Indonesia quells COVID, however is a brand new wave on the best way?

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Official information in Indonesia exhibits a Delta-driven second wave of COVID-19 that noticed the Southeast Asian nation turn out to be the worldwide epicentre of the pandemic in July and August has run its course.

But a number of the nation’s high epidemiologists say poor testing and tracing capability, inaccurate estimates on the loss of life toll and the deliberate falsification of knowledge, means there may be nonetheless no clear image of the pandemic in Indonesia and a 3rd wave could possibly be brewing.

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At the height of Indonesia’s second wave in July, a staggering one in three folks examined for COVID-19 within the nation confirmed a optimistic end result.

But the seven-day common positivity charge has now dropped to three.64 % and continues to be falling, based on the National Board for Disaster Management. It is the bottom positivity charge the nation has reported because the begin of the pandemic and a quantity that lies effectively inside the 5-percent benchmark the World Health Organization (WHO) makes use of as a sign that international locations with management of the virus.

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Indonesia’s day by day circumstances – which reached a peak of 56,757 new circumstances on July 15 and noticed hospitals bursting with sufferers on essentially the most densely populated island of Java – dropped to 2,577 on Monday. Meanwhile, the official variety of day by day fatalities, which surpassed 2,000 in July, tumbled to 276 on the identical day.

“The second wave in Indonesia seems history,” mentioned Udayana University professor Gusti Ngurah Mahardika, essentially the most senior virologist in Bali, the place day by day confirmed case numbers fell from greater than 1,500 final month to 122 on Monday.

Testing and tracing issues

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Mahardika, who final 12 months informed Al Jazeera there was “no transparency of data” in Indonesia says “the data is much better than even a month or two ago”. But he provides that it’s nonetheless unreliable as a result of the common variety of shut contacts traced after a person produces a optimistic check result’s “less than five and sometimes zero”. According to the WHO, a minimal of 15 shut contacts ought to be traced and examined each time an individual exams optimistic for COVID-19, however the optimum is 30.

Mahardika additionally criticised the federal government’s ongoing use of “substandard” speedy antigen exams rather than “gold-standard” pfanonolymerase chain response or PCR exams: “If all specimens were tested using PCR, more positive results would be revealed.”

Kawal Covid-19, an unbiased information initiative in Jakarta, agrees. Its information exhibits that among the many 98,900 folks examined with speedy antigen exams on Monday, only one % confirmed a optimistic end result. Among the 21,700 folks examined with PCR exams on the identical day, 7.6 % have been optimistic.

“Antigen tests are not as accurate as PCR tests as they have a smaller window to show positive cases,” mentioned Septian Hartono, a medical scientist and information coordinator for Kawal Covid-19. “If we were to perform all the tests with PCR, we are going to get a larger number of cases. But the downward trend the official data shows is still accurate.”

Hartono believes the scenario in Indonesia is much like India, the place there was “a very sharp increase and a very sharp decrease because the Delta variant ran out of fuel.”

“The reproduction rate for Delta was originally six to eight but emergency restrictions reduced it. Another thing that reduced it was the high number of people that were infected because once a person is infected they have much less risk of being infected again. The reproductive rate has now dropped to three or four, similar to the Alpha variant,” he says.

Deaths at home

Dr Dicky Budiman, an epidemiologist who predicted Indonesia’s second wave a month earlier than its peak, credit the federal government for making “some progress” in suppressing the pandemic.

“I am pleased with what is happening in Jakarta and some other cities on [the main island of] Java where officials there are diligent and their data is transparent,” he mentioned.

Students carrying face masks stroll home after class as faculties reopened on a trial foundation in Ciamis, West Java in September [Adeng Bustomi/via Reuters]

But exterior of Java, he says, it’s a totally different story: “The trend for new cases in Indonesia has moved from cities to villages and from Java to outlying islands where they don’t have enough capacity for testing. Most of these areas have performed poorly for one-and-a-half years but then suddenly in two months, they’ve shown a major improvement. This is the reason I am not convinced by their data.”

An epidemiologist advising the ministry who spoke on situation of anonymity as a result of they aren’t authorised to talk to the media, mentioned to say the info exterior of Jakarta was unreliable was a “massive understatement”.

“Jakarta is the only government doing their very best to gather and present data,” they mentioned. “Most provincial governments are incompetent in that they are not doing a very good job in terms of data collection while one or two are actually doing their best to hide the data so their provinces don’t get locked down.”

