Comprehensive, Open Contact Tracing of People with Covid-19 Urgent in Indonesia
Transparent and comprehensive contact tracing is critical to curb the spread of Covid-19. Indonesia needs it right now.
A firefighter helps disinfect a classroom at SD 05 state elementary school in Petukangan Selatan, South Jakarta, Thursday (26/3/2020) to curb the spread of COVID-19.
The government has been urged to be more comprehensive in its contact tracing of people who have tested positive for Covid-19, to curb the outbreak’s spread.
Transparent and comprehensive contact tracing is critical to curb the spread of the coronavirus.
Findings of Kompas daily’s investigation published on Thursday (26/3/2020) showed that the government had yet to be fully transparent about its contact tracing efforts. This lack of openness has led to missing links in Covid-19’s chain of transmission, and may even cause the outbreak to get out of control.
Indonesians who tested positive for Covid-19 had no idea where and from whom they got the SARS-CoV-2 virus that causes the disease. The amount of information that reaches the public is also very limited.
If we cannot follow the virus’ trail, we will not be able to stop its spread.
This is despite contact tracing carried out on people with Covid-19.
University of Indonesia School of Public Health epidemiologist Syahrizal Syarif said the virus would stop spreading if everyone with a history of contact with people with Covid-19 could be traced and subsequently ordered to self-isolate.
“If we cannot follow the virus’ trail, we will not be able to stop its spread,” Syahrizal told Kompas.
An Italian Covid-19, Corona patient arrives at the Helios hospital in Leipzig on March 25, 2020. - Hospitals in the German state of Saxony will take on at least six Italian coronavirus patients who are unable to receive treatment in their own country
59,000 people in 10 days
With Covid-19’s transmission rate or R0 at 3, one person with Covid-19 can transmit the disease to three healthy people. If the person with Covid-19 is not quarantined, the number of people he or she infects can be higher.
“The person can spread the virus to, say, 11 other people. If we do not track and find these 11 people, then we cannot order them to self-isolate and they can spread the virus to more people,” Syahrizal explained.
However, he said he acknowledged that contact tracing required a massive amount of resources, especially in a country as vast and hugely populated as Indonesia. “Especially as there are currently more than 700 cases in all of Indonesia,” he said.
In the case of Covid-19, one person can trigger a chain of transmission that includes 59,000 people.
Covid-19’s R0 of 3 may not seem that much worse than the common cold’s R0 of 1.3. However, in practice, this seemingly small gap means a huge difference.
University College London professor of medicine Hugh Montgomery said that, with an R0 of 1.3, a person with flu can trigger a chain of transmission involving 14 people in the span of 10 days. The figure is obtained from 1.3^10, which is 13.78.
With an R0 of 3, Covid-19 can spread from one person to 59,000 in just 10 days. “In the case of Covid-19, one person can trigger a chain of transmission that includes 59,000 people,” Montgomery said in an interview with UK TV channel Channel 4.
Singapore government COVID-19 information portal
Medical researcher and KawalCovid19 volunteer Septian Hartono said that contact tracing had been proven to curb the spread of Covid-19 in Singapore.
Covid-19’s spread in a cluster was stopped at Case 47. “If the virus’ spread is not quickly detected and traced, these people with Covid-19 can continue to spread the disease,” Septian said.
On Saturday (21/3/2020), the Singapore government launched a smartphone app called TraceTogether. Through Bluetooth network, the new application can trace the times a user is near other users.
The app is hoped to help the government’s contact tracing effort. If a person who has the app catches the new coronavirus, the government can easily track people who have been in contact with him or her in the preceding 14 days.
The Singapore government has ensured that the app will protect its citizens’ privacy. The app will not keep track of users’ phone number, movement and contact list.
Two steps ahead of the virus
Singapore has set an example in contact tracing. In mid-February, World Health Organization (WHO) director general Tedros Adhanom Ghebreyesus praised Singapore for its trace and test efforts.
The Singapore Health Ministry’s deputy director for communicable diseases Vernon Lee said the contact tracers had two hours to obtain early detailed information on people with Covid-19.
Patient data displayed by the Singapore government contains the travel history of each citizen tested positive for COVID-19.
Information gained from the contact tracing process is detailed. Other than basic questions on international travel history and family members, people positively tested for Covid-19 are also requested to list the people they have encountered.
According to Lee, contact tracing followed by forced quarantine and strict social distancing are key in mitigating Covid-19. Transparency of information is also important.
Residential and workplace information are published in an official online portal. Therefore, other citizens can get the necessary information to protect themselves.
Persons who have been in contact with people who tested positive for Covid-19 are forced to self-isolate. “We want to be one or two steps ahead of the virus,” Lee said.
Since the first positive case on 23 January 2020, Singapore has had 558 positive cases and two fatalities, as of 26 March.
On its online portal, the Singapore government provides highly detailed information but still protects sensitive personal details.
Protection of personal information
On the online portal, all positive cases are numbered and their age, sex and treatment location are also listed. Cases are also color-coded, with blue meaning hospitalization, green meaning discharged from hospital and grey for fatalities.
There are also additional details, including the date of Covid-19 positive confirmation, source of transmission (local or abroad), citizenship status, personal address and a history of visited places. Additional information from the authorities may also be given.
For instance, Kompas tried to find information for Case 214. The online portal shows that Case 214 is a 29-year-old male currently being treated at the National Center for Infectious Diseases (NCID). He was positively tested for Covid-19 on March 14, 2020.
Case 214 is a Singaporean citizen who got the virus locally. He lives in Jurong West Street and visited several places, including Youth Go! youth center, Project 180@Simei and the Singapore University of Social Sciences campus, before he was tested positive.
In a written official statement, the Singapore government also explains that Case 214 first felt symptoms on 5 March, one week before he underwent a Covid-19 test. It is also explained that Case 214 has no history of travel to countries exposed to Covid-19. It is mentioned that Case 214 is connected to Case 208.
The list of areas that open Covid-19 deployment data
With this information, people can contribute to protecting themselves and others in order to curb the virus’ spread. In Indonesia, the Covid-19 Mitigation Task Force website only provides barebones information.
The webpage, reachable at covid19.go.id/situasi-virus-corona/, only provides the latest number of positive Covid-19 cases, the number of patients currently receiving treatment, the number of patient who have recovered and the number of fatalities.
There is a detailed breakdown of these numbers at the provincial level. There are also four graphics showing the number of recoveries each day, the number of new fatalities each day, the number of new cases each day and nationwide accumulation graphics.
Only 12 provinces and cities have provided more detailed data, including Jakarta, West Java, Banten, Central Java, Yogyakarta, West Nusa Tenggara, West Sumatra and South Sulawesi. Cities include Bandung, Surabaya, Bogor and Semarang.
We need information on where people are moving in order to minimize the transmission.
At the provincial level, only barebones data is displayed. Jakarta and Yogyakarta present tabulations of positive cases, patients under surveillance and people under monitoring down to district level. At the city level, the Surabaya and Bogor administrations provides these data down to subdistrict level.
University of Indonesia digital communications expert Firman Kurniawan said information transparency was a measure to regain public trust in the government.
Public trust in the government’s Covid-19 mitigation has been eroded by the government’s neglect and underestimation of the disease in the first months of the outbreak.
“Currently, we need information on where people are moving in order to minimize the transmission,” Firman said.
