A man walks past a mural depicting the Covid-19 coronavirus in Surabaya, April 6, 2020. Photo: AFP/Juni Kriswanto

JAKARTA – If the experience of two random patients is any guide, it takes a fortnight or longer for the Indonesian health system to confirm a case of coronavirus, one probable reason why the nation appears to have the highest mortality rate in Southeast Asia and one of the highest worldwide.

Simplistically, that comes from dividing the official death toll (209) as of April 6 into the number of confirmed cases (2,491), but if the real number of infections is actually at the 40,000-50,000 level, as modeling by such institutions as the London School of Hygiene & Tropical Medicine suggests, then the ratio isn’t so high after all.

According to Statista, after topping the global tables three weeks ago, Indonesia’s current death rate of 8.7% now puts it in fifth place in the world behind Italy (12.3%), Algeria (11.5%), Britain (10.3%), Netherlands (9.8) and Spain (9.6%).

While early Chinese research showed it took a median period of 14 days from first symptoms to death, especially for those with underlying health issues, the World Health Organization (WHO) has so far not updated its last estimate of the average global mortality rate of 3.4% in early March.

Amid all the statistical uncertainty, Indonesians are left to speculate endlessly on whether a coronavirus bomb is still waiting to go off in their country — and just how long they can expect to wait in this strange, twilight-like existence for the pandemic to reach its lethal peak.

The Health Ministry confirmed 218 new coronavirus cases on April 6, the biggest daily jump since the first cases were announced a month ago.

An Indonesian woman wearing a face mask stands on a street in Jakarta on March 2, 2020. Photo: AFP/Adek Berry

Jakarta Governor Anies Baswedan, who has set a course separate from that of President Joko Widodo’s central government, raised eyebrows last week by noting that more than 400 suspected victims had been buried in Jakarta alone so far, compared to the city’s official Covid-19 toll of just 90.

But while news reports have noted a significant spike in overall funerals in the capital last month compared to previous years, the majority of the victims weren’t confirmed Covid-19 cases and autopsies as usual were not conducted.

Witnesses describe distressing scenes at Jakarta cemeteries where relatives are instructed to stand 40 meters away as plastic-encased victims are interred by hazmat-suited workers, in one case six burials in two hours. Yet there have been very few reports of overflowing hospitals and grieving families.

Older Indonesians, many with smoking habits, poor diets and a susceptibility to strokes, heart disease and diabetes, are particularly vulnerable to Covid-19 when Jakarta’s polluted air is also a common cause of acute respiratory ailments that weaken the immune system.

According to the World Health Organization (WHO), tuberculosis, influenza, asthma and other lung-related diseases claimed 285,000 lives across Indonesia in 2017, still short of the 332,000 deaths from strokes, where Indonesia remains the world leader.

Greenpeace Indonesia estimates about 7,400 Jakartans die each year from the effects of PM2.5, the tiny particles used to measure the level of pollution, while in 16 of the capital’s 44 sub-districts upper respiratory infections are the top cause of illness.

Gravediggers and health workers bury the body of a Covid-19 victim at a public cemetery in Bekasi Regency, West Java province, Indonesia on April 4, 2020. Photo: AFP via NurPhoto/Aditya Irawan

As the government dithers over how to stop the virus spreading from its Jakarta epicenter — and works on newly announced plans to spend an initialUS$24.3 billion on health care, social safety nets and business rescue programs – the health system struggles.

Take the case of Achmad (not his real name), a resident of south Jakarta who went to one of the eight state-owned hospitals designated for coronavirus testing on March 27 because he was suffering from a cold and dry cough he couldn’t shake.

After waiting for more than five hours, he underwent an obligatory blood test and a chest x-ray, and was told to come back next day for the results. He did, waiting another four hours in a crowd of several hundred for a doctor to prescribe him antibiotics.

He was told to spend four days in self-isolation, after which he would be called to undergo a Covid-19 rapid-test. The call never came.

At that point, a lower-income patient might well have given up and left it at that; most Indonesians have a fear of the doctor anyway.

Achmad, however, is an educated professional who was able to recruit the help of a well-connected friend and undergo a test at the former Asian Games athlete’s village in North Jakarta, which has been converted into a military-run emergency hospital.

The result came back in 15 minutes – negative for Covid-19. But that wasn’t enough. He has to return this week, seven days later, for a second test just to make sure. The medical profession doesn’t have a lot of faith in the procedure because false negatives are common.

Officials in protective gear disinfecting Indonesian students as they disembark upon arrival at Hang Nadim international airport in Batam following their evacuation from the Chinese city of Wuhan. Photo: Indonesian Embassy/AFP

Another female patient spent two weeks in and out of three hospitals without being tested. At a fourth hospital, a rapid test found her negative. Then three days later, on April 2, a polymerase chain reaction (PCR) test declared her positive for the virus.

Doctors consider the uncomfortable PCR swab test to be the gold standard, yet the same patient was told she still has to have a second test. So too does a third patient this writer knows who was found to be negative the first time.

West Java Governor Ridwan Kamil, a Widodo ally critical of the government’s handling of the crisis, said on April 2 that only 677 of the 15,000 people to have undergone the rapid test were positive for the virus. In Jakarta, however, 30% of the 7,986 tested had the disease.

The government has already distributed 400,000 rapid-test kits, but any positive tests from that method are not included in the government’s daily update of confirmed cases. So far, according to news reports, there have been only 8,000 PCR tests nationwide.

Kamil isn’t happy with the government’s flip-flop on its previously announced  plans to limit the movement of tens of thousands of people out of the capital, some either newly jobless workers and others anxious to avoid a possible lockdown.

But that seemingly impossible task is exemplified by the 24,000 new arrivals, documented by local transport authorities, in the district capital of Wonogiri, east of Jogjakarta, home to large numbers of domestic staff employed in Jakarta and abroad.

After initially indicating he would call off mudik, the post-Ramadan holiday when as many as 20 million people from the Greater Jakarta area head for their home villages, Widodo now says he will not try to prevent it.

Indonesian President Joko Widodo visiting a hospital for Covid-19 patients in Batam. Photo: AFP/Presidential Palace

The government had been looking for ways to stop the spread of Covid-19 into the Java countryside, but when the Cabinet met for a video conference on April 2, the president bluntly told his ministers: “We can’t stop mudik.”

Instead, he wants local governments to ensure that travelers self-isolate when they reach their destination, but that is equally as impossible as trying to stop them going home for mudik – a tradition involving mass get-togethers of family and friends.

Senior government officials, including Maritime Coordinating Minister Luhut Panjaitan and National Disaster Relief Agency head Lieutenant General Doni Monardo, are on record as saying they fear mudik will be disastrous if it goes ahead as usual.

Officials could not explain Widodo’s overnight change of tone, but as one well-placed source put it: “Something is missing from the video-conferencing. We can’t read the president’s body language. Suddenly there seems to be a distance between us.”

On two occasions now, the government has inexplicably trotted out Vice President Ma’ruf Amin for a televised discussion on the response to the crisis, but the aging cleric seems so out of touch with the situation he has proved to be an embarrassment.

All the government can do now is appeal to Jakartans to think long and hard before making the trip home in the cramped confines of buses and trains most of them will use on their week-long holiday.