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Jakarta Post

Non-coronavirus patients grow wary as hospital crisis looms

  • Ardila Syakriah
    Ardila Syakriah

    The Jakarta Post

Jakarta   /   Thu, April 2, 2020   /   12:03 pm
Non-coronavirus patients grow wary as hospital crisis looms Residents bask in the morning sun on the sidewalk in the Senayan area, Jakarta, Thursday, April 2, 2020. They bask in the sun because it is believed to prevent the spread of the Covid-19. (JP/Wendra Ajistyatama)

As the COVID-19 pandemic grows, non-coronavirus patients are worried about getting sidelined, while fearing that visiting hospitals might expose them to the highly contagious disease.

In December last year, 24-year-old freelance TVC producer Gilang Prabu was diagnosed with grade two brain tumor. It took him months on the waiting list of two cancer hospitals in Jakarta to start chemotherapy in early March, in addition to separate and more frequent general and blood check-ups.

Unfortunately for him, early March also marked the announcement of the country’s first two confirmed COVID-19 cases, although experts believe local transmissions occurred way earlier.

The outbreak has escalated rapidly since then, with the country recording more than 1,500 cases and 136 deaths.

Gilang and many others with underlying medical conditions are deemed the most at risk if infected by the virus as it could lead to complications requiring intensive care.

There is no data available to the public on the preexisting illnesses most frequently found in deceased COVID-19 patients in Indonesia. But various findings by health authorities abroad, like in cases in China, find that coronavirus patients with underlying conditions such as cardiovascular disease have higher fatality rates.

The United States Centers for Disease Control and Prevention’s morbidity and mortality report published on March 31, meanwhile, shows that 78 percent of ICU patients with COVID-19 in the US had at least one of underlying health problem -- diabetes, cardiovascular disease, chronic lung disease, long-term kidney disease and a weakened immune system.

"I'm terribly afraid of going out because my immune system is in a very bad shape. If I get infected, I will certainly not survive," Gilang told The Jakarta Post on Sunday.

But it is almost impossible for him to suspend his treatment as chances are high for his cancer to develop into advanced stage three.

Many hospitals in Indonesia have enforced health screenings for visitors and limited the number of visitors to ensure physical distancing. The Health Ministry has also suggested that those with mild symptoms self-isolate instead of seeking hospital treatment to avoid exhausting the country's healthcare system.

Some experts believe Indonesia's hospitals, unevenly spread across the country, with most in Java, are not prepared for the outbreak. Data collected by the World Bank shows that in 2015, the country only had 1.2 hospital beds per 1,000 people and four doctors per 10,000 people in 2017.

Health Ministry data, cited in modeling by the National Development Planning Agency (Bappenas) and the University of Indonesia's (UI) public health experts, shows that there are 276,458 hospital beds in the country, 40,829 of which are owned by the 132 COVID-19 referral hospitals.

As of March, there are 1,063 ICUs with isolation facilities, 157 isolation rooms with ventilators, 1,477 isolation wards, 4,155 oxygen tubes, 8,158 ventilators and 2,032 emergency rooms with isolation capability.

Read also: Bappenas, UI modeling shows grim projection of COVID-19 spread in Indonesia

Gilang said booking a bed in a ward at regional hospitals had always been difficult, and following the outbreak, reserving a bed in a ward and booking an appointment with specialist doctors at private hospitals had also become harder as people grew worried about their health.

"Everyone may be cautious about COVID-19, but there are millions of other people with illnesses as dangerous [as COVID-19]. They are as deserving of hospital treatment [as COVID-19 patients] because they also want to continue on living, or at least to extend their life expectancy," he said. "There are millions of us."

Indonesia has seen a growing prevalence of noninfectious chronic illnesses, according to the latest report of the five-yearly Basic Health Research (Riskesdas). The prevalence of cancer increased to 1.8 percent in 2018 from 1.4 percent in 2013, diabetes to 8.5 percent from 6.9 percent, stroke to 10.9 percent from 7 percent and chronic kidney disease to 8.5 percent from 6.9.

Dina Maharani, 24, who takes her 62-year-old father to undergo hemodialysis twice a week at Soedono General Hospital in Madiun, East Java, is worried that her father might contract the virus at the hospital -- now a COVID-19 referral hospital and currently treating nine positive patients, mostly from neighboring regions.

She said she was now pinning her hopes on the government to impose restrictions on the upcoming Idul Fitri exodus, which will see many people returning to their hometowns, prompting fears that the virus might spread further to smaller regions such as Madiun and take a toll on their limited healthcare systems.

"My father's hospital can still handle its patients [...] but God forbid, when Madiun starts seeing more cases later, the hospital will have to be selective [...] Patients like my father have to be prioritized as well as they can't live without hemodialysis," Dina said.

Public health expert at the Padjajaran University, Panji Hadisoemarto, said ensuring that non-COVID-19 patients could still receive their treatment was a "very important issue that doesn't earn enough attention".

He said that apart from applying triage to separate patients of infectious and non-infectious diseases, flattening the curve of COVID-19 infections must be done so as to not overwhelm the healthcare system and disrupt services.

"This doesn't necessarily mean that [all] COVID-19 should be prioritized, but there can be many people who will be infected by COVID-19, some of whom will need various degrees of hospital care. COVID-19 patients will take up hospitals' capacity," he said.

The Health Ministry's disease control and prevention director general, Achmad Yurianto, who is also the government's spokesperson for COVID-19 affairs, said that some hospitals, such as Jakarta's Sulianti Saroso Infectious Diseases Hospital and Persahabatan General Hospital, have been appointed to treat COVID-19 cases only. The two hospitals are among the 132 COVID-19 referral hospitals nationwide.

While the former athletes village in Kemayoran, Central Jakarta, which has been turned into an emergency hospital to treat COVID-19 cases, has a capacity of 3,000 people and has so far been filled with some 300 people, according to Yurianto.

Some of the referral hospitals can still treat non-COVID-19 patients, while there are also hospitals, like the state-run Cipto Mangunkusumo Hospital (RSCM), which currently do not accept COVID-19 patients at all, he said.

He, however, did not provide the exact number of hospitals treating COVID-19 patients nor comment on whether COVID-19 cases had overrun hospitals' capacity.

The number of COVID-19 cases needing hospital care could exceed hospitals' capacity by April -- in this case 50 percent of the beds at the 132 referral hospitals and 50 percent of the beds at class A and B hospitals -- without high degree of intervention that include mass testing and mandatory physical distancing, according to the Bappenas-UI modeling.

Read also: Vigilance key to avoid healthcare battle on two fronts

The outbreak has not only put a strain on hospitals but also demotivated people from donating blood. Indonesia has seen a decline in blood donors by 20 to 50 percent, while demand for blood persists, particularly for illnesses such as hemophilia, thalassemia and dengue fever, said Lilis Wijaya of the Indonesian Red Cross (PMI).

" The PMI is calling people to donate their blood. There's nothing to be afraid of because we routinely disinfect our facilities, use sterile tools and conduct health screening on every donor while providing hand sanitizer in our rooms," she said.