Putting an end to the COVID-19 pandemic in Indonesia

Putting an end to the COVID-19 pandemic in Indonesia

An Army soldier donates blood at the Blood Transfusion Unit of the Gatot Soebroto Army Central Hospital, Jakarta, Tuesday (August 18, 2020). (ANTARA FOTO/NOVA WAHYUDI/RA).

Scientists have predicted that the second wave of the COVID-19 pandemic, which peaked in Indonesia on July 15, 2021, may not be the last, as the coronavirus continues to mutate.

Experts from the Alliance of Indonesian Scientists for Pandemic Resolution said the situation is like a trap in which the cycle would revolve at high transmission rates with the emergence of new variants - longer pandemics - economic crises - and the lessening of public activities.

According to the COVID-19 Task Force report, from November 2020 to January 2021 Indonesia recorded an increase in daily cases from 24,932 to 89,052. In the second wave, from May to July 2021, there was a spike in cases from 35,470 to 253,600.

The government also has been working to reduce the number of cases through implementing Public Activity Restrictions (PPKM), fulfilling health care facilities, and accelerating vaccinations.

As a result, COVID-19 cases at the national level, as of August 29, 2021, decreased by 86.9 percent compared to the second wave.

"We have not succeeded in controlling the pandemic. We are still trapped in a vicious circle. Cases will continue to fluctuate if government policies are still patchy, where the program only focuses on dealing with the current situation, not on anticipatory measures," said Epidemiologist from the University of Indonesia (UI) Pandu Riono.

Riono added that Indonesia was still vulnerable to the pandemic due to the handling of the Corona outbreak, which tended to be sporadic. When there is a spike in cases, the government immediately imposes social restrictions.

However, when the easing is carried out, ironically, the mobility and activities of the community are the ones that trigger the increase in the number of cases again.

The presence of a new, more virulent variant, he said, could make it more difficult for Indonesia to get out of a protracted public health crisis. For this reason, a way out of the pandemic must be considered and realized to reduce the mortality and morbidity of COVID-19 at this time, and get Indonesia out of the pandemic crisis in the long term.

The COVID-19 Handling Task Force reported that as of Wednesday (September 1), a whole-genome sequencing (WGS) examination had been carried out in Indonesia on 5,790 samples, and it was found that 2,323 of them were variants of concern, namely Alpha, Beta, and Delta.

Health Minister Budi Gunadi Sadikin said the efficacy of m-RNA-based vaccines decreased quite dramatically when dealing with the Delta variant of the coronavirus. He observed that this condition occurred in the second wave of cases in some countries with high vaccination rates, for example, the United States.

For that reason, the Health Ministry has also changed its strategy to reach herd immunity from initially reaching 70 percent of the population to targeting as many as citizens vaccinated.

"We have carried out a series of situation evaluation analyzes, where the achievement of herd immunity is no longer 70 to 80 percent (of the population vaccinated), but most of the people in Indonesia can be vaccinated," Deputy Minister of Health Dante Saksono Harbuwono stated.

Post-pandemic Scenario

The Alliance of Indonesian Scientists for Pandemic Resolution has proposed a solution, in the form of a post-pandemic scenario.

The scenario was prepared by several independent and nonpartisan Indonesian scientists with diverse disciplinary and institutional backgrounds, including Sulfikar Amir from Nanyang Technological University, Pandu Riono from the University of Indonesia, Irma Hidayana from LaporCovid19, Iqbal Elyazar from Eijkman-Oxford Clinical Research Unit, Ines Atmosukarto from the Australian National University and Yanuar Nugroho from the ISEAS-Yusof Ishak Institute.

The three main principles in the scenario are 'empathy' or care for others, which is the foundation in handling every humanitarian crisis, 'equity' as equality and justice that guarantees access for all citizens, without discrimination in obtaining the right to a healthy and happy life. Finally, 'episteme' is an effort in scientific knowledge needed to guide the uncertainty and risk of a pandemic.

Based on these three principles, the Alliance of Scientists emphasizes two crucial points needed to resolve the COVID-19 pandemic and strengthen the government's capacity to anticipate future pandemics. These include the roadmap for resolving the pandemic and developing pandemic governance through institutionalizing disease outbreak control agencies.

Professor of Disaster Sociology from Nanyang Technological University (NTU), Singapore, Prof. Sulfikar Amir, divided the scenarios for dealing with the pandemic situation in Indonesia into three phases.

The first phase, he said, focuses on suppressing the rate of cases while the second phase is efforts to stabilize the pandemic, and the third one is the normalization of the pandemic.

"Indonesia is currently still in phase one. The target that must be done is to reduce the rate of transmission to below 10 percent, on average," he said.

The strategy in phase one, Amir said, is push and pull, focusing on integrated social restrictions between regions through the development of risk control techniques in public spaces and strategies to strengthen biosurveillance at the community level.

He noted that the implementation of the PeduliLindung app is a strategy to strengthen biosurveillance in public activities in offices, malls, restaurants, and other places. The application is connected to case tracking in health care facilities with the New All Record (NAR) as a centralized data system.

According to Amir, indicators of achievement that can be monitored in phase one include a decrease in the number of daily cases, deaths, and hospital occupancy rates.

In the second phase, Amir said, the transmission rate needs to be suppressed until the average positive number is below 5 percent. The strategy that can be taken is developing risk control techniques in the public space by reducing the reproduction rate (R0) to below one percent.

"The strategy is to increase public participation in integrated handling of the pandemic, development of community-based mitigation capacity, and public participation in handling pandemics at the community level," he said.

To reach phase three, Amir noted, Indonesia needs to reduce the transmission rate until the average positivity rate is below one percent. "The strategy is to strengthen biosurveillance at the community level, until the number of cases nationally is below five per 100 thousand citizens per week," he said.

The strategy that the government can take is to strengthen vertical and horizontal collaboration in pandemic surveillance.

"The strategy is to grow social resilience at the community level, restore socio-economic activities, especially at the lowest level. An indicator that can be considered is the growth of lower-middle-class income," he said.

Institutionalization

In the post-pandemic scenario, it is also proposed that the government establish a disease control and prevention center so that Indonesia is better prepared to deal with additional outbreaks.

Pandu Riono stated that the presence of the COVID-19 Handling Task Force, the 2019 Coronavirus Disease Handling Committee, and the National recovery (KPCPEN) were temporary committees specifically dealing with the COVID-19 pandemic.

"If it is still a committee, later after the pandemic has ended, the committee will disband. Knowledge and experience of dealing with the pandemic are lost, too," he said.

According to Riono, several developed countries in the world are better prepared to face the COVID-19 pandemic through the role of disease control and prevention centers in their respective countries. For example, the Centers for Disease Control and Prevention (CDC) in the United States and the China Central Depository & Clearing (CCDC) in China.

Ministries and government agencies, he added, need to have more mature and integrated preparedness in dealing with the emergence of the next outbreak.
 
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