Sausan Atika, Jakarta – The healthcare system in Jakarta is on the brink of collapse as medical workers are dying and hospitals have reported "alarming" shortages of beds needed to treat COVID-19 patients, prompting Jakarta to once again partially close down the city.
With the worsening COVID-19 situation particularly observed after the gradual easing of large-scale social restrictions (PSBB) in June, bed occupancy rates – the number of people hospitalized with confirmed or suspected cases of COVID-19 – in the city's hospitals are increasing.
The city's isolation bed occupancy rate stood at 77 percent and that of intensive care unit (ICU) beds at 83 percent as of Wednesday. The city currently has 4,053 beds in isolation rooms and 528 beds in ICU rooms.
"If we don't pull the brake [by reimposing the PSBB] or allocate additional beds, our projection shows that we will run out of isolation beds by Sept. 17 and ICU beds by Sept. 15," Anies said on Wednesday evening while announcing his decision, which will take effect on Monday.
"We have no choice," he said. "Without strict restrictions, [a collapsed healthcare system] is a disaster waiting to happen."
National COVID-19 task force spokesperson Wiku Adisasmito recently said that 80 percent bed occupancy was still considered safe, so that hospitals could carefully and promptly treat patients. But, in the case of Jakarta, Wiku said, the current rates were "no longer ideal", pointing to the need to bring them down to 60 percent.
The city administration plans to increase the number of isolation beds and ICU beds to 4,807 and 636, respectively, by allocating more beds in 13 city-owned hospitals for COVID-19 patients, adding beds in 67 referral hospitals as well as cooperating with private hospitals for additional referral capacity.
Even with these additional facilities, however, all isolation beds would be occupied by COVID-19 patients in mid-October and ICU beds on Sept. 25 unless the city returned to stricter PSBB, the Jakarta administration projects.
The grim outlook comes amid an increase in deaths of medical workers.
At least 109 doctors across the country have died of COVID-19, including 16 in Jakarta, according to the Indonesian Medical Association (IDI). Nine dentists have also died of COVID-19; five of them were based in the capital. Thousands of medical workers nationwide are infected, according to estimates.
Jakarta recently recruited 1,174 additional medical workers, including pulmonologists, internists, anesthetists, pediatricians, nurses, midwives and public health educators, who came from across the country, and Anies is considering recruiting more.
"[The question] is not only how to increase the number of beds, but also how to ensure that there are sufficient medical workers, medicines, personal protective equipment," he said.
On Thursday, Jakarta reported 1,450 new cases and 18 deaths – bringing the tally to 51,287 confirmed cases, 11,696 of which are active ones, with 4,728 patients hospitalized.
Adang Bachtiar of the Indonesian Public Health Experts Association (IAKMI) said reimposing the PSBB would help prevent Jakarta hospitals from becoming overburdened.
"Staffing shortages and increasing fatigue among medical workers might lead to unsafe procedures and expose them to the virus," he said. "Adding COVID-19 referral hospitals won't resolve the problem; bed occupancy rates reaching almost 80 percent indicates that preventive measures did not take place."
When the PSBB is in place next week, Jakarta will likely allow only 11 essential sectors to operate with limited capacity, while other businesses and offices will have to reimplement work-from-home policies. Operational hours and the passenger capacity of public transportation will also be reduced.
Anies, who is expected to issue a gubernatorial decree specifying the restrictions in greater detail, said the PSBB basically would require people to "work, study and pray" from home.
The governor's move on Wednesday was in line with what health experts have long insisted: Putting public health first through stricter social restrictions is key to curbing the pandemic and to eventually mitigate its economic impacts.
President Joko "Jokowi" Widodo earlier this week also said that "health is key to economic recovery".
But economic affairs ministers were quick to raise their concerns about Anies' decision, with Coordinating Economic Minister Airlangga Hartarto saying in a meeting with the Indonesian Chamber of Commerce and Industry (Kadin) on Thursday that the PSBB announcement had caused uncertainty in the stock market.
Industry Minister Agus Gumiwang Kartasasmita, meanwhile, said Jakarta's PSBB would affect the industrial performance that had somewhat improved over the past few months.
Epidemiologist Dicky Budiman of Australia's Griffith University said Anies' decision was bold and based on data, but, like other experts, he said reimposing the PSBB in Jakarta would be pointless if such restrictions were not well implemented in other areas as well, given that mobility across regions remains high.
"Other areas in Java must do what is being done in Jakarta, especially those with an immense burden on healthcare [systems] and a high number of deaths," Dicky said.
At least 30 percent of confirmed cases in Jakarta originated from outside the city, according to Jakarta Health Agency head Widyastuti.
Jakarta is among cities across the world that have decided to reimpose stricter curbs as COVID-19 cases flared up again after economic reopening, such as Australia's Melbourne, Portugal's Lisbon and India's Bangalore.
– Budi Sutrisno contributed to this story.