Covid-19 Strikes Indonesia Amid Chaos

Overwhelmed government struggles to cope with packed hospitals, deaths

By: Ainur Rohmah

The Indonesian government, beset by disorganization and disagreement, is racing against time to curb the spread of the Covid-19 virus, implementing stricter policies involving the security forces to force people to comply with social distancing and extending the emergency response status of the outbreak until the end of May.

The new regulations are going into effect even as hospitals in Jakarta are becoming overwhelmed by arriving patients, some of whom have died without adequate care. The Ministry of Health has instructed that medical services be prioritized for those with severe symptoms, with independent isolation for the rest. Some patients reportedly have been refused because of overcapacity. 

Local media reported that a journalist only known by initials WD who showed symptoms, died after being refused by two hospitals and being neglected for five hours by another. Nor is that the first such incident. One patient under surveillance in Purbalingga, Central Java, was rejected by four hospitals before being treated at a community health center (puskesmas) by medics clad in raincoats for self-protection.

After weeks of denial of the virus’s existence in the country, President Joko Widodo heads a government in deep disarray, with a health system tragically unequipped to handle a large-scale epidemic. He is squabbling with Jakarta Governor Anies Baswedan over whether the lockdown should be used to prevent millions of people who traditionally leave the capital for rural areas to observe the upcoming Idul Fitri holiday, which begins on May 23 and which could spread the virus across the island of Java and beyond. On March 30, he refused Anies’s request for a partial lockdown. 

The government will also ban all arrivals and transits by foreigners in Indonesia to prevent a further spread, a futile gesture given that the virus is here in massive numbers. Foreigners with stay permits and some diplomatic visits will be exempted. Around 30,000 adult and juvenile inmates will be released from prison early.

Unprepared

“They can’t handle the crisis because they have no health care system,” said a Jakarta-based business source. “They have been forced to act is if they are doing something because it is a global pandemic. The government believed from the beginning that people would tolerate deaths from disease, but that they wouldn’t tolerate mass economic disruption. Now they have both.”

Jokowi, as the president is known, signed regulations that allow cities and provinces to enact what the government described as “large-scale social distancing" over the increasing numbers of infections and deaths, which now total 1524 and 136 respectively, although those totals are probably frighteningly inaccurate. Given the limited testing, the true number of cases is simply unknown, with authorities hoping the supposed inability of the virus to survive in tropical temperatures would limit its spread.

Jokowi said he had ordered the National Police to enforce the restrictions, but didn’t explain what measures they could take. He said there is a possibility of implementing a civil emergency if things get very bad, although not now, when the situation is under control. Regional governments can now close schools, offices, businesses and non-essential services and limit social and religious activities.   

The president is said to be deeply concerned about the implementation of such an emergency because of the power it would give to the military, and particularly his 2018 presidential rival, Prabowo Subianto, the defense minister.

"We prepare all scenarios from mild, moderate, to the worst depending on the situations," said Jokowi. "The civil emergencies (scenario) only apply when abnormal conditions occur."

The number of people infected in Indonesia, a country with a population of around 270 million, is estimated to be far more than the number officially reported. Infectious diseases modeling from the Center for Mathematical Modeling of Infectious Diseases (CMMID) in London already suggests the true number of positive cases in Indonesia is in the tens of thousands and could be as high as 250,000 depending on the rate of transmission. Even a conservative estimate, according to the modeling, indicates there could already be 70,000 cases in the country.

Testing kits, essential to determining the scale of the outbreak, are almost nonexistent. About 1,000 tests are being completed daily, reaching a record high of 1439 on March 27.

In addition to the lack of test factors, the real and confirmed figures gap is also caused by the delay in reporting the first case, which was announced on March 2 after several weeks of denial. 

Singapore, for example, through the official website moh.gov.sg revealed some of its citizens were infected after a visit to Jakarta from mid-February to early March. A resident of Cianjur, West Java, died on March 3 according to West Java Governor Ridwan Kamil, although the government previously said the victim showed no effects of the virus. 

The Jakarta governor told a press conference on Tuesday that 283 people had been buried between March 6 to 29 using the usual procedure for Covid-19 patients even though the government’s official death toll, announced on March 31, was only 83.

"Not all patients tested positive for corona,” Anies said. “Some of them were still suspected of being infected or suspect but died before the test results were out." 

Nevertheless, Anies said, they must still meet Covid-19 protocols before burial. Among the protocols are burial in a coffin, the body wrapped in plastic and buried less than four hours after death, with burial carried out by personal protective equipment (PPE) -clad workers.

"The death rate illustrates that the situation in Jakarta related to COVID-19 is very worrying," Anies said.

At least 132 referral hospitals have been appointed by the government to treat Covid-19 patients, as well as the Wisma Atlet building with a capacity of around 3000 patients. But that's not enough. A doctor at one of the referral hospitals said patients have been rejected by the hospital because of limited isolation rooms, ventilators, personal protective equipment (PPE) and the lack of adequate medical personnel.

"That's all because the government didn’t think that the coronavirus would enter Indonesia, so it didn’t prepare itself," said the doctor, who spoke anonymously because of the sensitivity of the situation. "The number and capacity of referral hospitals is limited." 

According to the World Health Organization (WHO), Indonesia only has one hospital bed for every 1,000 people, the lowest in Southeast Asia. It only has four doctors for every 10,000 people, according to WHO data in 2017.

In addition, many medical personnel in hospitals and other health facilities are worried because of the lack of personal protective equipment. Before the government announced the first case in March 2020, health care workers in a number of health facilities became sickened and died after treating patients without protective clothing.

Anies, the Jakarta governor, recently said as many as 50 doctors and nurses in Jakarta have been infected. According to Indonesian medical association data, 10 doctors and two nurses have died from the infection.

The government is importing one million rapid test equipment from China although as many as 40 percent of Chinese test kits have been found to be faulty in other countries and medical personnel in Spain, Turkey and the Netherlands have refused to use them. Some local governments, such as West Java, have carried out massive tests with drive-through schemes for people deemed vulnerable, such as medical personnel.

Economic Incentive Policy

Jokowi said he will issue a government regulation in lieu of law (Perppu) that will boost state spending by up to Rp405.1 trillion (US$24.6 billion) and widen the budget deficit to 5.07 percent of GDP in the nation's fight against COVID-19.

Of the extra spending, the government will allocate Rp75 trillion for healthcare spending, including for the protection of health workers, especially the purchase of personal protective equipment (PPE), test kits, and ventilators. The budget will allow the government to provide incentives for doctors and medical personnel who handle the Covid-19 outbreak.

Another Rp110 trillion is earmarked for social protection and Rp70.1 trillion for tax incentives and credit for enterprises. The biggest portion, Rp150 trillion, will be set aside for economic recovery programs including credit restructuring and financing for small and medium businesses.