It was just last month that Indonesia’s coronavirus cases stood at zero, with officials fiercely rejecting suggestions that infections were spreading undetected.
Weeks later, 58 fatalities have now been linked to the virus, the highest number in south-east Asia. Seven health workers are among those who have died.
While confirmed case have risen to almost 800, researchers have estimated that there could be tens of thousands of hidden infections across the country, and there is growing concern that medical facilities will be unable to cope in the event of a major outbreak.
Over the past week, two major hospitals have appealed for supplies, while some healthworkers threatened to go on strike after they were forced to wear raincoats for protection. As of Monday, as many as 42 medical staff were infected with coronavirus in Jakarta.
“I just pray and have faith so that I can stop worrying, even though sometimes that feeling (of worry) appears again,” Agnes Tri Harjaningrum, a paediatrician who works in state and private hospitals in the capital, told the Guardian. She fears the country could face a crisis similar to that experienced in Italy.
Donations of protective equipment and testing kits arrived from China on Monday morning, but by Tuesday night shortages remained in some of Jakarta’s hospital wards. Equipment is being prioritised for doctors who are directly handling patients, she said.
Indonesia, the world’s fourth most populous country, was slow to carry out tests, having reportedly performed only a few hundred earlier this month. While cases were detected throughout February in most countries across south-east Asia, it was not until 2 March that the country of 264 million people confirmed its first infections. A study by Harvard University, which analysed air traffic from Wuhan, the Chinese city where the outbreak began, had raised questions over the country’s previous lack of cases. The health minister responded at the time by describing the analysis as “insulting” and stating the country was on high alert.
The president has since acknowleged the need for mass testing, which is being ramped up in priority areas. So far 2,863 have been tested.
On Monday, it was estimated by academics at the London School of Hygiene & Tropical Medicine that as few as 2% of Indonesia’s coronavirus infections have been reported. That could mean there are more than 34,000 cases. This is higher than the roughly 27,000 recorded in Iran – though the researchers also estimate that Iran may be identifying as little as 7.2% of its patients.
The researchers emphasise that these are rough estimates based on preliminary analysis and it is not yet peer reviewed.
There are some limitiations to the estimates. How a country’s demographics might affect the death toll from Covid-19, for example, has not yet been factored into the study. “Severity [of covid] is highly correlated with age, which means we need to account for it for it to be more accurate,” said Dr Timothy Russell, the lead author. With a median age of 28, Indonesia’s population is younger than many other affected countries.
According to official figures, the capital Jakarta, home to 9.6 million people, is among the worst hit, with hundreds of cases, while dozens of infections have also appeared in Banten and West Java.
Cases appear to be scattering. In West Papua, the easternmost province of Indonesia, three cases have been confirmed while 35 people have been put under surveillance because they have symptoms including pneumonia and have had contact with a confirmed patient.
Access to quality health care is limited in the provinces, especially in highland areas, and health workers are currently assessing patients online because of equipment shortages.
Analysis by Reuters suggests that the country’s health system is significantly less well resourced than that of Italy or South Korea, which have both faced major outbreaks.
Indonesia has 321,544 hospital beds, according to health ministry data, which is equal to about 12 beds per 10,000 people. South Korea has 115 per 10,000 people, according to the World Health Organization (WHO).
In 2017, the WHO found Indonesia had four doctors per 10,000 people. Italy had 10 times more, on a per capita basis. South Korea has six times more doctors.
Indonesia is converting the athlete’s village built for the 2018 Asian Games into an emergency hospital, which it is hoped will be able to treat 24,000 patients.
Modelling by the Eijkman-Oxford Clinical Research Unit (EOCRU), reported by the Jakarta Post, has suggested that, without tough steps to contain the virus, there could be up to 71,000 infections by the end of April.
Jakarta’s governor has declared a state of emergency, and told businesses and religious groups to take measures to stop the spread of the virus. All tourism and entertainment venues have been closed, and public transport limited.
But while various lockdowns have been imposed in Malaysia, the Philippines and Thailand, Indonesian president Joko Widodo has rejected calls for such measures. He has instead urged the public to stay at home and promised rapid testing. This is now being rolled out in three provinces, while 100,000 protective gears are also being distributed.
Zubairi Djoerban, head of the Indonesian Doctors Association coronavirus task force told the Guardian earlier this week that supplies will be distributed soon. “Private sector will help, businessmen will help.
“But in the field, please … the management must [match the] pandemic, meaning that it must be quickly-quickly-quickly-quickly.”