"Māori need to get vaccinated, especially with the Government signalling a relaxation of the Tamaki Makaurau (Auckland) border, plus an early move to the Covid-19 Protection Framework.
"That framework won't actually protect unvaccinated Māori, who now make up 41 per cent of all Covid-19 cases, a trend which is likely to continue upwards."
Halkyard said unvaccinated Māori were now selecting the option of getting very sick, being hospitalised or worse.
"In 1918 our tūpuna succumbed to the Spanish Flu at seven times the rate of non-Māori because there was no vaccine," he said.
"Today we do have a highly safe and effective vaccine so that is the only option Māori should take to protect their whānau."
Questions around how the impact of widespread Covid-19 in the community would be managed have also been high on people's minds.
To answer some of those questions, the Northland Age spoke to a range of Northland health providers to understand how they were preparing for Covid-19 in Te Hiku.
COMMUNITY SUPPORTED ISOLATION AND QUARANTINE (COMMUNITY SIQ MODEL)
Currently, in Te Tai Tokerau, the model of care used for someone who contracts Covid-19 is the Community Supported Isolation and Quarantine (Community SIQ) model.
According to the Northland DHB, anybody infected with Covid-19 who can safely isolate at home for 14 days will do so, and those who can't, will be supported to isolate in alternative accommodation.
Community SIQ is a coordinated approach with DHB, iwi, primary care, Māori providers and other Government and community providers which offer a range of wrap-around health, welfare and wellbeing services to keep people safe during isolation.
Northland DHB professional lead social work Te Ami Henare-Toka said the current model was an interim approach while the Government worked out how to transition to a community management framework.
"Under the current Community SIQ, we work in a small team where we receive referrals from public health," Henare-Toka said.
"Public health conducts the initial contact, and during that conversation, they assess a patient's welfare needs, if they need kai, credit for their phone or internet, etc.
"From there, our team can refer them to a provider in their community, iwi or Māori health provider, with which they might already have a relationship with."
Henare-Toka said GPs weren't usually alerted if one of their patients had contracted Covid-19, but under the new system, they would be.
"Migrating to a community management framework will mean we can share the load a bit better with GPs and, in turn, patients will get more personalised care."
RURAL HOSPITAL CARE
Dr Sarah Clarke is the clinical director for Rural Hospitals for NDHB and oversees Kaitaia, Dargaville and Bay of Islands hospitals.
Clarke takes part in weekly discussions with the DHB and other providers in preparation for the transition to the new community management framework.
She said under the new system, public health units would still handle contact tracing but each region would customise its own support service.
"The community management framework will provide a coordination hub which will consist of a GP, a Māori health provider and a practice team assigned to each patient," Clarke said.
"This will mainly be conducted via phone or video calls, with video preferable if people are getting worse."
According to Clarke, many people already had acute care plans, which would also be reviewed for other illnesses where necessary.
She said another factor was dealing with the fear and stress that comes with transitioning to a new system.
"There's going to be a lot of fear for a few weeks when this first rolls out, but when we start to do it people will realise it's going to be okay," she said.
"A patient's goals of care will continuously be discussed - some people might want to stay home with their family rather than go to hospital.
"If they do become very ill, then we have a Covid-19 team at Whangārei Hospital made up of medical, respiratory and infectious disease specialists.
"It's important everyone gets ready for managing at home if they do get Covid-19, because for most people it will be a mild illness.
"Not many people will die from Covid-19 so hopefully people won't need to worry too much."
ADMISSIONS TO HOSPITALS AND ICU
While hospital admissions aren't expected to be high, there will be instances where people suffering from Covid-19 symptoms will require acute care.
Currently, all hospital admissions in Northland are transferred to Whangārei Hospital, which has eight Intensive Care Unit (ICU) beds that can be expanded to 10 if needed.
In the past two months, ICU averaged 40 per cent occupancy, generally fluctuating between 10 and 75 per cent.
A DHB spokesperson said its five-tier Covid-19 plan outlined a stepped approach for its response to use wards in the Whangārei Hospital Medical wing.
With each tier, an additional ward could be utilised to care for Covid-19 patients.
