Learning from New Variant Breaking into the Country's Gates

If the government is serious about tightening the mobility of citizens, the entry gate for foreign nationals should also be strictly guarded. Because, through the country's gate, a new variant of the virus from abroad enters. The "half-hearted lockdown" policy must face the harsh reality. When the implementation of the emergency community activity restrictions (PPKM) was almost over, the Covid-19 rampage was even more intense. The optimism of the Coordinating Minister for Maritime Affairs and Investment Luhut Pandjaitan, who was appointed by President Jokowi as the commander to lead this special mission to deal with the second wave of Covid-19, was wrong. Instead of gently sloping towards the target of below 10,000 cases of transmission per day, it skyrocketed beyond 50,000. On July 15, 2021, the daily number of positive cases was 56,757 and 982 cases died. In fact, when the emergency PPKM began to be implemented on July 3, 2021, there were "new" 27,913 cases and 493 deaths. More than double!

Behind these numbers was human suffering. All the troops of the last bastion of the war against Covid-19 were overwhelmed. Hospitals (RS) were flooded with patients, with the bed occupancy rate (BOR) exceeding 100 percent. Doctors, health workers, ambulance drivers, mortuaries, and funeral workers were exhausted, and even fell. Field hospitals were established, but health personnel were lacking. Patients were neglected and many died before being treated by doctors. Many self-isolated patients died in isolation. Oxygen and drugs became scarce. People who were frantically chasing mass vaccinations had turned into high-risk crowds. Small entrepreneurs and people who did not have fixed income were screaming louder because of the tightening of the emergency PPKM.

Indonesia had fallen, and hit by the "neighbor". Singapore refused entry to Indonesian citizens. Likewise Taiwan, Hong Kong, United Arab Emirates, and Oman. Saudi Arabia had already closed its doors. Japan not only refused to enter Indonesian citizens, it even evacuated its citizens in Indonesia because it did not want more of its citizens to become victims of Covid-19, because there were 14 Japanese who had died here. Vietnam also picked up its citizens in Indonesia. The US had banned its citizens from going to Indonesia. Europe, especially the 26 countries with Schengen visas, also refused entry to Indonesian citizens. Likewise the Netherlands.

This was like "one-sided applause" because Indonesia had never closed its doors to foreigners. In fact, Indonesia's excuse for not closing its doors was because of reciprocal policies. What to say. Indonesia had taken over India's position as the epicenter of Covid-19 in Asia, even the world. Indonesia went hand in hand with Brazil as the daily Covid-19 "champion". On 14 July 2021 the “champion” was Brazil, the next day Indonesia became the “champion.” There was a sharp rise in the curve in these two Sinovac vaccine consuming countries. This affected the curve of the world, which started to climb as well. India, the culprit of the Delta variant, continued to slop in the 40,000 range. The peak cases in this country of 1.4 billion people were 10 times (400,000) a month earlier.

The Delta variant made Java dominated by the red zone. Luhut himself confirmed this. Showing the maroon graphic that was widely circulated to the media on July 15, 2021, he said "it's all controlled by the Delta variant". He also said the Delta variant was difficult to control. Whereas, three days earlier, he had challenged the person who said the situation was out of control.

The situation was getting more serious. The Delta variant (B1717.2) that reddened the island of Java had also moved to invade outside Java. Minister of Health Budi Gunadi Sadikin confirmed that the provinces of Lampung, South Sumatra, Riau, Riau Islands, Bengkulu, East Kalimantan and West Papua had been invaded by Delta. As a result, the BOR of hospitals in the province immediately rose sharply. Based on a report received on July 13, 2021, the Minister of Health stated that BOR in Lampung was 86 percent, East Kalimantan was 85 percent, South Sumatra was 80 percent, West Papua was 79 percent, Riau Islands was 76 percent, and Bengkulu was 70 percent.

Because it had become the epicenter of Covid-19 in Asia, and the number of additional cases exceeded 50,000 cases, WHO was increasingly paying attention. WHO said all mutants with malignant variants had entered Southeast Asia, including Indonesia. The emergence of new variants with high communicability and the ability to penetrate the immune system (immune invasiveness) contributed significantly to the latest wave of transmission which was much higher than previous waves, such as in India.

Of the four variants of concern according to WHO, the Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), and Delta (B.1.617.2), all had been found in Southeast Asia, especially Malaysia, Thailand, Philippines, Singapore, and Indonesia. Indonesia was the worst. In fact, the Head of the Institute for Molecular Biology Amin Subandrio said the Kappa variant had entered our country.

Currently at least 10 new variants of Covid-19 have been discovered. In addition to Alpha, Beta, Delta, Gamma and Kappa, there are Epsilon (B.1.427/B.1.429) from the US, Zeta (P.2) from Brazil, Eta (B.1.525) from the UK, Theta (P.3) from the Philippines, and Iota (B.1.526). The Delta variant is very virulent because it makes the CT (cycle threshold) number of the patients low, easy to transmit, and increases in severity more quickly. CT is the cycle number that appears during a swab test with polymerase chain reaction (PCR). The lower the cycle number, the more viruses there are. Conversely, the higher the CT number, the less virus there are. The safe CT threshold ranges from 35-40. The Ministry of Health released a finding that since the Delta variant entered Indonesia, the average CT in a number of areas had decreased. This means that the number of infectious viruses was increasing.


Escaped by “foolishness”

We need to revisit how this Delta variant invaded our country. This should be an important lesson because we have fallen into the same hole many times. Since the beginning, this Covid-19 is a case of a foreign virus, the one from China. So is the entry of the new variants. However, we have never really secured the gates of the country.

