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‘It’s Too Late’: In Sprawling Indonesia, Coronavirus Surges ‘It’s Too Late’: In Sprawling Indonesia, Coronavirus Surges
(32 minutes later)
The 1,340 Maluku Islands are a long way from anywhere. So remote are these Indonesian isles that the country’s most famous novelist was imprisoned there in a gulag that was actually an archipelago.The 1,340 Maluku Islands are a long way from anywhere. So remote are these Indonesian isles that the country’s most famous novelist was imprisoned there in a gulag that was actually an archipelago.
But the coronavirus is stalking the farthest reaches of the planet.But the coronavirus is stalking the farthest reaches of the planet.
The first case of the virus in the Malukus was confirmed in mid-March: a hardware technician who had journeyed from Indonesia’s most populated island, Java. With the central government loath to impose a national lockdown, local officials took matters into their own hands, instituting quarantines and limiting flights and ferries.The first case of the virus in the Malukus was confirmed in mid-March: a hardware technician who had journeyed from Indonesia’s most populated island, Java. With the central government loath to impose a national lockdown, local officials took matters into their own hands, instituting quarantines and limiting flights and ferries.
It didn’t work. Twenty-five medical workers at one hospital in Ambon, the biggest city in the Malukus, have tested positive for the coronavirus, even though none had contact with Covid-19 patients there. A hat vendor with no history of travel to other Indonesian viral hot spots became sick and died in early May, signaling that community transmission had begun.It didn’t work. Twenty-five medical workers at one hospital in Ambon, the biggest city in the Malukus, have tested positive for the coronavirus, even though none had contact with Covid-19 patients there. A hat vendor with no history of travel to other Indonesian viral hot spots became sick and died in early May, signaling that community transmission had begun.
Over the past week in Maluku Province, positive coronavirus tests have increased by double digits each day, with limited testing — only around 600 people have been tested — surely obscuring the true caseload.Over the past week in Maluku Province, positive coronavirus tests have increased by double digits each day, with limited testing — only around 600 people have been tested — surely obscuring the true caseload.
“We didn’t expect it to happen this fast,” said Kasrul Selang, the head of the coronavirus task force in Maluku Province. His wife has tested positive for the coronavirus.“We didn’t expect it to happen this fast,” said Kasrul Selang, the head of the coronavirus task force in Maluku Province. His wife has tested positive for the coronavirus.
The world’s fourth most populous country, Indonesia offers both a cautionary tale for how dithering leadership can thwart public health and a medical puzzle for why an unprepared nation’s hospitals have so far not been overwhelmed by the virus.The world’s fourth most populous country, Indonesia offers both a cautionary tale for how dithering leadership can thwart public health and a medical puzzle for why an unprepared nation’s hospitals have so far not been overwhelmed by the virus.
With thousands of islands straddling a section of the Equator wider than the continental United States, Indonesia has counted on its sprawling archipelago and youthful population to slow the deadly spread of the virus. But with sharp caseload increases in far-flung regions like the Malukus and full-blown outbreaks on more populated islands like Java, Indonesia’s luck may be running out.With thousands of islands straddling a section of the Equator wider than the continental United States, Indonesia has counted on its sprawling archipelago and youthful population to slow the deadly spread of the virus. But with sharp caseload increases in far-flung regions like the Malukus and full-blown outbreaks on more populated islands like Java, Indonesia’s luck may be running out.
In early May, Indonesia had recorded fewer than 12,000 cases of the coronavirus, with around 865 deaths. By Thursday, the number had increased to 24,538 confirmed cases and 1,496 deaths. Health experts say even this doubling of cases reflects the limits of testing rather than the true caseload.In early May, Indonesia had recorded fewer than 12,000 cases of the coronavirus, with around 865 deaths. By Thursday, the number had increased to 24,538 confirmed cases and 1,496 deaths. Health experts say even this doubling of cases reflects the limits of testing rather than the true caseload.
