The Covid-19 variant from India invaded by riding on our recklessness. As a result, Indonesia's Covid-19 positive patients suddenly jumped dramatically, starting from Kudus. According to reports, the reason for the incident was that locals observed the bakdo kupat or Lebaran ketupat ritual seven days after Eid al-Fitr without much fervor. They congregated, swarmed, and visited one another. The Covid-19 delta variation propagated among the locals from there.

So, the case of transmission exploded in the city center of kretek cigarettes. The number of patients in hospitals increased, and the death toll rose.The results of the whole genome sequencing (WGS) analysis, which were released by Siti Nadia Tarmizi, director of prevention and control of direct infectious diseases at the Ministry of Health, confirmed this rise. She said that 28 of the 34 Kudus specimens that were analyzed tested positive for the delta variation.

With the addition of more than 1,000 new positive cases every day, the Kudus tragedy forced Central Java Province to surpass the previous record of 10,000 Covid-19 instances. It was quite alarming. Such an event was not limited to Kudus. The same thing happened in Bangkalan, Madura. Foreign-based Madurese citizens crossed the Suramadu bridge to get home. The police were unable to stop the inhabitants from returning since they were overworked. And the result was the same. Bangkalan immediately turned into the epicenter of the pandemic in Madura.

The new variant had also overrun Bangkalan. The new strain of the corona virus from India, also known as variant B1617, was reportedly discovered in DKI Jakarta, Kudus Regency, and Bangkalan Regency, according to Minister of Health Budi Gunadi Sadikin. The expert claimed that this delta variation (B16172) was reported to be 40–90% more contagious than the parent virus and affected people of all ages, including youngsters, adults, and the elderly.

As reported, the critically ill Covid-19 patients at Syarifah Ambami Rato Ebu (Syamrabu) Hospital could not last long, dying within 24 hours. Sadly, there were 2-3 people in their family who died because of the outbreak in Bangkalan. The capacity of health facilities in Kudus and Bangkalan, however, were very limited. Many patients were consequently compelled to relocate to other places with more readily available hospital capacities. Even the emergency hospital in Bangkalan, which was operated out in field tents, was overflowing with patients.

The incidence in Kudus and Bangkalan showed that our society had not yet fully realized how lethal the COVID-19 pandemic was. The desperation for tradition of gathering had relaxed the vigilance and consideration of safety reason. This desperation had apparently also spread death.

Super-spreader VoC delta

The second year of the Covid-19 had brought many new surprises. We learned a "horror" lesson in April 2021 when India, which was credited with almost reaching herd immunity, unexpectedly descended into heartbreaking tragedy. The cause was the massive solemn bathing rite known as the Kumbh Mela, which attracted millions of Indians to the Ganges River. However, from a health perspective, what they were doing was ignorance.

India, which the WHO had previously praised for its rapid mass vaccination program, quickly descended into terrible disaster. Daily cases in India had decreased since May 6, 2021, when there were a peak of 414,000 cases. On June 13, 2021, there were 68 thousand new cases. Yet when it comes to the daily increase of Covid-19 cases, India continued to be the "global champion." India also holds the title of "holding champion" in daily deaths despite having dropped from a peak of 4,896 deaths (24 May 2021) to 1,761 deaths (13 June 2021).

Doctors and experts had long advised us to observe health precautions and stay away from crowds. The majority of clergy who had sound judgment even lost their voice in the face of a constant stream of ignorant comments and videos, including sermons from clergy who denied the pandemic and saw it as a hoax intended to restrict religious activities. These sermons spread through social media and various WA groups, and many people believed them.

According to the WHO, at least 14 novel mutation variants or mutants had been found in a number of nations. Ten of these 14 mutations were classified as variants of interest (VoI), which were thought to be less harmful. Examples of these variants included the epsilon variant (B1427/1429) that first arose in the US and the kappa variant (B16171) that first appeared in India.

There was still danger present. Don't let the "evil virus" of underestimating Covid-19 spread and make a patient regret as he is gasping for air in the ICU after being placed on a ventilator. It should have been kept in mind that this Covid-19 mutation variant, particularly the VoC kind, was becoming more dangerous.

