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A New COVID-19 Epicenter: Indonesia Coronavirus Cases Surpass India's

July 19, 2021

As oxygen supplies dwindle and the highly transmissible Delta variant rampages through the country, UNICEF is on the ground saving lives.

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In Indonesia, hospitals are turning patients away due to depleted oxygen supplies. Health workers are out sick with COVID-19 in a country that has only one doctor for every 2,500 peopleFirefighters are being dispatched to people's homes to pick up bodies of those who've died.

And at the COVID-19 cemeteries, those who dig the graves work well past dark to bury the dead.

Indonesia has become a new COVID hotspot, surpassing India with the highest number of coronavirus cases in Southeast Asia — nearly 3 million at last count, with nearly 75,000 deaths. 

Indonesia has taken India's place — but it's less equipped to handle the crisis

Indonesia's COVID-19 cases and deaths had begun to trend downward in March 2021. But the situation took a sharp turn for the worse when travel for the Eid al-Fitr and Eid al-Adha holidays in May and the highly transmissible Delta variant drove a spike in infections. Now, Indonesia has taken India's place as the worst-hit by COVID-19, and the nation is far less equipped than India to handle the crisis. Indonesia has 50 percent fewer doctors than India, and medical centers are near the breaking point.

Indonesia's most populous island, Java, accounts for 70 percent of the nation's COVID-19 cases. On July 3, a temporary partial lockdown went into effect in Java and Bali. The military set up roadblocks and checkpoints to restrict people's movement across the two islands, and public places such as churches, shopping malls and parks shut down. 

Taxi driver Komang Agus Sumantara lives with his family in Badung Regency, Bali, a popular tourist area now in lockdown to prevent the spread of COVID-19. “Before my husband was vaccinated, I was so worried when he went to work at the airport," says his wife, Niluh, above with their children, 2-month-old Komang and 5-year-old Rendra. "I told him to wear two masks and always shower and change his clothes when he got home." © UNICEF/UN0473636/Ijazah

When the restrictions were set to expire later in July, the Indonesian Medical Association's mitigation team sounded an alarm.

"Based on the data we have, a number of hospitals are still overloaded. Therefore, we hope these [restrictions] will be extended," Dr Adib Khumaidi, head of the mitigation team, which reports directly to the Indonesian health minister, told reporters.

With health workers sick and oxygen scarce, hospitals are turning people away 

Caught unprepared for the rapidly escalating crisis, the Indonesian Government has struggled to replenish the oxygen seriously ill patients need to survive. Over the weekend of July 4, dozens of patients died when a public hospital on the island of Java nearly ran out of oxygen.

"One hospital [typically used] three tons of oxygen in three days to a week; now it's gone in a day," Lia Gardenia Partakusuma, the secretary-general of the Indonesian Hospital Association, told the BBC.

One hospital [typically used] three tons of oxygen in three days to a week; now it's gone in a day. — Lia Gardenia Partakusuma, secretary-general of the Indonesian Hospital Association

Hospitals like the regional medical center in Bekasi, a city of 2.5 million near Jakarta, are erecting tents on their grounds to accommodate the sick. 

Lisa Wiliana’s husband was gasping for breath in one of these tents, but when his oxygen saturation level dropped to 84, well below the healthy range of 95 to 100, she had to get the oxygen he needed herself. “We are waiting for an available room because it is full,” she told the New York Times. “What else can we do? The important thing is to get the oxygen because he already had trouble breathing. It was scary.”

Equally alarming is the number of COVID-19 patients across the country who are health workers themselves. 

At a news conference held July 18, Mahesa Paranadipa, a senior official from an association for Indonesia's doctors, reported that some 114 doctors died of COVID-19 from July 1 to July 17, compared with 51 in the entire month of June. July's 17-day death toll makes up 20 percent of the doctor fatalities — 545 — since the pandemic began.

"We are worried about the potential of a functional collapse," Paranadipa said, noting that these are only the reported numbers. 

The Indonesian Medical Association's mitigation team is also arguing for an expansion of travel restrictions in regions beyond Java and Bali where cases have begun climbing.

UNICEF and partners are rushing vaccines, oxygen, therapeutics, testing equipment and other lifesaving supplies

More than 3 million COVID-19 vaccine doses arrive in Indonesia via COVAX. The Moderna vaccines, donated by the U.S. Government, will accelerate ongoing vaccination efforts amid Indonesia's second wave of COVID-19. © U.S. Embassy Jakarta/2021

UNICEF and partners are helping the Indonesian government fight the COVID-19 surge while working to lessen the impact on children’s health, nutrition, education and child protection services.

With UNICEF's help, Indonesia is accelerating its vaccination campaign in all 34 provinces, aiming to inoculate 2 million people per day by August. The U.S. government has also lent its support, shipping 3 million doses of the Moderna COVID-19 vaccine, which landed at Jakarta’s Soekarno-Hatta International Airport on July 11. The vaccines were shipped and delivered by the COVAX Facility, a partnership co-led by Gavi, the Vaccine Alliance, the World Health Organization (WHO) and the Coalition for Epidemic Preparedness Innovations (CEPI), with UNICEF as a key implementing partner. 

Vaccination rates are low across Indonesia. To help combat hesitancy, UNICEF has also worked with Indonesia’s NU (the nation’s largest Muslim organization) to facilitate the acceptance of COVID-19 vaccines among several influential religious scholars in East Java.

In coordination with the Indonesian Government and partners, UNICEF is also facilitating procurement of diagnostics, oxygen, therapeutics and other lifesaving supplies through the UNICEF Supply Division.

The pandemic poses a severe threat to children 

Children have mostly been spared severe COVID-19 infections. But now, world health officials have their eye on Indonesia. Children and young people under 18 make up 12.6 percent of confirmed cases and 1.2 percent of deaths. 

The percentage of Indonesia's coronavirus pediatric cases is comparable with other countries, where children make up 13 percent of total cases. But UNICEF is concerned by the proportion of deaths, which could be even higher due to insufficient testing, underreporting or misdiagnosis. UNICEF, Indonesia's Ministry of Health and the Indonesian Pediatric Society, along with WHO and other partners, are working to understand and address the epidemiology of COVID-19 in children.

Uul Masula, 28, holds her baby, Firdaus, as he receives a dose of the pneumococcal vaccine in Gresik, East Java Province, Indonesia, on June 22. © UNICEF/UN0479829/Ifansasti

UNICEF is also ensuring the continuity of routine immunization to protect children from vaccine-preventable diseases and pandemic-related setbacks to recent health and development gains.

As part of World Immunization Week, UNICEF supported a series of activities across Indonesia promoting the use of vaccines. In June, 1.6 million pneumococcal conjugate vaccine (PCV) doses procured via the UNICEF Supply Division through the Gavi Advance Market Commitment mechanism arrived in Indonesia. The doses paved the way for UNICEF, WHO and partners' support of expansion of the immunization program to protect children against 13 types of pneumococcal bacteria, all of which can cause pneumonia and other serious infections and earaches.

As schools reopen, UNICEF is also reaching out to key hygiene manufacturing companies to provide children with COVID-19 Safe School Kits that will support handwashing in schools.

You can help UNICEF rush critical lifesaving supplies and services to protect families and communities in Indonesia. Please donate today.

Top photo: At a vaccination site at the Intercontinental Hotel in Jimbaran, Badung District, Bali, Indonesia, a woman receives a dose of COVID-19 vaccine delivered by UNICEF in its role as key implementing partner of the COVAX Facility. © UNICEF/UN0473667/Ijazah