Independen -- Ita Septiana (28), a resident of Talang Buluh village, Talang Kelapa subdistrict, Banyuasin district, South Sumatera was tidying up her family photos when Wongkito visited her house on Monday, July 27.
In the recent month, she and her husband Ngadirun (35) just moved from Hamlet II to Hamlet III of the Talang Buluh village. Their new home still half-complete. A cement mix of mortar and sand for the house’s foundation could be found nearby. The house itself was surrounded by rubber trees. It was located quite far away from the main road or the village administration office. Only four neighboring dwellings could be seen.
Septiana admitted that they had moved to be away from their past trauma. The newly married couple had lost two children allegedly to acute respiratory infection (ISPA) due to prolonged exposure to smoke from Forest and Land Fires (Karhutla). “The brother [eldest son] died first,” she said.
Septiana showed a photo of her two children. One of them was Elsa Fitaloka, the four-month-old baby died on September 15, last year. At the time, Fitaloka was brought to the ER at Ar-Rasyid Hospital in Palembang. But her condition worsened, so she was referred to Mohammad Hosein (RSMH) Hospital.
Before they could move her, Fitaloka drew her last breath at 6.30 PM WIB (Indonesian Western Time). She was buried at the village’s public cemetery (TPU) on Monday morning. A diagnostic statement issued by the hospital in the afternoon stated that following a medical examination, Fitaloka had suffered from pneumonia and meningitis.
It had been extremely devastating for the couple as they automatically recalled a distressing memory from three years earlier when their first son Jaru (4) died of the same disease. “These photos are the only memories of our children,” said Septiana, “I am tidying up these photos now because it’s only recently that we can afford a photo album.”
The month of Fitaloka’s death—September 2019 was the peak of the year’s dry season. At that time, the air quality in her area was inferior, caused by smoke from raging forest and land fires. The South Sumatera Health Office recorded the highest number for ISPA cases in September 2019 compared to other months in the same year at 59,784 cases. Same as pneumonia, September 2019 held the highest record at 2,047 cases.
For the year 2020, based on weather development monitoring by the Meteorology, Climatology, and Geophysics Agency (BMKG) up to July 20, the South Sumatera province had entered the early-drought season.
There was an immediate concern if the forest and land fire haze disaster occurred once more in the dry season of 2020. Significantly it could increase the vulnerability and risk of transmission of the Covid-19 disease, which is currently endemic. Various online discussions were held to discuss the threat of the catastrophic smoke in the current Covid-19 pandemic.
In one of the online discussions on Tuesday, July 28, Senior Public Health Adviser at Alam Sehat Lestari (ASRI) Foundation Monica Nirmala said that people infected by Covid-19 while simultaneously exposed to the smoke from forest and land fires would suffer from a more severe health impact.
The double damage could happen because the smoke from forest and land fires weakened the body’s immune system. Meanwhile, immunity is an essential factor in facing Covid-19—a disease currently still has no known vaccine or cure. As a result, the risk of contracting, discomfort, and death due to respiratory, cardiac, and vascular diseases are more significant.
“More than that, smoke hazard increased the transmission of the virus exponentially. This is because smoke forced residents to take refuge in one enclosed room together. While in Covid-19 situation, everyone should keep their distance to bring down virus transmission,” said Nirmala.
When asked about any recommendation for the government regarding the public health sector, the Master of Public Health from Harvard University reminded that the most important thing was to prevent forest and land fires at all cost. It would be best if the government could turn the new normal adaptation to a “better normal” where Indonesians could live without smoke. The local government also had to facilitate air-conditioned shelters in forest and land fires-prone areas far away from health facilities. Keeping in mind the Covid-19 health protocols that need to be prepared, for example, adequate handwashing facilities or providing one room per family.
“There should be no stockpiling of N95 masks even though only medical masks or N95 that can filter smoke. But the people need to be educated to wear masks during Covid-19 [outbreak],” she said.
Forest, Land Fires Smoke, and Covid-19 Aggravate Respiratory Diseases
Outside the RSMH hospital in Palembang, Internist and Chairman of the Emerging Infectious Disease (EID) team Zen Ahmad said that the death of a child patient such as in Septiana and Ngadirun’s family could be not entirely caused by smoke haze. However, it can be said that the smoke made respiratory diseases such as pneumonia worse.
The oxygen source that the body needs is reduced because the air is polluted by smoke. Small particles from the smoke entered the lungs through the respiratory system can also cause irritation. Moreover, a child’s immune system is not as strong as an adult’s, making them more vulnerable.
“The baby who died already had pneumonia and other comorbid diseases. The smoke exposure had worsened her condition. If there had been no smoke, there was the chance that she could recover from her pneumonia,” Ahmad commented.
According to him, Covid-19 and smoke from forest and land fires put people at higher risk for respiratory diseases. The coronavirus may enter the upper and lower respiratory tracts, the lungs, even the heart and blood vessels.
“When the SARS-Cov-2 virus, as a foreign object, enter the respiratory tract, they can trigger severe symptoms. Then add smoke to the picture simultaneously, we can imagine the magnitude of the risk. Those in vulnerable conditions will clearly worsen,” he explained.