In addition, four variants listed in the category of variant of concern (VoC) and should be watched out were thought to be extremely harmful since they were far more contagious than their parent. The four were the alpha variant (B117) which first appeared in the UK, the beta variant (B1351) which first appeared in South Africa, the gamma variant (P1) which appeared in Brazil, and finally the delta variant (B16172) which appeared in India.

According to British epidemiologist Neil Ferguson, this delta variant was a super-spreader because it was 60 percent more contagious than the B117 (alpha) variant. Compared to alpha and other variant, it might even increase the chance of hospitalization. Since the delta variant (B16172) was the 'child' of the kappa variant (B16171), a descendant of the 'grandfather' virus that first appeared in Wuhan, China, it may be argued that India had passed down the 'grandson' of the corona virus.

This delta variant had caused the second wave of tsunami in India, which had spread to more than 60 countries, and had already entered Kudus, Central Java. Reportedly, the UGM team who examined the Kudus case had taken specimens and found 28 patients who were confirmed to have contracted the delta variant at the end of the second week of June (13/6). Some epidemiologists predicted that the end of June 2021 could be the peak of the cases as a result of traveling back to hometown during the Eid al-Fitr holiday.

The delta variant invasion to Kudus and Bangkalan as well as other areas did not mean that the government has missed out because this was not a new incident. This already happened on Eid al-Fitr in 2020 which also resulted in a spike in the  transmission so it should have been a valuable lesson.

Before Eid al-Fitr in 2021, everyone had known, the experts had also warned how dangerous the traveling home was, and the government had declared a ban on it. However, it was really hard when the people were stubborn. They did not even care even if their stubbornness can plunge them into the same death hole over and over again.

Health protocol, easy and cheap

After the incidents in Kudus and Bangkalan, the experts continued to remind us to follow the three fundamental formulae for preventing the spread of a pandemic : following health protocols, 3T, and vaccination. Wearing a medical mask, keeping a distance, avoiding crowds, and frequent washing hands are all fairly basic and affordable health precautions that have been shown to be quite successful in reducing transmission. This was the development of the standard response to quarantine: if there is an epidemic, stay as far away as possible from it, but if you have been in an outbreak area, stay inside.

The basic management strategy, which has actually been implemented by the government and the Task Force, is 3T, or testing, tracing, and treatment. The issue was that both the quantity of specimens and the scope of the tracing were still deemed inadequate. The government ought to have increased the quantity of examinations and tracking as the basis for information gathering and treatment mapping. Let there be no stupid joke: to stop adding cases, just stop the test.

Another step is vaccination. With the fourth largest population in the world, with the support of diplomacy, the government continued to try to obtain vaccine supplies from various manufacturers, while continuing to spur the development of vaccines for domestic products. However, according to epidemiologist Dicky Budiman, of all the vaccines that had been injected into Indonesians, only Pfizer and Moderna had relatively complete data and usage reports. No other vaccine yet. Hopefully, this was also noted by the government in order to encourage the reporting of data on vaccination implementation by other vaccine producers.

Local Lockdown

The Kudus and Bangkalan cases that spread to other areas immediately made the curve rise again. The addition of daily cases shot up. The beautiful story about the sloping curve until the approaching Eid was disturbed. In order to facilitate community control, it was time to take a more decisive step, the implementation of a local lockdown.

The government had decided to extend the program to enforce restrictions on micro community activities (PPKM) between 15-28 June 2021. This PPKM needs to be given a 'lockdown feeling' to be effective. People who are positive are isolated and their needs are guaranteed so that they really don't move, and in the target area the testing is strengthened until the addition of new cases is really zero.

It is time for the government and the Covid-19 Task Force to be more forthright. The explosion of transmission, the increase in patients and hospitals that are overwhelmed with patients, and the rising death rate are not something that can be underestimated and ignored. They are not something that health protocols can tolerate. Citizens are guided to discipline and the government should also be consistent in following the discipline. The situation is still dangerous. Don't let the 'evil virus' in the form of underestimating Covid-19 develop and only realizing it after being put on a ventilator in the ICU, when regrets come in the midst of shortness of breath. Remember, this covid-19 mutation variant is getting more virulent, especially the VoC type.

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

Translated from:

VoC Delta Invasion to Kudus and Bangkalan
Media Indonesia, June 17, 2021 by Djoko Santoso