Unsung Heroes Behind the Alleviated Cases of COVID-19

How the distribution of vaccines, data tracking of positive caves, hospital beds occupancy, logistics of oxygen tanks, etc were handled to solve COVID-19 in Indonesia

In late 2019 we got struck by a global pandemic in which no country on earth was actually prepared to handle, we know how horrible it was, no need to go long on that. Though, Since we are already at a much better place than how it was back then it’s easy to take it for granted how amazing it is that we manage to handle it up to this point.

Imagine this, every country was reporting similar symptoms of a new and highly contagious disease that it spread almost like a wildfire, you are being tasked to monitor how much the of the people of your nation contracted the disease, you are responsible of keeping that numbers down. By keeping that numbers down it means that leveraging healthcare workers (doctors, hospital occupancy, etc) to meet patients demands in hope of curing the disease and decreasing the positive cases rate. You work as an advisor at the Ministry of Health of Indonesia, what will be your first step? Plus, people are dying every day and every news get sent to your private communication application.

Alright, so that was the state of everything. I was fortunate enough to be invited to a private event that talked exactly how those problems were solved and how many insane problems are in between solving each problems. Though, there are some parts that are and should remain confidential I will not post complete detail due to many concerns such as the possibility of attacking the infrastructure, national secrets, etc. So let’s get started!

Hospital Beds Occupancy Problem

Let’s talk about hospital beds occupancy, big problem. COVID cases sky rocketing but hospital beds occupancy remains fixed, there will be an overflow at some time. Though, if only there is a way to know when your family member contracted COVID and to be hospitalized in a hospital where it has the highest possibility of being taken care of a.k.a available hospital bed occupancy. This case were explained in such extreme measure, because if a patient were to have COVID and had to wait in line for beds (for example 10 patients), there were cases that these 10 patients died in the streets beside the hospital. The need of real time data of hospital and updated to civilian is a crucial problem, we’re talking minutes to save lives. Here’s one of the link to such cases where patients died waiting in line.

How do you get real time data of hospital beds occupancy across many hospitals while all of the healthcare workers inside of the hospitals are also already too busy saving lives?

News on Hospital Beds being full due to COVID 19.

How we solved it back then, the advisor of ministry of health called a volunteer organization to remain in station and manually check for hospital beds that are in the hospital. Each hospital had three shifts and hundreds of thousands of volunteers were deployed to many hospitals. How do they communicate and update to the database? Through mf WhatsApp. Yeah you got that right, through WhatsApp. The pace that was necessary to solve that problem is immediate, there are hundred thousands of volunteers, so little time. So then after the data was sent to a WhatsApp bot, there’s a script to extract the data to an excel file in which there’s another script to extract that excel file to fit to the centralized database. There was probably not much time to make a dedicated end to end application but this imperfect architecture just—simply—works. And that’s admirable. So after that we can actually get real time data of hospital beds occupancy. Civilian who contracted COVID can check the latest updated data regarding hospital beds occupancy and be notified what minutes, hours were the data were last updated so they don’t make the wrong travel decision before deciding to go to any hospital.

Vaccination Problem

There were also problems regarding vaccination and deployment. Convincing the population to get vaccination is one problem, tackling the logistics of vaccination is another. Imagine this, an relatively unknown disease just attacked your country and attacked millions, the best safety measurements to solve the contagion is through vaccination. To who and to which group of people you will vaccinate first? How do you deliver those vaccines?

Take time to properly address the situation and come up with your own idea, until then you can scroll.

So obviously, the first group of people you need to vaccinate is doctors and healthcare workers. Since their existence is well—pretty self explanatory. I am not going to describe the problems on that due confidentiality problems. Then elderly people, so I don’t know if you are familiar with this when it happened, not many people actually believed in the vaccine. Then an app came out, called Peduli Lindungi, in which everyone who is not vaccinated are not allowed to travel overseas and go to the malls along with many public places. Then the elderly and the young get vaccinated … No, this actually happened, do you not remember 😂? That’s one of the magic of peduli lindungi. Even at that time the app was far from perfect, it drains battery, it’s laggy, etc. Well I mean it’s kind of obvious, can you imagine how many API need to be hit in each day? Imagine this, you want to gatekeep your citizen that could possibly be a carrier of COVID and yet they are so reckless that they still go out regardless of them possibility spreading COVID. How do you solve this problem? Also each passing day that this problems remain unsolved, more and more people died.

That question of a job made me contemplate how big of a burden it was for the key people to solve this problem. Yet one of the solution to that was rather unlikely when it happened. Who would’ve thought people who were skeptical of vaccination were to be actually want to be vaccinated if in return they would have access to public spaces? Also it is no joke on how to implement a system to confirm each citizenship verification of vaccination in order they could travel to public places and overseas. Not going to talk about the backend system too much so anyway, let’s just say that is not a piece of cake to make a system where the target was whole citizen of Indonesia were to use it and fires request everyday, whether it is for access to public spaces or to add vaccination status to the app. Plus the development and the implementation need to be extra quick. Truly truly unsung admirable heroes. Social consequences were also taken into consideration where group of people that found out one of them are unvaccinated and it shows from the application, they got scolded and being put more pressure to urgently vaccinate, for the sake of everyone. Those things that we may not think of really catalyze the place that we are in right now, where we can go to public space relatively safely.

