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ABC News
Health
Sastra Wijaya and Hellena Souisa

As Omicron cases climb rapidly, Indonesia tries to learn from its devastating Delta outbreak

Indonesian man Iman Nugroho has been infected with COVID-19 three times. (Supplied)

Iman Nugroho is currently isolating at home after getting COVID-19 for the third time. 

Nugroho, a 46-year-old journalist living in Tangerang, west of Indonesia's capital Jakarta, has witnessed a whole range of responses to the virus, including many people in the country not taking it seriously at first, to the disastrous Delta outbreak and now a surge in Omicron cases. 

When he first caught COVID-19 in February 2021, he asked to be treated in a special isolation centre arranged by the local government.

But when he was infected a second time, along with his wife and child in July last year,  Indonesia was in the middle of its catastrophic Delta wave, when thousands of people died at home because some hospitals could not cope. 

He was double-vaccinated with Sinovacs shot but last week, Mr Nugroho felt unwell and a PCR test confirmed he had been infected for a third time. 

He is now isolating at home and feels he knows how to handle the situation.

"I reported my case to our local health centre and they asked me whether I had enough medicine and I said yes," he said.

"I didn't want to take the medicine they offered as I have enough at home and also those medicines could be used for other people who needed them more than me." 

Nugroho said he saw a difference in how Indonesia's health system worked to tackle COVID-19 over the last two years.

"With my first case, I felt there was a sense of emergency. I was driven in ambulance, with all involved wearing full protection clothes, basically everybody followed all the procedures," he said. 

During the Delta outbreak, he said news reports showed Indonesia's health system was under strain and ill-prepared, with many patients waiting in hospital corridors.

"And now after getting COVID a third time, I was not that scared. The government response was also much better," he said. 

Lessons learned from horror of Delta wave

Indonesia reported its first case of the Omicron variant in mid-December and recorded cases have risen rapidly since early February.

During Delta's outbreak in 2021 hospitals in several cities in Indonesia were overwhelmed with COVID patients. (AP: Tatan Syuflana)

The country reported a new daily case record of more than 64,000 cases on Wednesday last week — surpassing the previous record of 56,700 in July 2021.

But the government insists it is better prepared for Omicron than it was for Delta.

It has tightened social restrictions, mainly in Java and Bali, since early February and has implemented telehealth for COVID patients experiencing mild symptoms to treat themselves at home.

Dr Tarmizi says Indonesia has sourced more oxygen tanks, but could struggle if Omicron cases far surpassed Delta. (Supplied: ANTARA)

"Because of Indonesia's experience with Delta and also Omicron in other countries, we know what we needed to prepare," Siti Nadia Tarmizi, a spokeswoman for the Ministry of Health, told the ABC.

Dr Tarmizi said Indonesia has prepared 140,000 beds to anticipate a surge in cases over the coming weeks, as well as greater stocks of medicines, ventilators and oxygen tanks.

The Ministry of Health has bought 400,000 tablets of molnupiravir to treat COVID, distributed 16,000 oxygen generators and installed 36 oxygen concentrators in hospitals, according to Dr Tarmizi.

But the health system could still come under pressure if the number of Omicron cases peaked far beyond those of Delta, she said.

Dr Erlina Burhan is a lung specialist and the head of the COVID-19 team at the Persahabatan Hospital in Jakarta.

 Dr Erlina Burhan says the situation is manageable but could be strained if there is a surge in cases. (Supplied)

She said that at the moment, 60 per cent of designated COVID beds at her hospital are already occupied.

"We are more prepared now with beds, infrastructure, medicines, oxygen," she said.

Dr Burhan welcomed the use of telehealth to help COVID patients recover at home.

"During the Delta outbreak last year, the system was very chaotic," she said.

"We did not have time to do the early screening as so many people were coming in with severe symptoms and some died before and before they could be put on oxygen.

"At the moment, we can still cope, we are not as panicked and chaotic as last year."

Less than 70 per cent of eligible Indonesians are fully vaccinated

The Indonesian government acknowledges it has missed its vaccination target and says it is ramping up inoculation efforts.

