Being Agile Against the Pandemic

Only a day after declaring the COVID-19 outbreak a pandemic (11/3/2020), director general of the World Health Organization, Tedros Adhanom Ghebreyesus, sent a letter to President Jokowi.

The WHO asked that President Jokowi immediately declare a national emergency; build a laboratory of adequate scale; expand case search, tracking, monitoring and careful data collection; and intensify preventive measures, including by encouraging people to wash their hands frequently.

However, this is an “exasperated” response on the part of WHO to see Indonesia’s response, which was considered too relaxed.

For more than two months, the Health Ministry boasted a zero status of positive COVID-19 cases. However, on Monday (2/3/2020), two weeks ago, the defense was broken. The President announced that two Indonesian citizens had tested positive for COVID-19. There was a Japanese citizen visiting Indonesia, then continuing to Singapore. A careful examination in Singapore confirmed that the Japanese had tested positive for COVID-19. Tracking was later conducted in Indonesia on someone who made contact with the Japanese citizen. The person was found and tested positive for being infected, then the President announced it.

The public was in commotion because the President announced it, not the health minister. Television and online media were constantly broadcasting breaking news, live coverage from the palace, up to the patients’ residence in Depok, West Java. It was later revealed how stuttering and chaotic the coordination of the handling of this outbreak, including things that were inappropriate, such as the mentioning of the names, residence, and photos of the patients clearly, even the installation of police lines in the patients’ homes. The Health Ministry looked stuttering.


Wasting time

The President’s announcement was like opening a Pandora’s Box. In a short time, the number of residents who tested positive for the virus continued to grow. A week later (9/3/2020), a spokesman for the COVID-19 outbreak handling task force, Achmad Yurianto, announced from the palace that 19 people had been infected. A day later the number swelled to 27 people. The next day there were 34 people. The next day it jumped to 69 people, and two people died. The increase in the number of infections was very fast. Alarming predictions have emerged, including by the State Intelligence Agency (BIN), which cited the peak of the COVID-19 outbreak to be during Ramadan next month.

More than a month ago, some medical circles, including from abroad, questioned why Indonesia had not yet announced the existence of COVID-19 positive citizens. At the same time, hundreds of other countries had openly stated that there were citizens who had been infected.

South Korea, Japan, Malaysia, Singapore, Italy, Saudi Arabia, Australia, the United States, Iran and many other countries. Why hadn’t Indonesia? In fact, the frequency of traffic of people traveling from Wuhan or other Chinese regions to Indonesia and vice versa was high, even far more than in neighboring countries. Based on statistical probability, there was a small likelihood of no cases of transmission in Indonesia. Moreover, the examination of hundreds of suspect samples of COVID-19 was only carried out in government labs, even though universities and the private sector were able to do so. This monopolistic attitude also disturbs the credibility of the government’s statement.

Imagine, developed countries like Italy, South Korea and Singapore, whose public services are very good, had admitted that many of their citizens had been infected and died. UNESCO reported that around 300 million students had to take days off. Thousands of interstate flights had been canceled. Italy even officially closed the entrance to the country alias lockdown. Stock indexes in a number of countries, including Indonesia, all fell out. Similarly, the value of the rupiah continues to decline. It can be said, almost all aspects of global life have been affected.

In such a situation, why hadn’t Indonesia announced the existence of COVID-19 positive people? It was natural that many parties doubted, including Australian Prime Minister Scott Morrison, who said Indonesia was a large country with many islands, so it was difficult to provide absolute assurance that there were no positive patients of COVID-19. That was revealed by Morrison a few days before President Jokowi announced there were Indonesian citizens who were tested positive.

However, all these doubts were answered by the health minister in a relaxed way. “People are in doubt, yes, just let it be, it will cause a headache to respond to people who are doubtful,” he answered as quoted by the media. Previously, the Health Minister also showed a confident gesture. “Medically, prayer, all because of prayer, I’m sure it is prayer that makes us all corona-free,” he said (15/2/2020). The health minister also said that Indonesians had very strong immunity so that it was difficult for the coronavirus to infect. Even the Health Minister felt comfortable when many parties doubted his statements and did not feel burdened by this pandemic. “Yes, It’s comfortable. It’s convenient because we are sincere, work sincerely, surrender, give our best,” he said as quoted by many media.


Eight vaccine candidates

This was the problem. The attitude of the Health Minister that looked dismissive and relaxed made the national and international public be in doubt. A national weekly magazine published a report, stating the President was disappointed with the attitude of the Health Minister. Perhaps this was what led the President to finally take over, announcing that there had been Indonesian citizens who had been infected. The decision of the President was able to pump up the enthusiasm and optimism of all levels of the staff to be persistent in facing the Covid-19 outbreak. Moreover, the international community also hopes and supports that Indonesia can successfully overcome this outbreak. Indonesia has also shown serious efforts. The repatriation of Indonesian citizens from Wuhan and continued with the quarantine in the Natuna Islands is an example of the serious effort. Nevertheless, it seemed the stuttering of the ranks of the Health Minister to appear as they did not any dissemination of information in advance to the citizens of Natuna so that there was once protest in rejection.

