The Jakarta Post
East Java, Indonesia's second most populous province, surpassed Jakarta as the nation's COVID-19 epicenter on June 26 with the highest record of confirmed cases and deaths.
The province has a cumulative total of 11,482 cases, 866 deaths and 3,891 recovered cases as of Monday morning. It also has the second highest case-fatality rate (CFR) – the percentage of deaths among confirmed cases -- at 7.5 percent, higher than the national CFR of 5.1 percent.
East Java has recorded 1,226 deaths among patients under surveillance (PDPs) and 164 deaths among persons under observation (ODPs), two categories referring to suspected cases pending testing or test results.
The provincial capital of Surabaya accounts for half of the confirmed cases and deaths in East Java.
Greater Surabaya, which includes the adjacent regencies of Sidoarjo and Gresik, eased the large-scale social restrictions (PSBB) in early June, even though it implemented the measure almost three weeks after Jakarta did. It is now establishing what it deems as the "new normal", despite the spike in new cases, its overwhelmed hospitals and expert calls for stricter measures.
President Joko “Jokowi” Widodo has given East Java two weeks to lower its infection rate after he visited the province on June 25.
Testing capacity better, though not 'ideal'
Joni Wahyuhadi, the curative management head of the East Java COVID-19 task force, attributed the recent spike to improved testing capacity and active tracing – echoing the central government's arguments for the daily highs in new cases the country has been seeing most of this month.
Joni said 27 labs in the province were processing samples now and working to increase their testing capacity.
Unlike Jakarta and West Java, East Java does not provide testing data on its website, but Joni said the provincial administration had tested some 53,000 people. Meanwhile, Surabaya provides swab testing data on the city's dedicated website, but the data has not been updated since it recorded 21,472 cumulative swab tests on June 28.
Epidemiologist Windhu Purnomo of Surabaya's Airlangga University concurred that the city's testing capacity had improved this month, but that it was “still far" from the ideal World Health Organization (WHO) standard of one test per 1,000 population per week.
With a population of some 40 million people, he said that East Java should be performing 40,000 tests per week.
Transmission continues, tracing 'not easy'
East Java chairman Sutrisno of the Indonesian Medical Association (IDI) said that the recent spike in cases showed that "community transmission was still occurring".
Joni also said that new cases were a possibility.
Tracing and isolating contacts were thus key to stopping the virus' spread, but the province was finding it difficult to recruit more people for its contact tracing teams due the fear of infection, said Windhu. But relying on puskesmas (community health centers) workers was not enough, he stressed.
Surabaya Governor Khofifah Indar Parawansa told Health Minister Terawan Agus Putranto and COVID-19 national task force chief Doni Monardo on June 24 that the tracing ratio in Surabaya was 2.8, or almost three contacts traced per confirmed case, kompas.com reported. Neighboring Sidoarjo had a tracing rate of 3.5.
"Tracing is not easy. It requires extraordinary manpower and teams," said Joni. "Being a [contact] tracer is not easy, they're at risk of contracting the virus, given the many asymptomatic cases [...] There's no room at all for carelessness."
He said that contact tracing should average 25 contacts per confirmed case, adding that local health agencies had been receiving help from the Indonesian Military and the police personnel in tracing contacts.
Contagion fear haunts overwhelmed medics
The IDI’s Sutrisno said that many medical workers and even administrative staffers had been infected at hospitals overwhelmed with COVID-19 patients in Greater Surabaya, as well as the nearby city of Pasuruan and Lamongan regency. This reduced not only the number of medical workers on duty, but also the quality of service in treating COVID-19 patients, he said, while ordinary patients without COVID-19 were sidelined.
East Java has 99 referral hospitals for treating COVID-19 patients, as well as several emergency hospitals for treating patients with mild to no symptoms.
Joni, who is also the director of East Java's main referral hospital, the Dr. Soetomo Regional General in Surabaya, said he had "read journals" that indicated a high correlation between the number of COVID-19 patients a hospital was treating and the number of its medical workers exposed to the virus, even if they were following the health protocols.
He said the province's hospitals were full, although some still had space for patients with mild to no symptoms. Around 20 patients had to wait in line for a bed at Soetomo hospital’s emergency room on Sunday, said Joni, highlighting the need for patients to be distributed across hospitals in the region.
As of last Friday, nine of Soetomo hospital's resident doctors were being treated for COVID-19, including one who was admitted to the intensive care unit (ICU), said Joni.
Early this month, an internal medicine resident at the hospital died after contracting the virus. At least 11 doctors in East Java have died of the virus.
The IDI Indonesia's records show that 76 doctors in East Java, excluding Surabaya, had contracted the virus. Sutrisno said IDI's East Java office was still gathering data on infected doctors in Surabaya, as it believed that the number could be "much higher".
People neglecting protocols amid 'absent enforcement'
During Jokowi;s East Java visit, the President expressed surprise on learning that 70 percent of the province's residents were not wearing masks.
The data allegedly came from an online survey the Airlangga public health alumni association conducted in late May to evaluate the PSBB implementation in the region. The survey results revealed low compliance in wearing masks and maintaining physical distancing in public spaces, including places of worship and traditional markets.
Experts said that mudik (exodus) and lax movement restrictions had helped the virus to spread. East Java recorded 460,000 mudik travelers between March 16 and May 22 ahead of Idul Fitri on May 24-25.
They also said that the PSBB had been ineffective in reducing transmission, given “the absence of" enforcement and sanctions against violators, and warned that the disease would continue to spread, now that people were resuming their daily activities.
"This is a critical [point in the] crisis, we're running against time. We can't wait months or years for people to become [self-aware]," said Windhu.