The first cases of Delta transmission were found among COVID-19 patients in Jakarta in January when the country saw the first surge of cases, with daily infections averaging above 10,000. Cases, however, began to decline in February, prompting the government to lower its guard and ease restrictions.

Authorities appeared to overlook the fact that this highly transmissible variant, when left unchecked, could lead to an even more catastrophic outbreak.

Now, seven months later, the Delta variant is wreaking havoc across the country, forcing the government to take almost all available measures to prevent further deaths, from extending restrictions and adding more hospital beds to sending first responders to pick up self-isolating patients whose conditions have deteriorated and bringing them to hospitals, and speeding up vaccination drives.

Read also: Darkest days ahead: Deaths surge in Indonesia as health facilities collapse

The second wave

The start of the second outbreak was down to the fact that the government had failed to anticipate the high mobility and holiday crowds caused by the Idul Fitri holiday in mid-May, with hordes of Indonesians going on mudik (exodus) despite an intercity travel ban.

As a result, the Delta variant spread rapidly in Jakarta, Kudus regency in Central Java and Bangkalan regency in East Java, before making its way to 22 out of Indonesia’s 34 provinces.

Daily cases rose sharply in the last week of June and overwhelmed hospitals across Java, but the government, for a time, defied calls from experts to impose stricter restrictions. On July 3, emergency public activity restrictions (PPKM) were put in place in Java and Bali, then were extended several times and expanded to other regions.

Read also: COVID-19 case spike looms as millions skirt 'mudik' ban

Even with the policy, cases and deaths soared to an unprecedented level, beyond what authorities had predicted, with hundreds of people dying outside hospitals and widespread oxygen shortages.

Several patients sleep under an emergency tent at Dr. Sardjito General Hospital in Sleman, Yogyakarta on July 4, 2021. Yogyakarta health authorities confirm on the death of 63 COVID-19 patients treated at the hospital between July 3 and 4 due to depleting medical oxygen supply. (Antara/Hendra Nurdiyansyah)

Critics have blamed the failure on the inconsistency of the government’s COVID-19 response from the beginning and the lack of testing and tracing.

‘Deadly’ Delta and why surveillance is key to slow down transmission

Griffith University epidemiologist Dicky Budiman said the Delta variant was far more dangerous because of its high reproductive rate and how quickly it could deteriorate the infected person's health, particularly someone with comorbidities and is elderly. He said the variant also strikes the patient's ability to breathe. 

“Its reproduction number could be as high as 9, meaning that each infected person could spread the virus to up to nine other people,” he said, adding that should the government fail to quickly detect cases of the Delta variant, it could lead to an even higher death toll.

Read also: RI COVID-19 death rate now higher than India’s second wave

Health Minister Budi Gunadi Sadikin said last month that he was aiming to increase the number of daily tests from around 100,000 to 500,000 tests — or two and a half to 12 tests per 1,000 people per week.

Indonesia conducted around four tests per 1,000 people per week from July 19 to 25 during the PPKM period, increasing from two and a half in the last week of June, higher than the World Health Organization ideal benchmark of one test per 1,000 people per week. However, only half of these were PCR tests. 

But a closer look at provincial numbers — as shown in a WHO situation report on Indonesia released on July 28 — suggests that the gap among provinces remains. Jakarta and Yogyakarta recorded a far higher number of tests at over 15 tests per 1,000 people per week, while about half of the 34 provinces recorded one test.

Read also: Indonesia’s static positivity rate highlights persisting gaps in testing capacity, capability

Masdalina Pane of the Indonesian Epidemiologists Association (PAEI) said besides testing, the government should also focus on increasing the country’s tracing efforts, adding that relying on the PPKM policy to reduce mobility was the wrong way to tackle the pandemic.

“It feels like we’ve been focusing on mobility for 16 months, calculating mobility to and fro, but the effects are not there; that has never been the way to handle a pandemic [...],” she said last month.

Coordinating Maritime Affairs and Investment Minister Luhut Binsar Pandjaitan, who heads the implementation of PPKM measures in Java and Bali, acknowledged the importance of tracing last week after seeing cases continue to rise despite the policy.

"So, now we better understand that tracing techniques are important in handling COVID-19," he said on July 29.

Reliance on vaccination

Since the first arrival of a COVID-19 vaccine in December 2020, the government has also relied on the national vaccination program as a way of tackling the pandemic. 

The government started its vaccination drive in January by prioritizing medical workers and the elderly before expanding it to the wider public in late June in a bid to meet the target of vaccinating 1 million people a day. And just on Monday, it allowed vulnerable groups without ID cards to get their shots.

Yet vaccine coverage remains very low, with some regions reporting a vaccine shortage and people failing to receive their scheduled second shots.

Read also: Vaccine shortage jeopardizes government's 1 million a day vaccination target

As of Wednesday, only 21 million people, or 10 percent of the 208 million targeted population, have been fully vaccinated.

Budi cited the lack of vaccines at the start of the year as the main issue hindering the national vaccination drive, but the country is expecting the arrival of more doses in the coming months.

Who is dying of coronavirus?

Data updated daily by the COVID-19 task force shows that people aged 60 and above account for the highest number of deaths nationwide as of Tuesday, at 46.8 percent. They are followed by people aged 46 to 59 at 36.7 percent, aged 31 to 45 at 12.7 percent and aged 19 to 30 at 2.8 percent, while children aged 18 and below make up the remaining 1 percent.

Read also: Yearender 2020: What went wrong with Indonesia’s virus response?

This is despite the fact that the 60-and-above age group accounts for just 11.4 percent of total infections, far lower than those of the 31-to-45 group at 28.9 percent, the 19-to-30 group at 25.1 percent and the 46-to-59 group at 21.8 percent. Children aged 6 to 18 and those aged 5 and below, meanwhile, contributed the smallest fraction, at 9.9 and 2.9 percent, respectively.

The government data did not include deaths in home isolation, but independent data initiative LaporCOVID-19 has recorded at least 2,837 people who have died while self-isolating during the second wave of the pandemic. The group also reported that at least 469 health workers lost their lives to the virus from June to July.