Celebrating Eid while Beware of XE Variant


 

After two years of not celebrating Eid al-Fitr due to the pandemic, muslims can finally celebrate the end of fasting in the holy month of Ramadan. As a country with the largest muslim population in the world, the moment of this holiday is celebrated so lively with local traditions that we know as "Lebaran". As a tradition and part of Indonesian culture, Lebaran is strongly colored by the local atmosphere.

Eid is marked by a large flow of going home (mudik). Millions of people flocked back to their hometowns using various modes of transportation. After Eid prayer, often held in open fields, people enjoy a variety of delicious dishes, followed by the tradition of visiting each other's relatives and neighbors, apologizing, and even the young paying respect to the elderly. Meanwhile, the children were busy choosing treats of various snacks and receiving Eid gifts from their parents and relatives. The atmosphere of Eid is full of brotherhood, delicious food, full of joy and full of blessings.

That is the happiness imagined after two years of Lebaran being lived without any homecoming activities, but by still praying for our brothers and relatives who passed away due to Covid-19 pandemic. As of April 22, 2022, in Indonesia there were 6,043,246 people exposed to COVID-19, 5,866,169 people recovered and 156,040 people died.

Thankfully now the situation is getting better. Data on April 22, which showed that there were only an addition of 651 positive cases, was a very far drop compared to February 16, 2022 when the third wave peaked, when there were 64,718 new cases.

The improvement in conditions is not only indicated by the decreasing number of cases, but also the continued implementation of 'care to protect' ("pedulilindungi") and the higher vaccination rates. The government targets vaccination of 208,265,720 residents. Until April 22, 2022, the first dose of vaccination reached 198,739,666 people (95.43% of the target), while the second dose reached 63,709,692 (78.61%) and the third dose was received by 34,280,741 people (16.46%). According to epidemiological parameters, with these figures, herd immunity has been achieved.

With these two main considerations, the government has finally decided to allow going home to celebrate Eid al-Fitr this year with relatively flexible conditions. For those who have only received dose 1 of the vaccine, they must show a negative result on the PCR test. For those who have received dose 2 of the vaccine, they must show a negative result on the antigen test. Those who have received a dose of 3 or booster vaccines can go straight home without another test. With these conditions, vaccine queues in various areas suddenly occurred, especially in Greater Jakarta. Prospective travelers are eager to pursue the third dose of vaccine in order to celebrate Eid al-Fitr in their hometown.

The public immediately greeted with great joy. Train and bus tickets were sold out. Free homecoming packages provided by the Jakarta Provincial Government and various other agencies were also sold out. This illustrates how great the people's desire is to immediately celebrate the Lebaran homecoming which has been delayed for two years.

 

Maintaining vigilance

However, in the midst of this national excitement, we need to remain vigilant because in an atmosphere of mass excitement like this, it is usually easy to let our guard down. Don't let the joy of Eid later have the potential to cause an increase in positive cases. There was a valuable experience one year ago, events in India and in ourselves, in Indonesia.

In India, there is an annual traditional Kumbh Mela ritual, when millions of people bathe in the Ganges River. At that time, exactly one year ago, India had not yet reached the state of herd immunity. The result was predictable. These millions of people infect each other and in a short time the positive cases of Covid-19 soared. Hospitals were full of patients with many victims who could not be helped, and brought India into a state of national emergency.

India's experience was almost similar to what happened in Indonesia. One week after Idul Fitri 2021, when the crowding ban was still in effect, Kudus residents were desperate to celebrate Lebaran Ketupat by visiting each other, grouping together, happily crowding. As a result, in a short time positive cases in the city of Kudus jumped dramatically, making Central Java Province break a record by adding 10 thousand new cases per day.

Not long after, a similar incident happened to residents of Bangkalan, Madura. The Madurese diaspora flocked back and forth for Lebaran past the Suramadu bridge until it was jammed. As a result, in Bangkalan, Covid-19 transmission exploded, new cases soared. Furthermore, the cases in Kudus and Bangkalan became the pioneers of the second wave of the explosions nationally, the peak of the record when there was addition of 65,000 new cases per day with a very high fatality rate.

That was an unpleasant experience during Lebaran of the last year, which we definitely do not want to repeat again. Of course, now the situation is different, both in terms of vaccination rates and the nature of the virus, both in India and in Indonesia. India's condition has improved. Covid-19 cases have decreased. The first dose of vaccination reaches almost 90% and the second dose reaches about 80%.

So, the Indian government was confident and allowed the celebration of Holi, which was still banned last year. Holi, or festival of colours, lasts for several days and culminates on March 18. One of his famous shows is when millions of people throw or smear various paints and dyes on others in a very boisterous atmosphere of joy. Experts in India can accept the government's decision to allow Holi celebrations this year. However, high vigilance was still advised.

According to Dr. Ravi Shekher Jha, senior consultant pulmonologist at Fortis Escorts Hospital, said this year's Holi celebrations were unlikely to result in a spike in coronavirus cases. However, people must still be careful by wearing masks, avoiding mass crowds as much as possible. That is because there is still the possibility of some remaining virus still being carried among the crowds.

