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From here, there is no turning back the worst case outcome
I worked in Indonesia for 5 years, and I was shocked to read last night that "at least" 25 Indonesian front-line doctors have succumbed to Covid19 fighting the pandemic.
They died because, like all their other medical infrastructure, Indonesia lacks the essential equipment to protect its medical workers.
A lack of Personal Protective Equipment was the primary reason for the deaths, according to the Indonesian Medical Association.
Tragic as it is that 25 doctors have died, all those nurses and other medical staff who support them have even less access to PPE and must be dying in droves.
Last week on ABC (America) World News, they crossed to a video call with one of the ER doctors on the front line in NYC. He was lamenting the lack of PPE, and that medical nurses and doctors were dying.
He said this, which sent a chill up my spine: "We need more PPE, because when we've gone there will be no one to save you".
That immediately flashed into my mind when I read about the doctors dying in Indonesia.
The Indonesia reports are opaque
Covid19 statistics from Indonesia are opaque. On April 7, the Indonesian Health Ministry announced 247 new cases, bringing the total number of infections nationwide to 2,738.
That's 2,738 total cases in a nation of 264 million, with no containment plan in place, no medicines, no equipment, no stay-at-home, and, of course, no PPE.
Because Indonesia lacks all these things, it has no choice but to allow unchecked community spread and to watch the playing out of the worst-case scenario.
That is, they will see the highest imaginable peak that flows from no having protective measures and will not have the slightest ability to control it.
Criticism of China abounds, but China mobilised massive and capable forces against Covid19.
The interventions implemented throughout China included the complete lockdown of cities, active case surveillance, rapid investments in increased testing capacity, isolation of cases, treatment of severe cases, quarantine of cases and high-risk groups, and behavioural risk-reduction strategies, such as the compulsory use of masks in the general population.
How does that compare to Indonesia?
Indonesia has introduced a token lockdown in Jakarta (starting April 7) and plans to suspend schools and offices, limit religious activities and restrict gathering in public places. Also, they have suggested that people wear masks in public.
Here's why I call the efforts tokenistic
In Jakarta, there is a law that motorcyclists must wear helmets. And the motorcyclists do wear helmets - plastic $2 ones like children wear when playing war games.
This is analogous to the wearing of face masks. The face masks which will be worn by the masses are cheap pieces of cloth, worn for weeks at a time, and handled without care. They are just a façad - more likely to spread the virus than contain it.
Ordering people to stay at home when they earn money one day to spend on food the next day can't work. If they are forced to stay inside, they starve.
So, all in all, Indonesia has no capacity what-so-ever to implement effectively anything that China implemented to control the spread. It has no telemedicine, little industry to produce ventilators, and few reserves to support the economy. Logistically, it is a challenging country to navigate and service.
And there are some other quirks, which won't help either. When you are a hospital in-patient in Indonesia, your family brings you your food. Otherwise, you'll only get a plain bowl of rice - if you are lucky.
Obviously, the family are not going to be able to be allowed to bring food to Covid19 patients. The logistics to provide food for thousands of patients is not going to be able to set up amid the pandemic.
The Ramadan effect will spread the virus throughout
Religion, and the celebration of Ramadan, will also play an unkind role in thwarting official attempts to control community spread. Ramadan is the ninth month of the Islamic calendar, observed by Muslims worldwide as a month of fasting, prayer, reflection and community.
In 2020 Ramadan will be celebrated between Thursday, April 23, and Saturday, May 23. The first phase requires fasting from dawn to dusk, while working normally, and then eating after dusk. This means that markets after dusk are especially crowded, and in homes, the breaking of the fast is celebrated with family and friends. At the end of Ramadan, there is a three-day celebration where people go back to their home village and celebrate with their families.
Jakarta has nearly 3 million “migrant workers” — that is from outside Jakarta, and they traditionally head home for the last 3 days. This spread will take the concentrated virus from Jakarta and spread it throughout the country. It would be beyond the realm of possibility to stop the movement of people as it is so ingrained in the culture, religion and family relationships to participate.
There is also the matter of the Muslim extremists, who may well choose to ignore any social distancing and social restrictions. These account for about 10% of the population — about 25m people. This type of civil disobedience makes community spread uncontrollable.
There is also the matter of the Muslim extremists, who may well choose to ignore any social distancing and social restrictions. These account for about 10% of the population, about 25m people. This type of civil disobedience makes community spread uncontrollable.
What's the scenario from here?
The death rate in China, as a result of their concerted actions, was 1.38%. At one stage the death rate in Italy was 9%.
The worst-case scenario presented to President Trump was 214 million Americans infected and 1.7 million dead. That is based on 64% of the population of 327 million contracting the virus.
Some argue that the Chinese death rate of 1.38% is a substantial underestimate - the CIA briefed President Trump to this effect.
However, let us say that in Indonesia, 64% of the population contract the virus (the worst-case for the US) and the death rate is 1.38% (best-case from China).
Using those numbers predicts 2.33m Indonesians will die.
However, Indonesia will be totally and absolutely overwhelmed, and the virus may reach 80% of the population. There will be a higher death rate than 1.38% as in China - let's say 2.00%.
On that basis, 4.22 million Indonesians will die. Hundreds of thousands of children will be orphaned. That is horrific, but a plausible outcome.
From here the only outcome possible is the worst case
It is even more horrific because, from now, there is no way back.
Even if Indonesia could get millions of items of PPE, and tens of thousands of ventilators, there is no way to deploy them in time.
The US won't help - it can't supply its own requirements. The only country which can and will step into the ring is China. No doubt China will supply Indonesia with huge medical aid. But the effect on the outcome - at this stage - will be marginal.
It's a horrific tragedy in Australia's own backyard, and we can't help either.
It is also a massive tragedy that is already playing out - more or less - in other countries such as Iran, Irak, Bangladesh, Pakistan, Afghanistan, Russia, India, Nigeria, Kenya, and more. We're heading for a global death toll of 10 to 20m people, not the 1m people for which we may have been hoping.
Praise to the doctors and medical workers in Indonesia, and may they live through this monumental moment in their young nation's history.
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