Jakarta, Indonesia – Indonesia reported its first two coronavirus cases on March 2, and has tallied 1,986 confirmed cases and 181 deaths as of April 3, making it the country with the most coronavirus deaths and the highest fatality rate in Southeast Asia.
Indonesia’s death rate stood at 9.1 percent compared to 5.2 worldwide as of Friday. In comparison, the Philippines had a 4.5 percent death rate and Malaysia had a 1.6 percent rate during the same period, although both countries have higher number of cases with more than 3,000 each.
Some 95 health workers in the capital Jakarta, the hardest-hit part of the country, have been infected with coronavirus, according to the news portal Kompas.com on April 3. At least 13 have died as of April 2, according to the government.
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From zero reported infections and fatalities in January and February, Indonesia now faces a sudden jump in its coronavirus statistics.
Experts say the overstretched health system, a shortage of personal protective equipment, and minimal rapid testing contributed to the high number of coronavirus deaths in the world’s fourth-most populous country.
“We can see the government is still a few steps behind the spread of this virus,” said Panji Fortuna Hadisoemarto, a faculty member at Padjadjaran University’s School of Medicine in Bandung.
“[There is] late provision of laboratories and examination tools, and a low number of tests,” he said. “Facilities and health workers are not ready, [the stay-at-home] policy is still only an appeal, and there is minimum information transparency.”
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According to Indonesia’s health ministry, there are 2,813 hospitals in the country, with an average of 12 beds available for every 10,000 people. There are also an estimated 110,040 doctors for the country of more than 260 million as of 2018 – or about four doctors per 10,000 people.
Indonesia has brought in 500,000 rapid-testing kits from China. According to the online publication Katadata.co.id, the country had tested just 25 people per one million citizens as of April 2, “the lowest compared to a number of countries in Asia”. In comparison, India and South Korea had 35 and 8,222 people per one million tested, respectively.
When asked about Indonesia’s coronavirus death rate being the highest in the region, the Indonesian government’s spokesperson for COVID-19 affairs, Achmad Yurianto, said he “has not concluded anything yet”.
“Dynamic data is still updated. If the number of people tested is high, then [the death rate] will go lower,” he told Al Jazeera.
‘Under-reporting of cases’
The Eijkman-Oxford Clinical Research Unit estimated that there could be as many as 71,000 people infected with coronavirus in Indonesia by the end of this month. Researchers from the University of Indonesia suggested that between 600,000 to 2.5 million people could be infected by the middle of May.
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Hadisoemarto, who was involved in the identification of the first human H5N1 avian influenza cases in Indonesia, said there is possible under-reporting of the number of infections in the country.
“But we don’t know for sure how much under-reporting it is in Indonesia. I’m sure it is huge, but certainly, we need more data,” he told Al Jazeera.
“Because of the under-reporting, the number of reported COVID-19 cases is too small.”
Struggling with resources
Saladdin Tjokronegoro is a senior official at a lung hospital in Bogor, near Jakarta. He told Al Jazeera that his hospital is struggling with its resources, including protective gear for its workers and ventilators for patients with breathing difficulties.
Tjokronegoro, who did not want his hospital to be identified, said “there is not much” the doctors can do to augment the shortage or lack of facilities. He said that his hospital had to scramble to accommodate a sudden influx of patients after it was designated as a coronavirus referral centre.
He noted that the “messy examination and treatment flow” contributed to the delay in the treatment of patients, many of who are in their 40s and 50s with chronic diseases.
The Indonesian government has planned to distribute about a half-million coronavirus test kits across the country, where the number of new COVID-19 patients has surged in the past week [Trisnadi/AP]
The burden on the hospitals also became “heavier” because the public health office “could not do much” in treating the patients, he said, adding that “there is no collaboration between hospitals”, causing many health facilities to be quickly overwhelmed.
In March, Jusuf Kalla, chairman of the Indonesian Red Cross Society and the country’s former vice president, told Reuters that only 49 out of 132 referral hospitals in the country were ready to accept coronavirus patients.
Michael Ryan, executive director of the World Health Organization (WHO) Health Emergencies Programme in Geneva, Switzerland, said on March 30 that countries like Indonesia were still in the early stages of the pandemic, and that they still have the opportunity “to implement comprehensive strategy focused on containment and suppression”.
“It’s really important that the health system is prepared for any increase in cases,” he said.
WHO Director-General Tedros Adhanom Ghebreyesus added that the United Nations health body is working “very closely” with Indonesia, and promised to “boost” cooperation in containing the disease.
Hoping for a ‘miracle’
At the lung hospital designated as a coronavirus referral centre, medical specialist Tjokronegoro said that patients who do not even have referrals have started coming in, and that his team is still trying to figure out where to keep those patients.
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“We have to sort out which patients can be treated, [and] which patients cannot be treated,” he told Al Jazeera.
For his part, Hadisoemarto of Padjadjaran University said if the current intervention for COVID-19 “with minimum enforcement” continues, then the spread of the disease in Indonesia is likely “to be like in Italy or the United States”, which is facing a high number of cases and still increasing number of fatalities.
“The miracle that I hope for is the age structure of Indonesia’s young population,” Hadisoemarto told Al Jazeera. “Half the population of Indonesia is under the age of 30, which might be protecting us from many serious illnesses and deaths.”
He said he also hopes that the “very high” use of the anti-tuberculosis drug, BCG (bacille Calmette-Guerin) in the country’s immunisation programme could also help protect people from coronavirus infection, although the proof has not been fully established.
But Ravio Patra, a 27-year-old political researcher based in Jakarta, said the government had done a “terrible job” in handling the health crisis, starting when it first emerged.
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“Even when the WHO declared it a pandemic, the central government continued underestimating the outbreak, and all of this was well-documented by the public and rights groups,” he told Al Jazeera.
“It’s a situation where a single misstep from the government can come at the cost of so many lives,” he said.
Yuliannova Lestari Chaniago, a 26-year-old doctoral student, experienced firsthand what it was like when the disease started infecting many people.
Chaniago was one of the 238 Indonesian citizens evacuated by the government in February from the Chinese city of Wuhan, then the epicentre of the outbreak.
While there is no single country prepared to deal with the outbreak, she said “it doesn’t hurt” to learn from other countries that have “almost recovered” and “succeeded in suppressing” infections.
But what she has seen so far in Indonesia worries her, she said, noting the state of the country’s health facilities and the lack of basic protective equipment for health workers.
“I am not competent in talking about the virus, but my experience there [in Wuhan taught me] that as long as I stay home, I am fine. I feel safe.”