Likewise, conditions in Indonesia are getting better. Vaccination has resulted in herd immunity, so the government has allowed Lebaran homecoming, as described above. Both in India and in Indonesia, the opinion of experts is relatively the same, that we must remain vigilant and careful.

The excitement of the Eid al-Fitr atmosphere at home will be fine, but by also minimizing the potential for new clusters to spread, as happened last year. As an epidemiologist in India said, here we can say, “Mudik Lebaran may not cause a spike in Covid-19 cases, but we must remain careful and avoid mass crowds because there may still be residual virus carried by crowds.” Therefore, it is better for us to pay attention to the following points to maintain vigilance, especially with regard to the emergence of new mutation variants, the next generation of omicron.

 

The emergence of a new variant XE

In early March 2022, scientists detected the emergence of a new, recombinant variant of the BA1 variant (original omicron) mutation with the BA2 subvariant. The UK Health Security Agency noted that up to 22 March there were 637 cases of the new variant found in the UK and they named the new variant as variant XE. Since it has only been a month, there has not been enough time to observe this XE character in detail. However, it was reported that the growth rate was not much different from the BA2 subvariant character.

The World Health Organization (WHO) only confirmed this XE variant on March 31, 2022, although they have detected its appearance since January 19, 2022. The WHO's initial estimate was that the XE variant was 10% more infectious than the BA2 subvariance, although further research is still needed. If the WHO estimate is correct, it can be said that XE is slightly more dangerous than the omicron variant.

Quoted by CNBC Indonesia, Erica Johnson, an internal medicine doctor at Johns Hopkins Bayview Medical Center in Baltimore, said that the symptoms of the XE variant are similar to the symptoms caused by the original omicron. The main symptoms of BA1 and BA2 are cough, fever, fatigue, and possible loss of taste or smell. Some patients also experience colds, digestive problems, headaches and skin rashes. The Zoe Covid-19 Study also reported that the symptoms of XE variant were similar to those seen in BA2 patients, ie. headache, sore throat, muscle aches, fever, diarrhea, nausea, vomiting, and abdominal pain.

Before the discovery of the new XE variant, the experts were already worried about the spread of the BA2 subvariant, which was referred to as the 'stealth' variant because it was more difficult to track than other existing variants. This stealth subvariant is also cited as the cause of the spike in new cases in China. Shanghai, China's largest trading city, is currently trying to contain the worrying spread of Covid-19. There are almost 25,000 new cases reported per day and local quarantine policies are implemented.

The city's quarantine policy has been criticized for separating children from their parents and mixing asymptomatic cases with those with symptoms. Quoted by CNBC Indonesia, the local health authority acknowledged that epidemic prevention and control in Shanghai was at the most difficult and most critical stage. This is certainly surprising because China has previously stated that it has successfully passed the pandemic.

In addition to China, this stealth variant infects residents in European region. In the last two weeks, several European countries have reported experiencing a decline in cases, although in general the European region is still reporting an addition of more than 1 million new cases every two days. In general, new cases declined in Germany, the UK and Italy, while those in France remained stable. However, current data shows a decrease in the number of Covid-19 cases in Europe with the number of new cases reaching 250 thousand per day.

Not only in Europe, in South Korea, new cases also suddenly jumped and there were reported to be more than 182,000 new cases of infection in a day. However, this number has decreased and currently the number of new cases in South Korea has reached 70-80 thousand per day. According to a Reuters analysis, one in four recent global infection cases has come from South Korea. In general, there are about 20 countries experiencing an increase in cases, including Taiwan, Thailand and Bhutan.

Overall, Covid-19 cases in the United States (US) have also fallen sharply after reaching a record peak level in January 2022. However, soaring cases in several countries in Asia and Europe have raised fears that this wave will spread to the US. According to WHO, of the surge in new cases globally, the 'stealth' variant of BA2 accounts for about 86%. Indeed, BA2 is more infectious, but evidence so far suggests this BA2 subvariance does not cause severe disease.

Therefore, more vigilance is directed at anticipating the possible entry of the XE variant. Has the XE variant entered Indonesia? As of April 21, according to a spokesperson for the Ministry of Health, Siti Nadia Tarmizi, there have been no reports of the XE variant entry in Indonesia. Of course, we should be grateful and hope that it will not appear in Indonesia by always being vigilant, as part of the anticipation program if this new variant one day enters Indonesia. Hopefully later we can be grateful to pass Eid Al-Fitr with joy and full of blessings while still maintaining prudence. Allahu akbar, walillahil hamd.

 

Djoko Santoso
Professor, Faculty of Medicine, Universitas Airlangga
Chairman of Health Department, 
Indonesian Council of Ulama, East Java

 

Translated from Indonesian:
"BerLebaran sambil Mewaspadai Varian XE" by Djoko Santoso
Media Indonesia, 25 April 2022



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