Drugs Delivery Problem

There were also concerns regarding the delivery of drugs. Now imagine another problem, how do you deliver drugs to patients that are just recently found to be positive the next day after they are reported to be positive? In the patient’s experience, you know to prevent COVID is to get vaccinated but what happened if you got COVID? What now? How do you as the member of the ministry of health alleviate that patient’s concern?

Have you figured out your own solution? If no try to think again!

If yes, scroll below!

The solution to that was telemedicine and it was glorious. So the ministry of health worked with lab testers, gain the result of whoever was tested positive, in which they have their phone numbers and asked whether they want to be sent a medical certified drugs or not. This drugs are no kidding, we are talking about 1 million IDR ~ 2 million IDR worth of drugs to be sent FREELY for us as citizens. The other problem to this was logistics, in which the advisor of the ministry of health came out w the solution to ask for a friends help to the director of SiCepat for the drug delivery services.

You know what they did? They agree to it and they worked for the ministry of health FREE OF CHARGE. The ministry of health team even need to confirm of such righteous deed, in a matter of months hundreds of thousands of drugs were delivered to patients with COVID and they got relieved. Imagine the costs…

It’s incredibly motivating to know all of these happens behind our backs. Had I not come to the talk I wouldn’t know of the sacrifices which made me so eager to share in this article. The nobility inspired me to be more productive and to live not only for myself but for the act that I believe I too, can be responsible and save many lives. In the middle of the talk today, I was suddenly reminded my main motivation of going to university where there were a huge dilemma between choosing medical school and engineering school. I argued with my mom who wanted very badly for me to go to medical school in which I argued that if I managed to create something or solve a problem in healthcare through engineering I would be able to help many in one time, while if I take the path as a doctor I would only work and help one person at one time, it is not scalable, if nobility from helping people is what my mom wants of me to become a doctor then let me become an engineer. Until now, that spirit still lies in me. The spirit of wanting to help others and lives if possible. I suddenly feel so refreshed after hearing the talk, to see another spirit lives and go to such lengths and heavy work and able to save lives through engineering and technology, truly a relieving moment. I really wish I could and become the same. The best part was also the speaker take into account of my health-tech startup, I was so happy.

Oxygen Tanks Problem

Anyway, we are at the end of the talk, but I suddenly remembered I haven’t explained the problem with oxygen tanks. So in the surge of COVID, one of the most important supply was oxygen tanks. The problem was that there aren’t many oxygen tanks factory… Plus to carry out these oxygen tanks, huge truck were needed for transportation and these trucks have schedule. The biggest problem is that hospitals usually run out of oxygen tanks supply every DAY, more precisely after 3 hours. The trucks only started transporting tanks in 7 AM in the morning, imagine how messed up the logistics were.

So one of the way to solve that we brought a data scientist PhD from Stanford in which he asked for the most accurate data regarding oxygen tanks stocks, usage in hospital, patients number, etc from the hospitals that are collected, there isn’t many in detail unfortunately, but there are some. In which from the imperfect or incomplete data, the professor created a model in which he precisely predicted when a hospital would run out of oxygen supply and advised the logistics to adjust and transport the oxygen tanks accordingly. We followed the model and it turns out to be accurate, it was also surprising for everyone, it’s not as if its obvious that you can actually create a model and followed out of imperfect data.

My deepest respects and admiration to the heroes that take part in solving the problem. Fast decisions need to be made, countless nights were spent in hope of solving the pandemic or at least alleviate the positive cases. There are probably still a lot of unmentioned credits or noble acts of deeds that remain unnoticed.

I have picked up some sentences that I could live by with from knowing and hearing these stories of the unsung heroes.

We Can Always Make Something out of Imperfection.

You ought to know that most of the system or architecture that was used in solving this COVID case, from tracking patients positive or negative test result, vaccination based on demography, vaccination verification, some were made using open source projects, fast partnerships with related companies (sicepat, loket.com). Decisions were need to be made fast and it was thanks to the brave souls and heart that we manage to get to this point. I haven’t and probably will not disclose to public how bad things really were, before the IT guys from the ministry of health steps in as I am not allowed to. But we can still cherish how fast those guys work and how relatively safe we have feel nowadays.

Imperfection do also rings something common in a existential way. I know there are sometimes where we could find our life to be unsatisfied, but even with the imperfections we could find meaning or value.

Glimpse For The Future of Health-tech Innovation.

There is a shocking discovery that one of the most well known drugs to cure stroke doesn’t work for Indonesian and the main reason is that our genetics doesn’t fit. While we spend approximately 5 Trillion IDR annual for the purchase of pharmaceuticals. Remember that the information that I shared here were sourced from the advisor of Ministry of Health of Indonesia, not from myself. It is a huge problem because we simply can’t stop keep being this way. It was also stated that most of the drugs for human were developed based on the genes based on Europe, China, and US. We don’t even have our own gene bank.

Above is a study from National Institute of Health regarding my statements. Well I know it is really unfortunate to not have our own gene bank but that’s literally what we are working for. The ministry of health is currently creating plans to ramp out genome sequencing of our people and how it could hopefully find a better suitable drugs usage so that not only we could know and prevent possible life threatening diseases that could causes by genes such as cancer, but also find a suitable drug that our genes influence the effectivity of those drugs.

---

Started writing at 30 June, finished at 1 July