done in person.
NDHB digital projects clinical director Alan Davis was a key figure in this rapid transition to telehealth. He and his team were presented with the enormous task of replacing usual protocol for in-person consultations with virtual measures in a matter of weeks.
Despite the expeditious implementation, Davis said it was important to further develop the recent advances made in telehealth.
"[Telehealth] is the way of the future and we need to keep building on it," he said.
One of the most impactful changes to healthcare provision through telehealth has been the introduction of the Rapid Information Telehealth Assessment unit, more commonly known as RITA.
RITA is a mobile video unit which allows clinicians in Whangārei or elsewhere to view patients, using Zoom, in regional hospitals and other facilities as clinicians on the ground care for the patient.
The unit, which exists across all four regional hospitals and soon to be at the Northern Regional Corrections Facility at Ngawha, was first used in 2018 and is now being used an average of nine times per month.
Davis, also a stroke physician, said RITA had shown its value in how it provided off-site clinicians with essential information much quicker than phone conversations could.
"There was a 40-year-old woman recently who had had a stroke in the emergency department and I wasn't even in Whangārei and in a [phone] conversation I clearly didn't get an idea of what was going on, but 10 seconds [of video] told me we needed a helicopter to get her down to Auckland to get a clot removed."
In a conversation held through a RITA unit, Kaitaia Hospital clinician Dr Joel Pirini said the technology made a huge difference to emergency healthcare provision.
"From my end, often these emergencies happen in the middle of the night, there's usually one doctor and one nurse on our end and we've got to be looking after the patient, we can't be on the phone, trying to relay information," he said.
"[Now, clinicians in Whangārei] can actually see the patient, see all the observations on the monitors, and talk to the patient and the family."
A few months ago, a patient in Kaitaia reported extreme abdominal pain and the attending clinician performed an ultrasound but wasn't certain of his diagnosis.
Thanks to RITA, an ultrasound specialist in Whangārei was able to view the patient, make a diagnosis and confirm the patient needed to be flown to Auckland - avoiding a stop in Whangārei.
"Traditionally, if they had to go to Whangārei for the diagnosis, that may have been a delay that cost them their life potentially," Pirini said.
NDHB consultant Michael Kalkoff, who provided special care for critically-ill patients, said RITA would make decisions around patient transport much more efficient.
"Half of the questions I have to ask via telephone, I already see in an instant and then you can make a plan, assist the team up [in Kaitaia], speak to the whānau, make them a bit more comfortable, and then allocate an appropriate team and method of transport."
"It's a gut feeling but I think it works to level out the [health service] gap between rural, regional and main centres."
*Aliases have been used to ensure anonymity