Māori are more than twice as likely to die from Covid-19 than Pākehā, according to new modelling that shows the rate is even higher for older Māori and Pasifika.
Public health researchers behind the report say it provides further evidence a "one size fits all" approach to the epidemic will fail vulnerable communities and interventions are needed much earlier for Māori and Pasifika.
Researchers at Te Pūnaha Matatini, New Zealand's Centre of Research Excellence in Complex Systems and Data Analytics, estimated simply factoring in age, infection fatality rates (IFR) for Māori would be around 50 per cent higher than non-Māori.
But if more importance was placed on underlying health conditions, the IFR for Māori increased to more than 2.5 times that of Pākehā, and almost double for Pasifika.
These rates were likely to increase even further due to racism within the healthcare system, and other inequities not reflected in official data, the report said.
Based on previous epidemics these findings were not surprising, University of Auckland Māori health researcher and statistician Andrew Sporle said.
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In the 1918 flu epidemic Māori died at seven times the rate of non-Māori, and even in recent times with the 2009 H1N1 influenza pandemic the rate was 2.6.
The difference with Covid-19 was that the research was being done now.
"With previous pandemics the unequal impacts were only known afterwards," said Sporle, of Ngāti Apa, Rangitāne and Te Rarawa.
"This information shows us the inequity that could result, and allows us to take actions to massively reduce avoidable deaths."
International data suggests older people area at greater risk of dying from the virus, along with those with underlying health conditions such as diabetes, heart disease, cancer and asthma.
The researchers calculated IFRs based on both scenarios, combining international fatality rates of Covid-19 with New Zealand population data, taking into account age, life expectancy, access to healthcare, and rates of heart disease, diabetes, asthma, cancer and smoking.
It estimated the death rate overall for Māori would be as high as 2.5 times that of Pākehā.
The estimated death rate for people aged 60-79 was 7.9 per cent for Māori and 5.5 per cent for Pasifika, compared with an overall rate of 2.8 per cent.
For those 80 and older, it was 13.9 per cent for Māori and 11.8 per cent for Pasifika, compared with 6.8 per cent overall.
But when factoring in unequal access to health these became even more "stark".
"You might have an overall infection fatality rate for the over-80s that is around 8 per cent, but for Māori it's 28 per cent," Sporle said.
"For the 60 to 80-year-old age group, for non-Māori, non-Pacific it's about 2 per cent. For Māori it's 20 per cent - it's 10 times higher."
The differences might not eventuate during the early stages if elimination measures stay strong and cases of Covid-19 stay very low, the report said.
However, if there was a "rapid out-of-control spread", as seen overseas, and healthcare had to be rationed that would "amplify existing racism in the healthcare system".
"For example, if triage decisions are based on [the] existence of underlying health conditions, this will automatically disadvantage Māori further."
On Friday, the total count of confirmed and probable cases rose to 1409, with Māori making up 8.5 per cent and Pasifika 4.5 per cent.
Sporle said to keep Māori cases low, the policies of self-isolation for vulnerable age groups needed to be adjusted downwards.
"So not 70 but 60, and even lower for those with pre-existing health conditions."
Access to data was also important, and for it to be available to healthcare workers living in vulnerable communities.
"The Government is not doing enough on this.
"Fair enough no one has practice at this kind of thing, but we are four weeks in.
"We need good ethnic information for testing and that has to happen at a local level and be available at a local level so they can spot the patterns in case of an outbreak and respond quickly.
"Wellington is not going to know where the vulnerable local communities are. The difference with other epidemics is we now have really good Māori health providers, and Māori public health force.
"They will be able to identify the individuals most at risk."
Due to the lack of information, iwi health organisations had started doing their own testing and community mapping, he said.
Sporle says checkpoints set up by iwi in absence of action by local authorities were essentially pre-empting those safe havens.
"Māori recognise this 'one size fits all' approach does not work - and it never has, and it is no surprise we are seeing community checkpoints popping up."
In March the Government announced $56.5 million for a Māori-specific response action plan, including $30m for Māori Health services, and $15m to Whānau Ora commissioning agencies to support vulnerable whānau.
Deputy Director-General Māori health John Whaanga has previously said there had been a "real drive" to increase testing across the country, and collecting accurate ethnicity data for Māori was a key part of this.