Associate Professor Collin Tukuitonga said home isolation was unsatisfactory but sadly, surging case numbers meant more deaths were likely.
"Isolating people at home is a higher risk strategy but enforced by the sheer numbers," Tukuitonga told the Herald.
He said health and social support services were supposed to be available to people in home isolation, but the domestic system was clearly inferior to hospital care models.
The Glen Eden man's death was announced at yesterday's 1pm Beehive press conference, but details about his living arrangements were not immediately released.
Asked on Radio New Zealand about three recent deaths of Covid patients who were isolating at home, Covid-19 response minister Chris Hipkins said he could not discuss individual cases but was aware of one instance where a Covid-positive person was advised to remain in hospital but discharged themselves anyway.
"That is challenging and it's not fair on the health workforce to put any blame on them for that situation," he said.
Hipkins noted the majority of positive cases preferred to isolate at home as opposed to in MIQ, and work was being done to refine how public health staff supported those people.
Tukuitonga understood a "halfway house" type of model between hospital care and home isolation had been discussed but had not advanced.
He was concerned about domestic overcrowding and low vaccination rates in some communities.
Associate Professor Collin Tukuitonga says surging Covid-19 case numbers has forced the use of inferior home isolation models. Photo / NZME
Tukuitonga said 40 per cent of Pasifika households were intergenerational, which in simple terms often meant "too many people in a small confined space".
Nationwide, vaccination numbers were approaching 80 per cent for two doses and 90 per cent for first doses, but regional and ethnic disparities remained.
Vaccination rates for Pacific Peoples were slightly below national averages but only 58.1 per cent of Māori were fully vaccinated.
Regionally, only 68 per cent of Tairāwhiti residents were fully vaccinated, compared to Auckland's 88 per cent.
Tukuitonga said even if nationwide rates surpassed 90 per cent, New Zealand would still face potentially devastating outbreaks from pockets of unvaccinated people.
"They are the ones who are going to continue to transmit the virus in their particular communities."
Tukuitonga said Scotland recently had a big outbreak despite high vaccination rates. The country's cases surged in September in what Tukuitonga said was an epidemic of the unvaccinated.
Prime Minister Jacinda Ardern visiting the Pacific youth lead vaccination event at Fale o Samoa on Bader Drive in Mangere. Photo / Dean Purcell
Professor Michael Baker said the Auckland MIQ system was "absurd" just as local Covid-19 transmission was placing contact tracing systems under massive strain.
He said low-risk foreign visitors arriving in Auckland must be allowed to isolate outside of the MIQ hotel network.
"You've got people flying in from Western Australia, where they haven't had a case for months.
"We haven't adjusted. We've got more than 1,000 people infected staying at home. The current settings are absurd."
Baker said in Te Waipounamu and the lower North Island, Covid elimination strategies were still in progress, and there was no need for such MIQ reform.
Director-general of health Dr Ashley Bloomfield, who yesterday announced a Glen Eden man had died in isolation at home. Photo / Mark Mitchell
Yesterday, 147 new Covid-19 cases were reported and Baker said contact tracing struggled to cope when numbers exceeded 120.
"If the contact tracing system is saturated, its ability to limit transmission is compromised."
Rising case numbers, slowing vaccination rates, a defunct Auckland MIQ system, and more home isolation are combining to pose significant risks, he said.
In a worst-case scenario, if the virus ripped through unvaccinated groups, potentially hundreds of people could die in months ahead, he said.
Covid-19 Response Minister Chris Hipkins yesterday announced the AstraZeneca vaccine would be made available from late this month.
The new option would be for people who could not take Pfizer for medical reasons, or were in workplaces with vaccine mandates but were refusing to take Pfizer.
Baker said the AstraZeneca jab would reassure a relatively small group of people who were worried about the Pfizer vaccine.
"If it helps get people over the line it's probably worth it."
Prime Minister Jacinda Ardern visited Auckland yesterday for the first time since the city entered its long Delta lockdown.
Ardern told reporters she hadn't visited earlier because of rules which previously required Parliamentarians to self-isolate if travelling from Auckland.
She flew up on an Air Force plane. Her office said the flight was travelling to relocate some defence personnel so she travelled on it too.
