Testing Limitations Lead to Case Spikes

KOMPAS/HARRY SUSILO

Officers are issuing PCR test samples for processing at the molecular biology laboratory at Margono Soekarjo Banyumas Regional Hospital, Central Java, Friday (6/11/2020). The testing capacity in this laboratory reaches 2,000 samples per day.

JAKARTA, KOMPAS — The rate of COVID-19 transmission in Indonesia is still high, which has resulted in health facilities being flooded with patients. Therefore, testing, tracing and isolation, in addition to the application of strict health protocols, need to be improved to break the chain of transmission and prevent the collapse of health services.

According to the COVID-19 task force report, daily cases in Indonesia increased by 5,533 people on Wednesday (2/12/2020) and the death toll increased by 118 people. With these additions, the total number of cases in Indonesia reached 549,508 with 17,199 fatalities.

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The highest increase in cases was in Jakarta with 1,166 cases, followed by Central Java with 944 cases, West Java with 764 cases and East Java with 460 cases. The highest increase in deaths was in East Java with 30, followed by Central Java and Jakarta, each with 23. According to Wiku Adisasmito, spokesperson for the COVID-19 task force, data synchronization involving the central government and regional administrations was being carried out.

In East Java, the COVID-19 outbreak worsened again after it had subsided. There was an increase in the number of high-risk areas. According to the region’s official website on Wednesday (2/12), the only low-risk areas or yellow zones are Pacitan and Sampang. There are four high-risk areas or red zones, namely Jombang, Batu, Situbondo and Jember.

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The high increase in daily cases caused hospitals to be filled up with COVID-19 patients. Data from the Health Ministry\'s Information Data Center as of Tuesday (1/12) show that the utilization ratio of isolation wards and intensive care units (ICU) in seven provinces exceeded the 60 percent safety threshold recommended by the World Health Organization (WHO), including in West Java, Central Java and Yogyakarta.

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Wiku Adisasmito, spokesperson for the COVID-19 task force.

In Bogor municipality, West Java, for example, the occupancy of rooms for COVID-19 patients at referral hospitals reached 83 percent. The Bogor municipality administration is now preparing an emergency hospital designated for COVID-19 services. According to Bogor Mayor Bima Arya, the average room occupancy at 21 referral hospitals was 83 percent while at ICU rooms it was 90 percent.

Testing

To prevent hospitals from being overwhelmed, the rate of transmission must be put under control. The head of data and information technology for the COVID-19 task force, Dewi Nur Aisyah, said that testing, tracking and isolation were crucial to break the chain of transmission.

The number of tests increases every month even though there are inconsistencies, especially during holidays. As of June, the average number of samples tested was 16,000 per day and the number of people tested was 8,500 per day. As of September, 36,000 samples were tested per day and 23,000 people were tested per day. As of November, there were 39,000 samples tested per day and 31,000 people tested per day.

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Referring to the minimum threshold recommended by WHO, out of 1 million people, 1,000 people must be tested per week, Indonesia with 267 million people should test 267,000 people per week. "Now collectively, we have tested 90 percent of the WHO target," she said.

There are 13 new provinces that achieved the 50 percent rate and 10 provinces achieved less than 50 percent.

However, the testing has not been evenly distributed. Only 11 provinces have achieved the minimum WHO standard testing rate, namely Jakarta, East Kalimantan, Riau, West Papua, West Sumatra, Papua, North Sulawesi, Yogyakarta, Bali, Central Java and South Kalimantan. There are 13 new provinces that achieved the 50 percent rate and 10 provinces achieved less than 50 percent. "[We] have to increase testing, especially in areas that are testing less by ensuring that all close contacts are tested," she said.

Indonesian epidemiologist at Griffith University, Dicky Budiman, said that with the high rate of COVID-19 transmission in Indonesia, the minimum threshold for the WHO standard test was insufficient. "The number of tests must be doubled from the minimum threshold because the ratio of positive cases in Indonesia is above 10 percent," he said.

KOMPAS/P RADITYA MAHENDRA YASA

Anteran visitors to buy an entrance ticket at Semilir Hamlet, Bawen District, Semarang Regency, Central Java, Saturday (1/8/2020). The crowd of visitors is one of the hot spots in preventing the spread of Covid-19.

Although the number of tests has increased, the ratio of positive cases is high. This shows that the rate of virus transmission in the community is higher than the number of additional tests. Another important thing is contact tracing to speed up isolation. If we fail to contain transmission, the number of patients who will need treatment will increase.

"To see the number of tests, we need to understand the supporting factors, such as the number of laboratories, human resources and logistics, such as PCR [polymerase chain reaction] devices and reagents. Given the geographic conditions of the Republic of Indonesia, the capacities per province cannot be equal," said Dewi.

There are now 466 COVID-19 test laboratories under 11 ministries and agencies.

The uneven distribution of COVID-19 testing laboratories is the main obstacle to increasing case tests. The number of laboratories cannot accommodate the number of people requiring tests. "There are now 466 COVID-19 test laboratories under 11 ministries and agencies," she said.

In Jakarta, 64 reference laboratories are available with a target of testing 10,846 people per week. This is different from East Nusa Tenggara, which only has five laboratories with a target of testing 5,411 people per week, and North Sulawesi, which has six laboratories.

Another obstacle is the limitation of qualified human resources in COVID-19 testing, both in numbers and capacity. (AIK/TAN/GIO/BRO)