Indonesia had hoped to get 70 per cent of its population over the age of 12 — some 208 million people — double-vaccinated in early 2022.

Health Minister Budi Gunadi Sadikin previously had predicted that the target could be reached in February this year.

However, according to the Ministry of Health's vaccination site on February 23, the vaccination rate was around 67.8 per cent or 141.3 million people, and only 4 per cent were boosted.

When the vaccination rollout started back in January 2021, Indonesia was heavily reliant on the Sinovac vaccine from China.

According to some studies, Sinovac has been less effective against Omicron. Dr Tarmizi said around 70 per cent of administered doses in Indonesia are Sinovac.

Indonesia is now also using other WHO-approved vaccines like those from Pfizer, AstraZeneca and Moderna.

Despite not reaching the target yet, Dr Tarmizi said Indonesia's vaccination program "is on track"'.

"Also the resistance from some communities because of religion was another challenge," she said.

COVID tests more affordable

When Paulus Jonaswar, 57, contracted the virus early last month, he recovered at home with the support of telehealth.

Paulus Jonaswar, who was fully vaccinated in May last year, caught COVID this month. (Supplied)

"The government is more responsive now," he said.

"In the early stage of the pandemic in 2020, Indonesia was very slow to recognise the danger of the virus spread."

Mr Jonaswar was tested positive in a hospital and the next day got a notification from the Ministry of Health's app Perduli Lindungi (Care-Protect) before receiving the medicine that was sent to his home using telehealth.

"I was positive on February 2 and back to negative on February 10, so grateful that I got the medicine quickly to help my recovery," he said.

Mr Jonaswar said PCR and rapid tests had become more accessible and affordable. 

While early in the pandemic he had paid around $100 for a PCR test, they now cost $27.50, he said.

The transmissibility of Omicron hit home for Priska Natallye when she was one of eight colleagues to contract COVID.

Ms Natallye works in the back office of a ceramic store and initially did not think that she caught the virus as she had only mild symptoms.

Priska Natallye has spent nearly half of her monthly salary on RAT and PCR tests. (Supplied)

"I went to see a GP and he told me it was a common sore throat," she said, adding that she had the second dose of AstraZeneca's vaccine last September.

"But only when I heard from all my colleagues that they were positive, I went for the RAT and PCR tests, and came back positive."

Ms Natallye, who earns a monthly salary of $400, ended up spending around $140 on PCR and rapid tests before returning to work, although she received some free medicines from the telehealth program.

Indonesia's Omicron cases similar to India

Indonesia is trying to avoid overcrowded hospitals by promotong telehealth and self-isolation at home. (Supplied: ANTARA/ Adeng Bustomi)

The highest daily toll during the peak last year was 2,069 deaths, but Health Minister Budi Gunadi Sadikin predicted that Omicron deaths won't exceed 500 daily, according to the Associated Press. 

Professor Hari Kusnanto, an epidemiologist from Gadjah Mada University in Yogyakarta, said the Omicron trend in Indonesia was similar to what happened in India.

"In other countries like the US, Omicron cases were around five to six times more than Delta cases," Professor Kusnanto said. 

"Indonesia is similar with India, where the case numbers are nearly the same as the Delta numbers.

"Also the death rate is 10 times lower than during the Delta outbreak." 

On Tuesday, more than 57,000 new cases were reported, but Coordinating Minister for Economic Affairs Airlangga Hartarto said the peak was still two or three weeks away, according to local media.

Professor Kusnanto said the next few weeks would be critical for Indonesia to see whether Omicron will reach its peak.

"What we need to do is more testing to check the real number as much as possible," he said.

School lessons are paused to disinfect classrooms when a COVID case is detected. (AP Photo/Binsar Bakkara)

To anticipate the wave of COVID-19 cases in Indonesia, the government also promised to ramp up vaccination rates among the elderly and prioritise second doses.

"Several things have been done, for example, sending vaccinators to remote areas, as well as visiting residents door-to-door. We have enough vaccines for the population," Dr Tarmizi said.

"We are targeting that by the end of March, 208 million people will have received a complete [two doses] of vaccination."

How and when will the COVID pandemic end?
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