PRESS RELEASE

Impact of Failing to Overcome the Rate of Covid-19 Transmission: Health Facilities and Health Workers Collapse

July 1, 2021 – The spike in Covid-19 cases has triggered a crisis in health facilities and services. From June 14 to June 30 2021, LaporCovid-19 received 101 reports of residents confirmed positive for Covid-19 who asked for help in finding hospitals, isolation rooms and intensive care rooms such as Neonatal Intensive Care Unit (NICU), Intensive Care Unit (ICU), or High Flow Nasal Cannula (HNFC). Some of them also need ventilators and oxygen. Reports of hospital requests are mostly spread from the Jabodetabek area. Most of them had moderate to severe symptoms, and had previously undergone self-isolation. A total of 11 patients died while waiting for treatment because the hospital was full.

ReportCovid-19 Findings:

• Health facilities and services collapsed. We received reports of 65 residents who were confirmed positive for Covid-19, with moderate to severe symptoms who needed emergency medical assistance. At one of the government's central public hospitals in Jakarta, a patient died shortly after arriving there. Previously he was rejected by several hospitals on the grounds that there were no oxygen cylinders in stock. Apart from that, the next day, there was a report of a patient whose oxygen saturation was below 90 percent, who was forced to go home from the emergency room. The reason, officials said: there are no wheelchairs, beds, oxygen stock, and there are still around 65 patients queuing to be treated.
• On June 29, a 26 year old patient in South Tangerang was expelled from his boarding house because he was positive for Covid-19. His office rented an ambulance and took him to Kunciran Community Health Center. There he just waited in a wheelchair and was not served. Moment
  asked for a referral letter, he was taken to two other health centers. On his way to the Paku Alam Health Center, the patient vomited and became unconscious. Then the patient was referred to Grha MM2100 Hospital and only received an infusion four hours after arriving. Then, even without a referral letter, the patient was taken to the isolation area at the Nagrak Flats. When he got there, he was actually kicked out by several other patients with the reason: they would recovered and did not want to be close to new patients. Having not eaten since last night, he finally queued again to get a room.
• On June 30 morning, there was a report coming in from 1 family with 3 people confirmed positive for Covid-19. They tried to go to RSUI on Tuesday but were sent home because it was full. Even though they have a referral letter, they cannot go to the Wisma Atlet Covid-19 Emergency Hospital (RSDC) because it is already full. One of them, aged 65 years, was directed to the nearest emergency room because he experienced worsening breathing. Meanwhile, the LaporCovid-19 team contacted the Depok Ambulance Hotline but could not be served because it was without approval from the referral hospital. The health center provides the option to use a paid ambulance, but the family does not have the costs. During the day, community health center officers carry out home visits, but the patient did not receive oxygen or medicine. Community health center officers and the local task force helped find a referral hospital. After waiting for about four hours, the patient's condition worsened. When he was taken to the nearest emergency room, there was no ambulance that could take him. Finally the patient died at home.
• A positive Covid-19 patient who had been treated since June 12 at a South Tangerang regional health center, on June 27 needed an oxygen cylinder. The patient's family contacted 112 several times but failed. An hour later, the patient finally got an ambulance to go to RSU South Tangerang. Even though the patient's oxygen saturation at that time was 82 percent, the South Tangerang RSU security guard was not allowed to enter. At that time we contacted the South Tangerang Health Service and their response was: currently the hospital is full and everyone is in need of oxygen. The family then took the patient to Fatmawati Hospital. However, when he got there the patient did not receive oxygen and died while queuing in the emergency room.
  The Covid-19 pandemic crisis means hospitals can no longer accommodate patients, health workers are exhausted and many of them are even infected with Covid-19, and oxygen stocks are running low.

Given the urgency of the situation on the ground, we urge that:

1. Once again, President Joko Widodo must prioritize public health and consider the opinions of health experts in making data-based and humanitarian policies.
2. The government immediately took extraordinary emergency steps by enacting lockdown throughout Java-Bali and other affected areas to reduce the rate transmission of Covid-19, accompanied by an increase in 3T and data transparency so that public understanding is better developed. Enforcement lockdown also accompanied by massive education and providing basic needs assistance to affected communities. Without stopping mobility, health facilities will not be able to accommodate the surge in patients.
3. The government provides protection to health workers, both health protection and incentives to support their duties in caring for Covid-19 patients.
4. Realize the acceleration of oxygen production and distribution to prevent deterioration in Covid-19 patients who experience shortness of breath or decreased oxygen saturation. The Covid-19 pandemic crisis must be handled with help from all parties. However, firm leadership that is oriented towards the welfare of the wider community is needed to lead the control of this crisis.
   

