Indonesia was relatively “late” to the Covid-19 scene, reporting its first two cases on March 2, three months into the outbreak. Even then, concerns were mounting that the fourth most populous country in the world was failing to properly identify transmission of the virus.
A Harvard study released in February noted that despite not reporting any cases yet, Indonesia might be housing many undetected cases, as the country has strong travel connections with China. The country’s Health Minister, Dr Terawan Agus Putranto, said the study was “insulting” and that Indonesia had no cases to report, “all because of prayers”.
Nine days after Indonesia confirmed its first case of the coronavirus, it reported its first fatality on March 11. At that point, Indonesia reported 27 confirmed cases of infection.
As of Monday (March 23), the country has 579 confirmed cases and 49 deaths, with its fatality rate being the highest in the world at an alarming 9.3 per cent. According to scientists and experts, this is because the reported case numbers are too low. Given the government’s reputation, the reality may not line up with what is being publicised.
It has only been three weeks since the first Covid-19 cases were reported in Indonesia, yet the numbers are rising concernedly every day. The government, led by President Joko Widodo, has so far been criticised for being slow to act — there was not enough transparency, they were slow to notify regional governments of cases and measures, and there was confusion and a lack of communication between government bodies.
Indonesia finds itself facing a huge challenge — to rally and get a firm grip on the outbreak, before it spreads unrestrained throughout the country’s more remote islands, where it could grow and spread, “undiscovered and untreated for years to come”.
“The coronavirus could live on in Indonesia long after it has disappeared from the rest of the world,” wrote Muhammad Zulfikar Rakhmat and Dikanaya Tarahita of the South China Morning Post.
The Indonesian government’s response to the outbreak has been questionable in its lack of urgency to act and transparency about its mitigation measures and its count of confirmed and suspected cases of infection.
Last week, Jakarta Governor Anies Baswedan reported that the city was monitoring nearly 300 patients and 700 individuals for the virus. The provincial government of West Java noted that it was monitoring more than 700, and Banyumas city was monitoring more than 200. These numbers have been increasing daily, and regional governments are struggling to deal with the crisis themselves, without much direction from the central government.
The Ministry of Health’s National Institute of Health Research and Development (NIHRD) is the only institution authorised to test individuals for Covid-19, with only 10 Centres for Environmental Health and Disease Control Engineering nationwide that were authorised to test for the virus, along with Airlangga University Laboratories, Eijkman Molecular Biology Institute and a few other facilities.
The NIHRD supposedly has the capacity to test 1,700 samples per day. However, a little over two weeks after the first case appeared, only 1,293 samples had been examined. The turnaround time from getting tested to receiving results is an average of three days, due to long lines as well as the time needed to send samples from more isolated areas to Jakarta.
What is worrying is that many individuals were not even tested, as they either did not show any symptoms, did not have a recent travel history or did not have close contact with a confirmed case. While those were the main testing criteria in the beginning of the outbreak, Indonesia has already entered into the local transmission stage, and experts confirm that those points are no longer relevant.
To get a more accurate look at how the disease is spreading and other relevant data, Indonesia needs to reach out to all its regions and conduct as many tests as possible.
“To suppress and control epidemics, countries must isolate, test, treat and trace,” otherwise “transmission chains can continue at a low level, then resurge once physical distancing measures are lifted”, said World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus recently on the Covid-19 pandemic.
In terms of testing measures, Indonesia should take a leaf out of South Korea’s book. It confirmed its first case on Jan 20, and within a month, the country had tested almost 8,000 people. A week or so later, it had tested nearly 82,000, with the health authorities working around the clock to test as many as 10,000 individuals per day.
The central government needs to authorise regional governments to conducting testing, which will allow more patients to be examined efficiently.
Left without advice from above, regions are acting independently.
Jakarta Governor Baswedan shut down schools in his city for two weeks and postponed the national examination. Governor Ridwan Kamil of West Jaba confessed that his province had been purchasing test kits from a neighbouring country. In Central Java, Governor Ganjar Pranowo temporarily shut both schools and tourist destinations. And in Jambi, Sumatra, the army set-up its own coronavirus isolation tent, as there are not enough isolation wards in hospitals to handle the demand.
Other provinces have been unsure whether to act on their own, waiting for cues from the central government. As a result, schools and other public places have been left open, exposing residents to risk of catching the disease. Incredibly, the Governor of Yogyakarta even allegedly remarked that “coronavirus should not be an obstacle for children going to school”.
While the larger provinces have thus far been fending for themselves, the more remote and less developed parts of the country will be left to fend for themselves and will most certainly be overwhelmed. If not enough testing is being done, who knows how many cases of infection there already are, and without an accurate picture, how can the spread of the virus be mitigated?
Without the support and direction of the central government, Indonesia is facing an even bigger crisis — of not being unified as a nation in the battle against Covid-19. /TISG
