Those working on the frontline treating the majority of south Auckland's COVID-19 cases say they are in a race against time before more lives are lost to the virus.
"My big worry is that we're going to see a lot of deaths in people who shouldn't be dying. This is completely preventable to a large degree by vaccination, but we need to race to get people vaccinated, otherwise people will die," says Inia Tomash, an emergency department consultant at Middlemore Hospital.
Middlemore's emergency department is the busiest in Australasia and it can see more than 400 people in one day.
"We're trained to plan for the worst, so we're always ready for the worst to occur, at any given day, and it can be the worst of anything; heart attacks, car crashes, respiratory issues, strokes, shootings, stabbings. Part of your emergency department training is to be prepared for those things, be prepared for the worst of those things," says Dr Tomash.
Over the past 10 weeks, a stream of COVID cases has been added to the list.
"I will say that this is the first time in my career that a single entity has led to significant change within the department and the whole hospital," Dr Tomash says.
"So previously we would have our winter surge that we would always expect of respiratory illnesses and we would have our non-winter business as usual, and then we would ramp up for winter. We're used to 100 percent occupancy over winter, we'd increase services or ward staffing, or open up a new ward, whereas these things are now happening at any time because of COVID."
A triage tent has been set up in the hospital's car park in preparation for the expected surge in COVID cases that will come through their door.
"What the tent does is effectively move that outside the door into a better-ventilated space where we can have our COVID pathway processes occurring outside the waiting room. The waiting room is enclosed and small and there's a risk of transmission pretty much in that waiting room, hopefully, the tent minimises that in some way."
Modelling data paints a grim picture for the Counties Manukau area. Even if vaccination rates reach 90 percent - which is a long way off - south Auckland is expected to see between 1000 and 14,000 COVID-19 cases a week.
"The large numbers in south Auckland is nothing that we weren't expecting, every Māori and Pacific doctor was expecting south Auckland to blow up in terms of COVID cases," Dr Tomash says.
"I would anticipate that when COVID starts increasing in numbers in south Auckland, we will be seeing a lot more children in our emergency department and that worries me a bit a lot actually.
"Every day I go to work I see inequity for Māori and Pasifika, across all specialities and COVID's nothing new. Now I see it again every day I go to work, the people who should be vaccinated who are not.
"That includes the very vulnerable, as well as the young and fit who are more likely to spread it, both across all groups, so that's a big worry for me."
The experiences of emergency departments in Australia gives Dr Tomash and his team a glimpse into what the future will look like. He predicts Aotearoa will get to the level of hospitalisations and casualties relatively soon.
"It is a little bit daunting to think our colleagues in Australia are in survival mode because they go through the same training system as us, so it is a bit of a worry if they say they're in survival mode. All we can do is prepare as best we can and rely on our processes," Dr Tomash says.
"I think Melbourne and Sydney are a bit further ahead in their COVID experience compared to New Zealand, but we can rightly predict that we're going to get to that point relatively soon I think."
Made with support from Te Māngai Pāho and NZ On Air.