It is an amazing turnaround initial praise won over the progress toward herd immunity turning chaotic in just a short time due to “herd ignorance”.
The alarming spike in coronavirus cases in India should serve as a prompt reminder for our country in the face of Lebaran (Idul Fitri). It is also worth pondering whether promoting local tourism is justifiable while we prohibit mudik (Idul Fitri exodus). One large crowd is prevented, but another is encouraged. We need to adopt an attitude of protecting our own safety.
Let us look at India, which is now in the spotlight of global concerns. This country of 1.393 billion people is big in many ways and this time it is related to the coronavirus.
India began vaccination rollout on January 16, 2021 and as of early March, 18 million people had been vaccinated.
At one point, more than a million jabs were given daily, which is a world record. The ambition was that it expected to be able to vaccinate 300 million citizens in just seven months. The ambition and the following vaccination progress drew praise from various parties, including many circles in Indonesia.
Inevitably, people began suggesting that India would reach herd immunity soon. Prof. Tjandra Yoga Aditama, former director of the World Health Organization (WHO) Southeast Asia Region hailed India’s achievements in vaccination.
He put the success down to three implemented strategies -- private sector participation, being cheap (around Rp 50,000), and prioritization, which saw free vaccination for health workers and the elderly (this is also implemented in Indonesia).
Everything had been going as expected until health protocols and social restrictions were let off guard. WHO chief scientist Soumya Swaminathan had warned although several regions in India showed that herd immunity was achieved, it was important not to be complacent.
Also read: Vaccine-induced and Natural Immunity
However, complacency is human innate nature and the time has come now that India should pay dearly for the negligence.
In the name of faith and adherence to a tradition, more than 1 million Indians participated in the Kumbh Mela, a bathing ritual in the Ganges River, the world's largest religious festival (12/4/2021).
“Our faith is the biggest thing for us. It is because of that strong belief that so many people have come here to take a dip in the Ganges," a member of the organizing committees said as quoted by AFP news agency.
Millions of people flocked to the legendary river, in ignorance of health protocols – wearing a mask, physical distancing, hand washing. It was blatant massive negligence.
The noisy crowd was ignorant of the lurking threats posed by the coronavirus. Worldometers recorded 8,947 new cases on February 8, which was the country’s lowest number of cases this year. Negligence helped bring up the cases in March. Come April, they were rocketing.
Worldometers reported that in mid-April (16/4/2021) there were 217,353 new cases of infection, which went up to 314,835 a week later (22/4/2021). The number continued to rise to 345,147 cases (24/4/2021).
The rising trend of daily cases lifted the daily deaths, as showed on a curve resembling a thumb and forefinger pointing upward.
Also read: Vaccination and Threat of Virus Mutation
India is in panic; the national health system is hardly able to bear the heavy burden. The media is flooding the world with horror news. Ambulances carrying patients are queuing for a long time to enter health facilities, while beds, ventilators and oxygen are running out.
It is an amazing turnaround – initial praise won over the progress toward herd immunity turning chaotic in just a short time due to “herd ignorance”.
Indian "dual mutant"
Apart from the human factor that sees incompliance with health protocols, the virus having mutated into malignant strains has pushed India into a corona tsunami. The mutant variants of the virus are too many in number and complicated in their identification attribution to memorize.
The variants are as difficult to memorize as to deal with. Epidemiological and viral genetic sequencing studies have found four mutant variants in India, namely the UK strain (B1.1.7), the South African strain (B.1.351), the Brazilian strain (P.1), and most recently, the double mutant strain (B.1.617).
At the end of 2020, the world was shocked by the emergence of coronavirus B.1.351 from South Africa, which is known to be different from previous mutants because it has the potential to reduce the effectiveness of the antibody obtained from vaccines or previous infections.
Also read: Responding to the New Covid-19 Variant
Unlike its predecessors such as the UK strain, which spreads faster but can be intercepted by vaccines, the E484K mutation found in the South African strain makes antibodies unable to detect viral proteins.
Following this more threatening mutation, other variants are found to have been spread across the world, such as the United States variant (B.1.427), which has the L452R mutation and also reduces antibody protection.
The Indian "double mutant" variant is said to be alarming because it contains two terrifying mutations, namely E484K (from South Africa) and L452R (from the US), both having the ability to evade the human's antibody defense system.
