Only in the past week has the Government granted powers to provincial leaders to impose their own restrictions on social movement. Here’s why some health experts say they are too little, too late.

April 20, 2020 15:38:52
The coronavirus pandemic could not have struck Indonesia at a worse time of year.
The rapid spread of COVID-19 across the archipelago comes as the majority Muslim nation prepares for the fasting month of Ramadan starting next week and the annual exodus of millions of people from Jakarta and major cities for their home villages.
Last year, almost 20 million people left greater Jakarta for the week-long Lebaran holiday that coincides with Idul Fitri, when Muslims feast and celebrate the end of Ramadan.
With most businesses and stores now closed in Jakarta the epicentre of the outbreak about 1 million people have already left the capital.
It has fuelled fears they will take the virus with them to other parts of the country and cause an explosion of COVID-19 cases.
Government decentralisation complicates efforts to contain the coronavirus
President Joko Widodo has resisted calls for a national ban on ‘mudik’ the name for the annual homecoming for fear it will destroy people’s livelihoods and the wider economy.
Only last week had his Government under pressure to do something granted powers to provincial leaders to impose their own restrictions on social movement.
The governments of Jakarta, West Java and neighbouring Banten province have in recent days ordered the closure of businesses, workplaces, houses of worship, and entertainment venues.
Only essential services such as supermarkets, pharmacies and petrol stations can remain open.
And gatherings of more than five people are prohibited although markets and traffic in some areas were still busy earlier this week.
Transport services have also been cut back, and limits imposed on how many people can enter trains, buses or even cars.
Some voice concern over mass movement of people
But crucially there is still no lockdown in the capital, or a ban on movement in or out of the city except for civil servants and security forces who make up less than 10 per cent of the wider population.
With about half of all deaths from COVID-19 in Jakarta and work for millions of people drying up the exodus is likely to gather pace in the days and weeks ahead.
The Governor of West Java province which includes Jakarta’s southern satellite cities of Depok and Bogor has complained that tens of thousands of people have already poured into cities and towns across his province alone.
Authorities at Tegal in Central Java recently barricaded the town to prevent outsiders from coming in.
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Similar restrictions have been introduced in other cities and provinces in Java, Sulawesi and Papua.
But health experts say the Government’s recently adopted measures are still too little, too late.
A recent study by health researchers at the University of Indonesia predicted there could be at least 140,000 deaths and 1.5 million cases of the coronavirus across the country by May, if more measures weren’t taken to curb its spread.
“If we don’t have mudik, we can keep the numbers from reaching that high,” one of the report’s co-authors, Pandu Riono, said.
How Indonesia’s health system is more vulnerable to COVID-19
Indonesia is especially vulnerable to a high death toll from the coronavirus because of its weaker hospital system and widespread poverty.
The country has only four doctors and 12 hospital beds for every 10,000 people, and only three intensive care beds per 100,000 people.
On top of this, at least 30 doctors and health professionals have died treating victims of the coronavirus.
Health ministry figures also showed last month that Indonesia had only 8,413 ventilators essential for treating people with respiratory illnesses.
It is a fraction of the number needed to respond to the outbreak.
Indonesia also has poor health indicators that predispose a disproportionate number of its 270 million people to poor lung health or pulmonary disease, in turn making them more vulnerable to COVID-19.
It has one of the world’s highest incidences of tuberculosis, with half a million new cases each year and 175,000 deaths, according to the World Health Organisation.
Tuberculosis remains one of the two top causes of death for Indonesian adults.
The country also has some of the highest rates of smoking in the world, one of numerous risk factors that have been linked to worse outcomes for those infected by the coronavirus.
Official data shows about two-thirds of Indonesian men and one in five teenagers smoke. A thriving tobacco industry and the lack of regulation on sales or advertising have only helped to fuel these rates.
“Smokers are at high risk for heart and respiratory diseases, which are factors in severe COVID-19 infections and complications,” Indonesia’s WHO representative, Navaratnasamy Paranietharan, said earlier this month.
“This means smokers in Indonesia are at high risk for COVID-19.”
In fact, in the early days of the coronavirus pandemic, social media users in Indonesia were spreading claims that smoking could prevent infection by COVID-19, because the composition of tobacco and cloves were resistant to the virus.
One post even suggested cigarette smoke was effective in killing the virus.
Indonesia’s Government making ‘same mistakes’ as colonial government
Then there is Indonesia’s history with pandemics, with one Melbourne-based historian questioning whether Indonesia faces a repeat of what happened in the 1918 Spanish influenza epidemic.
Indonesia, then known as the Dutch East Indies, was one of the worst-affected nations when the global pandemic struck more than 100 years ago.
Estimates suggest 2 per cent of its population about 1.5 million people died from the Spanish flu. Only India and South Africa had a higher death toll.
“The large number of deaths was caused by a slow government response, ineffective health policy and the impact of irresponsible parties who sought to take advantage of the situation. Sound familiar?” Ravando Lie wrote last month.
Mr Lie said the 1918 Spanish Flu occurred in two waves in the Dutch East Indies, with the first reported case in North Sumatra in mid 1918 apparently spread by plantation workers from Singapore and a second, bigger wave spreading further east, engulfing virtually all of the Dutch East Indies by early 1919.
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Just as today’s Indonesian Government initially downplayed the threat of the coronavirus, Mr Lie said the government in Batavia (now Jakarta) also underestimated the threat in 1918.
“When it first emerged, the Spanish Flu was considered by the colonial government to be nothing more than an ordinary flu,” he said.
“The [colonial department of health] seemed to await the arrival of the disease passively, even though advances in communication available at the time meant it surely knew that the pandemic had already killed millions in Europe and the United States.”
The historian goes on to explain that the Dutch East Indies government “failed to respond adequately to the 1918 Spanish Flu”.
“The colonial government’s failures in 1918-1919 are important lessons for the Indonesian Government as it faces the rapidly escalating threats of COVID-19,” he added.
“Sadly, it looks to have made many of the same mistakes that the colonial government made some 100 years ago.”
What the experts are saying about coronavirus:
How badly could Indonesia be hit?
The COVID-19 epidemic in Indonesia may not prove to be as serious as the Spanish Flu pandemic.
But Indonesia could still be one of the hardest-hit nations.
With 6,575 official cases of infection and the death toll now 582, Indonesia’s crude death rate is almost 9 per cent.
It’s one of the highest rates in the world, and by far the highest fatality rate in South-East Asia.
However, it’s worth noting Indonesia also has one of the lowest rates of testing in the world, meaning the true and final death toll may never be known.
When asked back in February how it was possible Indonesia had no confirmed cases, Health Minister Terawan Agus Putranto said it came down to faith.
“In medical terms, prayers,” he said at the time.
“All because of prayers.”
The economic costs of the coronavirus epidemic will also be devastating.
The Indonesian Government predicts about 5.2 million people will lose their jobs during the pandemic, as a result of businesses having to shut down. Up to 3.78 million Indonesians will fall into poverty.
The International Monetary Fund predicted last week that economic growth would plunge to just 0.5 per cent which would be the country’s lowest level since the 1998 Asian financial crisis and down from an original forecast of 5.1 per cent.
The Government has set aside trillions of rupiah for welfare spending and economic stimulus measures, including a social safety net scheme similar to unemployment benefits, job training programs, and tax relief for businesses.
It has also allocated increased spending for public health.
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