In an alarming glimpse at what could be runaway transmission, a random sampling of 11,555 people in Surabaya, the country’s second largest city, found last week that 10 percent of those tested had antibodies for the coronavirus. Yet the entire province of East Java, which includes Surabaya, had 4,313 officially confirmed cases as of Thursday.In an alarming glimpse at what could be runaway transmission, a random sampling of 11,555 people in Surabaya, the country’s second largest city, found last week that 10 percent of those tested had antibodies for the coronavirus. Yet the entire province of East Java, which includes Surabaya, had 4,313 officially confirmed cases as of Thursday.
“Massive infection has already happened,” said Dono Widiatmoko, a senior lecturer in health and social care at the University of Derby and a member of the Indonesian Public Health Association. “This means it’s too late.”“Massive infection has already happened,” said Dono Widiatmoko, a senior lecturer in health and social care at the University of Derby and a member of the Indonesian Public Health Association. “This means it’s too late.”
Yet even as the country’s caseload accelerates, the Indonesian government has said that national coronavirus restrictions, already a scattershot effort, must be relaxed to save the economy.Yet even as the country’s caseload accelerates, the Indonesian government has said that national coronavirus restrictions, already a scattershot effort, must be relaxed to save the economy.
“If people don’t eat and they get sick, it will be worse,” said Joko Widodo, the president, at a briefing for the foreign news media.“If people don’t eat and they get sick, it will be worse,” said Joko Widodo, the president, at a briefing for the foreign news media.
There is widespread concern among public health experts, however, that Indonesia’s health care system will break down if the coronavirus spreads as intensely as it did in the United States or Europe.There is widespread concern among public health experts, however, that Indonesia’s health care system will break down if the coronavirus spreads as intensely as it did in the United States or Europe.
Worryingly, more than half of Covid-19 deaths in Indonesia were of people below age 60. In the United States, most deaths have been among the elderly. The relative youth of the victims in Indonesia, health experts say, hints at hospitals that are unable to provide the kind of lifesaving treatment offered in other countries.Worryingly, more than half of Covid-19 deaths in Indonesia were of people below age 60. In the United States, most deaths have been among the elderly. The relative youth of the victims in Indonesia, health experts say, hints at hospitals that are unable to provide the kind of lifesaving treatment offered in other countries.
And epidemiologists fear an even bigger surge in cases next month. Last week, in a country with the largest Muslim population in the world, millions of Indonesians gathered to pray and travel at the end of Ramadan, the Islamic holy month. In the capital, Jakarta, more than 465,000 vehicles left the capital during the holiday period, according to a toll operator.And epidemiologists fear an even bigger surge in cases next month. Last week, in a country with the largest Muslim population in the world, millions of Indonesians gathered to pray and travel at the end of Ramadan, the Islamic holy month. In the capital, Jakarta, more than 465,000 vehicles left the capital during the holiday period, according to a toll operator.
While the Indonesian government announced some coronavirus travel restrictions in late April, they have not been enforced rigorously, critics say. Loopholes abound. Airport staff have complained about entire families, including children, flying under exemptions meant for business travelers.While the Indonesian government announced some coronavirus travel restrictions in late April, they have not been enforced rigorously, critics say. Loopholes abound. Airport staff have complained about entire families, including children, flying under exemptions meant for business travelers.
Modeling by epidemiologists at the University of Indonesia forecasts that up to 200,000 Indonesians may require hospitalization for the virus because of Ramadan-related activity.Modeling by epidemiologists at the University of Indonesia forecasts that up to 200,000 Indonesians may require hospitalization for the virus because of Ramadan-related activity.
Achmad Yurianto, the spokesman for the National Covid-19 Task Force, said that he expected a surge in confirmed cases beginning next week because of all the holiday movement.Achmad Yurianto, the spokesman for the National Covid-19 Task Force, said that he expected a surge in confirmed cases beginning next week because of all the holiday movement.
Because Indonesia’s testing rates are the worst among the 40 countries most affected by the virus — 967 per 1 million people, compared to 46,951 per 1 million people in the United States, as of Wednesday — Indonesians, especially those with asymptomatic or mild cases, are unknowingly spreading the virus, infectious disease experts warn.Because Indonesia’s testing rates are the worst among the 40 countries most affected by the virus — 967 per 1 million people, compared to 46,951 per 1 million people in the United States, as of Wednesday — Indonesians, especially those with asymptomatic or mild cases, are unknowingly spreading the virus, infectious disease experts warn.
