The Jakarta Post
Home to more than 10 million people, Indonesia’s capital is already the epicenter of the COVID-19 outbreak in the country, but it may have to deal with a sixfold increase in infections that experts say the city administration would not be ready to handle.
Drastic measures are deemed necessary to address the escalating health crisis as the number of positive cases nationwide rose past 1,400 with 122 deaths as of Monday. Jakarta accounts for roughly half of these figures with 698 cases and a death toll of 74.
In a worst-case scenario, the city may be looking at the possibility of handling up to 8,000 COVID-19-positive cases, Jakarta Military Command chief Maj. Gen. Eko Margiyono estimated.
“Based on a simulation [discussed in a meeting] of Jakarta’s Forkopimda [Leadership Communications Forum], the worst-case scenario may give us between 6,000 and 8,000 positive cases in the city,” Eko said in a press conference last week.
City officials were either unreachable or could not elaborate on the model used to come up with the figures, although some say that preparations for the worst are underway.
“The Jakarta administration has prepared [for the number of COVID-19 cases] rising to 500, 1,000 or even 8,000 cases,” Jakarta Health Agency head Widyastuti said in a written statement recently.
In one scenario based on how bad the onset of COVID-19 symptoms is in a patient, the 8 percent of patients with severe symptoms and the 12 percent with serious symptoms would be treated first at referral hospitals, where they would have full access to intensive care and emergency facilities.
The remaining 80 percent of COVID-19 cases – people exhibiting only mild symptoms of the disease – would be referred to wards with fewer facilities, Widyastuti said.
However, public health experts have expressed reservations about the projection for the worst-case scenario, noting that estimates may still be too far removed from reality on the ground.
Nurul Nadia, a public health specialist from the Center for Indonesian Strategic Development Initiatives (CISDI), questioned the mathematical model used as the basis of the projection, which is deemed conservative compared to other studies.
She cited several models stating the proportion of the global population that will be infected by the coronavirus ranges between 20 percent, as Harvard School of Public Health epidemiologist Marc Lipsitch has found, and up to 50 percent or even more.
“Does [the projection of 8,000 cases] include the assumption of our country’s limitations with regard to testing people? If, not then the figure does not represent the real conditions,” she told The Jakarta Post on Friday.
A public health expert from the University of Muhammadiyah, Prof. Dr. Hamka Hermawan Saputra, expressed a similar concern, comparing the situation in Jakarta with that of China’s Wuhan, ground zero of the COVID-19 pandemic and home to 11 million people.
“Jakarta is pretty similar to Wuhan from a demographic perspective. The [case number] in Wuhan reached tens of thousands, and they imposed strict lockdown rules,” said Hermawan, who is also on the Indonesian Public Health Expert Association (IAKMI)’s COVID-19 task force.
Chinese authorities put Wuhan into lockdown beginning Jan. 23 – nearly two weeks after the first reported COVID-19 death – when the Hubei administration recorded some 400 cases. As of Saturday, Wuhan has more than 50,000 confirmed cases and over 2,000 deaths.
Previously, Hadi Susanto, a professor of applied mathematics at the University of Essex in Britain, projected that Jakarta would reach its peak when 50 percent of the population was infected.
Experts argue that Jakarta’s healthcare system would not even be able to cope with the administration’s lower worst-case projection of 8,000 cases at a time. Hence, stringent measures needed to be taken immediately, they say.
For Hermawan, the lack of medical workers and a shortage of protective gear are of utmost concern. “For every additional [patient that is treated], there are 10 medical workers who need to be monitored [for the disease]. We aren’t ready yet, even now,” he told the Post.
“Looking at the trend, we are heading toward [the worst-case scenario].”
As the number of cases keeps rising, the city administration has called upon the help of medical volunteers to pad the limited number of medical workers for virus-positive patients, suspected patients and persons under observation.
Hermawan suggested that the central government should recruit medical workers from outside the capital and enforce priority treatment for referral hospitals, general hospitals and makeshift facilities, as well as those who could treat themselves at home.
A public health expert from the University of Indonesia, Hasbullah Thabrany, however, said challenges would remain, as the nation only had around 1,200 lung specialists considered proficient in examining respiratory illnesses caused by the virus. “We can have general doctors and nurses ready within a month, but that is not the case for lung specialists,” he said.
Containing the spread of COVID-19 should be the government’s main focus, he said, suggesting fines as a deterrent for people violating physical distancing measures.
This unprecedented situation has triggered public outcry on social media, urging the government to impose a lockdown through hashtags and slogans, with #LockDownNasionalSerentak (SimultaneousNationalLockDown), #KarantinaWilayah (RegionalQuarantine) and Jakarta Sudah Gawat Darurat (Jakarta is in an emergency state) trending on Twitter over the weekend.