Our nation is one of those who easily become sensitive, especially to things related to the Covid-19 pandemic. They were frustrated because they were forbidden to travel inland (mudik), but they broke through the ban on inland traveling. The result was a tremendous explosion of Covid-19 cases. The government also pulled the 'hand brake' with the implementation of emergency community activity restrictions (PPKM) at that time. The explosion was compounded by the 'foreign factor', the delta variant from India. The Central Indonesian Medical Association (Ikatan Dokter Indonesia/IDI), through its Deputy General Chair Slamet Budiarto, said this variant was the main trigger for the current bad situation. This variant was brought by foreigners or Indonesians who returned home because the country's gates were not closed while the people were prohibited from traveling inland between regions.

The combination of the factors of inland-traveling break-ins and foreign variants had proven to be deadly. Eid al-Fitr in 2021 was the peak moment to show the strength of citizens' neglect of the virus. Around 1.2 million people travelled inland, by all means, including breaking through the guard of enforcers for the prohibition on inland traveling.The Madurese completed this big drama of community cohesiveness against the pandemic. Thousands of Madurese were desperate to travel inland, broke through, and fought against the tight security at the Suramadu Bridge. No matter how strong the guard of the officers, they could not stop the reckless crowd.

That was the colossal show of the courage of the masses against the pandemic, but in their own way, they allowed themselves to be infected and infected each other. So, the survival of the strongest applies. Who is strong, who survives, who is weak will lose. The result was Kudus and Bangkalan became new clusters. Positively infected cases soared. The health care systems of the two cities were on the verge of collapse. In just three weeks, the cases in Kudus and Bangkalan had spread to almost all cities and regencies throughout Java, Bali and Madura.

This incident was very similar to the tragedy of the second wave in India. Previously, WHO praised India for being able to carry out mass vaccination and reduce the positive number quickly so that India received praise from the media that India would soon achieve herd immunity. However, the solidarity of the people who were determined to resist the government's advice and health officials, while still carrying out the traditional Kumbh Mela ritual, taking a colossal bath in the Ganges River, immediately became a heartbreaking tragedy.

Foreign invasion of VoC

The Kudus and Bangkalan cases eventually became national cases. It was even more troublesome when a new variant of B16172 (delta) was discovered, which originally came from India, with a much more infectious character and had spread to 85 countries.

In the UK, Public Health England reported that the delta variant was 60% more contagious than the alpha variant. The doubling time ranged from 4.5 to 11.5 days. The delta variant caused the rate of lung damage, from the previous 5-10 days, to just one day, like a lethal lightning strike. This delta variant was easier to attack children.

A study in Singapore noted that the delta variant infection had made the patients to need more oxygen, more intensive care, and increased the risk of death. With a character like this, delta (B16172) was a very dangerous variant so WHO included it as a variant of concern (VoC) that must be very carefully monitored.

From Greater Jakarta travelled home to Central Java and East Java, from East Java travelled home to Bangkalan Madura, bringing the imported delta variant, and transmitting it. After Kudus and Bangkalan exploded, two weeks later, these travellers returned to their overseas destinations, to East Java and Greater Jakarta, of course, carrying the delta variant so that the cycle of mass transmission completed. Until June 23, 2021, the Ministry of Health recorded 160 positive cases due to the delta variant spread across 9 provinces, the most in Jakarta with 57 cases. That is, the malignant delta variant has begun to spread.

The daily number of cases that had previously decreased to its lowest point of 2,385 cases (15/6), immediately skyrocketed to reach 27,913 cases (3/7) or 12 times. Hospitals, regional hospitals, field hospitals were full of patients. The mass media every day presented news of patients who could not be accommodated in the treatment room, so they had to queue in the halls and doors of the hospital. The funeral parlors were exhausted. Drug prices soared, plus the oxygen crisis exacerbated the situation.

Doctors and health workers were overwhelmed, exhausted, and fell again. IDI noted that in June alone (until June 27, 2021) 27 doctors had died. A total of 401 doctors and 324 nurses died while guarding the last bastion of the Covid-19 battlefield since March 2020. What an extraordinary humanitarian jihad.

Jakarta was again the region with the heaviest burden. The highest number of positive cases. The bed occupancy rate (BOR) in hospitals jumped to 100%, so emergency tents had to be provided.

Mass tests, as part of the tracking mechanism, were improved. The results showed that the positivity rate (PS, the number of people who were positively infected, out of the total number of people tested) jumped immediately. Previously, as of May 11, 2021, the PS in Jakarta was only 7%, almost close to the safe standard according to WHO of 5%. Nationally, the PS was 11.1%. This meant that the management in Jakarta was better than the national average.

After the tragedy of Kudus and Bangkalan, the numbers jumped rapidly. Data on June 21, 2021, showed that Jakarta PS was 33% and the national PS was 23.3%. The situation was reversed. Jakarta welcomed back homecoming travellers who had been infected so that the Jakarta PS number was greater than the national PS figure. In other words, the national situation, especially in Java, Bali, Madura, was at the level of a health crisis.