“The disaster is still coming,” said Dr. Pandu Riono, an epidemiologist who led the University of Indonesia’s modeling effort. “Even after many months, we still have leaders who believe in miracles rather than science. We still have terrible policies.”“The disaster is still coming,” said Dr. Pandu Riono, an epidemiologist who led the University of Indonesia’s modeling effort. “Even after many months, we still have leaders who believe in miracles rather than science. We still have terrible policies.”
The Indonesian government should have known better. For weeks, even as nearby countries recorded spiraling local infections, Indonesia’s leaders acted as if the archipelago were somehow immune to the coronavirus.The Indonesian government should have known better. For weeks, even as nearby countries recorded spiraling local infections, Indonesia’s leaders acted as if the archipelago were somehow immune to the coronavirus.
“They were in denial,” said Dr. Erlina Burhan, a senior pulmonologist at Persahabatan Hospital in Jakarta. She noted that she has already been falling asleep in exhaustion at her desk because of the deluge of coronavirus casework.“They were in denial,” said Dr. Erlina Burhan, a senior pulmonologist at Persahabatan Hospital in Jakarta. She noted that she has already been falling asleep in exhaustion at her desk because of the deluge of coronavirus casework.
Indonesia didn’t confirm its first coronavirus case until early March. Neighboring Malaysia and Singapore recorded their first cases in late January.Indonesia didn’t confirm its first coronavirus case until early March. Neighboring Malaysia and Singapore recorded their first cases in late January.
Meanwhile, some hospitals, particularly on crowded Java, were logging big upticks in pneumonia cases with symptoms similar to Covid-19. But bodies were buried before coronavirus tests were administered.Meanwhile, some hospitals, particularly on crowded Java, were logging big upticks in pneumonia cases with symptoms similar to Covid-19. But bodies were buried before coronavirus tests were administered.
The governor of Jakarta said hundreds of people had probably died of Covid-19 in the capital but were not part of any official coronavirus count.The governor of Jakarta said hundreds of people had probably died of Covid-19 in the capital but were not part of any official coronavirus count.
Denial continued among Indonesia’s top leaders, even as a cabinet minister fell ill in mid-March. The nation’s health minister suggested that prayer could ward off the virus. Or maybe exercise and vitamins could do the trick.Denial continued among Indonesia’s top leaders, even as a cabinet minister fell ill in mid-March. The nation’s health minister suggested that prayer could ward off the virus. Or maybe exercise and vitamins could do the trick.
Mr. Joko, the president, eventually admitted that the true situation wasn’t being shared with the public to avoid panic spreading across the archipelago.Mr. Joko, the president, eventually admitted that the true situation wasn’t being shared with the public to avoid panic spreading across the archipelago.
Updated June 30, 2020
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Because national restrictions weren’t put into place until about a month ago, some provincial officials instituted their own travel bans, just as state governors did in the United States.Because national restrictions weren’t put into place until about a month ago, some provincial officials instituted their own travel bans, just as state governors did in the United States.
In Maluku Province, the governor began limiting arrivals at the airport and big ports in late March, after the first case was confirmed there. About 6,000 outsiders were quarantined.In Maluku Province, the governor began limiting arrivals at the airport and big ports in late March, after the first case was confirmed there. About 6,000 outsiders were quarantined.
But in a notoriously corrupt country, not everyone followed the rules. Even if official ports of entry were monitored, fishermen moved back and forth from the Malukus to viral hot spots like Makassar on the island of Sulawesi, where infections proliferated after a gathering of a Muslim revivalist group.But in a notoriously corrupt country, not everyone followed the rules. Even if official ports of entry were monitored, fishermen moved back and forth from the Malukus to viral hot spots like Makassar on the island of Sulawesi, where infections proliferated after a gathering of a Muslim revivalist group.
For each place like Maluku Province that tried to impose local discipline, others were proceeding as if life were normal.For each place like Maluku Province that tried to impose local discipline, others were proceeding as if life were normal.