As if there was ignorance, foreign nationals remained free to enter when the people were confined in various types of strict restrictions in their own territory. From developing information, this Delta variant was rampaging in our country because of the failure to prevent and deter immigration against foreign nationals, some of whom carry the Delta variant. The Delta variant appeared in India for the first time last April. According to the BBC, the virus was causing a very severe second wave in India. At that time, many countries decided not to accept flights or travelers from India temporarily, including the European Union, US, Australia, Singapore and Thailand. Indonesia took a similar step on April 25, 2021. For Indonesian citizens who lived or visit India within 14 days, and wish to return to this country, they can still enter with strict health protocols.

Unfortunately, this decision only emerged after one chartered plane from India entered Indonesia. It contained 129 foreign nationals, with 12 confirmed positive for Covid-19. The AirAsia charter plane with flight code QZ-988 came from Chennai and entered through Soekarno-Hatta Airport. Prior to this incident, there was also a lot of news in the media about the large number of Indian citizens who entered Indonesia, especially through air travel. Head of Sub-Directorate of Health Quarantine, Directorate General of Disease Prevention and Control, Ministry of Health, Dr Benget, confirmed this. "Yesterday, many Indian citizens have entered Indonesia, a lot," he said in Pekanbaru on April 22, 2021.

Then, in May 2021, Riau was among the top three contributors to the additional new cases of Covid-19 in Indonesia. This condition had never happened before because it had always been dominated by the Java region. The spike in cases occurred after the Covid-19 Task Force in Riau found an Indian citizen who was positive for the corona virus. On 27 April 2021, a CPO carrier ship from India docked at Dumai Port. The crew of this ship consisted of one captain and 22 crew members. A few days later, the captain of the ship showed symptoms of fever and shortness of breath. After being tested, the captain and four crew members tested positive for Covid-19. They received special treatment in Pekanbaru. A month after these events, a second wave of the corona virus hit Indonesia. New variants were found in Jakarta and Kudus, Central Java, the two locations where the spike in cases began. Head of the Professional Development Division of the Indonesian Association of Epidemiologists (Pengembangan Profesi Perhimpunan Ahli Epidemiologi Indonesia/PAEI) Masdalina Pane said the Delta variant was the main cause of the increase in those cases. In her prediction last June 2021, Jakarta would experience a 400 percent increase in cases, Depok 305 percent, Bekasi 500 percent, Central Java 898 percent, and West Java 104 percent. According to Masdalina, the spike occurred not only because of the impact of the 2021 Eid homecoming, but also because of the failure of prevention and deterrence, which resulted in the entry of new variants into Indonesia. She even called it "conceded".

Many people entered Indonesia from abroad with only five days of quarantine, when it should have been 14 days based on WHO standards. All of these malignant variants developed abroad, then entered Indonesia easily because of the weakness and slowness of anticipation in the immigration system.


Let's apply Pancasila

Then a question arose, was there a new variant that appeared in Indonesia? It was very possible, although until that time there had been no official data released by the government or research institutions. In Indonesia, there was no such report. However, in several countries there had been reports of continued mutations from the Delta variant, becoming Delta Plus (AY1 and AY2), and had spread to a number of countries. Data compiled from various sources, such as Public Health England, Aljazeera, Indian Express, and Katadata, stated that, until June 22, 2021, the AY 1 genome had spread to at least ten countries, including the US, Portugal, Switzerland, Japan, Poland, India, Nepal, Canada, Russia and Turkey.

What should have been a serious concern, this Delta Plus character was more dangerous than Delta. Compared to its parent, the Delta Plus variant was more infectious, attached more to lung cell receptors, and had the potential to decrease antibody responses. What would happen if this much more dangerous Delta Plus got into Indonesia? This was something that should have been of particular concern at the immigration gate. The carelessness and slowness of the immigration yesterday, which became a gap for the entry of the Delta variant to Indonesia, should not have plunged us into the same hole.

The main consideration should be health considerations. Do not give more priority to investment considerations, such as Coordinating Minister Luhut who asked that the flow of foreign workers from China not be a problem because, according to him, it had already met the procedure. The procedure for foreigners who enter Indonesia is that they must have had a second dose of vaccination, and previously had a PCR swab test with a negative result. Once in Indonesia, foreigners must undergo PCR swab again and must undergo quarantine for eight days. After quarantine, they have to do a PCR swab test again. If the result is negative, then they can continue their activities in Indonesia. This means that foreign workers who kept coming in waves from China must have been free of Covid-19 when they entered Indonesia, so Luhut asked not to make a fuss. This is where the problem lies. Luhut seemed to always make things easy, as if everything was fine. In just a matter of days, the media reported that one of the foreign workers from China who entered the city of Bula, Eastern Seram Regency, Maluku, who used to be Covid-19 free, was examined at the Bula Hospital after having fever, flu, cough, and was tested positive for Covid-19. He must undergo isolation.

Once again, if the government is serious about tightening the mobility of its citizens, the gates for entry of foreign nationals should also be strictly guarded. Because, this is the main gate for the entry of new variant viruses that come from abroad. Don't let the government seem very strict in limiting its own people, but loose on foreigners. Don't just disperse a crowd of commoners, but don't act when a crowd is made by high-ranking officials or elites. Humanity, justice, and the spirit of unity in attitude are the keys to the successful handling of the pandemic. Apply Pancasila for real.

Djoko Santoso
Professor, Faculty of Medicine, Universitas Airlangga
Chairman of Health Department, Indonesian Council of Ulama, East Java
Covid-19 Survivor


Translated from Indonesian: "Belajar dari Bobolnya Varian Baru di Pintu Negara" by Djoko Santoso
Kompas, 27 July 2021