"At tier five, the plan to occupy the entire Medical Wing will provide 121 Covid-19 beds, which is approximately half of our inpatient bed capacity," they said.
"In addition, all of our existing ICU capacity will be used for our Covid-19 response.
"We also have plans that enable Covid-19 patients to be cared for at Bay of Islands and Kaitaia Hospitals."
Dr Joel Pirini is the clinical lead at Kaitaia Hospital and works with the hospital's Health Pathway (online system).
Pirini has lived and worked as a doctor in Kaitaia for eight years and has become a trusted source of local medical knowledge, particularly within the Māori community.
He said given the rising level of vaccination rates, he was hopeful there would be minimal hospital care required and most care could be managed at home.
"As I understand, the DHB is looking at models in Canada for people to manage Covid-19 at home and how that can be applied to the New Zealand context," Pirini said.
"There are possible scenarios that could play out, and if we did see a massive outbreak of unwell people there could be a backflow to Kaitaia.
"That really is the worst-case scenario."
Reports of three people in Auckland dying at home from Covid-19 have also been a concern for many.
Strict criteria are in place to take action and admit someone to the hospital if they had been self-isolating.
For example, when Covid-19 positive patients (who have been deemed low-risk) self-isolate at home, healthcare providers are meant to be in regular contact to check oxygen saturation levels and other key indicators.
A fever higher than 40 degrees, severe shortness of breath at rest, coughing up blood, confusion, drowsiness, chest pain, an inability to take oral food and fluids, or rapidly escalating symptoms, would indicate it was time for a transfer to hospital.
The second biggest risk factor to dying at home was having other co-morbidities- underlying conditions such as heart or lung diseases – or taking certain medications which can make someone immunosuppressed.
Pirini said given better access to resources in Auckland, he questioned how the deaths had occurred, but hoped things would be different in the Far North.
"I'm not sure how that happened, but I would assume it might be because the health providers did not know in time more care was required," he said.
"I would hope that as a small community we would rally together and support each other more here given our close ties," he said.
"As Māori in particular, we always ensure to bring everyone with us and to make sure everyone is cared for."
Regarding the spread of Covid-19 and its impact on the Māori population, Pirini said Aucklanders were likely to be more at risk travelling to the region.
"Everyone in Auckland has been doing the hard yards for the rest of the country, and in turn, the vaccination rates there are really good," Pirini said.
"In my opinion, they're earning the right to be released out of the city and to do the things they enjoy and are some of the safest people to be moving around.
"If I was from Auckland and was double vaccinated, I'd be really upset if I caught Covid-19 up here after doing all the right things."
A GP'S PERSPCETIVE
While the Government is in the process of working out the transition of public health to community care, local GPs are also preparing for what the new system might look like.
Te Hiku Hauora medical director Dr Norma Nehren said the very nature of healthcare during Covid-19 was that it was constantly changing.
"Things are always changing, sometimes as often as daily, which requires continuous, evolving education," Nehren said.
"We have our mobile team out doing vaccinations and consultation with the vaccine-hesitant is our priority.
"The most recent information coming through is we're going to be giving boosters and there's some talk it might start with the healthcare teams, just like the initial vaccinations did.
"We're currently waiting for the announcement on when that will be funded and available."
Clarke agreed the transition from public health to primary might have its teething issues but GPs were capable of adapting to the new model.
"GPs are amazing and nimble people. Their systems are agile and overnight they went from patients coming in the doors to virtual care," Clarke said.
"We've been doing virtual care for more than 18 months, so GPs are very capable of doing this and once people get used to it, it's not that tricky.
"I'm incredibly grateful to Auckland for having shared their lessons with us and nationally there's been a heck of a lot of work to be prepared for this eventuality."
Clarke said for GP practices that already had closed books, there would be backup provided and a telehealth provider already used by rural hospitals may be picked up as a virtual provider.
If anything needed to be done in person, the hospital or other GPs could support them.
In Northland, 83 per cent of the eligible population have received their first dose of the vaccine, with 72 per cent a second dose.
As of Wednesday, there were four new cases in Northland; one in Kaitaia, two in Dargaville, and one unlinked case in Whangārei, bringing the total number of active cases in the region to 50.
One person remains in Whangārei Hospital in a stable condition.
