The Pandemic Has a New Epicenter: Indonesia

BEKASI, Indonesia – Thousands of them sleep in hallways, tents, and cars, gasping for air while waiting in crowded hospitals for beds that may be out of oxygen. Others see hospitals as hopeless, even dangerous, and take their risk at home.

Wherever they lie while Covid-19 takes their breath away, their families embark on a hectic, daily hunt for scarce supplies of life-giving oxygen.

Indonesia has become the new epicenter of the pandemic, overtaking India and Brazil, and is the country with the highest number of new infections in the world. The surge is part of a wave across Southeast Asia, where vaccination rates are low but countries had contained the virus relatively well until recently. Vietnam, Malaysia, Myanmar and Thailand are also facing their largest outbreaks to date and have imposed new restrictions, including bans and stay-at-home orders.

In Indonesia, cases and deaths have skyrocketed over the past month as the highly contagious Delta variant sweeps across the densely populated island of Java and Bali. In some regions, the coronavirus has pushed the medical system to the limit, despite hospitals taking emergency measures to expand capacity.

The Bekasi Regional Public Hospital, where some Covid patients waited for days for treatment, has set up large tents with beds for up to 150 people on its premises. A long line of people waited for hours in front of a small pharmacy near the capital Jakarta, hoping to fill their portable tanks with oxygen.

Among them was Nyimas Siti Nadia, 28, who had looked for oxygen for her aunt’s family who had Covid.

“She is a doctor and is afraid to go to a hospital because she knows the situation,” said Ms. Nyimas. “There are many cases where patients are not given beds or oxygen. When we go to the hospital, we have to bring our own oxygen. “

On Thursday, Indonesian authorities reported nearly 57,000 new cases, the highest daily total to date – seven times as many as a month earlier. On Friday, they reported a record 1,205 deaths, bringing the country’s official toll from the pandemic to more than 71,000.

However, some health experts say these numbers significantly underestimate the prevalence in Indonesia, the fourth most populous nation in the world, because the tests were limited. Dicky Budiman, an Indonesian epidemiologist at Griffith University in Australia, estimates the actual number of cases is three to six times higher.

In India, where the delta variant was first identified, daily cases peaked at more than 414,000 in May but have since dropped to around 40,000.

Despite the rising number of cases in Indonesia, officials say they are in control of the situation.

“If we talk about the worst-case scenario, 60,000 or a little more, we’re pretty much fine,” said Luhut Pandjaitan, a senior minister tasked with managing the crisis by President Joko Widodo. “We hope it won’t reach 100,000, but we are still preparing now to see if we will ever get there.”

However, many Indonesians have been confronted with their worst-case scenarios for weeks.

Family members describe nightmare scenes in which they tried to reach a hospital to take in their sick loved ones. Some hospitals only accepted patients who brought their own oxygen, they said. Patients waited at others wherever they could find a place to lie down.

In Bekasi, a 2.5 million city bordering Jakarta, patients flocked to the regional public hospital. In order to cope with the onslaught, 10 large tents were set up on the site, equipped with beds for up to 150 people.


July 17, 2021 at 4:28 p.m. ET

Lisa Wiliana’s husband had been in one of the tents since the day before and was waiting for a place on a ward. After nine days of illness, she said his oxygen saturation dropped to 84, well below the 95 to 100 range that is considered healthy. The hospital gave him some oxygen, but she had more to attend to.

“We are waiting for an available room because it is full,” she said. “What else can we do? The important thing is to get the oxygen, because he was already having difficulty breathing. It was scary.”

Even an intake does not ensure the oxygen supply. In the Dr. Sardjito General Hospital in the city of Yogyakarta, 33 patients died this month after central oxygen supply went out. Staff switched to police-donated tanks, but it was too late for many patients.

Overworked hospitals have added thousands of beds, but on average 10 percent of their healthcare workers are isolated after exposure to the virus, said Indonesian Hospital Association Secretary-General Dr. Lia G. Partakusuma. Some hospitals are using five times as much liquid oxygen as normal and dealers are struggling to keep up with demand, she said.

“Some hospitals have said, ‘If you brought your own oxygen tank, please use it first as we have limited oxygen supply,'” she said. “But they don’t need to bring their own oxygen.”

Because hospitals are so overcrowded, many people choose to stay at home – and many die there. Lapor Covid, a nonprofit group tracking deaths from the disease, reports that at least 40 Covid patients are now dying at home every day.

Mr Joko, the president, has stopped before a nationwide lockdown but has placed restrictions in Java and Bali, including closing places of worship, schools, shopping malls and sports facilities, reducing public transport capacity and restricting take-away restaurants. The restrictions are due to expire on Tuesday, but officials are weighing whether to extend them.

Only about 15 percent of Indonesia’s 270 million people have received a dose of a coronavirus vaccine, and only 6 percent are fully vaccinated. Indonesia has relied heavily on the vaccine from Sinovac Biotech, a Chinese company, which has been shown to be less effective than other vaccines. At least 20 Indonesian doctors who were fully vaccinated with Sinovac have died from the virus.

This week the United States donated 4.5 million doses of the Moderna vaccine to Indonesia. Officials said the first priority is to give nearly 1.5 million health workers a booster dose.

Dr. Budiman, the Indonesian epidemiologist in Australia, predicted more than a year ago that Indonesia would become an epicenter of the pandemic due to its dense population and weak health system. He called for more testing, contact tracing and isolation of infected people.

Indonesia’s Health Minister Budi Gunadi Sadikin said Friday the country had increased testing to about 230,000 people a day, from about 30,000 in December. His goal is 400,000 a day.

But dr. Budiman claims tests are still pathetically limited, noting that the percentage of positive tests has risen to more than 30 percent in the past few days. Health experts say a high rate is a sign of under-testing.

“For more than a year now, our test positive rate has almost never been below 10 percent, which means we miss many cases and cannot identify the majority of infections and clusters,” he said.

In front of the small oxygen shop CV Rintis Usaha Bersama in South Jakarta, more than 100 customers stood on the street with their oxygen bottles and waited for hours for the opportunity to refill them.

Alif Akhirul Ramadan, 27, said he was getting oxygen for his grandmother, 77, who was cared for by family members at home. He said her condition suddenly worsened and her tank was low.

“Now it has to be refilled,” said Mr Alif, who had Covid twice. “There is no backup at home. That’s why we have to refill quickly. “

Fira Abdurrachman reported from Bekasi, Richard C. Paddock from New York and Muktita Suhartono from Chonburi Province, Thailand.

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