Health officials say the sharp rise in Covid-19 cases in Tairāwhiti may be the result of "poverty in action".
Photo: RNZ / Tom Kitchin
The region, which includes Gisborne and the East Cape, has the highest per capita rate of Covid-19 in the country.
Ilminster Intermediate School is a predominately Māori decile one kura in the suburb of Kaitī.
Two cases were found there on 10 February but in just over a month, principal Megan Rangiuia said the school's roll of nearly 400 students dropped dramatically.
"We've got half the school away today, there was 199 students absent this morning, and that's been growing steadily from last week, so last week we would've had 85, 95 a day."
Many of these students were because they were household contacts of cases. But Rangiuia said despite the rise, she was looking forward in hope.
"We sort of feel like we'll just get through this and we'll be over that hump and starting to get back to normal, so it's a really positive place to be in spite of what's happening."
Tairāwhiti has the highest proportion of youth and Māori in the country and is isolated - Gisborne is about seven hours from Wellington and six from Auckland.
It also has the highest proportion of overcrowded households outside of Auckland and local GP Fergus Aitcheson, of Three Rivers Medical, said that could be one of the issues.
"I think what we're seeing is actually a result of poverty in action," Dr Aitcheson said.
"When people have to spend a large proportion of their income on housing, the way that they manage that is to have lots of people in one house," he said.
"When you've got lots of people in one house and a very infectious organism, you end up with a lot of cases - what we're talking about is the wider determinants of health playing out here.''
He and his colleagues saw that first hand.
"When we ring people up as a positive Covid case, they'll often say 'oh, by the way, there's another six people here who are positive', some of whom have recorded themselves on the system and some of whom haven't, so I think probably the official case numbers nationally don't represent the burden that's out there."
Local iwi provider Turanga Health chief executive Reweti Ropiha said Tairāwhiti was going through "chaotic times".
Beyond overcrowding there could be other reasons for the high case rate, he said.
"We've been chasing some vaccine uptake that we didn't quite sort of zoom in on, and then we've had whānau intimately coming in from other spaces and not all the best practises are being put in place wearing masks."
A drive-through vaccination centre in Gisborne, pictured late last year. Photo: RNZ / Mani Dunlop
His team were expanding the rapid antigen test uptake, taking them directly to more rural areas around Gisborne.
"Going to marae settings, the shearing sheds or settings where rural communities can come to and they've got the trust and confidence around turning up there and picking things up."
Further up along the East Coast in even more remote settlements, there are roughly 150 cases in each of the small towns of Tolaga Bay and Ruatorea.
Ngāti Porou Hauora primary care and senior business manager Cara-Lee Pewhairangi-Lawton said they had appointed hapū leads and other volunteers to help those who had Covid-19.
Cara-Lee Pewhairangi-Lawton. Photo: RNZ / Tom Kitchin
"Their work is to ensure social need is taken care of, ensure the pathways to accessing clinical assistance are clear and understood by our whānau," she said.
Despite the high proportion of case numbers, Tairāwhiti has not yet seen a huge spike in hospital numbers.
As of yesterday, there were three people in hospital. One man died after leaving hospital last week.
But Hauora Tairāwhiti District Health Board chief executive Jim Green said the challenges were not just in health.
"We've got increasing numbers in our community who are positive. That's really putting a strain on all sorts of services - not just in the health services but more widely - so we are feeling that pressure at present."
The region reached the 90 percent double vaccination rate on 11 February, but Māori double doses were only at 87 percent.
Booster rates in the region are the fifth lowest in the country.
Vaccine clinics are still operating, encouraging whānau who are not yet vaccinated to come along, with loud music and prizes available.
The region has more than 3000 active Covid-19 cases.