JAKARTA - Indonesia reached the grim milestone of 100,000 Covid-19 deaths on Wednesday (Aug 4), only the second nation in Asia to do so, as the number of patients surge in the provinces outside the main island of Java.
The rapid rise in cases in Sumatra, Kalimantan, Sulawesi and Papua - attributed to the highly infectious Delta variant of the coronavirus - is putting a severe strain on local hospitals and health workers.
Scenes common across Java, Indonesia's most populous island, are being replicated across the rest of the archipelago and the growing emergency is causing a shortage of beds, drugs and oxygen as hospitals are swamped by patients.
Since last year, critical care physician Novita Anggraeni has been shuttling between two hospitals in Pekanbaru, Riau's provincial capital, to tend to Covid-19 patients.
The region has seen a resurgence in infections which peaked in September and October last year.
"The situation since last month, especially the past few days, has been extraordinary as the number of cases rose sharply. ICU beds have been full over the past few weeks," the 42-year old doctor said, referring to the situation at Arifin Achmad general hospital, one of the city's Covid-19 referral hospitals.
"Most patients coming here are those with severe symptoms or critically ill. Many of them have tried to self-isolate," Dr Novita told The Straits Times.
Last month, the hospital opened a new Covid-19 ward to treat more patients. Now, it has 129 beds in total, including 19 ICU beds.
Only 15 ICU beds are functional, though, and Dr Novita attributed this to a manpower shortage. "Every day, there are health workers who get infected," she said.
Dr Novita spoke of a similar situation at Syafira hospital, where she also works. Almost all of its 60 or so beds are occupied and its 12 ICU beds have always been full since June, she said.
Between 10 and 20 patients are in the queue for intensive care beds at both hospitals.
Dr Zul Asdi, a surgeon who is head of Riau's chapter of the Indonesian Medical Association (IDI), said that many hospitals across the province, notably in Pekanbaru, had a high bed occupancy rate right now, with their ICU wards fully occupied.
"We are worried that the cases will continue to increase and hospitals cannot accommodate (patients)," he told ST. The local government is planning to build four emergency hospitals in the city to cope with the situation, he added.
Indonesia registered 1,747 Covid-19 deaths on Wednesday, bringing the total number of fatalities in the country thus far to 100,636. Public health experts believe the actual toll is likely to be far higher.
Now regarded as the epicentre of the pandemic in Asia, the country logged 35,867 new cases in the past 24 hours, with the total number hitting 3.53 million.
Riau and East Kalimantan have seen more than 1,000 new cases daily over the past week.
Last week, the two provinces - along with South Sulawesi, Central Kalimantan and South Sumatra - registered the highest number of weekly deaths among provinces outside Java.
The Covid-19 surge in the provinces is taking place even as Java, home to 56 per cent of Indonesia's 270 million population and accounts for the majority of cases, has gradually seen a dwindling in infections and deaths which the authorities attributed to the imposition of emergency restrictions since early July.
Pulmonologist Mauritz Silahahi, deputy director for service at AM Parikesit hospital in Tenggarong, in East Kalimantan, said the hospital had converted regular beds into Covid-19 beds, which now totalled almost 200, including 16 ICU beds.
"They are full and there are between 15 and 20 (patients) in the queue," he told ST. "There has been a surge in incoming patients over the past two weeks."
Hospitals have begun turning to volunteers as health workers succumb to the disease. "But we still need a lot of people because the patients keep coming," he said.
Ms Elina Ciptadi, co-founder of crowdsourcing platform KawalCOVID19.id, which analyses publicly available data on Covid-19 in Indonesia, said the growth rate of cases outside Java was concerning.
"While the mobility restrictions are starting to show results in Java, we are now seeing that the 'epicentre' of the pandemic is moving to outside Java, where testing is far more limited than Jakarta and the rest of Java," she said.
She cited the capital, Jakarta, to prove her point. While representing only 3 per cent of the country's population, the city accounted for around one-third of Covid-19 polymerase chain reaction (PCR) tests nationally.
Health experts have issued a stark warning, saying the regions outside Java may yet deteriorate into a much worse health crisis due to their weaker health systems.
"The population (outside Java) is smaller (than Java), but the number of the hospitals are also fewer. On top of that, the oxygen (supply) is very limited.
"If that hits smaller islands, the situation can be worse - how to distribute oxygen and other stuff. If that happens, the number of deaths will be high," said Dr Pandu Riono, epidemiologist from University of Indonesia.
Indonesian Hospital Association (Persi) secretary general, Dr Lia Partakusuma, called on the regional authorities to respond promptly to the growing crisis.
"As facilities outside Java are limited, we really need to be careful. The regional governments must set up the facilities quickly. Otherwise, the number of deaths will soar," she said.