Painting a Covid Picture

So I want to paint a picture for you. I will use a brush of numbers, and a brush of maps, and a brush of storytelling, and we will paint a vignette. But first, a little Covid101.

Vaccinations are the strongest tool to protect yourself, but they are not the only tool, and it’s important we understand that. Being vaccinated does not mean you don’t have to wear a mask. Being vaccinated does not mean to stop social distancing. Being vaccinated does not mean complete freedom of movement.

There are such things as “breakthrough infections”. Amongst healthy populations they are very rare. But there are things that make them more likely to happen. Those things include:

• Living in a crowded situation with a covid positive case (because of the constant exposure in closed quarters as opposed to brief contact outdoors or elsewhere).
• Having low immunity to start with. This means that while the vaccine has BOOSTED your immunity, it will not be at the same level of a double vaccinated person with standard. immunity levels. This includes whanau who have had treatment for things like an organ transplant, or chemotherapy that has lowered their immunity, or whanau who might have been born with a condition that makes their immunity low.

Secondly, the vaccine helps your body to fight the virus so you will more likely get better. But also, there are some health conditions that, even with double vaccinations, you may still get very sick.

For all of these situations, and reasons, it’s important that as many people get vaccinated as possible. The best protection for those that can’t vaccinate (like children under 12) and for those with weak immunity, is that everyone around them is vaccinated and forms a protective bubble around them. As I write this, about 20% of the current outbreak are under 12 – that’s well over 1000 children. Mainly tamariki Maori. The other thing that’s incredibly important to do is work through an isolation plan for your whānau/household, and try really hard to reduce exposure to those that are not vaccinated, or immune compromised, or have health conditions.

Some of those health conditions are:

• Cancer
• Chronic kidney disease
• Chronic lung diseases including regular bronchiolitis, asthma, cystic fibrosis
• Heart conditions including heart disease, coronary artery disease, and high blood pressure
• Diabetes type 1 and 2
• Smoking
• Addiction
• Dementia
• Obesity

Ok so – early summary:

• Vaccinations are the strongest protection
• Vaccinations ALONE don’t keep us safe
• You are still high risk from crowded housing and low immunity
• You are also high risk of severe covid if you have certain health conditions.

But enough with numbers and tables…. let’s consider a scenario to play out what these facts mean for an average household in the East Cape.

Riripeti is a 35 year old mother, her whānau call her Riri. She has a 5 year old, a 14 year old and a 15 year old. The 5 year old had bronchiolitis when they were 2 and has mild asthma. Her partner works in forestry. They live in the whanau homestead here, somewhere between Wharekahika and Potaka… it’s a modest but well kept homestead, built in the 50s. One bathroom one toilet, 3 bedrooms. Their 17 year old nephew lives with them, sleeps on the couch. They are all double vaxxed.

Riri is also asthmatic.

14 year old contracts covid at school and brings it home. They can’t isolate away from her because they only have the one bathroom, and of course Riri wants to take care of her 14 yr old baby, so the whole family has to isolate. Her partner is hesitant to stay home because there were just 500 job losses in the forestry industry and he doesn’t want to lose his job – he’s stressed at having to isolate. The 14 year old, because they are vaccinated and young and healthy, has a rough time but recovers after 10 days and gets the all clear to stop isolating at 14 days, but then Riri tests positive, and because she is asthmatic, she deteriorates fast. At 10am she was able to talk. At 10.30am she is struggling to breathe and they call 111. The ambulance takes 20minutes to get to her and 3 hours to get her to town alone and she is barely alive at that point (in fact it’s a miracle she makes it there). The entire household clock resets to 14 days again, even though she is transferred out.

The damage from the time it took to get Riri to hospital means she needs ICU but there are only 2 beds, both full in Gisborne hospital but there is a spare one, free, for 7 days in another district. The hospital barely manage to keep her alive long enough to transfer her again to fight for her life in another district, alone. The family are notified of the transfer after it happened because the staff are too busy to call and the decision to save her life is too urgent.

The father and the 5 year old now test positive and you have a covid positive parent looking after a very sick covid positive child, and of course the clock resets itself again for the remaining household members. the 5 year old also needs ICU. There are only 15 staffed child ICU units in the country, all in Auckland.

Here are the fathers choices:

1. Allow his 5 year child to be transferred to Auckland by herself for ICU treatment (if it’s available)
2. Allow his 5 year old child to be transferred to Hawkes Bay ICU where there is one available, not sure about how long for though.
3. Keep his child at home with him where, if she also deteriorates, she will probably not make it to hospital in time, and will not be able to access ICU.

