More than 110 aged care homes are battling Covid-19 cases and 27 residents have died after catching the virus, figures released to the Herald on Sunday reveal.
The toll remains much lower than other countries with worse vaccination protection. However, deaths are expected to increase in the coming weeks, as the Omicron variant sweeps facilities also struggling with a staffing crisis.
"This is the pattern seen around the world with the Omicron wave - you get the wave of cases, you get the wave of hospitalisations, you get the wave of deaths," said University of Otago epidemiologist Michael Baker.
"That tail carries on for several weeks after the peak. And the people who are most affected are the elderly - a very powerful risk factor is increasing age."
Official figures released to the Herald on Sunday show that, as of Friday, there were 372 active Covid-19 cases among residents in 116 of the country's more than 650 aged care facilities.
Twenty-seven aged care residents have died in the current outbreak.
The Ministry of Health last week changed its reporting to include all deaths of people who died within 28 days of a positive test result. New Zealand's overall number of Covid-related deaths includes people whose death was clearly not Covid-related (two people), and a large number still under investigation.
Yesterday the ministry announced a further 10 deaths had been reported in the past 24 hours, including four people aged in their 80s and three in their 90s.
The latest deaths took the death toll to 166. The ministry also confirmed 18,500 new cases in the community.
This takes the death toll of publicly reported Covid-related deaths to 166, and the seven-day rolling average of reported deaths to eight, according to the ministry.
Omicron outbreaks overseas have killed many more elderly, including in Hong Kong - where fewer elderly are vaccinated - and Australia. The latter has recorded more than 870 aged care deaths this year, many of whom had not had a booster shot by the time of their infection.
New Zealand has had the vital protection of aged care residents and workers being triple-vaccinated before Omicron took hold.
However, the sector entered the current outbreak desperately short of workers. The long-term shortage of nurses became a crisis after Covid-19 shut borders and created fierce competition for workers.
Aged care is short of 1000 registered nurses - 20 per cent of the workforce - and nurses are working double and even triple shifts - 24 hours straight - to plug gaps.
"To work 24 hours does provide real health and safety concerns," said Nurses Organisation kaiwhakahaere Kerri Nuku.
"We are talking about an already fatigued workforce."
Public hospitals are grappling with their own staffing problems - this week the Herald revealed Auckland nurses and midwives have been offered a $500 bonus for every night shift they work.
Nuku said some DHBs were also paying "incentives" to staff who agreed to temporarily work in Covid-struck aged care homes.
"However, the staff aren't necessarily familiar with the workplace or residents, so there's still additional pressure on the staff who are still working in those facilities."
Such emergency measures would help get the aged care sector through the current wave of infections, Nuku said, but the staffing problem would remain.
"We were acutely short-staffed before the pandemic. Now we are in a crisis."
The Nurses Organisation union is part of a broad coalition that this month wrote to Health Minister Andrew Little asking him to urgently introduce pay parity for aged care nurses. Other members include Age Concern, Grey Power, Alzheimers NZ, and home and aged-care associations.
A difference in government funding means DHBs can pay significantly more money to hospital nurses, and many have been actively headhunting aged care nurses for roles.
Little has said he has already instructed officials to urgently work on pay parity for aged care and other nurses, but it's unclear when that will happen.
Simon Wallace, the chief executive of the Aged Care Association, which represents most facility owners, told the Herald on Sunday Covid-19 deaths in aged care reflected wider community infection and fatality rates.
"Rest homes look after many of our most vulnerable older people often with multiple health disorders and, in fact, more than one in three people who die in New Zealand each year, die in aged residential care.
"Now, with the border open, and the number of community cases remaining high we expect there will be some further deaths in aged residential care given the vulnerability of our residents and other underlying conditions."
Wallace said any death was tragic, but he was confident infection control measures "will continue to protect our residents and limit the level of transmission amongst our vulnerable residents".
Baker said the current Omicron wave looked to have peaked in most or all DHBs, and in the next six weeks or so case numbers would drop to a "new baseline".
Excess deaths from illnesses like influenza in winter numbered about 2000-3000, and Covid-19 would add to that threat, he said. The challenge would be choosing what measures to keep in what situations. Aged care should be one of the few areas to keep vaccine passes, he said, as well as other steps such as mask use.