There are fears the phase three Omicron response will see already-stretched rural health services in crisis as they try to care for increasing numbers of Covid-19 patients at home.
Many people in Otago and Southland (pictured) lived at least an hour from the nearest hospital. Photo: RNZ / Cosmo Kentish-Barnes
Questions are being asked about what happens when sole-charge GPs are forced to shut their doors if required to isolate themselves.
It was not uncommon for rural communities to be serviced by a single doctor and nurse.
A fortnight ago, there was no Covid-19 detected in the Southern District Health Board.
Now, there were almost 2000 active cases and the outbreak was growing fast.
Balclutha GP Branko Sijnja, who is also University of Otago's rural medical immersion programme director, said rural healthcare was in a precarious state in the south.
"Say you've got a town with just one doctor - a sole practice - and that doctor becomes a contact or gets Covid, and that's the health services gone," he said.
Rural areas also tended to be the least vaccinated, which created concerns, Dr Sijnja said.
"They're also the people being uncovered by the immunity given by the two shots and a booster, who will be more ill when they present. So they're going to be the ones that may need a lot of care and will need to be transported then to an urban setting.
"That also becomes a problem as to how to transport these people safely."
Many people in Otago and Southland lived at least an hour from the nearest hospital.
The worst case scenario, with so many people potentially self-managing Covid-19 at home, was a life being unnecessarily lost, Dr Sijnja said.
Southland MP Joseph Mooney said some communities in his electorate only had the services of a temporary doctor.
Joseph Mooney. Photo: supplied
He feared rural communities were heading into a crisis.
"We already don't have the GPs available and/or the nurses to do the work, and now we have this additional requirement that the response to Omicron is being put on their shoulders when they're already over-stretched and overwhelmed in many cases."
The government had been warned of the shortfalls in staffing, and had not taken steps to shore up services, he said.
"I'm aware of a letter that's been sent to the prime minister raising these concerns.
"Raising the lack of funding keeping up with inflation. Raising the lack of attention given to getting more health staff into the country. Raising the concerns around people having to pay for things like X-rays and prescriptions that they wouldn't have to pay if they were in town.
"There's a significant difference in the level of care that's available to people who live in regional New Zealand compared to those that live in urban areas."
Rural General Practice Network clinical director Jeremy Webber said the strain on rural healthcare providers was mirrored across the country.
"The rural workforce has, for a long time, been stretched, at capacity and with no real fat in the system to accommodate extra," Dr Webber said.
"Add into this increased demand and we are looking really over the next three to six weeks having the whole of winter compressed into a couple of weeks, and that's going to put huge demand on our rural workforce.
"It makes our rural communities really vulnerable if those clinicians have to stand down."
But at least one Southern rural doctor, Lumsden GP Mathew Stokes, was quietly confident about how the region would fare during the forthcoming wave.
"We're certainly a lot better prepared than we were during the first lockdown. We'll tackle it head on and deal with it as best we can. At this stage, I'm not feeling too concerned, our population is likely to just stay in their rural homes and I don't know that we're going to have the peak in rural areas as they would in urban areas.
"My colleagues would probably argue against what I'm saying but I'm feeling quite optimistic."
Health Minister Andrew Little said he was also confident GPs in the region would handle the Omicron response.
Health Minister Andrew Little says he is confident the Omicron outbreak won't place further undue pressure on rural practices due to preparation. Photo: RNZ / Angus Dreaver
"As a result of the successful vaccination campaign, we have a high level of vaccination - the Southern DHB region has been a leader in the respect - and this means by far and away most of the people infected will have mild to moderate symptoms," Little said.
"Most people will recover at home without the need for medical intervention. In any event, DHBs have planned and prepared for the outbreak. Part of that preparation has included arranging additional financial support for GPs supporting patients at home," he said.
"Representatives of GPs have been involved in the arrangements to support GPs during this time.
"Although rural health services have been under pressure, I am confident that preparations for this outbreak won't place further undue pressure on rural practices."