Covid-19, an Iceberg Phenomenon

KOMPAS/TOTOK WIJAYANTO

A member of the Sawah Besar District medical team takes the mucus of an employee of the Sawah Besar District Office, Central Jakarta, during a swab test conducted in Jakarta, Tuesday (18/8/2020). The swab test aims to track emerging new coronavirus cases and prevent the formation of office clusters. The transitional large-scale social restriction (PSBB) period for Jakarta will be extended again until 27 August, given that the rate of positive cases ofCovid-19 has increased.

Covid-19 cases continue to rise while testing and tracing remain minimal. The situation may worsen as the healthcare system could become overwhelmed.

JAKARTA, KOMPAS – Poor surveillance has turned the Covid-19 outbreak in Indonesia into an iceberg phenomenon. It is worried that Covid-19 will continue to spread, as more and more people neglect health protocols.

Without progressive steps in testing, tracing and isolation, it is a worry that the number of Covid-19 cases continue to rise and overwhelm the healthcare system. Currently, healthcare facilities in several cities are flooded with Covid-19 patients, like they were in March and April. Meanwhile, more and more medical professionals have succumbed to the disease.

Also read: Greater Jakarta’s Specificity

According to a World Health Organization (WHO) report, the number of Covid-19 patients receiving hospital treatment in Jakarta has continued to rise since 8 July. Today, Jakarta has 2,500 Covid-19 patients in hospitals other than in Wisma Atlet in Kemayoran. Meanwhile, Wisma Atlet, which houses patients showing mild to moderate symptoms, currently treats 1,377 persons.

Kompas/Ferganata Indra Riatmoko

Visitors line up to enter the disinfecting booth at Beringharjo Market, Yogyakarta, on Friday (21/8/2020). A number of tourist attractions in Yogyakarta have been relatively busy as visitors take advantage of the long weekend, even though the number of positive cases of Covid-19 continues to increase in the city. The day before, 48 were confirmed to be positive with Covid-19 in Yogyakarta.

The concern of an iceberg phenomenon was expressed by Indonesian Doctors Association (IDI) Covid-19 task force head Zubairi Djoerban in a discussion in Jakarta on Friday (21/8/2020). “President Joko Widodo has requested that testing be increased to 30,000 a day, but the reality remains far from it,” he said.

National Covid-19 Task Force data showed 2,197 new cases on Friday, bringing the total number of confirmed Covid-19 cases nationwide to 149,408. The new cases were found based on 13,534 new tests. In total, testing has been done on 1,121,602 people.

On average, only around 10,000 people per day were tested in the past week, with the lowest count of 7,224 on 17 August and the highest count of 14,940 on 19 August.

In current conditions, we should do at least 50,000 – 100,000 testing per day.

“There were over 1,500 new cases a day. We are still far away from the peak, let alone the downward slope. In current conditions, we should do at least 50,000 – 100,000 testing per day,” Zubairi said.

Low testing has led to ineffective outbreak control. The true scale of Covid-19 spread remains unknown.

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As comparison, based on worldometers.info data, the US is testing 222 people in 1,000, Brazil is testing 64 in 1,000 and India is testing 24 in 1,000. Indonesia’s testing rate is only 7.2 in 1,000. We rank 163rd globally.

KOMPAS/RADITYA HELABUMI

Even though they are vulnerable to being exposed to Covid-19, a number of children play at Tomang Rawa Kepa Park, West Jakarta, Friday (21/8/2020). The Jakarta administration will fine residents, businesspeople and people in charge of public facilities who repeatedly violate health protocols, including wearing masks when going about activities outside their homes.

Other than its limited number, testing is also still concentrated in Jakarta. As of 16 August, 504,075 people in Jakarta and 557,646 people in 23 other provinces had been tested. This shows that 47 percent of testing is done in Jakarta, which only has 4 percent of the national population.

Today, 6,500 Indonesians have died from Covid-19, with the latest daily increase at 82. This is the highest in Southeast Asia. The case fatality rate of Covid-19 in Indonesia reaches 4.35 percent, higher than the global average of 3.4 percent.

Zubairi also highlighted the high fatality rate among medical workers. He said this indicates not only personal protective equipment (PPE) shortage and improper use but also fatigue. IDI data shows that 86 doctors and 82 nurses have died from Covid-19.

Vaccine development

Amid the ongoing pandemic, vaccine gives the world hope and shows progress. Padjadjaran University School of Medicine’s vaccine clinical test research team head KusnandiRusmil said that the candidate vaccine had been administered to 110 people. “Thus far, no significant side effect has been reported,” he said.

Kusnandi said that public enthusiasm to participate in the clinical trial was high. Some 2,200 people registered for the trial, far more than the target of 1,620.

“We gave the vaccine based on who registered first. Participants must also pass requirements, such as having no allergies or severe illness,” he said.

With a weekly vaccination target of 240, Kusnandi said the clinical trial was aimed for completion in early 2021. “We will analyze the first 520 people to see their immunity and side effects. We hope that effectiveness will be high, like in the first two phases,” he said.

Right now, I already see people on the streets and in markets, some without masks. On weekends, many are traveling from Jakarta to Bandung.

Despite promising progress in vaccine development, Kusnandi said that people should maintain health protocols at all times to curb the virus spread. “Right now, I already see people on the streets and in markets, some without masks. On weekends, many are traveling from Jakarta to Bandung,” he said.

The government’s Covid-19 spokesman, Wiku Adisasmito, said the government had prepared necessary vaccine production capacity and supporting equipment for the vaccine’s mass production. Anticipatory measures are in place to mitigate potential obstacles in distribution.

KOMPAS/RADITYA HELABUMI

A fruit seller serves project workers in Gambir, Central Jakarta, Friday (21/8/2020). Many informal workers and micro-businesses, such as street vendors, have been affected by the pandemic but have not received government assistance. They are also at high risk of being exposed to Covid-19 because they have to work outside their home and sometimes neglect to implement health proto

The Health Ministry’s health research and development agency acting head, Slamet, said international collaboration and cooperation would be increasingly important, both in providing health infrastructure and vaccine research. International transfer of knowledge and experiences is important. (TAN/MEL)