It’s Time to Conduct Massive Testing

KOMPAS/SAIFUL RIJAL YUNUS

An Indonesian Military (TNI) personnel and a civil servant of a joint Covid-19 team disinfect a motorcycle, its driver and passenger at a checkpoint in the border city of Kendari, Southeast Sulawesi, Wednesday (1/4/2020). The team disinfects every motorist and their vehicle. Meanwhile, new arrivals from other towns must have their temperatures checked and fill out a health declaration form.

After imposing large-scale social restrictions, it is now the time for the government to conduct massive testing coupled with preparations for the treatment of COVID-19 patients.

JAKARTA, KOMPAS — The capacity of hospitals and medical workers has become more limited due to the rapid increase of COVID-19 cases in Indonesia. Health services in Java and Bali are expected to no longer be able to handle new patients infected with the coronavirus at the end of April if there are no immediate measures taken to reduce the number of new cases.

"Indonesia must overcome the backwardness in conducting massive COVID-19 testing and tracking down suspected coronavirus cases. This is the basis of treatment and isolation to suppress the increase of new cases,” Indonesian epidemiologist Dicky Budiman said when contacted from Jakarta on Wednesday (1/4/2020).

Without massive testing, we don\'t know who to track, we can\'t deal with patients to prevent them from infecting others.

The testing, case tracking, treatment and isolation of patients should be the keys of the government’s efforts in overcoming the COVID-19 pandemic. "Without massive testing, we don\'t know who to track, we can\'t deal with patients to prevent them from infecting others," he said.

Dick explained that the upward trend of new COVID-19 cases and fatalities in Indonesia and compared them with the capacity of health services and medical personnel. With the increase of cases scenario, the capacity of the existing hospitals in Jakarta will be insufficient in accommodating additional patients by mid-April, while for Java and Bali it will be by the end of April.

KOMPAS/FERGANATA INDRA RIATMOKO

Newly arrived bus passengers to Solo line up to wash their hands with soap on Wednesday (1/4/2020) at Tirtonadi Terminal in the city in Central Java. The bus terminal has installed disinfection booths and hand washing facilities for arriving passengers to flatten the curve of the Covid-19 outbreak in Indonesia, although the number of passengers passing through the terminal has dropped dramatically since the outbreak emerged.

Due to the surge in the number of patients in regions, a number of non-referral hospitals have been used to treat COVID-19 patients. For example, the Soreang Regional General Hospital, West Java, now accommodates two patients under monitoring (PDP) while Kopo Hospital, West Java, treats three PDPs.

For this reason, according to a government spokesman on the handling of COVID-19, Achmad Yurianto, around 360 referral hospitals have been prepared to treat COVID-19 patients. In addition, 340,000 pieces of personal protective equipment have also been distributed to medical personnel in regions.

President Joko “Jokowi” Widodo instructed the newly completed special hospitals for the handling of COVID-19 on Galang Island, Riau Islands, to begin operation on Monday (6/4). The observation and isolation facility on Galang Island became the second COVID-19 special hospital after the Wisma Atlet Kemayoran apartment complex, which has been converted into an observation and isolation facility for the coronavirus.

"We hope that this hospital will not be used as the number of people affected by COVID-19 decreases. If it is not used, it will be transformed into a special hospital for infectious disease, "said the President.

KOMPAS/PRIYOMBODO

A police officer wears a mask and medical gloves as he stands guard on Wednesday (1/4/2020) at a security post to the Wisma Atlet Covid-19 emergency hospital in Kemayoran, Central Jakarta. The government has temporarily converted the Kemayoran Athletes Village into a hospital for treating Covid-19 patients and is building an infectious diseases hospital on Galang Island of Riau Islands province as measures to combat the outbreak. It has also declared a public health emergency through Presidential Decree No. 11/2020 and issued sweeping social restrictions under Government Regulation (PP) No. 21/2020.

Obstacles

Although there are additional laboratories in several areas, massive COVID-19 testing has not been conducted. Data from the Indonesian Health Ministry show that, as of March 30, there were 1,414 confirmed cases out of 6,663 examinations. Meanwhile, as of March 31, there were 1,528 confirmed cases out of 6,777 examinations. So, in one day there were only 114 samples examined and all were positive.

The total number of examinations of samples using the polymerase chain reaction (PCR) method in Indonesia is very small at around 20 per 1 million people. While in South Korea, the number of people being checked with the same method has reached 371,300 people – 7,500 people per million people – and in Singapore the number totaled 39,000 people, 6,800 per 1 million.

According to Yurianto, 5,000 officers have conducted epidemiological investigations related to COVID-19.

As of Wednesday (1/4) there were 1, 677 confirmed cases with 157 deaths in 32 provinces in Indonesia, while 81 patients recovered. According to Yurianto, 5,000 officers have conducted epidemiological investigations related to COVID-19.

A number of regions have carried out massive rapid testing. The results of the rapid testing in Jakarta show 1.7 percent of the people being tested showed symptoms of COVID-19. The head of the Infectious Diseases Division of the Jakarta Health Office, Dwi Oktavia, said that 705 people were waiting for the results of laboratory tests. Of the 2,350 people under general monitoring (ODP), 500 were treated and 1,153 were classified as PDPs.

KOMPAS/KRISTIAN OKA PRASETYADI

A checkpoint officer scans the temperatures of motorists crossing the border between Minahasa and Southeast Minahasa in North Sulawesi on Wednesday (1/4/2020). Southeast Minahasa has imposed a local restriction on vehicles entering the regency to curb the spread the coronavirus.

The Bekasi regency government has completed a rapid test with 1,000 tools. Of the total, 4,000 tools were procured using the regional budget. Meanwhile, the Tangerang mayor, Arief Wismansyah, acknowledged that the Tangerag city lacked rapid testing kits.

According to Yurianto, 4,500 rapid testing kits for COVID-19 initial examinations have been distributed and more than 6,500 samples were sent to 34 laboratories for examination using the PCR method. The government will also use the TB PCR examination devices in 132 hospitals and several health centers for COVID-19 examinations. "The special COVID-19 cartridge will soon arrive. The devices need to be set. We hope the delivery time from patients to the testing laboratory can be shortened. This is also better because the examination is made through antigens, not antibodies as in a rapid test kit,” he said.

The deputy director of the Eijkman Institute for Molecular Biology, Herawati Sudoyo Supolo, said the PCR machine for TB screening could analyze one specimen in about 45 minutes. This analysis tool is suitable to be operated in regions because it does not need a lot of analysts and is better than a rapid antibody-based rapid test.

An epidemiologist from the Faculty of Public Health, University of Indonesia, Pandu Riono, said that large-scale social restrictions (PSBB) needed to be applied in all regions. That step must be accompanied by examinations of residents at risk of COVID-19 with wider coverage.

KOMPAS/P RADITYA MAHENDRA YASA

Civil servants distribute free lunches to ojol (ride-hailing motorcycle taxi drivers) on Wednesday (1/4/2020) at the Central Java Governor\'s Office in Semarang, Central Java. The public welfare and community service program was initiated as a show of solidarity to help residents who have begun to feel the economic impacts of the Covid-19 outbreak.

Coordinating Human and Cultural Development Minister Muhadjir Effendy said that technical guidelines related to the implementation of the PSBB would be published soon. The guidelines would include criteria for restrictions, authority and responsibility, coordination and activities that will be excluded from social restrictions.