“If they had restricted movement since the beginning, the disease would not have spread to almost all over Indonesia,” said Dr. Rodrigo Limmon, head of the Ambon branch of the Indonesian Doctors Association.“If they had restricted movement since the beginning, the disease would not have spread to almost all over Indonesia,” said Dr. Rodrigo Limmon, head of the Ambon branch of the Indonesian Doctors Association.
In the Malukus, medical staff resorted to using plastic raincoats from convenience stores for lack of proper equipment. Ambon, which was devastated by communal violence at the turn of the century, has only 25 ventilators. The Haulussy Hospital, where the 25 medical workers tested positive, was forced to close.In the Malukus, medical staff resorted to using plastic raincoats from convenience stores for lack of proper equipment. Ambon, which was devastated by communal violence at the turn of the century, has only 25 ventilators. The Haulussy Hospital, where the 25 medical workers tested positive, was forced to close.
“If they get sick or die, how will we survive?” said Wiesye Pelupessy, founder of an Ambon civil society group that has been distributing personal protective equipment for local medical workers.“If they get sick or die, how will we survive?” said Wiesye Pelupessy, founder of an Ambon civil society group that has been distributing personal protective equipment for local medical workers.
Some officials are hopeful that, for now, the virus hasn’t spread to the farthest-flung islands in the Maluku island chain. The southeastern Malukus have not yet recorded a single case.Some officials are hopeful that, for now, the virus hasn’t spread to the farthest-flung islands in the Maluku island chain. The southeastern Malukus have not yet recorded a single case.
There are other, even more unlikely, places in Indonesia that have avoided out-of-control epidemics. The tourist island of Bali had direct flights from Wuhan, the Chinese city that was the center of the initial outbreak. Even in March, holidaymakers were arriving in Bali from Europe and other places hard hit by the virus.There are other, even more unlikely, places in Indonesia that have avoided out-of-control epidemics. The tourist island of Bali had direct flights from Wuhan, the Chinese city that was the center of the initial outbreak. Even in March, holidaymakers were arriving in Bali from Europe and other places hard hit by the virus.
Yet Bali has had just 420 confirmed cases. Gusti Ngurah Mahardika, a virologist at Udayana University in Bali, checked in with local crematories to see whether more bodies were coming in because of the coronavirus. They were not.Yet Bali has had just 420 confirmed cases. Gusti Ngurah Mahardika, a virologist at Udayana University in Bali, checked in with local crematories to see whether more bodies were coming in because of the coronavirus. They were not.
“It is not the Indonesian habit to hug and to kiss,” he said, looking for possible factors that might have contributed to the island’s low caseload. The same cultural social distancing has been mentioned in connection with the relatively low number of infections in countries like Japan and Thailand compared with Brazil or Italy.“It is not the Indonesian habit to hug and to kiss,” he said, looking for possible factors that might have contributed to the island’s low caseload. The same cultural social distancing has been mentioned in connection with the relatively low number of infections in countries like Japan and Thailand compared with Brazil or Italy.
Nevertheless, public health experts in the Malukus are bracing for what many fear will be a new wave of cases following the post-Ramadan festive period. Over the weekend, local markets were packed with holiday shoppers.Nevertheless, public health experts in the Malukus are bracing for what many fear will be a new wave of cases following the post-Ramadan festive period. Over the weekend, local markets were packed with holiday shoppers.
Despite local government regulations limiting spiritual worship, the faithful flocked in Ambon last Sunday to celebrate the end of Ramadan. Few wore masks. So far, most of the region’s biggest outbreaks have been linked to superspreader religious events.Despite local government regulations limiting spiritual worship, the faithful flocked in Ambon last Sunday to celebrate the end of Ramadan. Few wore masks. So far, most of the region’s biggest outbreaks have been linked to superspreader religious events.
“In Maluku, we are lucky that we are islands,” said Meikyal Pontoh, the head of the provincial government health office. “But because this is already worldwide, we have to fight really hard and pray really hard.”“In Maluku, we are lucky that we are islands,” said Meikyal Pontoh, the head of the provincial government health office. “But because this is already worldwide, we have to fight really hard and pray really hard.”