Analysis of Covid-19 Risk Indicator
The risk indicator analysis is an activity to assess the situation of readiness in the field as well as potential problems that may be encountered, such as the possibility of an increase in cases after Lebaran.
TJANDRA YOGA ADITAMA
Kompas reported on June 7, 2021 that Covid-19 cases had soared in the provinces of the mudik (exodus) destinations.
Some time ago, the Health Minister also said that an increase in Covid-19 cases was expected after Idul Fitri with the peak being 5-7 weeks after Idul Fitri, or the end of June.
This is of course the main concern of the government and all of us so that the increase in cases can be controlled properly. One of the important control modalities is to apply the Covid-19 risk indicator properly and this needs to be intensified very carefully in the future.
Basically, the risk indicator analysis is an activity to assess the situation of readiness in the field as well as potential problems that may be encountered, such as the possibility of an increase in cases after Lebaran. In general, it can be said that this analysis aims to detect "what\'s going on and what can go wrong".
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By doing a good analysis of the risk indicator, of course it will be possible to know what deficiencies may exist and what efforts need to be made from the start to close the gap. In a World Health Organization (WHO) document in November 2020, it was said that in the risk analysis process two important factors could be seen, namely the existing pattern of transmission and its potential in the coming days, which is matrixed with the existing response capacity and what can/should be improved.
Anticipating the pattern of transmission
In general, the pattern of transmission of Covid-19 can be divided into five levels. It starts at zero level where there has been no transmission in the past 28 days. Then in the first level, there is a system in place that is good enough to prevent transmission, or cases have started to exist, but there has been no significant disruption to socio-economic life.
Then the second level where there has been a cluster of cases and there is a risk of transmission in the community. Starting from here, it is necessary to start better countermeasures. Moreover, the third level when there has been transmission in the community and health services are already quite overwhelmed so that more complex health management is needed in the field.
Implementation of a rapid antigen test for motorists from Madura Island at the exit of the Suramadu Bridge, Surabaya, East Java, Monday (7/6/2021). Blocking and inspection for motorists from Madura Island to Surabaya has been intensified again due to the increasing number of positive cases of Covid-19 in Bangkalan Regency.
What really needs to be watched out for, of course, is the fourth level, when the epidemic is out of control and the health care system is practically collapsing, requiring extraordinary mitigation to prevent the continued increase in cases and deaths.
There are also those who simplify this potential pattern of transmission to just four levels. First, the pattern of transmission is very low if it deals only with the existence of imported cases. Second, the level is low if there are clusters or the beginning of transmission in a limited community. Third, the medium level if transmission is found in the limited community.
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Meanwhile, the fourth level is divided by two. Level 4a is categorized as high with transmission in the wider community and level 4b is a very high category with transmission in the wider community with a very high number of new cases.
In assessing the severity of the epidemiological situation, five indicators can also be used, namely (1) the number of new cases, (2) the number of deaths, (3) whether there is an increase of more than 10 percent between the weeks, (4) whether the positivity rate in above 10 percent, and (5) whether the transmission rate (Rt) is above 1.0.
Response capacity
On the other side of the pattern of transmission, the response capacity can also be divided into four parts. First, a health service system that can at least include the availability of beds in hospitals, including isolation rooms and ICUs, health workers, medicines and health equipment, referral systems, and others.
Second, the public health system, which includes, among other things, how active the community testing and tracing activities, surveillance, and other public health and social approaches are. In this regard, it is also necessary to emphasize the importance of the readiness of primary health services, not only hospitals. Community health centers, clinics, or other health service facilities that are regularly visited by the community must also be checked for their readiness and their response capacity needs to be continuously improved.
Primary health services can handle basic complaints of the community, prepare a referral system to hospitals if needed, and handle patients who are in isolation or self-quarantine in their respective homes. Of course, to do this, primary health care facilities need to master the health situation in their working area.
The third aspect of response capacity is regulatory management which at least includes cross-sectoral coordination, disaster management, and preparedness to deal with escalating situation which is increasing uncontrollably. The fourth is also a very important factor, namely risk communication and community empowerment.
Each of these response capacities can then be compiled and grouped into adequate, moderate, or limited response capacities.
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Of course, every component of the potential for transmission and response capacity must be analyzed very deeply so that accurate information and data and accurate scientific predictions can be obtained. Then, by combining the four levels of potential transmission with the four existing response capacities in the form of risk analysis, management and preparation can be done better because they are made based on correct scientific analysis and based on real situations in the field as well.
Restrictions
What always becomes the subject of discussion later is when the number of cases and deaths increases sharply, is it really necessary to do a kind of social activity restriction in the community that is carried out with a strict public health approach.
In this case, WHO explains the concept of PHSM (public health and social measure). One thing that is important from the concept is efforts to avoid crowds, such as limiting gatherings, maintaining distance, and restricting travel within the country.
Evaluation must continue to be carried out properly so that if there is a change in policy, it is in line with the development of the epidemiological situation, and it is necessary to ensure active community involvement.
TJANDRA YOGA ADITAMA, Director of Post-Graduate Department of the University of YARSI, Professor at the Faculty of Medicine of the University of Indonesia, Former Director of WHO Southeast Asia, and Former Director General of P2P & Head of the National Institute of Health Research and Development (Balitbangkes)
This article was translated by Hyginus Hardoyo.
