TRI WAHYONO was trying to keep it together. It was rush hour on a weeknight in late June in Yogyakarta, a city on the Indonesian island of Java, but the streets were almost empty. It had been like that for a couple of weeks. Since the number of covid-19 cases spiked in the city early last month, people had been staying home. Mr Tri was speeding through the streets on his motorbike, trying not to think about how his 63-year-old mother was gasping for air in the makeshift ambulance behind him, but about how she would be cured of the respiratory disease, if only they could find a hospital that would admit her. The first one was full. The second one had run out of oxygen. As they pulled up in front of the emergency ward of yet another hospital, four medics in protective gear rushed out to meet them. Mr Tri hoped for a “miracle”, but by then it was too late. He chokes back tears remembering how his fear of catching the virus prevented him from holding his mother in her last moments.
South-East Asia is swimming in covid-19. For much of last year, it had far fewer cases than Europe and North America. But low rates of vaccination, limited testing, and the arrival of new, more transmissible variants means covid is surging throughout the region. Cambodia, Myanmar, Thailand and Vietnam are breaking their own records for daily cases every day. Malaysia has the highest caseload in the region relative to its population.
But in absolute terms Indonesia has the most cases in Asia after India. The daily number of new infections has grown eight-fold over the past month, hitting a record high of more than 38,000 on July 9th. Since early July, the country has had the world’s third-highest number of daily cases, taken as an average over seven days, after Brazil and India. But because testing is patchy, the virus is likely to be much more widespread than official figures suggest. The proportion of tests that come back positive—a whopping 26%—suggests that the disease is running rampant.
Indonesia’s health-care system is drowning. Over the past five weeks, the number of hospital patients has more than trebled to around 81,000. Nearly three-quarters of hospital beds are occupied, according to the Indonesian Hospital Association. In Java, where most Indonesians live and most cases are found, few hospitals are now admitting patients. On July 5th the health minister said, “Hospitals are full.” Oxygen supplies are running dangerously low. On July 3rd dozens of covid patients at a public hospital in Yogyakarta died after the facility ran out of the gas. Because of the shortage of medical supplies and equipment, doctors report being forced to choose which patients will live and which will die.
On July 5th the health minister urged those with mild symptoms to refrain from going to hospital. Many Indonesians are taking his advice. Some who stay home are dying. Nearly 300 infected people have perished while self-isolating at home, according to LaporCovid-19, an NGO which collects data on the pandemic. There has been a steep increase in deaths since June, says the World Health Organisation.
The rapid spike in cases and the “collapse” of the health-care system, as Pandu Riono, an epidemiologist at the University of Indonesia, puts it, has invited comparisons to India, another big country with a weak health system. But Indonesia is even more poorly equipped to deal with such a crisis. It has just 0.4 doctors for every 1,000 people—less than half the ratio in India.
Several factors have exacerbated the latest outbreak. The government never imposed a full lockdown, for fear of paralysing the economy and impoverishing the country’s millions of informal workers, who cannot toil from home. The restrictions that the government did impose were poorly enforced. During Eid celebrations in May, 1.5m people intent on going home for the holiday flouted a travel ban—an example of “herd stupidity”, as Dr Pandu puts it. The effect is that the virus is spreading practically unchecked. During the May holiday, many Indonesians travelling from the cities to their villages brought the Delta variant with them, which now accounts for 90% of cases in the country.
Making matters worse is the shortage of health workers. While 95% of them have been fully vaccinated, the vast majority have been jabbed with the shot from Sinovac, a Chinese firm, which is less effective than other vaccines. The Indonesian Hospital Association surveyed big state-run hospitals across Java’s big cities and found that 10% of their staff have tested positive. LaporCovid-19 found that 131 vaccinated healthcare workers have died since June, 50 of them in the first week of July.
The government has sprung into action. It is trying to accelerate vaccination; currently just over 5% of people have been double-jabbed. In early June it expanded eligibility for vaccination to anyone over the age of 18. In July it announced new restrictions. Houses of worship, malls and restaurants on Java and Bali, another island, have closed their doors for 17 days until July 20th. Non-essential workers on those islands must work from home. Big roads in some cities have been blocked off. On July 10th, in a sign of its growing concern, the government announced that restrictions would be imposed on 15 regions outside of Java and Bali. But for Dr Pandu, the government’s efforts are too little, too late. He thinks restrictions should be much stricter. The government says it will think about it. That will be little comfort to Mr Tri.