The father thankfully recovers because he is also healthy and vaccinated, the 17 year old nephew catches it last which resets them for another 14 days but he also recovers because he is vaccinated. By now that one house has had to isolate for 70 days. Nobody in, nobody out.

Over that time, who is delivering their kai? Who is delivering their medicine? Their watertank runs out…. who is arranging a refill? Who is feeding or moving their animals? Who is taking care of income? Physically they are fine, but the 17 year old is now suffering depression, and the father has lost his job and is also severely depressed, and the 11 year old daughter is now carrying the whānau – and they can’t reach anyone to find out about Riri.

Their living situation is not an uncommon living situation, or health profile, where we are in the East Cape. Now take this situation and multiply it by hundreds. Consider what this means for single parents. Consider what this means for grandparents looking after multiple mokopuna under 12.

Maybe it’s not asthma, maybe it’s diabetes, or obesity, or heart disease, or maybe they beat cancer a few years back with help of drugs which worked, but lowered their immunity. All of these things mean that although you are MUCH safer than if you had no vaccination, you still don’t have 95% protection. If you are in close living quarters, you can halve that protection again.

That is for vaccinated.

The lowest protections and worst outcomes of all sit around whanau who are unvaccinated, and lower immunity, and underlying health conditions, and are living in crowded situations, and we still have too many unvaccinated in Ngāti Porou

We have very high rates of asthma, of diabetes, of heart disease. We have people who have had or are on immune suppressing treatment. We have over-crowding. If you look at these maps, you can see – in all of the covid risk factors, places like Tairawhiti and Tai Tokerau, even with vaccinations, are still very high risk (source: MOH).

I could keep putting maps up for all of the risk factors – cancer, addiction, kidney disease and you would see the same, consistently that eastern tip is dark.

Now to add to these health factors, consider the following maps which focus on housing deprivation (overcrowding, damp homes, and homes without all amenities); and travel distance to a hospital:

Can you see now why the picture I painted above is not just a story of one, but many whānau where I live? I say this because I need us all to understand that we have to do everything we can, even with vaccination, to keep our whānau safe. It really will take all of us as a community to protect each other, with masks, with distancing, and with courage to make strong calls about things like holidays, about gatherings, about visiting. We are going to have to dig deep to avoid the deeply tragic scenario above playing out again, and again.

I know, already that there will be those that will come here for summer anyway. They are already here. Our campervan parks are already full. Hotels might not have vaccine mandates but they are asking people for their vaccine passport when they take bookings anyway. Consequently, unvaccinated tourists are flocking to campgrounds in rurally isolated regions. One tourist from New Plymouth was laughing at my cousin last week who was fishing and wearing a mask. When my cousin asked him what brought him here to the East Cape he replied “nobody else would take us”.

We are doing everything we can as a community to prepare. We are working hard to vaccinate. We are putting together home isolation plans. It will take a lot of community volunteer hours just to keep our community safe, even with vaccinations (but especially for those that are not). We cannot afford to wrap our limited health resources around visitors as well, at the expense of our own people.

So I need to know from you…

If you are here camping on our beach, 5 hours away from any health service, and you carry an infection you picked up from the petrol station you stopped at 2 days ago, and spread it in my community….

1. Are you expecting all of the volunteer community hours going into supporting our own community to isolate at home, to then wrap around you??? Who then looks after our whanau here? Are you expecting us to volunteer to look after you when you walked away from a fully resourced health service whereever you normally live??

2. Who is going to transport you to hospital and to which hospital? The one with only 2 icu beds? Our whānau will be more likely to decline fast bc of the diabetes, rheumatic fever, heart disease and poor housing. You’ve just spread it in our community, but you get the ICU bed?

3. If you are willing to return home, HOW will we get you home without leaving a wake of infections in your path?

Every year, our population swells to 3 or more times its normal size, from tourists. That terrifies me when I consider how hard it is for us to plan to just look after our own whānau, and how hard we are working to stop them from getting infected too. I don’t think any of those people travelling here think that they individually are a risk. They don’t seem to realise that from where we are standing, anxiously watching them drive past us, they are just one of hundreds of others we have seen that week, and that for us, that risk is cumulative. That for us, that risk is severe. Or maybe they do, and they don’t care, because for them, we are just somewhere to use for an escape. I hope not… I hope you care. I hope you care enough, to wait just one more summer.

Noho haumaru, noho ora ra.