Budiman provides that the drop within the nationwide positivity charge additionally displays the falling use of PCR exams: “PCR testing has decreased from about 60,000 per day to about 20,000 per day in the first week of September, which is very worrying in a country with a huge population like Indonesia,” he mentioned, citing the latest WHO coronavirus scenario report on Indonesia.

Budiman says Indonesia’s official loss of life toll can also be inaccurate as a result of the federal government’s definition of a coronavirus loss of life doesn’t comply with WHO tips. “They only include victims who died and who received a positive response from a PCR test,” he mentioned. “This is a narrow definition and supports my conclusion that Indonesia is not yet producing the kind of clear and convincing data needed to show it has control over the pandemic.”

Hartono concurs: “From June to August, the official fatality rate for COVID-19 in Jakarta was 6,000. But in the same period, 18,000 excess deaths were recorded in the city because there were thousands of people who died at home without being tested as they couldn’t even get to a hospital.”

Many folks in Indonesia have acquired China’s Sinovac vaccines, however the authorities can also be giving folks Pfizer, Moderna and AstraZeneca [File: Dedi Sinuhaji/EPA]

Ministry of Health spokeswoman Dr Nadia Wikeko denied testing numbers have been reducing and informed Al Jazeera that Indonesia has a narrower definition of a COVID-19 loss of life “because we want to confirm the cause of death and get the valid data.”

A 3rd wave?

A conservative, poorly organised, corruption- and flood-prone archipelagic nation home to the world’s fourth-largest inhabitants, vaccinating Indonesia was by no means going to be simple. To date, solely 20 % of the goal grownup inhabitants of 181.5 million is absolutely vaccinated with an extra 35 % partly vaccinated. This begs a query: is a lethal third wave looming on the horizon in Indonesia?

Using a sample that exhibits the coronavirus peaking in Indonesia each six months, Udayana University’s Mahardika says the subsequent wave might strike in January. But “it doesn’t matter if cases re-explode,” he mentioned. What issues is “will vaccines be effective in curbing hospital admissions and fatalities.”

China’s Sinovac vaccine is essentially the most generally used jab in Indonesia, which took half in late-stage trials for the drug. The newest massive phase-three trial in Brazil confirmed the Chinese-made vaccine had an efficacy charge in opposition to symptomatic circumstances of 51 %, in contrast with 76 % for  AstraZeneca and effectively above 90 % for the Pfizer and Moderna mRNA vaccines.

Medical consultants agree that any vaccine is leagues higher than none in any respect, however Indonesia is hedging its bets by giving not less than eight million Moderna booster pictures to pregnant girls and medics, in addition to hundreds of thousands extra folks Pfizer and the Astra Zeneca pictures donated by international international locations.

Kawal Covid-19’s Hartono says a 3rd wave could be prevented in Indonesia if the federal government conducts an unlimited nationwide “seroprevalence” research: “Seroprevalence testing tells us the total number of people who have been infected and the number of people that have been vaccinated and there will be some overlap of course. Based on estimates that 40 percent to 50 percent of the country has been infected, I believe the seroprevalence rate in Indonesia is about 60 percent.”

With this information in hand, Hartono explains, the federal government could have a transparent image of the pandemic and may use it to make a data-based resolution on whether or not to additional ease restrictions launched in July. “The central government is traumatised by what happened in Indonesia so they are now doing things in a very careful manner,” he mentioned. “But if they lift all the restrictions, the rate will go up again.”

A healthcare employee prepares a dose of Pfizer-BioNTech COVID-19 vaccine throughout a vaccination drive in Depok earlier this month. The Indonesian authorities is accelerating its vaccination marketing campaign [File: Mast Irham/EPA]

Dr Wikeko on the Ministry of Health mentioned the federal government can precisely predict and is ready for a possible third wave however will want “the support and collaboration of the people” to sort out it successfully.

But her colleague on the ministry who needed to stay nameless informed Al Jazeera nothing could possibly be farther from the reality: “If the subsequent wave is as massive because the one we had in July, I don’t suppose the nation is any higher ready.

He provides: “I am not saying the government is doing nothing. The ministry is very energetic and pushing to increase tracing and testing. But the fact is we have very limited ability to influence provincial governments in Indonesia. We can only issue regulations. We have no power to enforce them.”

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