PCR Price Reduction has yet to Accelerate COVID-19 Testing

KOMPAS/KRISTIAN OKA PRASETYADI

Officers take a swab sample from a resident\'s nose for a polymerase chain reaction (PCR) test in Wanea, Manado, North Sulawesi, on Tuesday (27/7/2021).

The government-mandated price reduction of PCR COVID-19 tests has yet to help accelerate testing and tracing, two keys to breaking the chain of virus transmission.

JAKARTA, KOMPAS — The reduction in the price of polymerase chain reaction (PCR) swab tests appears not to have automatically cut the chain of COVID-19 transmission. The government still has to increase the number of free tests and speed up contact tracing.

"We have received many complaints from residents regarding PCR tests. Paid testing prices are still too expensive, while free testing provided by community health centers [puskesmas] are limited and the process is long. The results also take a long time to come out," said Amanda Tan of LaporCOVID-19 at a virtual discussion in Jakarta on Friday (20/8/2021).

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Many residents, some with COVID-19 symptoms, have asked for PCR tests at puskesmas but have not received responses, as reported in Sukabumi and Bandung, West Java, on June 19. A number of residents in Jakarta also reported the same experience on July 7.

"This is my seventh day of self-isolation, and I have not been contacted by the [COVID-19] task force for a PCR test," one of the residents said, as quoted by Amanda.

She said the complainant had received a reactive result from an antigen test. The resident’s test result, identity and contact number were submitted to the local puskesmas.

KOMPAS/RONY ARIYANTO NUGROHO

Poster of an appeal for Covid-19 alert in the Bogor City Hall Complex, West Java, on Wednesday (23/6/2021).

A mother in Surabaya, East Java, filed a complaint with LaporCOVID-19 on July 15 claiming she had not received her puskesmas PCR test result a week after testing. She said she was in self-isolation and needed the test result for contact tracing in her family. “I am worried about my baby’s condition,” she said, according to Amanda.

The PCR test result delays, said Amanda, held back efforts to contain virus transmission and endangered patients. A resident of Bekasi was reportedly unable to go to the hospital despite suffering shortness of breath simply because the PCR test result had been on hold for five days.

"The price reduction in paid PCR tests does not automatically amplify testing necessary for contact tracing purposes. The government should step up the capacity of free testing for citizens so as to achieve the government\'s target of 400,000 tests per day," Amanda said.

The government has lowered the maximum legal price of a PCR test from Rp 900,000 to Rp 495,000 for Java and Bali and to Rp 525,000 outside Java and Bali, as stipulated in an Aug. 16 Health Ministry circular.

Data from the Health Ministry shows that nationwide new cases increased by 20,004 on Friday. The number of active cases fell by 7,466 to make for 327,286 active cases in total. However, the daily mortality rate was still high with 1,348 deaths, bringing the cumulative death total to 123,981.

In fact, in a number of provinces, such as Aceh and Lampung, almost half of the tested residents were positive for COVID-19 on Aug. 19.

The increase in the daily caseload came from the results of swab tests on 113,847 people, only 38,095 of whom were tested by PCR or rapid molecular tests (TCM). With this group of tests, the positivity rate was 35.69 percent. In fact, in a number of provinces, such as Aceh and Lampung, almost half of the tested residents were positive for COVID-19 on Aug. 19.

Griffith University epidemiologist Dicky Budiman said the seemingly low daily caseload with the high death toll indicated a problem with data filing, resulting in undetected cases because of limited testing and tracing. The data filing problem was also blamed for the high positivity rate.

The condition is more alarming outside Java, where the capacity for testing and tracing is more limited. The government has been urged to be more aggressive in its testing and tracing efforts.

One positive case requires the tracing of eight close contacts, and an area with a high positivity rate requires enhanced COVID-19 testing, according to Siti Nadia Tarmizi, the Health Ministry’s director for prevention and control of contagious diseases.

"We continue to remind local governments to increase testing and tracing. We also ask for support from the Indonesian Military [TNI] and National Police. Currently, many traced contacts have not been followed up with testing,” she said.

Kompas/Bahana Patria Gupta

Officers check bus passengers who will enter Surabaya City at the Suramadu Bridge Blocking Location, Suramadu City, East Java, on Wednesday (16/6/2021).

Of the 34 provinces, only three have a weekly 1 to 8 tracing ratio of confirmed positive cases. Those are West Nusa Tenggara, East Java and North Sumatra. The lowest ratio is in North Kalimantan, Bangka Belitung Islands and West Papua.

East Java

President Joko “Jokowi” Widodo lamented the continually high death rate in East Java, which was at 7.1 percent, blaming it partly on late admission of patients to either government-designated isolation shelters or hospitals for those with severe symptoms.

“Only after the [oxygen] saturation dropped were they taken to hospital. It was too late. Second, [they had] comorbidities. In my opinion, these two are [the reasons] why [the death rate] is high," the President said during the East Java Regional Leadership Coordinating Forum (Forkopimda) in Madiun on Thursday (19/8).

Once a patient enters an isolation center, medical attention must immediately be given.

He imparted three points of direction: transfer those who are self-isolating to government-administered isolation shelters at regencies and cities, accelerate vaccination efforts and speed up the distribution of drugs. Once a patient enters an isolation center, medical attention must immediately be given, he said.

Health worker mortality

According to data from the East Java chapter of the Indonesian Doctors Association (IDI), as many as 14 doctors, 2 of whom were professors, died of COVID-19 in three weeks in August. Four of them died on Wednesday (18/8): Professor Triyono Karmawan of IDI Surabaya, Yudia Supradini of IDI Blitar, Arief Suseno of IDI Jember and Moelyanto.

The other professor who died was Suhatno of IDI Surabaya. He died on Sunday (8/8). East Java IDI chair Jati Sutrisno said the association was shocked to learn about the loss of their fellow doctors.

Kompas/Wawan H Prabowo

Towards the end of the extension of the Implementation of Community Activity Restrictions (PPKM) level 4, a number of roads were again enlivened by community cycling activities, as found in the Summarecon area of Bekasi, West Java, on Sunday (15/8/2021).

Amid the high caseload and the deaths of medical staff, 28 regencies or municipalities have reportedly not allocated the budget to provide incentives for regional health workers handling COVID-19. As many as 18 of them are in level 3 or 4 of the ongoing restrictions. Among them are Central Aceh, Bekasi, Sorong, Makassar and Pematang Siantar.

"We hope these regions will allocate the budget for health personnel and carry out their obligation to pay their incentives," said Mochamad Ardian Noervianto, the Home Ministry’s director for regional finance. (BRO/NIK/WKM/AIK/TAN)

(This article was trqnslated by Musthofid).