JAKARTA (THE JAKARTA POST/ASIA NEWS NETWORK) - When Jakarta became the epicentre of Covid-19 transmission, other regions, including the East Java capital of Surabaya, lagged behind the capital city in implementing restriction policy.

When large-scale social restrictions (PSBB) were enforced in Greater Surabaya (Surabaya, Sidoarjo, Gresik) on April 28, positive Covid-19 cases in Surabaya had already reached 372.

As a comparison, New Zealand imposed a nationwide lockdown on March 25, when 205 cases were reported.

However, the PSBB policy actually did not lower single-day infection rates in East Java.

On June 26, after three PSBB periods, East Java emerged as the leading contributor of Covid-19 cases in Indonesia, overtaking Jakarta, with 66.9 per cent of national cases.

Experts warn that Surabaya may emulate Wuhan in China, where the pandemic began. A record-breaking single-day case of 463 came on July 19, bringing the toll of confirmed cases to 18,129, higher than the total cases in Vietnam.

The East Java provincial government has taken various measures to contain the virus' spread. Its testing rate has reached 9,004 per two weeks with a positivity rate of 31.6 per cent.

Testing capacity stands at 2,250 per day, lower than the World Health Organisation (WHO) standard of 40,000 tests per week and a positivity rate of below 5 per cent.

Covid-19 tracing in East Java is not improving either. Surabaya has recorded the lowest tracing ratio of only 2.8 possible/asymptomatic cases, while the WHO standard is 25 possible/asymptomatic cases.

Nonetheless, hospital capacity in East Java for Covid-19 cases is already overloaded. There are not enough isolation rooms in Greater Surabaya, where most infections are found.

Dr Soetomo General Hospital, the main referral hospital, has added 200 beds, but it is still not enough. An emergency hospital for Covid-19 was then built on Jalan Indrapura, with a capacity of 500 beds.

According to our sources in the East Java Covid-19 task force, problems in referral system arise because the hospitals do not have an integrated system that can map the number of available beds in each hospital.

This has slowed down the referral process for Covid-19 patients immensely.

Therefore, the provincial government launched the One Gate Referral System, which was initiated by School of Medicine at Airlangga University and is supported by the Covid-hub system comprising the East Java government and the Joint Defence Regional Command (Kogabwilhan) II.

The Covid-hub system aims to serve as the coronavirus control system on the downstream side, especially in terms of curative management.

The system provides an open referral system that is updated online 24 hours a day, so hospitals can get real-time information on the availability of beds in Covid-19 referral hospitals.

Under the new system, a hospital cannot see other hospitals' data, which is expected to encourage hospitals to be open concerning Covid-19 data. The system is monitored by Kogagwilhan in a data centre located in the Indrapura emergency hospital.

All Covid-19 referral hospitals in East Java are expected to join the Covid-hub system, with 32 having joined so far.

The Covid-hub system is a breakthrough for reducing referral times, improving services for Covid-19 patients and accelerating response to Covid-19 cases.

At the end of the day, the system may prevent an overload in referral hospitals and hopefully lower Covid-19 cases soon.

Another problem East Java faces is the rising number of medical workers who die of Covid-19.

Across the country, the fatality rate is already an unacceptably high 6 to 7 per cent, compared to the global rate of less than 1 percent.

In East Java, the figure is 10 per cent, according to our latest data.

Therefore, the East Java Covid-19 task force recruited 470 medical volunteers to help with patient care.

However, the figure is not enough given the fast rising number of Covid-19 cases. Recently, Surabaya Mayor Tri Rismaharini approached Airlangga University to ask for more health workers.

The level of pressure facing health professionals in East Java right is immense. Unfortunately, the government has not fulfilled its promise to provide financial incentives.

One of the main reasons behind East Java's significant surge in Covid-19 cases is the people's reluctance to follow health protocols.

A video recently surfaced showing people talking walks, cycling and exercising without physical distancing in Surabaya. Malls and restaurants remain open and do not promote physical distancing.

The local government's failure to enforce health protocols is the biggest impediment of our efforts to contain the spread of Covid-19.

Our online survey on perception of the public regarding Covid-19 and health protocols recently confirmed that people's behavior is responsible for the high number of infections in East Java.

We found that 2.7 per cent of respondents think Covid-19 is not transmissible and 4.2 per cent do not consider Covid-19 dangerous.

Regarding health protocols, such as wearing a mask, physical distancing, avoiding crowds and staying home, about 1.8 per cent of respondents disagree with the measures.

The largest portion of public disagreement concerns religious belief: 15.8 percent of respondents who reject the protocols prefer to pray in places of worship rather than at home.

When asked about self-obedience of health regulations, 19 per cent of respondents said they never or rarely perform physical distancing or avoid crowds, 4 percent said they never or seldom wear a mask when going out.

They also kept socialising: 15 per cent said they went to a wedding reception, 5.5 per cent to shopping malls and 28 per cent went to places of worship in the past two weeks.

Without behavioural changes and strict enforcement of health protocols, the Covid-19 situation in East Java will not improve, regardless of the local government's efforts. East Java is definitely in a state of emergency.

Maria Cellina Wijaya is a medical doctor from Airlangga University and Rizqy Rahmatyah is a medical doctor from Airlangga University and an independent researcher. The Jakarta Post is a member of The Straits Times media partner Asia News Network, an alliance of 24 news media organisations.