Hundreds have died from Covid-19 in recent weeks, many of them under the age of 5. National leaders face mounting criticism that they have been unprepared.
Hundreds of children in Indonesia have died from the coronavirus in recent weeks, many of them younger than 5, a mortality rate greater than that of any other country and one that challenges the idea that children face minimal risk from Covid-19, doctors say.
The deaths, more than 100 a week this month, have come as Indonesia confronts its biggest surge yet in coronavirus cases overall — and as its leaders face mounting criticism that they have been unprepared and slow to act.
"Our numbers are the highest in the world," the head of the Indonesian Paediatric Society, Dr. Aman Bhakti Pulungan, said of the death rate. "Why are we not giving the best for our children?"
The jump in child deaths coincides with the surge of the delta variant, which has swept through Southeast Asia, where vaccination rates are low, causing record outbreaks not only in Indonesia but also in Thailand, Malaysia, Myanmar and Vietnam as well.
Indonesia, the world's fourth-most populous nation, this month overtook India and Brazil in the number of daily cases, becoming the new epicentre of the pandemic. The government reported nearly 50,000 new infections and 1,566 deaths among the entire population Friday.
Based on reports from paediatricians, children now make up 12.5 per cent of the country's confirmed cases, an increase over previous months, said Aman, executive director of the Paediatric association. More than 150 children died from Covid-19 during the week of July 12 alone, he said, with half the recent deaths involving those younger than 5.
Overall, Indonesia has reported more than 3 million cases and 83,000 deaths, but health experts say the actual figures are many times higher because testing has been very limited. Critics say the nation's leaders have relegated health experts to a secondary role in combating the spread of the virus, even after the delta variant devastated India earlier this year.
"The government has never taken this pandemic seriously from the beginning," said Alexander Raymond Arifianto, a research fellow at the S. Rajaratnam School of International Studies in Singapore. "The voice of the actual experts in how to best handle the pandemic is simply not being heard."
On Sunday, Indonesia's president, Joko Widodo, extended some restrictions on gatherings and commerce through August 2 but relaxed others, such as allowing traditional markets to resume operating as usual with strict health protocols.
Joko, a former businessman who has been reluctant to impose lockdowns that slow the economy, had said he would begin lifting restrictions if case numbers declined.
"With our hard work together, God willing, we can soon be free from Covid-19, and the socioeconomic activities of the community can return to normal," he said Sunday evening.
More than 800 children in Indonesia younger than 18 have died from the virus since the pandemic began, Aman said, but the majority of those deaths have occurred only in the past month.
"Until now, children have been the hidden victims of this pandemic," said Dr. Yasir Arafat, Asia health adviser to the nonprofit group Save the Children. "Not anymore."
"Not only are countries like Indonesia seeing record numbers of children dying from the virus," Yasir said, "but we're also seeing an alarming rise in children missing out on routine vaccinations and nutrition services that are critical for their survival, which should ring major alarm bells."
Health experts said a number of factors contributed to the high number of deaths among children. Some could be vulnerable to the virus because of underlying health conditions such as malnutrition, obesity, diabetes and heart disease, doctors said.
The country's low vaccination rate is another factor. Just 16% of Indonesians have received one dose, and only 6 per cent have been fully vaccinated, according to the Our World in Data project at the University of Oxford. Like other countries, Indonesia does not vaccinate children younger than 12 and only recently began vaccinating those age 12-18.
At the same time, many hospitals have been stretched beyond their limit by the recent surge in cases, with patients waiting in hallways and overflow tents for a bed in a ward to open. Few hospitals are set up to care for children with Covid.
"If the children get sick, where are we going to take them?" Aman asked. "To the emergency room? Emergency wards are overwhelmed with adults. And as you have seen for the past couple of weeks, people have to wait at the emergency room for days. How do we expect children to go through that?"
With hospitals at capacity, about two-thirds of adult patients are in isolation at home, which increases the chance that children will be infected, said Edhie Rahmat, executive director for Indonesia at the nonprofit health care group Project HOPE.
Infants are also put at risk by the tradition of friends and neighbours visiting a newborn's home to celebrate the birth, he said.
"These newborns are being released from hospitals with negative Covid-19 status but later contracting Covid-19 and dying after being visited by neighbours and extended family members," Edhie said. "It is heartbreaking."
Aman said educating the public and getting more people to comply with health protocols would be a good start in protecting children.
"It all goes back to the adults," he said. "The adults are the stubborn ones. They refuse to wear a mask. They bring their children to crowded places."
Indonesia, a vast archipelago of 17,500 islands, also ranks in the bottom third among nations in testing, said Dr. Windhu Purnomo, a lecturer in public health research at Airlangga University in Surabaya.
The country's health minister, Budi Gunadi Sadikin, has set a goal of 400,000 tests a day. But the country has never come close to that figure. Last week, the number dipped below 115,000.
Positive tests are averaging more than 30 per cent, a sign that the virus is spreading rapidly and that not enough tests are being conducted. The World Health Organization recommends a positivity rate below 5 per cent.
"If we evaluate these numbers, this means that the emergency restrictions haven't been working," Windhu said.
Luhut Pandjaitan, the coordinating minister for maritime affairs and investment and perhaps Joko's most trusted adviser, is leading the country's Covid-19 response. He pledged last week that the government would increase testing and tracing and provide more isolation centers, especially in densely populated neighbourhoods.
"Believe me that we are doing our best, but this delta variant is a difficult situation, and that is the reality of it," Luhut told reporters. "No country in the world can claim they have overcome it."
This article originally appeared in The New York Times.
Written by: Richard C. Paddock and Muktita Suhartono
© 2021 THE NEW YORK TIMES