As COVID-19 cases in Indonesia have been soaring in number remarkably, Greater Jakarta has played a key role in addressing the pandemic. The availability of hospitals and healthcare facilities in the area will indicate the number of patients that the metropolitan area can hold.
Hence, the most important questions are on whether the region possesses enough facilities and whether it is prepared to handle COVID-19 and, if not, are there possible strategic actions that can be done to bridge the gap?
Since the announcement of the first two COVID-19 cases in Indonesia on March 2, the number of infected people has been increasing exponentially. According to Kawalcovid19 data, the average growth of number of infected patients is around 42 percent daily with a total of 309 cumulative cases, meaning the number doubles every two to three days. The mortality rate of the virus has risen to around 8 percent, with most fatalities belonging to those aged 50 to 59 years old.
Business Insider reported that, by taking into account the R0 or "R-naught” and trend modeling, the upcoming trend of infected patients can be conjectured to be a very dramatic number. First, this coronavirus has an R0 of 2 to 2.5, meaning that a new person can spread the disease to about 2.2 people – the number of R0 is not fixed; it can be higher or lower as time goes by. In other words, this number is relatively higher than that of the regular influenza, but the virus is less contagious than SARS.
In an article of his, Tomas Pueyo tried to model the spread. If we put it into the context of Jakarta, under the “business as usual” scenario, there will be more than 1 million cases in 40 days since the announcement of the first two cases. He also noted that the identification of new patients can take seven to 14 days, during which the virus can spread under the radar.
Given this, there are two approaches to estimating under-the-radar cases. First, by using historical data, Pueyo analyzed that the total number of cases, including under-the-radar cases, may be 27 times higher than the actual reported cases. The second approach is to estimate the number of under-the-radar cases based on the number of deaths.
Taking into account both approaches, the real cases (including those that are under the radar) could reach as many as 6,000 as of March 19 in a business-as-usual scenario. Mathematicians from the Bandung Institute of Technology (ITB) who made estimates using the Richard curve concluded that the number of cases in Indonesia could reach 8,000.
Almost all predictions mention social distancing as an effort that could flatten the curve so that hospitals are not overburdened with more patients than they can handle. Meanwhile, preparing the right amount of healthcare facilities such as hospitals, pharmaceuticals and testing protocols should be prioritized to mitigate worst-case scenarios.
Greater Jakarta plays a key role in addressing COVID-19. It is important to address the issue of commuters within the metropolitan area when discussing COVID-19. A person who lives in Depok but works in Jakarta, for instance, could play a role in spreading the disease.
Data shows that, overall, the hospital capacity in Indonesia is 2.7 critical care beds per 100,000 people, slightly higher than the Philippines (2.2) and slightly lower than Malaysia (3.4). Both neighboring countries have implemented lockdowns to slow the spread of COVID-19, while Indonesia has opted for social distancing. Jakarta as the epicenter of Indonesia’s outbreak has tried to control mass transportation, schools and tourist sites.
As the center of the metropolitan area, Jakarta also has to bear the heaviest burden. That is why Jakarta has started to address its capacity problems at hospitals, which will surely be unprepared to handle 500 to 1,000 cases.
According to the experiences in other countries, from 100 percent of reported patients, only 20 percent require hospital treatment, and 5 percent require intensive care, which can mean the need for ventilators and/or extra corporeal oxygenation (ECMO). Based on the estimation that COVID-19 patients will near 8,000, Jakarta will require around 1,600 to 4,800 treatment beds, 400 to 1,200 intensive care unit (ICU) beds and 200 to 600 isolation beds with ventilators and/or ECMO.
According to 2018 data, in total, Jakarta only had 181 hospitals (including private, government, and military hospitals). Not every hospital owns an ICU room; all 432 ICU beds in the capital are located within only 72 hospitals. That’s why the government is building temporary hospitals at the Kemayoran Athletes Village and Patra Jasa Hotel.
The second problem is the number of medical staff, which will certainly be exhausted if the number of patients increases exponentially. As a result, some patients will not receive proper treatment and die or the health of medical staff will deteriorate due to exhaustion.
A new release from WHO considers COVID-19 an airborne disease in certain conditions; therefore, it is important to equip medical staff with the appropriate equipment.
Currently, COVID-19 tests can be performed at 12 labs in Indonesia, three of which are located in Jakarta. The rapid testing policy of some provinces is not efficient and will waste the budget due to the relatively high number of false-positive or false-negative results. At the end of the day, rapid testing will reduce the number of open rooms at Jakarta’s hospitals because of the possible high number of false-positive patients.
Citizen literacy on COVID-19 can indicate how social distancing will affect the number of cases. Even though literacy in Greater Jakarta is relatively high, the effectiveness of the strategy is said to stand at only 45 percent. It means approximately 8 million people within the population face the threat of COVID-19.
In addition, hospitals are not only handling COVID-19, as there are several illnesses they must also deal with, such as dengue.
Increasing the readiness of hospitals in Greater Jakarta can be achieved by having private hospitals improve their capacity. Furthermore, assistance from foreign countries and support from the private sector can also be considered.
Many policies have been put in place to flatten the curve. We have to appreciate the government’s decision to close schools and encourage social distancing. The government can also optimize the effort by producing a national protocol for volunteers who want to help, particularly in the process of assisting suspected patients in self-quarantine. Establishing an online medical check-up platform will be also helpful in more accurately estimating the number of cases.
All in all, the exponential growth of COVID-19 cases in Jakarta forces the city to quickly develop adequate healthcare facilities, bearing in mind the gap that might exist in a worst-case scenario.
Mikhail Gorbachev Dom and Ega Kurnia Yazid are respectively research fellow and research intern at Disaster Management Research Unit, CSIS, Jakarta.