Covid infections imperil Indonesia's vaccinated health workers, and hospitals

Indonesian pulmonologist Erlina Burhan is exasperated after another long shift in a jam-packed hospital missing 200 staff infected by the coronavirus despite being vaccinated just months ago.

"It's crazy, really crazy," she tells Reuters. "More patients but less staff. This is ridiculous."

About 95% health workers have been fully vaccinated, overwhelmingly with China's Sinovac, said the Indonesian Hospitals Association (IHA).

But, according to independent data group Lapor Covid-19, 131 healthcare workers, mostly vaccinated with the Sinovac shot, have died since June, including 50 in July.

An Indonesian health ministry spokesperson did not immediately respond to a request for comment.

Amid the surge in infections, some medical professionals are now questioning the efficacy of the vaccine though the Indonesian government says the problem lies with the Delta coronavirus variant not the vaccine.

Most infected health workers exhibit only mild symptoms but a survey by Reuters of doctors, hospital directors and health industry chiefs indicates that thousands have been forced to isolate across Java island, home to about 150 million people and the epicentre of Indonesia's worsening outbreak.

Lia Partakusuma, secretary general of the IHA, said she had surveyed big state-run hospitals across Java's major cities.

"They say 10% of their staff are positive for Covid," she said.

Those staff should isolate for two weeks, she added, although other medical professionals said many were sequestered for as little as five days because they were so badly needed at work.

The surge in deaths and infections of health workers could not happen at a worse time, say doctors and hospital executives.

A fourfold increase in official figures for coronavirus cases in the past month to more than 31,000 per day means the numbers needing hospitalisation have gone up by "three to five times", according to the IHA.

Epidemiologists say that low testing rates mean official Covid-19 data does not truly reflect the extent of the outbreak.

Manpower is the problem

Patients hooked up to intravenous drips in car parks, others lying comatose in makeshift beds in corridors, the frantic search for oxygen amid shortages - all now commonplace in hospitals across Java, doctors and hospital directors say.

Many hospitals are either nearly full or over-capacity, hospital directors and the IHA say.

Public health experts fear the situation will deteriorate and warn that Indonesia could be "the next India", where Covid cases skyrocketed and the health system was swamped in April and May.

But Indonesia is less prepared than India to handle such a crisis. The Organisation for Economic Co-operation and Development says Indonesia has 0.4 doctors per 1,000 people, the fifth lowest in the Asia-Pacific, and less than half that of India.

Struggling with the staff shortages, hospitals are recruiting "volunteers" - pharmacists, radiographers and medical students paid modest amounts.

An executive of a hospital chain, who spoke on condition of anonymity, said caring for Covid-19 patients often required skills that could not be provided by students or other volunteers.

"It's not really a solution," the executive said.

The government has imposed tough social restrictions on the islands of Java and Bali, while the health minister has promised nearly 8,000 more hospital beds.

But doctors ask what good more beds will do without the staff.

"The problem is manpower. Even if we can add space, who can take care of them?" said neurologist Eka Julianta Wahjoepramono.

"Nobody. That's the problem."

'No significant antibodies'

Indonesia has relied heavily on China's Sinovac vaccine because it was the only pharmaceutical company to quickly sell it large numbers of doses.

It vaccinated most health workers in February and March, making them an important global test case for the efficacy of the vaccine.

At first the Sinovac inoculation programme significantly reduced deaths from Covid-19. In January, 158 doctors died from the respiratory disease but by May the number dropped to 13.

Since June, at least 30 doctors have perished, according to the Indonesian Medical Association.

Eka, who was fully vaccinated with Sinovac, ended up in hospital with a severe case of Covid-19 last month.

"Many of my colleagues did not have significant antibodies increase after Sinovac," he said, meaning they did not have high levels of protection against infections.

Sinovac did not respond to requests for comment but last month, Sinovac spokesman Liu Peicheng told Reuters preliminary results showed the vaccine produced a three-fold reduction in neutralizing effect against the Delta variant.

He said a booster shot could quickly elicit stronger and more durable antibody reaction. He did not provide detailed data.

Health Minister Budi Gunadi Sadikin has defended the Sinovac vaccine. "The issue that we are facing is not about the different efficacy between vaccines, it is primarily because of the Delta variant."

The Medical Association has urged the government to give health workers a third dose of the vaccine, and quickly.

Some doctors are flying to the United States to get inoculated with other vaccines. For most though, such a trip is too expensive, said Dr Berlian Idriansyah Idris.

"We cannot isolate ourselves and work from home, for God's sake. Not now," he said.

"A third shot will give us the protection we need."