These two mutations are reported to substantially reduce the neutralizing effect of antibodies and, when combined, can become more uncontrollable. The variants have been recently detected through genome sequencing on patients in India.
As many as 800 cases of double mutant variants have been found in 21 countries including the UK, US, Belgium, Australia and Singapore with India accounting for 40 percent of the cases.
Although the level of spread and fatality due to this virus strain has not been verified through research, it can be predicted – based on the location of mutation – the virus will spread faster and be more lethal. It means this Indian strain should be avoided by other countries by banning the arrival of citizens from India.
Also read: The Race to Creating a Vaccine
The so-called "dual mutant" appears to be quite fearsome because it can jack up new cases 10 to 20 fold. While other variants have one spike protein, the "dual mutant" known as B.1.617 has two spike proteins, and is more contagious. One is dangerous, let alone two.
A number of countries have responded quickly with Pakistan, Singapore, Hong Kong, the UK, the US, New Zealand and Canada immediately barring the arrival of passengers from India.
And as always, we let our guard down. The media reported that 127 Indians had entered Indonesia using charter flights from Chennai, India, and arrived at Soekarno-Hatta Airport on Wednesday (21/4/2021). They hold visit visas and limited stay permit cards (KITAS). Thank God, the Health Ministry finally took action following criticism from netizens.
Two days later (23/4/2021), the government, as Health Minister Budi Gunadi Sadikin said, carried out an antigen test on the Indian visitors and found 12 positive for Covid-19. Genome sequencing was immediately conducted to detect the possibility of the new variant among the positive cases. The Transportation Ministry has now barred all flights from India.
Mudik vs tour travel
If India has the Kumbh Mela ritual, we have the mudik tradition during the Idul Fitri holiday.
For most Indonesian Muslims, it seems incomplete to end Ramadan fasting session without celebrating Lebaran with family members and relatives in one’s hometown. However, like last season, to celebrate this year’s festivity, we should refrain from heading home.
The homecoming tradition must be seen as part of sending the message of rahmatan lil alamin [blessings for the world]. In the face of pandemic, the blessings will be obtained more precisely with us doing away with the homecoming tradition. After all, handshake greetings can be done virtually. Tipping money can be done through transfers and gifts through online delivery services. We protect our elders and relatives from possibly being exposed to Covid-19, which is found to be increasingly violent.
Positive cases of Covid-19 are still seen to be an "urban phenomenon", being concentrated in large, densely populated cities. Jabodetabek (Greater Jakarta) is the largest contributor to the cases, followed by Bandung and Semarang. If crowds of people persist with homecoming from big cities to villages, Covid-19 will come home too, because with humans moving, Covid-19 will be moving.
If allowed, mudik would potentially bring Covid-19 from big cities to all corners of the country. That would make the homecoming tradition mafsadat lil alamin, or causing harm to the world.
Thank God, the government has taken strict measures by prohibiting mudik from 6 to 17 May, with scrutiny already carried out beginning April 22.
However, the government’s firm stance on mudik will be more effective if the ban also applies to all assembling activities, including visits to tourism destinations. Imagine Jabodetabek residents flocking to Ragunan zoo, or Solo residents crowding the Pengging bathing pool in Boyolali, isn't it a gathering of people like in India?
Bear in mind that the current spike in cases in India has been spurred by a massive spread of cases in rural communities who were not hit by the virus in previous waves of infection.
If a spike takes place in small towns and tourism areas in a number of regions in Indonesia, it will be more difficult to deal with because the health facilities are not as many and complete as in big cities. So, don’t let us patch up the lagging economic growth by an approach that might risk worsening the situation.
There is a middle way that we can adopt wisely in the case that the government is still biased about crowding measures during Lebaran. We must initiate self-restraint from going on mudik and traveling on tour. We are blessed with an innate disposition to be able to take up efforts freely to avoid danger. If anything bad happens after we travel, it is us who would suffer, not the government.
Let’s welcome Idul Fitri by being grateful for and mindful of the health favored on us.
Professor of Airlangga University Medical School, Chair of the East Java MUI Health Division, and a Covid-19 Survivor
This article was translated by Musthofid.