COVID: Why Indonesia is unable to rein in the pandemic

As the COVID surge in Indonesia continues, the situation on Java, the archipelago's most populated island, is improving. However, poor health infrastructure in other far-flung regions threatens to prolong the crisis.

Medical facilities on Indonesia's largest and most populated island, Java, are starting to absorb the blow of surging COVID cases over the past month, with more medical oxygen and hospital beds being made available.

However, hospitals elsewhere in Indonesia are reporting low oxygen supplies as cases increase.

Java, home to Indonesia's capital, Jakarta, has much better health care facilities compared to other islands. Health officials worry that there are many COVID cases and deaths going unreported outside of populated areas, masking the true severity of the surge.

The Indonesian Health Ministry shows that the number of COVID cases outside Java has been steadily increasing in the last three weeks. On July 25, there were 13,200 cases reported. On August 6, that number increased to more than 21,300.

The provinces with the highest cases include North Sumatra, Bali and South Sulawesi.

Paradise islands in need of oxygen

On the vacation island of Bali, hospitals are currently approaching 80% of their full capacity. To accommodate incoming patients, many are adding more beds for COVID intensive care units and isolation rooms.

"The cases have increased since the beginning of July, from 700 people per day to more than 1,000 per day," I Gusti Agung Ngurah Anom from the Indonesia Medical Association (IDI) in Denpasar, Bali, told DW.

Anom said that medical oxygen in the province is running low as the demand has tripled along with the COVID surge.

Ideally, a hospital in Bali could receive up to 80 oxygen canisters daily, but now they only get about 20 canisters with each delivery.

The IDI has urged hospitals to postpone all non-urgent surgeries to provide oxygen for COVID patients.

Similar conditions are also reported in Lombok island to the east of Bali, where hospitals in smaller districts have started to turn away patients as they have no oxygen for treatment.

"Oxygen in our clinic has been empty since last week. Our distributors said they could not deliver it because they were out of stock. Usually, we get 5-10 canisters of oxygen per delivery," said Kurnia Akmal, a doctor at a clinic in east Lombok.

Akmal said only large hospitals have limited supplies of oxygen.

"You can bring your own tube to the oxygen refill station but there is a line for one or two days," he added.

Incomplete COVID data

An independent data initiative, "LaporCovid-19," reported that more than 2,970 Indonesians with COVID have died while self-isolating between June and August 3.

LaporCovid-19 collects data based on local citizens reporting on the COVID situation in their areas, including self-isolation,

availability of hospital beds and oxygen.

"We just coordinated with colleagues in Mataram, West Nusa Tenggara Province, and in Palu, Central Sulawesi. The availability of oxygen is very scarce there, while hospitals are also very difficult to access," Irma Hidayana, a public health expert and cofounder of LaporCovid-19, told DW.

Hidayana said the COVID situation in regions outside of Java is often underreported by the media.

"We sometimes don't hear what is going on there, so it's often overlooked," she said.

Indonesia's industry, agriculture, education and health care facilities are mostly centralized in Java.

In other parts of Indonesia, people sometimes have to walk for days or take various means of transportation to get to a clinic and see a doctor.

Hidayana said she regrets that the government did not impose a widespread, strict lockdown to contain the virus, instead opting for movement restrictions, which were considered by many epidemiologists to have had little effect.

"We need something like a micro-lockdown to contain the virus since healthcare in many areas has almost collapsed," she said, adding a lockdown could reduce the number of hospitalizations and lower demand for scarce medical supplies.

What action is Indonesia taking?

Indonesia's COVID task force has said it is relocating oxygen supplies from Java to other areas in need.

"We already asked the oxygen task force to monitor oxygen availability in their respective areas," Siti Nadia Tarmizi, a Health Ministry spokesperson, told DW.

However, Dicky Budiman, an Indonesian epidemiologist at Griffith University in Australia, told DW that official government data does not reflect the severity of the COVID surge outside of Java.

"The potential for COVID cases in rural areas is very high because there are many elderly people with comorbidity, lack of vaccines and limited medical facilities. It indicates that there are more undetected cases," he said.

As of August 10, over 52 million people in Indonesia (25.10% of the population) have received their first vaccine shots, while 25.7 million have been fully vaccinated. The government is seeking to vaccinate another 200 million by April 2022.

According to data from Indonesia's COVID task force, a total of 2,048 COVID-related deaths were reported in Indonesia on August 10, bringing the total death toll from the virus to 110,619 since March 2020.

The daily number of new cases is currently around 32,000, with a total of 3.7 million people having been infected so far.

A woman is treated for COVID in a temporary hospital tent outside a hospital in Jakarta