Hutt Hospital. Photo: RNZ
It has been a winter from hell for Lower Hutt mother "Jane", whose four children - aged 18 months to eight years - have had Covid, RSV and two strains of the flu since mid May.
She was forced to rush her three-year-old to Hutt Hospital's emergency department when he started breathing rapidly after two weeks sick with RSV (respiratory syncytial virus).
"They took him straight in to see a doctor and he tested positive for RSV and Influenza A at the same time."
Her young niece also had to go to the emergency department, and unfortunately, they infected another family who was staying with them.
"Three of their kids got RSV from us and the youngest one (18 months old) ended up in hospital for five days.
"She was on oxygen because her breathing was so bad, and fluids as well. She was very poorly."
Jane is hoping the school holidays will have been "the circuit-breaker" for them.
"At the hospital they said 'After the latest round of Covid, the kids are catching everything that goes round', and that's definitely been our experience.
"It took us three weeks to go through Covid in the middle of May and I don't think there was a week last term when everybody was at school or kindy from that point on."
But this year's flu season started early, in April - and young children are disproportionately affected.
The rate of hospitalisations for acute respiratory illness in under-fives in Auckland shot up nearly 40 percent in the week ending July 16 to 52 per 100,000 head of population.
That's more than two-and-a-half times the hospitalisation rate for those over 65 but not as high as the peak at the start of July, which was 62.75 per 100,000.
Doctors fear some children will suffer long-term problems, including asthma and lung scarring, from illnesses that could have been treated earlier - or even prevented with vaccination.
Auckland University Paediatrics Associate professor Cass Byrnes, a respiratory specialist at Starship, said New Zealand's hospitalisation rates for RSV were higher than Australia's, Canada's, the United States or Britain's.
"It is also an example of one of those diseases that has health inequities. So it impacts our Māori and Pasifika children more greatly."
Children who live with the worst socioeconomic deprivation were twice as likely to be hospitalised for respiratory problems - and six times as likely to suffer bronchiectasis, i.e irreversible lung damage.
Clinicians hope an RSV vaccine for babies, Nirsevimab, that has just received regulatory approval in the United States, will be funded here.
Professor Byrnes said clinical trials involving over 3000 children reduced RSV infections by 76 percent and cut hospitalisations by 60 percent.
That would save a lot of suffering - and a lot of money in future health costs, in her view.
"Early RSV that causes hospitalisation is also associated later with an increased risk later of having an increased risk of preschool wheeze, asthma or lung scarring."
The flu vaccine is free to children aged six months to 12 years, and GP visits are also free to those 13 and younger.
However, General Practice New Zealand chair Dr Bryan Betty said a third of all clinics were not accepting more patients - and even those who were enrolled still struggled to see a doctor.
"It can take up to two to three weeks to get an appointment. These problems have become quite pronounced since Covid, and certainly I don't think it's being tracked adequately by Te Whatu Ora or the system."
Cure Kids chief executive Frances Soutter said the government should work more closely with research organisations to solve the underlying problems.
"Why do some children just get a sore throat with a strep infection and others develop rheumatic fever?
"Why are respiratory conditions responsible for a third of all acute admissions?
"By the time a child arrives at the emergency department, it's too late."
It was not enough just to make GP visits free for children, she said.
"Mum or Dad might have to take time off work to take their kid to the doctor, and find the money for petrol. Some families may be choosing between taking their child to the doctor or putting food on the table that day.
"We need mobile health services to go where the children are."
Te Whatu Ora said it was encouraging people to get their Covid booster and flu vaccines and ensure their children were up to date with their vaccines.
"Taking practical steps to make sure you don't get seriously unwell is the first line of defence this winter," a spokesperson said.
Under the government's winter plan to ease pressure on the health system, different regions were using "various specific activities depending on what is right for their community".
These included clinical telehealth, pharmacy advice and care, and longer-term initiatives to boost services for Māori, Pacific, disabled people and older people.
The Seasonal Pressures Clinical Telehealth Service, providing after-hours support for eligible practices, had taken over 20,000 calls since December.
About 1000 patients have avoided a trip to the emergency department through the telehealth service for ambulance staff, and more than 700 pharmacies have provided 30,000 consultations through the Minor Health Conditions Service.
"Emergency departments in our country's hospitals get particularly busy over winter and it's important that EDs are reserved for emergencies only and see only the sickest people in our communities."