With One Million Covid-19 Cases, Implementation of PPKM Needs to be Strengthened

The number of Covid-19 cases in Indonesia, which has reached 1 million, indicates the pandemic is getting out of control. The public activity restrictions have not been enforced fully to suppress new Covid-19 cases.

KOMPAS/AGUS SUSANTO

Ambulance drivers await their turn to drop off bodies for burial under strict Covid-19 protocols at TPU Bambu Apus Cemetery in Cipayung, East Jakarta, on Tuesday (26/1/2021). Since it opened on Thursday last week, an average of 38 bodies were buried there under such protocols. The Jakarta administration cleared 3,000 square meters at TPU Bambu Apus for the burial of Covid-19 patients. The new burial site is expected to accommodate 700 bodies.

The number of Covid-19 cases in Indonesia, which has reached 1 million, indicates the pandemic is getting out of control. The public activity restrictions (PPKM) have not been enforced fully to suppress new Covid-19 cases.

JAKARTA, KOMPAS — The number of Covid-19 cases in Indonesia exceeded 1 million on Tuesday (26/1/2021). With the growing number of cases, the situation could get worse.

As part of efforts to suppress the spread of Covid-19, the government has extended the implementation of public activity restrictions (PPKM) until 8 Feb. 2021 in a number of areas in Java and Bali. Each region on the two islands need a clear target and specific operational programs to ensure social restrictions effectively reduce the number of new cases by up to 50 percent as initially targeted.

"What needs to be watched out for now is not the 1 million cases but number of the new cases. Since early January, the number of new cases has reached new records, indicating that many cases have not been detected and that transmission is further widespread," the chairman of the Indonesian Public Health Expert Association, Ede Surya Darmawan, said in Jakarta on Tuesday.

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On Tuesday (26/1) there were additional 13,094 cases, bringing the total number of Covid-19 cases in the country to 1,012,350 cases. The death toll increased by 336, bringing the total number to 28,468 people. The daily death was the second-highest on record since March 2020.

KOMPAS/RONY ARIYANTO NUGROHO

Wearing personal protective equipment and hazmat suits, people bury a Covid-19 patient at TPU Situ Gede Cemetery in Bogor, on Tuesday (26/1/2021). The number of Covid-19 cases reached 1,012,350 that day, breaking the one million mark. The number of death in Indonesia stood at 28,468 people.

With this number of cases, Indonesia became the first country in Southeast Asia to reach a million Covid-19 cases. According to data from the World Health Organization (WHO), the increase in casualties in Indonesia in the past week is the highest in Asia and 12th largest in the world.

Could be worse

According to Ede, the transmission rate in Indonesia could be worse than the available official data, because most of the cases found are the result of self-examination. It means that the examination is carried out when there are symptoms. Meanwhile, the public does not know the number of examinations which are carried out as the result of contact tracings.

"The number of cases in Indonesia is actually much higher than 1 million because the number of people being tested is very low," said epidemiologist at the University of Indonesia\'s School of Public Health, Iwan Ariawan.

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Outside of the confirmed cases, many infected people are still undetected and continue to spread the disease. “We haven\'t reached the peak yet. I am afraid the current situation is not yet the worst, "he said.

Indonesian epidemiologist at Griffith University, Dicky Budiman, estimates that the number of cases in Indonesia is three times the number found.

This situation will get worse if the number of cases continue to increase.

The upward trend in the daily death toll indicates that health facilities are at brink of collapse. This situation will get worse if the number of cases continue to increase.

Referring to modeling by the Center for Global Infectious Disease Analysis at Imperial College London, the number of new Covid-19 cases in Indonesia has reached 257,748 cases per day. According to Dicky, the modeling calculates various factors, including the trend of mortality and the test positivity rate (ratio of positive tests). The test positivity rate 28.3 percent in the past week shows that the transmission had been very massive.

Real steps

On Tuesday, President Joko “Jokowi” Widodo chaired a meeting to discuss the prevention of Covid-19 transmission at Merdeka Palace, Jakarta. Present at the closed meeting were, among others, Health Minister Budi Gunadi Sadikin, State Secretary Pratikno, and Cabinet Secretary Pramono Anung.

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With the number of Covid-19 cases exceeding 1 million and the further increase in the death toll, Budi Gunadi Sadikin said after the meeting that it was now the time to mourn. Efforts to reduce the transmission rate must be strengthened so that health facilities would not be overburdened.

KOMPAS/AGUS SUSANTO

A woman who tested positive for Covid-19 at community health center (Puskesmas) in Duren Sawit, East Jakarta, awaits a car that will take her to the Covid-19 hospital in Kemayoran on Tuesday (26/1/2021). The total number of Covid-19 cases in Indonesia per 26 January 2021 at 3:53 p.m. was recorded at 1,012,350, with total deaths of 28,468. The daily addition of cases and deaths in Indonesia was quite high compared to other countries. With a positive test ratio of 27.8 percent in the past week and the low number of people being tested, it is almost certain that the real number of cases is higher than that being reported.

For that, two things must be done together. The discipline in following the health protocols such as wearing a mask, washing hands and keeping distance from others should be further improved.

Second, the importance of testing, contract tracing, and isolating those infected with Covid-19. "The responsibility of the Health Ministry is to ensure testing programs for people who are suspected of being affected so that we can identify and reduce the transmission rate as well as tracing the close contact of the infected people, and preparing isolation places so that they can recover without infecting other people," said Budi.

As per WHO standards, 30 close contacts should be traced from one confirmed case.

According to Iwan, an increase in the number of tests must be accompanied by the ability to trace cases so that the examination targets are not mistaken. As per WHO standards, 30 close contacts should be traced from one confirmed case. "We can\'t just rely on health workers from the Puskesmas (community health centers) to carry out tracing," he said.

As part of an effort to suppress the transmission of Covid-19, the government has extended the PPKM until 8 Feb. 2021.

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Regions that implement PPKM include areas on the north coast of Central Java, East Java, South Kalimantan and West Nusa Tenggara. The Sidoarjo regency government, for example, will close down the locations of street vendors during the second PPKM period.

Kompas/Heru Sri Kumoro

A public order police officer orders a motorbike driver to pull over during a crackdown on health protocol violations on Jl Palmerah Barat in Jakarta on Tuesday (26/1/2021). The crackdown was part of efforts to improve discipline among people in complying with health protocols. Violators were recorded and fined or told to clean up the sidewalk.

According to Ede, the PPKM implementation must be firmer. Coordination between the Central and local governments should be further strengthened. Examination in all regencies or cities that implement PPKM also needs to be increased. "If necessary, there are prohibitions. There is no other choice so that the health quarantine is implemented. The impact is bad if allowed to continue," he said. (INA/TAN/AIK/PDS/JUM/BRO/ETA/TAM/NIK/DIT/JOG/COK/XTI/ZAK/DIA)

(This article was translated by Hendarsyah Tarmizi)

(These captions were translated by Kurniawan)