Hope for the Best, Prepare for the Worst

KOMPAS/AGUS SUSANTO

A medical worker takes a saliva sample for a swab test at the Duren Sawit puskesmas (community health center) in East Jakarta on Monday (31/8/2020), when the center tested about 90 local residents. The Indonesian Medical Association (IDI) recorded that 100 doctors had died on the Covid-19 front lines as of Tuesday.

The last six months have been difficult because almost every day we hear of our neighbors, acquaintances or relatives contracting and dying from Covid-19. However, the worst might still be awaiting us because we are in the middle of a pandemic.

The Covid-19 pandemic has triggered a multidimensional crisis. But don\'t forget: there is no economy without people, no economic recovery without mitigation of the outbreak.

The last six months have been difficult because almost every day we hear our neighbors, acquaintances or relatives have contracted and died from Covid-19. However, the worst could still happen as we are in the middle of a pandemic that has shown no signs of abating.

Also read: The Continuing Struggle of Recovered Covid-19 Patients

Since the first case of Covid-19 was detected in Indonesia in early March 2020, the number of transmission has accelerated. It took nearly three months from the first two cases to 50,000 cases. However, it took only one month to double to 100,000 cases and to 150,000 cases in 25 days.

KOMPAS/RONY ARIYANTO NUGROHO

Public order officers speak to a restaurant owner on Sunday (30/8/2020) to abide by the 8 p.m. curfew on Jl. Jenderal Sudirman in Bogor, West Java. The city has reinstated its status as a Covid-19 “red zone” of high transmission risk and imposed a curfew to curb the spread of the disease.

The high rate of transmission can be seen from the increasing trend in the ratio of positive cases (positivity rate), which is the ratio between the number of tests and the Covid-19 cases found. In the past week, the positivity rate was 14.8 percent, far higher than the 5 percent safe threshold recommended by the World Health Organization (WHO). In fact, on Tuesday (9/1/2020), of the 15,293 people being tested, 2,775 of them were positive, so the ratio was 18 percent.

The efforts to mitigate the Covid-19 are still faced with many challenges, such as the addition of cases, the number of tests that must be increased [and] the quality of health care must also be improved.

Spokesperson for the Covid-19 Task Force, Wiku Adisasmito, said the government was facing many challenges in overcoming this pandemic. "The efforts to mitigate the Covid-19 are still faced with many challenges, such as the addition of cases, the number of tests that must be increased [and] the quality of health care must also be improved," he said.

"Our struggle is to control this case. We have to work hand in hand,” said Wiku in a virtual conference from the Presidential Office in Jakarta, yesterday.

Below standard

According to an Indonesian epidemiologist at Griffith University, Dicky Budiman, in overcoming the Covid-19, the (rapid or swab) test is like a net. The fish is the new type of coronavirus (SARS-CoV-2) that causes the Covid-19 and the people are the sea. "If you use a small net and you can catch a lot of fish, it means that there are lots of fish in the sea. The virus is everywhere," he said.

According to WHO standards, a minimum of 1 person per 1,000 of population is tested per week. This means that at least 38,000 people are tested per day. In fact, from 24-30 Aug. 2020, only 125,434 people were tested, even on 17-23 Aug. only 95,463 people were tested. This number is not yet half of the minimum requirement.

Compared it to India, which tests 1 million people per day and 4.34 tests per 1,000 of population per week. The Philippines is already doing 2 tests per 1,000 of population per week, Malaysia, Thailand and Singapore are even better. According to the ranking on worldometers.info, the number of tests per 1 million of Indonesia\'s population ranks 161st out of 215 countries.

KOMPAS/RONY ARIYANTO NUGROHO

Cemetery workers in protective gear bury a Covid-19 victim on Monday (31/8/2020) at Situ Gede Cemetery in Bogor, West Java. The Covid-19 Mitigation Task Force’s records show that of 597 confirmed cases in the city, 31 patients had died of the disease by 10 a.m. on Monday. Bogor has again been declared a “red zone” of high-risk Covid-19 transmission.

The spread of the test was also not well distributed. As many as 47 percent of the tests are carried out in Jakarta, which has only 4 percent of Indonesia\'s population.

Another problem is that the surveillance works to find the cases are weak. As many as 62 percent of new cases in Jakarta were identified only after the patient got sick and went to the hospital, 34 percent was found from contact tracing and only 4 percent was found from the specific effort to find new cases.

With the lack of tests and poor surveillance, the number of Covid-19 cases and deaths in Indonesia is similar to the tip of the iceberg. Based on data from Rumah Sakit Online, the number of people who died in the Indonesian hospital network with suspected or positive Covid-19 status reached 21,570 people as of Tuesday. That number is three times more than the number of people who died from Covid-19 announced by the government.

Reducing test

Now, Indonesia is scrambling for tests because the transmission rate exceeds the speed of preparing laboratories and equipment, adding personnel, work systems and reporting. The lack of testing in Indonesia is complicated by the tugs of war involving political-economic interests.

Antibody-based rapid tests are forced to be made into a diagnostic tool and a requirement for traveling or working. Apart from slowing down case finding, it often creates social problems because the results can be false.

