Māori health experts fear an inequity crisis could be looming with long Covid, and not enough is being done to avert it.
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Those on the ground are already starting to see the impact on whānau health and their ability to work, but a strategy for how to deal with it - particularly one for Māori - is only just starting to be developed.
Long Covid is widely defined as symptoms that persist months after an infection, like fatigue, brain fog or headaches that can be mild or debilitating.
In Porirua, the low-cost clinics of Te Rūnanga o Toa Rangatira are already starting to see an emerging pattern of patients showing signs of long Covid, and that has chief operations officer Jennie Smeaton increasingly worried.
"We are seeing a number of patients coming through that already had long term health conditions, or were already suffering from a number of illnesses, that have now had Covid," Smeaton said.
"Because of that they'll now have conditions as a result of Covid. So yeah, it's snowballing."
That snowball effect has Victoria University epidemiologist Mona Jeffreys fearing there could be another equity disaster approaching.
Māori have been infected with Covid at some of the highest rates, and that high proportion could see long Covid hit hard.
"Where the inequities lie is that we know that Māori do not get the same level of access to care as non-Māori; we know that taking time off work if you are in a lower-paid job, which many Māori are, has much more significant impacts," Jeffreys said.
"So we know the social and financial impacts are going to be much bigger."
Jeffreys is the co-leader of a Ngā Kawekawe o Mate Korona, a longitudinal study into the impacts of the pandemic in New Zealand. It has so far found that 45 percent of Māori with long Covid say their usual activities have been affected to a moderate or extreme level; about 20 percent have severe pain; and about ten percent have difficulty moving.
She warned that could create severe strain in a health system that is already not delivering for Māori.
"When you start with an unequitable situation and put on top of it an unequitable illness, then we're just going to magnify those differences in the coming months to years."
And that risk, she said, requires a Māori-specific plan and policy. It would also involve social and health support that, right now, isn't there.
Associate Health Minister Peeni Henare said government agencies are developing plans for long covid, with equity a key focus, although he conceded they were only an information-gathering phase.
"What we're trying to do is get a full capture of exactly what long Covid is," Henare said. "Some countries have obviously had it a bit longer than us but for us it's being able to prove what is long Covid, and of course, we've got to come up with a plan on how we combat that."
"We're still coming to terms and to grips with understanding that."
Henare, who himself was getting severe headaches and sinus troubles nearly two months after his infection, said he would ensure the new Māori Health Authority had a heavy hand in any plans developed, once it came into force on 1 July.
The Ministry of Health said it is "ensuring equity" and "giving effect" to its treaty obligations as it develops plans to manage the longterm effects of Covid, including "considering the interests and needs of Māori."
But that's been said before.
Last year, the Waitangi Tribunal was scathing in its review of the Covid response, with a report finding that "in many instances, consideration was where the Crown determined its treaty obligations ended."
That urgent inquiry was brought by the Māori Council, after a lack of consultation over the vaccine rollout and traffic light system late last year.
The council's general secretary, Peter Fraser, said Māori authorities were being consulted with by Crown agencies including the Ministry of Health and the Department of Prime Minister and Cabinet.
But he said that wasn't to an extent that allayed his fears about Māori needs being ignored.
It's no use "desiring" an equitable response, he said: It's a fundamental obligation on the Crown.
"We don't want to risk Covid and long Covid being the next rheumatic fever when as a country we can't even beat existing rheumatic fever," Fraser said.
"This is one of the issues we have with co-design: In many cases within government, co-design is seen to be desirable, not mandatory, and that's just unacceptable."
In Porirua, Jennie Smeaton said by-Māori, for Māori approaches were vital as the threat of long Covid continued to emerge.
"We're not quite sure what's to come but we know that it's not gonna be great and we need to prepare the best we can," she said.
"If we have a specific programme of work targeted for our whānau, we'd be able to try and curb the impacts that they'll likely suffer from this."
