‘Mudik’ Amid Covid-19 Outbreak
Economic activity in the cities has slowed down considerably, people are no longer able to manage their livelihoods if they remain in urban areas.
Participating in mudik (post-Lebaran exodus) amid the spread of Covid-19 is not recommended, but this year’s mudik will prove difficult to stop. During the 1998 economic crisis, those who lost their jobs in big cities chose to earn a living in the regions, especially in the villages, to fulfill their basic needs.
Economic activity in the cities has slowed down considerably, people are no longer able to manage their livelihoods if they remain in urban areas. The problem is compounded as mudik travel is feared to bring a new wave of coronavirus transmission to residents who do not have immunity. At present, more than 70 percent of Covid-19 cases being reported are from Jakarta, Banten and West Java, while mudik travel destinations are outside the areas of the outbreak.
According to the Google Mobility Report, compared to the median value of mobility for five weeks (from 3 January to 6 February 2020), at the end of March 2020 it is estimated that there was a decline in mobility in Indonesia. Decreased mobility reached a range of between 15 percent (places of work) and 54 percent (stations, bus stops, public transportation terminals). Meanwhile, a 15 percent increase in mobility was observed in residential areas.
Death trend from Covid-19
Communities in regions are gradually becoming aware of the danger of coronavirus transmission, some are being very aggressive in dispersing crowds and closing villages as a local quarantine effort. The number of deaths caused by Covid-19 in Indonesia is indeed the highest among countries in Southeast Asia, but the actual death trend is relatively moderate, similar to Malaysia, the Philippines and Thailand, and even South Korea, which is known to have successfully fought off the Covid-19 outbreak.
We do not know what would happen if people traveled en masse to populations with low herd immunity, and they did not heed the government’s advice to practice physical distancing, avoid crowds, put your arm over your face when sneezing, wear a mask, and wash your hands with soap often.
In China, the movement of people during Chinese New Year resulted in the spread of the infection, especially in cities connected to Wuhan. Similarly, the movement of people from Lombardi to other regions in Italy spread the coronavirus, causing an explosion of cases and an extraordinary number of deaths in the country. Restrictions on movement in Lombardi were no longer able to stem the increase in Covid-19 cases throughout Italy.
Territorial restrictions
Italy, Spain and France closed their borders and imposed tight lockdowns until around mid-April. People are asked to fill out forms to explain why they leave the house. The army and police have been mobilized to oversee the community. Policies in Germany are somewhat more relaxed than in other European countries, only stopping public life and strengthening social distancing. The United States reports the highest number of Covid-19 cases, 57 percent of which are in New York and the surrounding states, reflecting the massive transatlantic movement as a source of transmission. US President Donald Trump does not dare to close New York and its surrounding areas, fearing chaos when the US economic engine is drastically slowed.
Japan has not held a lockdown so far, although the government is considering doing it if the outbreak becomes difficult to control. South Korea is considered to have been successful without any lockdown. India has failed to implement a lockdown due to the large number of urban migrants and homeless people flocking to rural areas, potentially spreading the coronavirus to large areas. The Philippines has locked down Manila and Luzon Island, under threat of gunfire on the spot for dissidents, hoping to ease the Covid-19 outbreak. The poor in the Philippines, who make up almost a quarter of the population, must struggle not to starve to death.
The majority (80 percent) of those who can transmit the coronavirus to others do not show symptoms of the disease or have mild symptoms that cannot be recognized, except by laboratory examination.
What about Indonesia, when many of its residents have been traveling home, and in the coming days more and more people are heading to their hometowns even though the government has tried to prevent it? The majority (80 percent) of those who can transmit the coronavirus to others do not show symptoms of the disease or have mild symptoms that cannot be recognized, except by laboratory examination.
While Lombardi in Italy failed to stem the outbreak of Covid-19, Veneto, a city also located in northern Italy, was able to minimize the number of cases and deaths caused by the coronavirus. The key to its success was conducting widespread checks in the community, including drive-through testing, of course with optimal protection of laboratory personnel. A doctor in Veneto likened the struggles of health workers to bowling players who have to see a pin at the end of the game lane to be able to drop it and make a strike.
As much as possible the source of transmission must be identified and isolated to stop new cases. South Korea has succeeded in stopping the Covid-19 outbreak by mass rapid inspection without regional restrictions. Indonesia will do the same. The coronavirus is faster than bureaucracy, said a social service official in Italy. Hopefully the bureaucracy, health workers and the community, especially in the mudik areas, can be faster than the coronavirus.
One village head is distributing soap to families who need it. Several families are hanging dry food on their fence for anyone in need.
Several villages are preparing for the arrival of mudik travelers with their local wisdom. A village near the slopes of Mount Merapi is preparing houses for locals who are known to be healthy, while their homes are used to quarantine their respective relatives coming home. Several villages have begun to raise funds to prepare food granaries. In a dense housing complex, internet access has been opened through shared Wi-Fi routers, or tethering (phone-as-modem) which is used to communicate virtually, thus limiting physical contact. One village head is distributing soap to families who need it. Several families are hanging dry food on their fence for anyone in need.
Creativity in facing the mudik phenomenon is not only needed by people in the mudik destination areas. Public health officials need to develop innovative regional systems to monitor people\'s movements, by utilizing information technology. As the spread of people being monitored (ODP), people suspected of being tested positive with the virus under supervision (PDP), and patients with Covid-19 can now be monitored by choosing a radius of 3 kilometers, 5 kilometers, etc., a crowd of people (mudik travelers or not) can also be mapped by utilizing the same geographic information technology. An application developed by the government called LindungiPeduli can immediately be used to find out if we are near ODP or asymptomatic people who have been exposed to coronavirus positive patients.
A community-centered approach must accompany patient-centered treatment, it is not enough simply to say "You stay at home for us, when we work for you.
When the government and the community, especially hospital staff, are still struggling with protecting patients and hospital staff from transmission of the coronavirus and the complications of Covid-19, which can be fatal, the mudik phenomenon, which is inhibited, but difficult to prevent, requires health workers and the public to jointly examine and implement more stringent efforts to prevent coronavirus transmission. A community-centered approach must accompany patient-centered treatment, it is not enough simply to say "You stay at home for us, when we work for you".
Hari Kusnanto, Professor of the Department of Family and Community Medicine, Gadjah Mada University