Indonesia is an archipelago with thousands of islands, the world’s fourth most populous. The Covid-19 character is increasingly showing pathogenicity with very strong, fast, and efficient transmission power. Imagine, one infected person can spread to 2-3 other people very quickly, exponentially. Borrowing the motto of the national hero Pangeran Sambernyowo, the founder of Mangkunegaran, the Covid-19 outbreak has the potential to lead to tiji tibeh, mati siji mati kabeh (Death to One, Death to all).

Epidemiological health experts say Covid-19 has a fatality risk of around 3 percent. This is much worse than ordinary seasonal influenza. Like the Covid-19 pandemic, the outbreak at that time spread with a very broad scope, affecting many countries on a massive scale, with a very large number of victims.


Good news

The Covid-19 epidemic is actually very obvious to lead to a pandemic. Covid-19 can kill healthy adults, in addition to old people who have been sick earlier. The data so far shows, there is strong evidence Covid-19 can be transmitted by people who only suffer from mild illness or even healthy without symptoms. It means, dealing with Covid-19 will be far more difficult than when dealing with outbreaks of Middle Eastern respiratory syndrome (MERS) or severe acute respiratory syndrome (SARS), which is only spread by symptomatic people.

The fact is that Covid-19 has caused 10 times more cases in only a quarter of the time span compared to SARS. In such a condition, it can be understood that WHO finally announced Covid-19 as a pandemic. Therefore, we need to be more alert after losing a lot of crucial time. We also need to accelerate and strengthen work in the care sector, racing with death to produce a vaccine for Covid-19.

Currently scientists in a number of countries are trying to sort the viral genome and develop several vaccine candidates for Covid-19. The Eijkman Molecular Biology Institute and several universities that have centers for the study of tropical diseases, such as the Institute of Tropical Disease at Airlangga University, can work together to produce vaccines.

Interstate cooperation in the form of coalitions for epidemic preparedness initiatives has also been prepared. According to the latest news, there are already eight promising vaccine candidates to enter soon clinical trial stage. If some of these vaccine candidates prove to be safe and effective in animal testing, they can be ready for the large-scale trial phase in early June. And, we can be sure of drug discovery can also be accelerated.


Standby budget

Then, how is the budget? The war against Covid-19 clearly requires a very large cost. This is to strengthen the surveillance sector and on the response side of the disease. A much higher number of temperature heat scanners need to be prepared in public places as an initial detector. Likewise, specimen test equipment must be prepared in sufficient quantities. A national media reported that until the end of February, the Health Ministry only examined 136 samples. With a population of around 270 million, this sample size is considered very minimal. For comparison in the same period, Singapore, which has a population of 5.6 million, had examined more than 1,200 samples. Malaysia with a population of 31 million had examined 1,000 more samples, Australia with a population of 25 million had 4,000 samples.

The Covid-19 pandemic is extraordinary. Other countries responded quickly, including immediately closing the flow of visitors from countries affected by the outbreak. Italy declared lockdown, cancelled all activities that brought together citizens on a large scale. The soccer competition was halted. This was immediately followed by several other countries. When other countries closed the arrival of foreign guests, Indonesia instead poured a large budget to attract tourists. Some local governments, private offices, and educational institutions actually show a more reasonable step. Such as closing tourist attractions and canceling gathering permits, recommending the stoppage of schools and lecture activities, providing hand sanitizers and heat scanners in public places, as well as encouraging religious people to be more secure in gathering during worship, even announcing vulnerable points for the spread of Covid-19 suspects.

Gratefully, now President Jokowi is alert. As soon the WHO declared Covid-19 a pandemic, the President immediately formed a rapid reaction team and appointed Doni Monardo as its chairman. We support

Lt. Gen. Doni in the war against this pandemic. A number of major works await, as stated in the WHO Director General’s letter to President Jokowi. A large budget must be prepared. Finance Minister Sri Mulyani provided Rp 1 trillion. Naturally, this support also includes supporting efforts to quickly produce the Covid-19 vaccine.

If the vaccine has been produced and has passed clinical trials, the government must immediately spend very large funds for the procurement, distribution and action of the vaccination to all corners of the nation. By doing so, Indonesia does not only seek to protect its own citizens, but also contributes to the world to help minimize the spread of this vicious virus. Facing a pandemic requires mutual cooperation of all parties. The government is seriously trying to overcome it, and residents should follow the guidance of medical experts. No less important, don’t let us panic. We face together with optimism. So that there will also be tiji tibeh, namely mukti siji, mukti kabeh (Glory to One, Glory to all).


Djoko Santoso, Professor of Internal Medicine, School of Medicine, Airlangga University.