When Ngāti Kahungunu shared its "East Coast wave" with the nation it went viral, but in the best way possible.

"It conveyed a very important public health message, but linked back to tikanga and provided a light-hearted way of doing the right things," said Dr Rhys Jones of his iwi's response to the pandemic.

But behind the humour was a much more serious issue, both historical and tragically current.

During the influenza pandemic in 1918, the mortality rate was seven times higher for Māori than for New Zealand Europeans.

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In one community, Mangatāwhiri in the Waikato, about 50 out of 200 local Māori died.

Whina Cooper told of similar suffering at Panguru, Hokianga:

"Everyone was sick, no one to help, they were dying one after the other. My father was very, very sick then. He was the first to die. I couldn't do anything for him.

"I remember we put him in a coffin, like a box. There were many others, you could see them on the roads, on the sledges, the ones that are able to drag them away, dragged them away to the cemetery. No time for tangis."

PM Jacinda Ardern demonstrates the East Coast wave as an alternative to handshakes.

Historian Geoffrey Rice, who wrote the pre-eminent book on the pandemic, told the Herald this week higher Māori death rates were linked to living in "isolated, rural areas, and so weren't exposed to the flu's first, milder wave earlier in the year, and so probably missed out on some immunity".

"Also they had lost their land and had very poor nutrition and living conditions, tuberculosis was rife, and Maori had high rates of smoking tobacco. All of that likely contributed."

Today Māori are still disproportionately impacted by similar health issues.

A 2017 University of Otago study found in the 65-79 year age group, Māori were 3.6 times more likely to die of influenza than those of European/other ethnicity.

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Jones, a public health physician and senior lecturer at the University of Auckland, says the reasons for those disparities are complex.

The roots are in colonisation and the dispossession of Māori from their land and their culture, which lead to higher rates of poverty and socioeconomic deprivation, engrained over the ensuing centuries by governments.

As a result Māori were also more susceptible to disease.

"In relation to the current pandemic, those at high risk are the older population and those with pre-existing health issues, such as cardiovascular, cancer, and diabetes - all of which Māori have much higher rates of. Those result in compromised immunity, and all put Māori at higher risk.

"So the risk not only higher of being infected, but of developing more serious complications."

The New Zealand Influenza Pandemic Plan aimed to "minimise the impact of the disease and to mitigate its effects on the people of New Zealand without increasing health inequalities".

Lady Tureiti Moxon says Māori are doing everything they can to prepare for Covid-19. Photo / File
Lady Tureiti Moxon says Māori are doing everything they can to prepare for Covid-19. Photo / File

But Jones said the structural inequalities - and inequitable approach to healthcare - meant Māori were again likely to come off worse.

"We haven't changed, the lessons have not been learned. The inequities are still there, and also many Māori communities are remote, with poor access to healthcare.

"It reflects a failure of successive governments to fully engage with equity, to honour obligations under Te Tiriti o Waitangi."

The Waitangi Tribunal agrees, with the first stage of the kaupapa inquiry into health services and outcomes last year finding the Crown had breached the Treaty for not closing the gap between Māori and non-Māori.

"Overall the health sector hasn't developed the capacity and capability to engage appropriately with Māori communities and is still perpetuating inequities," Jones said.

The Covid-19 response needed to take an "equity-based" approach, Jones said, factoring in the challenges different sectors of the population face.

Examples included the distance from health services, issues with transportation, and even things like access to water and food provisions.

"If schools are closed and parents need to stay home to look after the children, it disproportionately impacts those on low incomes, who have to take time off work and still put food on the table.

"It is not just about Māori. If we can get it right for our most vulnerable and bridge these systematic barriers it will benefit all New Zealanders."

Māori health leaders across the country had recently joined forces to co-ordinate an equitable response.

One of them, director of Te Kōhao Health, Lady Tureiti Moxon, said they were making sure whānau were well-informed and communities properly resourced.

"Before this pandemic Māori were already dying needlessly from preventable diseases, in huge numbers, but no one seemed to think there was something wrong with the picture.

"In this pandemic we are not going to suffer the way we have suffered in the past.

"We will do everything in our power ensure the safety of all our people."

They had been working through marae networks distributing information posters, and alongside councils, district health boards and the Ministry of Health to identify vulnerable whānau.

Across the country Māori health providers had been setting up communication hubs, call centres and establishing isolation rooms in case of an outbreak in their area.

"Everybody is on red alert - this is of huge concern to us," Moxon said.

East Cape resident Tina Ngata said with a very high Māori population and very isolated, their community was particularly vulnerable to a Covid-19 outbreak.

"When we talk about immuno compromised, susceptible to respiratory illness so asthmatic, rheumatism - that is largely Māori, and especially on the East Cape.

"We are very vulnerable, and in my own family too."

Iwi Chairs Forum spokesman Mike Smith said the organisation was meeting regularly to update whānanu across the country. Photo / File
Iwi Chairs Forum spokesman Mike Smith said the organisation was meeting regularly to update whānanu across the country. Photo / File

Compounding the fears was the local health system, and difficulties for the rural community in accessing it.

"We have to wait a good few weeks to see a doctor, it is three hours from where I am to the nearest hospital in Gisborne and then that only has six beds in the intensive care unit serving a population of nearly 50,000."

Ngata and other members of the community had been proactive in educating whānau about the disease, how to prevent its spread and running workshops on things like making their own hand sanitiser - crucial in a region short on water after a tinder-dry summer.

"But for us the key is keeping it out of the region in the first place."

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New Zealand's borders will be closed to everyone but citizens and residents, Prime Minister Jacinda Ardern has announced.

At a national level the Iwi Chairs Forum, which represents 74 iwi rūnanga, has created a National Pandemic Response Group to ensure Māori communities are prepared to fight Covid-19.

Spokesman Mike Smith said the group was meeting regularly to get safety messages out to whānau and encourage them to temporarily change cultural practices for safety.

Marae should be considering closing their doors and avoiding large hui or gatherings.

"Kaumatua and people with compromised immunity need to be supported. We endorse the caution to maintain distance, limit unnecessary social contact and the temporary adaptation of tikanga.

"This is not an extinction event, if we prepare and manage well together, we will get through this."

NZ Māori Council also issued a guide for Māori and Covid-19, covering everything from hui to tangi.

Ministry of Health deputy director-general Māori health John Whaanga said planning was being undertaken to consider and address equity and the needs of vulnerable populations such as Māori, Pasifika and disabled peoples, which included engaging and communicating with key groups and organisations.

The ministry had a work programme in place to ensure the needs of Māori are addressed in relation to Covid-19 and that included establishing a Māori reference group, developing a specific Māori response, and communication and partnerships with Māori communities.