The RSMH Palembang hospital was the primary referral for treatments of Covid-19 patients, focusing on severe pneumonia cases. During the early onset of the Covid-19 outbreak in February, RSMH only had five beds with a ventilator in their isolation room. To date, the hospital had increased its capacity to 160 beds, all nearly filled. Ahmad admitted that there was an increase in the number of pneumonia patients during the pandemic. Doctors had also been actively taking thorax x-rays on patients to ensure thorough internal diagnostics.
South Sumatran Microbiology expert from Sriwijaya University (Unsri), Prof. Yuwono, agreed with Ahmad’s views. According to him, the smoke from forest and land fires could aggravate respiratory diseases. Even though it contains no biological particle and a size that is larger than a droplet, smoke from forest and land fires can quickly settle in the lungs and cause diseases such as asbestosis.
“Smoke aggravates respiratory diseases. If someone is infected with Covid-19, their situation will be more at risk,” said Yuwono, who was also the Director of Pusri Palembang hospital.
However, Yuwono reminded that people do not need to be worried. Because it is the government that should protect the public, and therefore they should also take into account the risk prediction for vulnerable residents.
South Sumatera was one of the seven provinces with numerous forest and land fires from 2015 until 2019. Six other regions were Riau, Jambi, West Kalimantan, Central Kalimantan, South Kalimantan, and East Kalimantan. As mentioned by the Minister of Environment and Forestry (LHK) Siti Nurbaya Bakar in a special coordination meeting for forest and land fires in Jakarta, July 2.
Based on TERRA/AQUA data, the total hotspots in South Sumatera in 2019 was recorded at 3,872 sites. The total burn area for the time was 136,875 hectares of peat and 32,549 hectares of mineral field, according to a report by Sipongi—a web-based forest fire information system that belonged to the Ministry.
As if not learning the lesson from the 2015 fires—the largest recorded number of hot spots and burn area with haze smoke that severely impacted the public health, the numbers for 2019 showed an increase in trend compared to the three previous years.
In 2015, there were 13,628 hot spots recorded with 646,298 hectares of total burn area in South Sumatera. Since then, the government started to pay more attention to forest and land fires, considering most of the burned lands were peat. In 2016, the number of hot spots and total forest and land fire incidents had reduced significantly. However, the fires took up again in the coming years, until in 2019, hot spots and forest and land fires began to soar.
“Now the dry season has started. Fires in six regions were observed, namely Banyuasin, Muba, OKI, Ogan Ilir, Muara Enim, and East OKU districts. Fire extinguishing operations are already underway,” said Head of Emergency Management at South Sumatera Disaster Prevention Agency (BPBD) Ansori on July 29.
On the other hand, areas affected by forest and land fires were also those at risk of Covid-19 transmissions, especially in Palembang and Banyuasin district. Their red zone status was still fluctuating, a team of epidemiology experts of South Sumatera Covid-19 task force warned the high transmission potential. “New confirmed positive cases continue to grow,” explained South Sumatera Covid-19 Task Force spokesperson Yusri.
Appeal to Use Mask and Strengthen Immunity
South Sumatera was the seventh province with the highest Covid-19 positive cases in Indonesia and the highest in Sumatera as of July 19. It recorded 3,012 confirmed cases, 1,413 people recovered (46.91%), and 139 people died (4.61%). These patients were increasingly vulnerable if forest and land fires occur, especially in the peat area.
Meanwhile, South Sumatera governor Herman Deru reviewed fire extinguishing equipment in Talang Betutu Air Force operations base in Palembang, July 29. The region was prepared with eight water-bombing helicopters with four tons capacity and one extra unit with five tons capacity.
It had also raised an alert on forest and land fire smoke to standby since May 20. The Technology Assessment and Application Agency (BPPT) had also launched efforts to modify the weather. Regarding the budget, Deru guaranteed that none would be cut for Covid-19 response. Instead, his administration disbursed Rp 45 billion (US$ 3 million) financial stimulus for 10 districts and cities prone to forest and land fires. The governor also guaranteed strict sanctions following the Law and Environment and Forestry Ministry Regulation No. 10 of 2010, not only for the perpetrators but also to the landowners.
However, when asked about strategic steps in preparing the health sector for haze smoke during the pandemic, Deru only said that the people only need to provide masks and strengthen their immune system.
“Yes, that’s it. Masks and immunity boost, eat nutritious food,” he said. According to him, the Air Pollution Index Standard (ISPU) was currently still at the normal range. As far as the governor’s concern, no flights had been disrupted due to low visibility because of the haze.
Meanwhile, the South Sumatera Health Office hoped that there would be no forest and land fire incidents during the Covid-19 pandemic that could damage public health. In terms of healthcare preparedness, the Office claimed that it would provide healthcare services not only for the local residents but also for the forest and land fire task force in the field. They would also prepare temporary shelters depending on the condition.
“We hope there would be no smoke from the forest and land fires because it can increase vulnerability and Covid-19 cases,” said Head of Disease Prevention and Response of the South Sumatera Health Office Ferry Yanuar. (Yulia Savitri)
