Indonesia has thousands of empty hospital beds. So why are Covid-19 patients dying at home?

By Akanksha Sharma, Masrur Jamaluddin and Hilary Whiteman, CNN

Taufiq Hidayat enters the homes of the dead to claim bodies no one will touch.

He leads a dozen volunteer undertakers who take calls from grieving families in the Indonesian capital, Jakarta, the center of one of the world’s largest Covid-19 outbreaks.

“It’s really tough and hot for us because we are always in full hazmat suit while trying to navigate small alleys and high floors with a body in tow,” said Taufiq.

The number of calls has eased since the peak of Indonesia’s second wave in mid-July, but there are still reports of people dying at home, despite new capacity in the country’s hospitals and isolation centers, where thousands of beds are sitting empty.

So far this month, almost 50 people have died at home from Covid-19, according to LaporCovid-19, an online citizen reporting platform that receives information from families and local officials.

The number surged during July to around 2,400 — a sixfold increase from June, according to Fariz Iban, the site’s data analyst, who called the number “the tip of the iceberg.”

According to LaporCovid-19, most of the deaths were in Jakarta, because that’s the only local government sharing figures on deaths at home from Covid-19.

Indonesia’s Health Ministry doesn’t keep records on the number of people who die at home, said ministry spokesperson Siti Nadia Tarmizi. She said people should only isolate at home when asymptomatic or experiencing mild symptoms.

But the Indonesian Medical Association is urging the government to change its policy, saying home isolation has deprived some patients of medical care and the lack of supervision is helping the virus to spread.

An impossible choice

Last month, as the highly contagious Delta variant swept through Indonesia, its hospital system were quickly overwhelmed.

Positive patients were told to isolate at home if they were asymptomatic, but some were unable to find a hospital bed when their condition worsened.

Warsa Tirta returned a positive Covid test in late June and followed instructions to stay at home, said his son-in-law Fakhri Yusuf.

The 62-year-old driver wasn’t feeling ill, but he had taken a test because his boss had caught the virus and there was risk he’d passed it on.

But within days of Warsa’s home isolation, Fakhri’s mother and two sisters also became ill. Warsa tried to care for them, but before long all three needed professional medical help, Fakhri said.

“I tried to register them all to Covid Emergency Hospital, but they only can accept one person,” said Fakhri. “All beds in the hospital were fully occupied. So we decided to send my sister (to hospital).”

Warsa died on the morning of July 6.

Fakhri said he called the local health center, but no one was available to take the body as hundreds of other people had also died that day.

“Their response was very slow. I was told that all of undertakers are busy with other death victims all around Jakarta,” he said.

So Fakhri called the National Board of Zakat (Baznas), a government-run group that distributes zakats, or alms in the Muslim faith, where Taufiq works as a volunteer.

“They do all the process at home smoothly,” Fakhri said. “Around 4 p.m. we depart to the cemetery, and the whole funeral procession was finished before dark.”

Hospitals overwhelmed

As Covid cases mounted, the government raced to build new field hospitals and isolation facilities.

They included Pasar Rumput, a low-cost apartment block that would offer almost 6,000 new beds, according to a spokesman from the Ministry of Public Works and Public Housing.

The facility opened as planned. But as of this week, local media reports suggested fewer than 300 people were using it.

Siti, the government spokeswoman, says there are more than enough beds for the 30,000 or so new cases being reported each day.

“Now we really don’t see any difficulties for the patient to access treatment, either in the isolation centers or in the hospitals,” she said.

But despite the availability of beds, asymptomatic people and those with mild symptoms are still being given the option to stay at home.

“The ones who have more moderate symptoms, they need to go to the isolation center,” said Siti. “The ones who have very severe symptoms, including difficulties in breathing, they should go to the hospital.”

Siti said positive cases are being monitored at home through a private telemedicine company, where they can access help if needed.

But Dr. Daeng M. Faqih, chairman of the Indonesian Medical Association, says the government’s health advice needs to change.

“We are now advocating government change the policy of home isolations. Isolations should be centralized in special isolation shelters,” he said.

Daeng said home isolation aids the spread of the virus because many people live in crowded conditions, where it’s impossible to protect family members.

“Culturally in Indonesia, it is very common to have more than one family sharing one house, even three families in one house is not uncommon so, this will create family cluster,” he said.

He also said it’s difficult to stop asymptomatic people from leaving their homes.

“They can easily be moving around and infecting others,” he said.

Death toll rising

Indonesia’s daily number of cases may have halved since July, but it’s still reporting the world’s highest death toll each day — about 1,500 people compared to 490 in India and 342 in the United States.

The crisis has delayed the country’s vaccination rollout, and now officials are racing to double the number of daily doses to at least two million.

The country is aiming to vaccinate 208 million of its population of 270 million people, though that is some way off.

As of August 13, less than 10% of Indonesians had received at least one dose of Covid-19 vaccine, according to a CNN count.

In the meantime, Taufiq and his team of undertakers stand ready to help, if and when they’re required.

Taufiq says his day starts with a prayer for his and his team’s safety — and ends with one for those who succumb to the virus.

He says his faith has kept him going through several difficult weeks.

“My family are afraid and scared that I will get infected and bring the virus (home) to them. But I convinced them (it was safe), and they also pray for me,” he added.

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