Country where COVID-19 is killing kids

Indonesian children are dying from COVID-19 at a much higher rate than in other countries but the government has already started lifting restrictions even though cases keep going up.

The archipelagic nation, made up of thousands of islands north of Australia, is the most populous in South-East Asia, and doctors there are warning up to 160 children may have died.

According to John Hopkins University's tally of coronavirus cases around the world, Indonesia has had over 41,000 cases, and 2,276 deaths, and the curve is still rising even as the restrictions begin being lifted.

There's also fears the true number of cases could be significantly higher due to insufficient testing.

New cases of coronavirus in Indonesia continue to rise steadily.
New cases of coronavirus in Indonesia continue to rise steadily.

The country has one of the largest populations in the world, with 267 million people spread across its islands, more than 10 times the population of Australia.

At the start of June, Indonesia had a testing rate of 1253 tests per million people, one of the lowest rates of testing around the world.

Official figures towards the end of May showed that 28 children had died, but the Indonesian Paediatrician Association recently told the ABC that its own calculations suggested a much higher number.

The Association suspected at least 160 children had died from the disease.

The Indonesian Child Protection Commission also predicted that more than 17,000 children were being observed or were thought to have the disease, but only 715 cases in children had actually been confirmed.

A higher rate of deaths in children compared to other countries is thought to be due to a combination of underlying factors, primarily stemming from poverty.

"COVID-19 proves that we have to fight against malnutrition," senior health ministry official Achmad Yurianto told Reuters.

He said the children were caught in a "devil's circle" of malnutrition and anaemia (lack of red blood cells) that made them more vulnerable, going on to compare the country's malnourished children to weak buildings that "crumble after an earthquake".

Poor healthcare infrastructure was another factor.

"The biggest discrepancy in Indonesia is the availability of paediatric intensive care units," Jakarta based paediatrician Shela Putri Sundawa told the news outlet.

Another paediatrician said his hospital on Madura Island, where an 11-year-old died in March, didn't have ventilators for children.

The father of a nine-month old boy who died from COVID-19 on Lombok told Reuters the hospital did not have care units for children, adding that his son would probably have survived if the hospital had complete facilities.

The fact that Indonesia is a country of islands doesn't seem to have done much to help stop the virus from spreading either, but it may have hindered its government's ability to respond.

In Australia, the government introduced the National Cabinet (that will remain and replace the slow-moving Council of Australian Governments) so the federal government could quickly collaborate with state and territory administrations over the response.

Indonesia is made up of 34 provinces spread over approximately 17,500 islands.

But it wasn't until mid-April that those provinces were allowed to decide on their own restrictions to try and stop the spread of coronavirus.

Indonesian president Joko Widodo has faced widespread criticism over his government's response.

A group of workers filed a class-action lawsuit against President Widodo in Jakarta in April, claiming 10 billion rupiah ($A103,000) in damages.

The group argues for two and a half months after the virus was reported in Wuhan, the government did nothing to prepare for it spreading to Indonesia, and even joked that it wouldn't be able to.

"The plaintiffs certainly have a lot of examples of the government's disappointing response to the disaster," Gadjah Mada University law lecturer Laras Susanti wrote recently.

"These responses led to public frustration exploding on social media. The Indonesian Doctors' Association (IDI) sent letters begging the government to provide proper personal protective equipment and implement rapid public testing," she said.

But it wasn't until the end of February that the country declared a state of emergency.

The government responded to the lawsuit saying it wasn't liable because the COVID-19 crisis was historically unprecedented and its scale unpredictable, and told the public it had managed the crisis relatively well when compared to some other countries.

Ms Susanti said the lawsuit had a "quite high" chance of success, but that a recently issued presidential regulation in response to a previous successful lawsuit against the government could mean it wasn't held liable if it implemented policies in good faith.

An Indonesia aviation officer checks a passenger's body temperature at the arrival terminal of Adisucipto International Airport in March. Indonesia’s government has been criticised for not taking the virus seriously enough in its early stages. Picture: Ulet Ifansasti / Getty Images
An Indonesia aviation officer checks a passenger's body temperature at the arrival terminal of Adisucipto International Airport in March. Indonesia’s government has been criticised for not taking the virus seriously enough in its early stages. Picture: Ulet Ifansasti / Getty Images

She said accountability was akin to good faith, and unfortunately on that count the president's "leadership in the COVID-19 crisis has left much to be desired".

She added regardless of the outcome, the lawsuit delivered a clear message to the government that the public was watching their poor handling of the crisis and were willing to hold them accountable for it.

People aren't waiting for the lawsuit to end to form an opinion though.

"The government's narrative from the beginning has been one that denied the science and denied the need for early action," communications specialist Elina Ciptadi said during a webinar on the politics and economics of Indonesia's response.

Ms Cipatdi co-founded a website that aimed to provide Indonesians accurate information on how to deal with the pandemic.

According to the International Institute for Strategic Studies (who organised the webinar), the website is considered one of the most reliable sources of news on the virus in Indonesia, with think tanks and even government officials relying on their data.

An article posted on the website notes the country has been impacted differently than others, documenting an "interesting trend" in Indonesian COVID-19 victims: they were younger than in other countries and higher in the productive age group.

It's theorised Indonesia's high rates of heart disease risk could be a factor.

Two-thirds of Indonesians over the age of 40 are at risk of dying of heart disease, and those vulnerable might not realise it.

People with other health conditions were at an elevated risk from COVID-19.

A shop opens for business at the start of June. Restrictions have started being eased in Indonesia but its case numbers continue rising. Picture: Ulet Ifansasti / Getty Images
A shop opens for business at the start of June. Restrictions have started being eased in Indonesia but its case numbers continue rising. Picture: Ulet Ifansasti / Getty Images

"Seeing the high rate of death due to comorbidities in other countries, combined with findings about the high prevalence of heart disease among productive age, these two things are consistent to explain the trend of high mortality due to COVID-19 in the productive age group in Indonesia," the article reads, warning the trend "has the potential to exacerbate the economic impact caused by this health crisis in the long run, because the productive age group is the motor of the family economy and the motor of state productivity".

The economy has been a common focus for hard-hit countries as they seek to reopen even while cases continue climbing.

The so-called "new normal" in President Widodo's country advises Indonesians will simply have to learn to "coexist" with the virus, but people will still be required to wear masks and observe physical distancing.

As restrictions begin lifting, Indonesia recorded its highest single day of new infections, with 1031 new cases, overtaking Singapore as the country with the most infections in South-East Asia.

Originally published as Country where virus is killing kids


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