Lessons from Surges in Covid-19 Cases
We need to learn to anticipate surges of new Covid-19 cases following long holidays. We should have learned from the experience last year, when new Covid-19 cases surged in four long holidays.
The prediction of surges in Covid-19 cases following Lebaran (Idul Fitri) has come true. Covid-19 red zones in Indonesia are widespread.
The broadening of Covid-19 red zones is due to the recurring upward trend in confirmed Covid-19 cases. Confirmed Covid-19 cases in Kudus, Central Java, have surged drastically. The Covid-19 Task Force on Wednesday (9/6/2021) revealed that the total of cases in Kudus over the last three weeks, in the post-Lebaran 2021 period to be exact, had increased by as high as 7,594 percent.
The figures have made Kudus a town with the highest spike in cases in Indonesia, as an effect of Lebaran 2021 holidays. Almost 50 percent of the villages in Kudus regency belong to Covid-19 red zones. Besides the increase in daily cases, active cases have also surged over more than the past week. Rising Covid-19 infection is marked by a drastic hike in the positivity rate. In fact, the World Health Organization (WHO) has put the safety standard of the Covid-19 positivity rate below 5 percent.
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After Lebaran, the positivity rate has shown a rising indication. A look at Jakarta province gives a very disturbing picture indeed. Based on data from the Jakarta Health Office, the positivity rate of daily new cases in the capital has again risen above 10 percent.
On Saturday (1/5/2021), the positivity rate in Jakarta listed 12.3 percent. In detail, of the 6,957 people subjected to PCR tests, 854 were confirmed Covid-19 cases. On Sunday (2/5/2021), 6,765 people were tested and 757 of them were infected with Covid-19. The positivity rate on that day reached 11.2 percent, far above the Covid-19 positivity rate standard of 5 percent set by the WHO.
Several factors
The question is, why has the Covid-19 positivity rate increased? At least there are several causes of the rise, including the numerous data from PCR swab tests with negative results that were not directly sent to the central data system. Positive tests could be directly recorded so that patients could be promptly isolated. In this way, the data received by the Health Ministry mostly comprised confirmed Covid-19 cases so that negative test results were not included.
The other cause is that positive tests were recorded for immediate isolation. This certainly caused the positivity rate to rise. Meanwhile, according to the Health Minister, the total of Covid-19 tests was not sufficient while positive cases among people might be large in number.
Has the appeal that people who are traveling should impose self-isolation for five days on arrival at their destinations be complied with? This applies to those with positive results from random tests as well as those declared negative.
Unsurprisingly, based on the calculation of Kompas, until the third week of post-Lebaran, there was a surge of 3,704 cases (10.1 percent) over the pre-Lebaran weekly cases. The figures were believed to have not yet been the peak of the Lebaran effect. For comparison, the peak of cases after Christmas-New Year holidays was reached about a month after the last vacation day.
Central Java, besides West Java, East Java and South Sulawesi, are potential mudik (exodus) destinations. The application of health protocols becomes the main key to reducing the potential for infection, especially during the Lebaran exodus. In reality, this principle was not always applied in the destinations so that there were “explosions” of cases in several regions.
Let’s take the town of Kudus as an example, which was suddenly shocked by an “explosion” of patients, even rendering its hospitals incapable of accommodating them. As indicated above, Kudus became a regency with the highest number of cases. The cities around it like Semarang, Pati, even the Donohudan Haj Dormitory, were crowded with patients from the town.
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The surge in cases also occurred in East Java, also an exodus destination province, with an increase of 92 cases between a week before Lebaran and three weeks thereafter. A few days after the last week, Covid-19 cases surged in Bangkalan regency and Lamongan regency.
The spike in Bangkalan cases was dominated by the cluster of health workers. In Lamongan, the case explosion began from infected residents who had earlier visited Bojonegoro and Sidoarjo. The Covid-19 task forces in the respective regencies had even imposed limited lockdowns. Covid-19 is not impossible to prevent after holidays, including after Lebaran. Case surges can be prevented particularly at air, sea and land entry gates. Even restrictions on travelers using the transportation modes have been applied, especially by land.
However, as we have witnessed, playing cat and mouse with security personnel was still attempted. Centralized quarantine should have been mandatory for travelers showing symptoms, without exception for those using sea and air transportation modes.
Monitoring and contact tracing are required of travelers if they don’t undergo centralized quarantine and self-isolation.
Hierarchical notifications of travelers should be followed up to the levels of regencies/cities. Case contact tracing and monitoring of travelers at regency/city levels can benefit from the services of village/subdistrict administrative personnel and community groups while observing the rights and privacy of residents as well as avoiding discrimination and stigmas against travelers.
Isolation or quarantine?
There is a difference between isolation and quarantine that the public should understand. Quarantine is meant for healthy people with no Covid-19 symptoms, but they have close contact with confirmed cases or have been engaged in activity with high risk of exposure such as high mobility during the pandemic period. Meanwhile, isolation must be gone through by people showing symptoms or confirmed with coronavirus infection by accurate diagnosis.
Quarantine is an attempt to separate people who are exposed to Covid-19, both from contact tracing and history of travel to regions where community transmission has occurred, but they have not yet shown symptoms whatsoever or are in the period of incubation, with the aim of reducing the risk of infection. Quarantine is imposed although no symptoms are shown or the incubation period is in progress.
People are declared completing quarantine if exit tests on the fifth day produce negative results. If exit tests are positive, they are declared confirmed Covid-19 cases and required to undergo isolation. If exit tests are not conducted, the quarantine has to last for 14 days.
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It’s unlike isolation, because this is an attempt to separate sick people needing treatment or confirmed Covid-19 cases, from healthy people with the aim of reducing the risk of infection. For asymptomatic confirmed cases, isolation is required to last for at least 10 days starting from the sampling of specimens based on confirmed diagnoses.
For symptomatic confirmed cases, isolation is required to last for ten days starting from the appearance of symptoms plus at least three days of freedom from symptoms of fever and respiratory disturbance. In this way, for cases experiencing symptoms for ten days or less, isolation must last for 13 days.
We need to learn to anticipate surges of new Covid-19 cases following long holidays. We should have learned from the experience last year, when new Covid-19 cases surged in four long holidays. Long vacations accompanied by the public tendency to go on trips have proven to trigger spikes in Covid-19 cases.
Anies
Furthermore, long-holiday trips often proceed with slackening adherence to health protocols. Command posts in villages/subdistricts should control the implementation of quarantine. They also need to take other preventive measures in a parallel way such as testing and tracing.
Anies, Professor of Public Health and Preventive Medicine, Faculty of Medicine, Diponegoro University.
This article was translated by Aris Prawira.
