From her home in Pamekasan, East Java, Dr Ratna Hermawati can hear the names of the dead echoing out across her neighbourhood. A new COVID-19 fatality is announced from a speaker at the nearby mosque at least five times a day. Ratna would normally be at work, managing the hospital’s overstretched isolation rooms, but, after testing positive for COVID, she has been required to stay home.
“I know my fellow medical workers are trying their best to use whatever we have to serve our patients,” she said. Nine other doctors in the hospital are also infected, just as the wards are busier than ever.
Her hospital is one of many buckling under the pressure of Indonesia’s escalating COVID-19 outbreak. The country announced another record daily increase in cases on Thursday, with 38,391 infections and 852 fatalities. Epidemiologists say the official numbers are likely to be a significant underestimate and point to the country’s severe lack of testing.
“We know we have already achieved more than 100,000 a day,” said Dr Dicky Budiman at Australia’s Griffith University. His estimates are based on fatality data recorded at a local level.
Images taken at hospitals in Java’s main cities show the severity of the outbreak. Emergency tents have been set up in car parks, where patients lie in rows awaiting a space on a ward. Elsewhere, long queues stretch outside shops selling oxygen, as families unable to find a hospital bed for their relatives try to treat them at home.
Workers at Rorotan public cemetery in Jakarta stay until after dark, expanding the grid of graves dug for COVID fatalities. The number of burials in the capital had increased 10-fold since May, according to officials. “This is an accumulation of our weakness in the system,” said Pandu Riono, an epidemiologist at the University of Indonesia, of the latest outbreak.
Human Behaviour To Blame
“You cannot only blame the virus, actually this is the problem of human behaviour.” Indonesia’s pandemic response has been fraught from the start. It was not until 2 March last year that the country confirmed it had detected two COVID cases, despite indications the virus had been present in the country as early as January.
The health minister at the time, Terawan Agus Putranto, attacked a report by Harvard University that Indonesia may have unreported infections. He said that praying had kept the virus away.
Indonesia has since faced one of the worst outbreaks in Southeast Asia, though demographics and geography have offered some cover over the past year, said Dicky. “Indonesia has experienced a ‘silent outbreak’ so far … We have this young population and we have many islands,” he said, adding that this had helped to slow or mask the extent of the virus’s spread.
Such factors, however, have been vastly overwhelmed by the arrival of the more infectious Delta variant. The new strain, combined with travel related to Eid al-Fitr, has laid bare the longstanding failures in the country’s pandemic measures.
Epidemiologists had warned of a surge in cases and urged the government to restrict travel and gatherings during the festive period. By the time a short travel ban was imposed, many had already packed into airports and train stations to travel to their home towns.
Government Acted Too Late
“The government acted too late to reduce the transmission rate. [It has been] incompetent in reading the data and ignored the warnings of experts,” said Yurdhina Meilissa, chief strategist at the Center for Indonesia’s Strategic Development Initiatives.
The country’s president, Joko Widodo, has been reluctant to impose strong lockdown measures throughout the pandemic for fear of economic disruption. Rules that have been in place have not always been strictly enforced.
Until recently, officials were encouraging domestic travel, unveiling a “work from Bali” scheme to boost the hotel and tourism sector there. The programme was suspended last week, when tougher measures were imposed in Java and Bali in response to spiralling case numbers.
Health experts accuse the government of sending mixed messages to the public, and of failing to boost health systems and surveillance when infections were more manageable. Indonesia’s testing rate remains one of the lowest in the world. The number carried out has increased over the past week, but it is still far below government targets and is not keeping pace with the outbreak.
The number of people found to have the virus has also risen, with more than a quarter of tests coming back positive nationally. The rate in Jakarta is 50%.
There is little active case tracing, said Dicky, who added that health teams in the worst-affected areas were operating in the dark. “Many districts in Java, and out of Java also, don’t know about the problem because they don’t have enough data,” he said.
Hospitals are barely able to cope with the current surge. “What is happening right now in the hospitals is a functional collapse,” said Adib Khumaidi, the risk mitigation team leader at the Indonesian Medical Association (IMA).
In Ratna’s hospital more than half of patients are being treated for COVID, compared with roughly a third last year. Most are in critical condition when they arrive, she said, which was not the case previously. Some patients refuse to accept that they have tested positive, and instead lash out at hospital staff.
Medics Under Pressure
Infections among health workers, who have mostly been given the Chinese-made Sinovac vaccine, have added to the pressure facing medics. 22 nurses and 35 doctors have died after catching COVID in the past nine days, according to the IMA and the Indonesian Nurses Association.
The government has imposed restrictions across Java and Bali to try to curb the number of cases, but health experts point out that domestic travel is still allowed and that there are many exceptions for essential workers.
Whether the restrictions are effective will depend on how strictly they are enforced, said Pandu Riono, an epidemiologist at the University of Indonesia. “Do you want the worst scenario, the very extreme, or the best scenario [where] you should do everything that you can to reduce the transmission, and then you will reach the peak in the next month?”
Ratna will return to work in five days. Her husband and her two children, who also became infected, are still recovering. Despite the challenges, she believes her hospital is in a better place than many others. “I hope we all can survive this pandemic,” she said. – The Guardian