Envy to Euro 2020

When we got a delta variant attack, unfortunately our national defence weakened. It was true that the number of people who have been vaccinated is now increasing. The Covid-19 Task Force stated that until June 26, 2021, as many as 13 million people had been vaccinated twice. However, residents' non-compliance with health protocols was getting worse. The trigger, among others, was the flood of misleading opinion information that had gone viral (spreading like a virus) through social media.

Easing in other countries was manipulated into a sense of 'envy'. Every night we could watch the Euro 2020 broadcast. We were surprised because the audience almost filled the stadium capacity. Their expressions and screams were seen because the majority were not wearing masks. To enter the stadium, local spectators simply needed to show a vaccination card, while foreign spectators must show a swab test card.

How could this happen? Of course, because they believed they could enforce and familiarize health protocols in the community during the pandemic. In addition, also the vaccination factor. England and Hungary, which were hosting Euro 2020 and other host countries, had already managed to vaccinate most of their citizens.

According to Sky News (28/6), the UK had injected 113.1 doses per 100 residents. Iceland 113.3. Hungary 98.5. Belgium 90.5. This means that on average every adult there had received one shot of the vaccine or half of the population had been vaccinated twice. In comparison, the country with the highest vaccine injection was the United Arab Emirates, at 154.2 per 100 population. For our country, with 13 million people being double-vaccinated, that means only 26 million injections. Far from our population, 270 million.

We shouldn’t have need to be jealous so that the perception was misguided. When we are struggling with the second wave of attacks, it seemed that many European countries had succeeded in overcoming the COVID-19 pandemic so that they had been able to relax their public activities. This needs to be a lesson so that there is consistency in policies in fighting the pandemic.

Epidemiologists try to make sure that the most basic way to minimize transmission is by limiting mobility, the name can be PPKM, regional quarantine or lockdown, whatever it might be. However, this epidemiologist's suggestion was immediately countered by a very basic argument: who will guarantee food supplies for the majority of the lower class people if a lockdown is implemented?

The Health Quarantine Law is indeed too strict in regulating regional quarantine. Not only food and clothing for residents, even livestock food must be guaranteed by the government when the regional quarantine is carried out. Obviously this is difficult to implement because our budget is very limited and we already have a lot of debt. Finally, the government took a more compromising stance. Restrictions on mobility were only on a limited scale, while continuing to boost vaccinations to reach the level of herd immunity as soon as possible.

One word - one deed

The problem was that the choice of a 'saving package' with restrictions on mobility plus vaccination is also plagued by conspiratorial and unreasonable speeches. Opinions and counter narratives were scattered, produced by those who actually did not have competence, including various lectures from religious leaders who inflamed distrust in pandemics and vaccinations and opposed restrictions on crowds for worship activities. Because it was wrapped in a religious narrative, some people believed it.

The general flow of most mass organizations and religious leaders agreed to handle Covid-19 according to the procedures, including restrictions on joint worship. However, they often lose to this group of short-sighted and long-sighted people, not caring that this loud opinion can bring death. In fact, it became the master's weapon. There had been many cases of conspiracy theorists and anti-vaccine proponents contracting Covid-19 and dying. Even this also did not relieve the ignorance of this group.

The question is, can our state and apparatus not overcome this disobedience? Indeed, some have been arrested, such as Jerinx in Bali. Bareskrim said that until April 4, 2020, at the beginning of the pandemic, as many as 75 people were arrested by the police for spreading hoaxes about Covid-19. If we google it, there are many similar arrest cases, from Aceh to Puncak Jaya. This crackdown should have been a deterrent.

On Facebook, an irritated person suggested that those who do not believe that the Covid-19 pandemic really exists, do not believe in vaccinations, and spread their distrust, have their full identity recorded. If at any time they are exposed to Covid-19, just put them in one place. They don't need to be treated, they don't believe it anyway. If they end up getting better on its own without treatment, fine. However, if they finally die, we can all give our best wishes.

Of course this suggestion was out of date. The doctor's oath that has been upheld since Hippocrates was first coined 400 years BC emphasizes that doctors are obliged to help patients, anyone, from any group, without distinction. However, we can understand the emergence of the above proposal because we are so irritated to see how easy it is to spread misguided and misleading opinions on social media.

The three factors discussed above are indeed troublesome in handling the pandemic, namely mass behavior that does not comply with health protocols, state gates that are not strictly guarded, and the spread of conspiracy theories plus anti-vaccines. One more thing, which is no less important, the example of the elite is often absent. Not in line with words and deeds. All of this must be brought under control so that it is in accordance with the rationale for handling the pandemic in a fair and civilized manner. In addition, as a reflection of mutual cooperation, it is easy to bear together so that we can more definitely take the route out of this suffocating pandemic. []

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

Translated from Indonesian:
"Menertibkan Nalar Penanganan Pandemi" by Djoko Santoso
Media Indonesia, 5 July 2021