KOMPAS/HENDRA A SETYAWAN

A security guard coordinates departing traffic on Monday (31/8/2020) at a shopping center in Bojongsari, Depok, West Java. The shopping center is closing at 6 p.m. in compliance with the 8 p.m. curfew that was implemented in the city on Monday curfew to curb the spread of the coronavirus (Covid-19) starting Monday (31/8/2020) to curb the spread of Covid-19.

On the other hand, many regions are suspected of reducing the number of tests due to political interests ahead of the regional head elections. "Many doctors in the regions reported this [practice] because the [local administration] thought that the minimal number of cases was an achievement," said Adib Khumaidi, chairman of the Indonesian Doctors Association (IDI).

Given the zoning system is used as a precondition for the reopening of economic activities and education, many regions are competing to declare their area a green zone, including by minimizing the number of tests. The absence of an indicator of the adequacy of the test makes the zoning system a false sense of secureness.

“The absence of an indicator of the adequacy of the test makes the zoning system a false sense of secureness.”

Covid-19 Task Force public health experts team member, Dewi Nur Aisyah, said the government in September will change the scale of the indicators. Each region must include adequacy of tests as an indicator before setting the zoning, whether their area is in the green or red zone.

Policy evaluation

In view of the current trend, it is feared that the case in Indonesia will grow. Learning from the failures of the United States and Italy, prevention is the best way to fight Covid-19. No matter how strong the health system is, it can be battered if the rate of transmission of the disease is not controlled.

The number of hospital beds and isolation wards can be increased, like in Jakarta, Surabaya and other cities. But, what about the availability of the health workers?

Based on IDI data, until the end of August 2020, more than 102 doctors in Indonesia died due to Covid-19. In addition, 9 dentists and 68 nurses also died with a mortality ratio compared to the general public was 2.4 percent. In the US, for example, the ratio of medical personnel who died was 0.37 percent. "We are exhausted and overwhelmed. If the pandemic gets bigger, it will be very heavy," said Adib.

Losing medical personnel was a huge blow considering the limited number of health workers. The World Bank (2017-2020) noted that the number of doctors in Indonesia was the second lowest in Southeast Asia, namely 0.4 doctors per 1,000 of population. Losing 100 doctors meant reducing health services to 250,000 residents.

“Losing medical personnel was a huge blow considering the limited number of health workers.”

KOMPAS/BAHANA PATRIA GUPTA

Ali Wafa (left), 10, helps his 7-year-old brother Muhammad Yusuf with his schoolwork on Thursday (6/8/2020) at the roadside bird shop the boys’ father, Abdul Sakur, runs on Jl. Kapasari in Surabaya, East Java. The two brothers are using whatever space is available to them to continue their schooling, and started studying at 10 a.m.

Statistically, the handling of this pandemic is not encouraging. Not to mention the threat of an economic crisis.

This committee was formed to balance the handling of health and economic recovery.

In order to more effectively handle Covid-19 and its impacts, the Covid-19 Task Force was changed into the Committee for Handling Covid-19 and National Economic Recovery. This committee was formed to balance the handling of health and economic recovery.

President Joko Widodo also requested that the efforts to boost economic recovery and put a brake on the spread of Covid-19 must be balanced. "Until vaccinations can be performed in a large scale, I also ask the governors to balance between ‘the gas and brake’ according to the data they have," said the President, yesterday, at the Presidential Palace in Bogor.

However, the portion of the budget tends to be heavy on the economy. The economic recovery budget is Rp 297 trillion, excluding social protection and sectoral spending by the ministries, state institutions and regional administrations, while the budget for the handling of the outbreak is Rp 87.5 trillion. Until mid-August, the absorption of the health budget was only 13.8 percent.

These figures reinforce public concerns that the government is not yet focused on mitigating the outbreak. In fact, without addressing the health aspect, the economy cannot be restored.

Get through the crisis

Currently, with the increase in Covid-19 cases and deaths, the government is forced to hit brakes more. That means we can not only rely on the availability of vaccines or drugs.

As WHO has said there is no "silver bullet" for SARS-CoV-2. "Phase III trials do not mean that the vaccine is ready to end the pandemic," said Mike Ryan, the executive director of the WHO Emergency Health Program.

KOMPAS/RONY ARIYANTO NUGROHO

Bogor municipality public order officers detain a young man in an operation on Friday (1/9/2020) to enforce the use of face masks on Jl. Pajajaran in Bogor, West Java. The city has started imposing penalties on barefaced residents, fining violators Rp 50,000 that must be paid to the account of the Bogor municipal treasury through non-cash payment transactions, such as online banking or ATMs. Many people continue to flout the health and safety protocol, despite Bogor’s reinstatement of the “red zone” status for high-risk Covid-19 transmission.

With Covid-19 vaccines and drugs not yet found, the best effort is to strengthen epidemic mitigation through detection, isolation and treatment. Social restrictions must also be tightened and residents change their health behavior.

President Jokowi also has strong capital to get through this crisis because of high public support. The Kompas Research and Development Survey for August 2020 shows that 58.9 percent of the public is satisfied with the government\'s performance and 41.6 percent is optimistic that they can get through the crisis. Those who are optimistic mostly from the lower middle class and less educated. On the other hand, the upper classes, including businessmen, are pessimistic.

This virus does not choose the optimists or the pessimists. Those who are "forced" to be optimistic because they have to work outside the home are more at risk of being exposed. The epidemic would expand as the mobility of people who do not comply with health protocols becomes higher. (TAN/LAS)