Contact Person:
Amanda Tan (+62 858-6604-4058)
Windy (+62 881-0269-19144)

Attachment
Complete chronology of patient stories:

1. Homestead Nagrak patient
   
   Tuesday (29/06/21)
   19.20: Report via Twitter Female patient (26 years), location in South Tangerang. Asked to leave the boarding house after being confirmed positive. The patient is alone and there is no family. Ask to find an isoman location in South Tangerang. The condition is weak and a little tight.
   20.15: The patient's office rented an ambulance, directed to Kunciran Community Health Center. Waiting in a wheelchair but not being treated.
   21.30: Asked Kunciran Community Health Center to make a referral letter for isoman but the community health center stated that it could not issue a referral letter and asked to go to Parigi Community Health Center.
   21.40: The doctor on duty at Kunciran Community Health Center was contacted by a LaporCovid-19 volunteer doctor, stating that the community health center was full and would refer him to the self-isolation center in South Tangerang.
   22.00: The ambulance was directed by the community health center to go to the Parigi Community Health Center.
   22.30: At the Parigi Community Health Center, patients were again rejected and told to go to the Paku Alam Community Health Center.
   22.38: On the way, the patient vomited and became unconscious.
   23.00: The Paku Alam Community Health Center was also rejected again, on the grounds that there was no oxygen and no nurses.
   23.20: After the LaporCovid-19 volunteer doctor contacted another doctor, the doctor contacted the Paku Alam Community Health Center. Only then was help given (it turned out there was oxygen at the health center).Wednesday (30/06/21)
   00.20: The ambulance officer was informed that the patient was being treated at the Paku Alam Community Health Center and could spend the night there.
   00.20: The LaporCovid-19 team succeeded in contacting the home isoman location of Rumah Lawan Covid Tangsel and was informed that the waiting list was full, 35 people.
   01:08: The Paku Alam Health Center stated that it could not treat the patient if there was no companion. However, when asked what the companion was for, he only said that someone would accompany him. The companion waited outside because he could not enter the room where there were Covid-19 patients. The final agreement is that if there is no one to accompany you then the Puskesmas will not check the patient's condition, maybe later on the morning shift they will check again. Not long after, the reporting person's relatives were contacted again by the community health center that they had found a referral hospital in Cibitung (RS. Graha Cibitung MM2100 Bekasi.). Because the ambulance was still at the Paku Alam Community Health Center, the patient was asked to be taken to Cibitung on the grounds that he had already received a referral and could not choose where to go and what time. The patient goes to the hospital. Graha Cibitung MM2100 Bekasi was alone without anyone accompanying him.
   03.00: The patient arrived at Graha Cibitung Hospital but did not receive treatment. Even though the community health center stated that the referral hospital was ready.
   07.04: New patients receive treatment and infusion at the hospital. Graha Cibitung.
   08.04: The patient received approval to be treated at Wisma Nagrak Cilincing.
   09.30: Grha Cibitung Hospital refused to issue a referral letter to go to the isoman location. Because according to the examination, the symptoms were mild, so he was asked to go home. Even though it was explained that the patient had no place to stay because he had been asked to leave the boarding house and there was no family, and there had been approval from Wisma Nagrak.
   10.30: An ambulance from a social foundation came and took the patient to Wisma Nagrak, without a hospital referral letter.
   11.40: The patient arrived at Wisma Nagrak. The officer at Wisma Nagrak asked for the results of the PCR swab, but the patient only had an antigen swab.
   13.30: The patient had got a room but was kicked out by other patients who were already in the room on the grounds that they wanted to get better so they didn't want to accept and be close to new patients. The patient was asked by the officer to queue again. 14.00: The patient complained of dizziness because he had not eaten since evening. It turned out that the hospital did not provide food, and the food delivered to the hospital in the morning did not reach the patient. While waiting, the patient ordered food from his co-worker.
   14.30: The patient was finally able to get a room at Wisma Nagrak.
2. The patient died at home.
   06.00: Reports received via WA: Patient 1 (M, 65 years old) has had shortness of breath since Tuesday, patient 2 (F, 37 years old) is weak, patient 3 (F, 9 years old) is weak. I went to RSUI on Tuesday but was rejected and went back home. Have a referral letter to the athlete's home but can't contact again because it's full. It is recommended to go to the nearest emergency room considering Patient 1's congested condition. The Laporcovid team helped contact the Depok Ambulance Hotline but did not want to take them if there was no Referral Hospital. I also contacted the Depok Regional Hospital to ask for ambulance assistance but couldn't because it was for transporting hospital patients. The health center has provided information regarding paid ambulances too. The patient did not have a vehicle and had been pushed into a grab bag but the child was also weak and had no one to accompany him. According to the patient, neighbors also couldn't help.
   10.30: During the day there is home visits from the health center staff, but did not receive oxygen or medicine. Officers checked and recorded data to find a referral hospital. Already notified the local task force. Asked to wait for news.
   15.00: The Laporcovid team followed up on the latest news, also called the community health center staff but were only informed that they were waiting for the Referral Hospital. The patient was encouraged to immediately go to the nearest emergency room again because Patient 1's condition was increasingly congested.
   15.38: Patient 2 reported that Patient 1 had died.

Notes:
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