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How Indonesia became the new epicenter of the coronavirus pandemic

BEKASI, Indonesia – By the thousands, they sleep in hallways, tents and cars, breathlessly waiting for beds in overcrowded hospitals that may not have oxygen to give them. Others see hospitals as desperate, even dangerous, and try their luck at home.

Wherever they are, as Covid-19 takes their breath away, their families embark on a frantic, daily hunt for the scarce reserves of vital oxygen.

Indonesia has become the new epicenter of the pandemic, overtaking India and Brazil to become the country with the highest number of new infections in the world. The increase is part of a wave across Southeast Asia, where vaccination rates are low but countries until recently had relatively well contained the virus. Vietnam, Malaysia, Myanmar and Thailand are also facing their biggest outbreaks to date and have imposed new restrictions, including lockdowns and stay-at-home orders.

In Indonesia, cases and deaths have skyrocketed over the past month as the highly contagious delta variant sweeps across the densely populated island of Java, as well as Bali. In some areas, the coronavirus has pushed the medical system beyond its limits, although hospitals are taking emergency measures to increase their capacity.

The Bekasi regional public hospital, where some Covid patients have waited days for treatment, has erected large tents on its land, with beds for up to 150 people. Nearby, in the capital Jakarta, a long line of people waited for hours outside a small dispensary, hoping to fill their portable tanks with oxygen.

Among them was Nyimas Siti Nadia, 28, who was looking for oxygen for his aunt’s family, all sick with Covid.

“She is a doctor and she is afraid to go to the hospital because she knows the situation,” Ms. Nyimas said. “There are a lot of cases where patients don’t have beds or oxygen. If we go to the hospital, we have to bring our own oxygen.

Indonesian authorities on Thursday reported nearly 57,000 new cases, the highest daily total to date – seven times more than a month earlier. They reported a record 1,205 deaths on Friday, bringing the country’s official death toll from the pandemic to more than 71,000.

But some health experts say those numbers dramatically underestimate the spread in Indonesia, the world’s fourth most populous country, as testing has been limited. Dicky Budiman, an Indonesian epidemiologist at Griffith University in Australia, estimates the actual number of cases to be three to six times higher.

In India, where the Delta variant was first identified, daily cases peaked at more than 414,000 in May, but have since fallen to around 40,000.

Despite the growing number of cases in Indonesia, officials say they have the situation under control.

“If we are talking about the worst case scenario, 60,000 or a little more, all is well,” said Luhut Pandjaitan, a senior minister appointed by President Joko Widodo to manage the crisis. “We hope it doesn’t reach 100,000, but even so, we are preparing now if we ever get there.”

However, many Indonesians have been facing their worst case scenarios for weeks.

Family members describe nightmare scenes trying to get a hospital to admit their sick relatives. Some hospitals only accepted patients who brought their own oxygen, they said. In others, patients waited wherever they could find space to lie down.

In Bekasi, a city of 2.5 million people adjacent to Jakarta, patients have flocked to the regional public hospital. To cope with the influx, 10 large tents were set up on the site, equipped with beds for up to 150 people.

Lisa Wiliana’s husband had been in one of the tents since the day before, waiting for a place in a room. After nine days of illness, she said, her oxygen saturation level had fallen to 84, well below the 95 to 100 range that is considered healthy. The hospital was giving her oxygen, but she had to manage to get more.

“We are waiting for an available room because it is full,” she said. “What else can we do? The important thing is to have oxygen, because he was already having trouble breathing. It was scary.”

Even being admitted doesn’t make oxygen a certainty. At Dr. Sardjito General Hospital in Yogyakarta City, 33 patients died this month after the central oxygen supply ran out. Staff switched to tanks donated by the police, but it was too late for many patients.

Overwhelmed hospitals have added thousands of beds, but on average 10% of their health workers are isolated after being exposed to the virus, Indonesian Hospital Association general secretary Dr Lia G. Partakusuma said. Some hospitals are using five times more liquid oxygen than normal and distributors are struggling to keep up with demand, she said.

“Some hospitals have said, ‘If you brought your own oxygen tank, use it first because we have a limited oxygen supply,’” she said. “But they don’t have to bring their own oxygen.”

With hospitals so overcrowded, many people choose to stay at home – and many die there. Lapor Covid, a nonprofit group that tracks deaths from the disease, reports that at least 40 Covid patients per day now die at home.

Mr Joko, the president, stopped before a nationwide lockdown but ordered restrictions in Java and Bali, including the closure of places of worship, schools, shopping malls and sports facilities, reducing public transport capacity and limiting take-out restaurants. The restrictions are set to expire on Tuesday, but officials are wondering whether to extend them.

Only about 15% of Indonesia’s 270 million people have received a dose of a coronavirus vaccine, and only 6% are fully immunized. Indonesia has relied heavily on the vaccine made by Sinovac Biotech, a Chinese company, which has been shown to be less effective than other vaccines. At least 20 Indonesian doctors fully vaccinated with Sinovac have died from the virus.

This week, the United States donated 4.5 million doses of the Moderna vaccine to Indonesia. Officials said the first priority would be to give booster shots to nearly 1.5 million health workers.

Dr Budiman, an Indonesian epidemiologist in Australia, predicted over a year ago that Indonesia would become a pandemic epicenter due to its dense population and weak health system. He called for more testing, contact tracing and isolation of those infected.

Indonesian Health Minister Budi Gunadi Sadikin said on Friday the country had increased testing to around 230,000 people per day, up from around 30,000 in December. His goal is 400,000 per day.

But Dr Budiman maintains that testing is still woefully limited, noting that in recent days the share of positive tests has risen to over 30%. Health experts say that a high rate is a sign of an insufficient number of tests.

“For over a year, our test positivity rate has almost never been less than 10%, which means we miss many cases and cannot identify the majority of infections and clusters,” did he declare.

Outside the small CV Rintis Usaha Bersama oxygen store in South Jakarta, more than 100 customers lined the street with their oxygen cylinders on and waited hours for a chance to refill them.

Alif Akhirul Ramadan, 27, said he was receiving oxygen for his grandmother, 77, who was cared for by family members at home. He said his condition suddenly worsened and his tank ran out of fuel.

“Now you have to fill it out,” said Mr Alif, who has twice had Covid. “There is no backup at home. That’s why we need to fill it up quickly.

Fira Abdurrachman reported from Bekasi, Richard C. Paddock from New York and Muktita Suhartono from Chonburi province, Thailand.

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