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According to official data from Indonesia, the second wave of COVID-19 driven by the delta made this Southeast Asian country the center of the global pandemic in July and August.
But some of the country’s top epidemiologists said that poor detection and tracking capabilities, inaccurate estimates of the death toll, and deliberately falsified data mean that the pandemic in Indonesia still has no clear picture and a third wave may be brewing.
At the peak of the second wave of epidemics in Indonesia in July, one-third of the country’s COVID-19 testers tested positive, which was shocking.
However, according to data from the National Disaster Management Committee, the 7-day average positive rate has now dropped to 3.64%, and it is still declining. This is the lowest positive rate reported in the country since the beginning of the pandemic, and this number is well within the 5% benchmark used by the World Health Organization (WHO) to indicate countries that have contained the virus.
Indonesia’s daily cases — peaking at 56,757 new cases on July 15 and crowded with patients on the most densely populated island of Java — dropped to 2,577 on Monday. At the same time, the official daily death toll of more than 2,000 in July fell to 276 on the same day.
“The second wave of the epidemic in Indonesia seems to be history,” said Gusti Ngurah Mahardika, Bali’s most senior virologist and a professor at Udayana University, where the daily The number of confirmed cases dropped from more than 1,500 last month to 122 on Monday.
Testing and tracking issues
Mahathir told Al Jazeera last year that Indonesia “data is not transparent”, he said “data is much better than a month or two ago.” But he added that it is still unreliable because the average number of close contacts traced after a person produces a positive test result is “less than five, sometimes zero.” According to the World Health Organization, whenever a person tests positive for COVID-19, at least 15 close contacts should be tracked and tested, but the best case is 30.
Mahathir also criticized the government for continuing to use “substandard” rapid antigen testing to replace the “gold standard” pfanonolymerase chain reaction or PCR test: “If all samples are tested using PCR, more positive results will be found.”
Kawal Covid-19, Jakarta’s independent data project, agrees. Its data showed that of the 98,900 people who underwent rapid antigen testing on Monday, only 1% showed a positive result. Of the 21,700 people who underwent PCR testing on the same day, 7.6% were positive.
“Antigen tests are not as accurate as PCR tests because they have a smaller window for showing positive cases,” said Septian Hartono, medical scientist and data coordinator at Kawal Covid-19. “If we use PCR for all the tests, we will get more cases. But the downward trend shown by official data is still accurate.”
Hartono believes that the situation in Indonesia is similar to that in India. “Due to the exhaustion of the Delta variant, India has experienced a very rapid growth and a very rapid decline.”
“Delta’s reproduction rate was originally 6 to 8 times, but emergency restrictions lowered it. Another thing to reduce infection is that there are many people infected, because once a person is infected, their risk of being infected again Much smaller. The reproduction rate has now dropped to three to four, similar to the Alpha variant,” he said.
Die at home
Epidemiologist Dr. Dicky Budiman predicted the second wave of outbreaks in Indonesia a month before the peak, and he believes that the government has made “some progress” in containing the pandemic.
“I am happy about what is happening in Jakarta and some other cities [the main island of] Java, the officials there are diligent and their data is transparent,” he said.
In September, the school in Chamis, West Java, reopened on a trial basis, and students went home from get out of class wearing masks [Adeng Bustomi/via Reuters]But outside of Java, he said, this is a different story: “The trend of new cases in Indonesia has moved from cities to villages, and from Java to outlying islands without sufficient detection capabilities. Most of these areas are within a year and a half. The performance was poor in the past two months, but a major improvement suddenly appeared within two months. That’s why I don’t believe their data.”
An epidemiologist advising the Ministry of Health did not want to be named because he did not have the right to talk to the media. He said that claiming that data outside of Jakarta is unreliable is a “serious understatement.”
“Jakarta is the only government that does its best to collect and display data,” they said. “Most provincial governments are incompetent because they are not doing very well in data collection, and one or two governments are actually doing their best to hide the data to prevent their provinces from being blocked.”
Budiman added that the decline in the national positive rate also reflects the decline in the use of PCR testing: “In the first week of September, PCR testing decreased from approximately 60,000 per day to approximately 20,000 per day. Population,” he said, citing the latest WHO report on the coronavirus situation in Indonesia.
Budiman said that Indonesia’s official death toll is not accurate because the government’s definition of death from the coronavirus does not meet WHO guidelines. “They only include victims who died and got positive results from PCR tests,” he said. “This is a narrow definition and supports my conclusion that Indonesia has not yet provided the kind of clear and convincing data needed to show that it has contained the pandemic.”
Hartono agreed: “From June to August, the official death rate for COVID-19 in Jakarta was 6,000. But during the same period, the city recorded 18,000 excess deaths because thousands of people were at home because they could not go to the hospital. Died without being tested.”
Many people in Indonesia have been vaccinated with China’s Sinovac vaccine, but the government is also vaccinating people with Pfizer, Moderna and AstraZeneca. [File: Dedi Sinuhaji/EPA]Dr. Nadia Wikeko, a spokesperson for the Ministry of Health, denied that the number of tests is decreasing and told Al Jazeera that Indonesia has a narrower definition of death from COVID-19, “because we want to confirm the cause of death and obtain valid data.”
The third wave?
Indonesia is a conservative, poorly organized, corrupt and flood-prone archipelago country. It has the fourth largest population in the world and vaccination is no easy task. To date, only 20% of the target adult population of 181.5 million have been fully vaccinated, and another 35% have been partially vaccinated. This begs the question: Is Indonesia about to see a deadly third wave?
Udayana University’s Mahathirka used a pattern that showed that the coronavirus peaked in Indonesia every six months, saying that the next wave might arrive in January. But “it doesn’t matter whether the case breaks out again,” he said. The important thing is “can the vaccine effectively reduce the number of hospitalizations and deaths.”
China’s Sinovac vaccine is the most commonly used vaccine in Indonesia, and the vaccine participated in the late-stage trials of the drug. The latest large-scale Phase III trial conducted in Brazil showed that vaccines made in China have an effective rate of 51% for symptomatic cases, compared with 76% for AstraZeneca, and the effective rate of Pfizer and Moderna mRNA vaccines is much higher than 90%.
Medical experts agree that any vaccine is better than nothing, but Indonesia is hedging its bets by providing pregnant women and medical staff with at least 8 million Moderna booster injections and millions of people injected by Pfizer and Astra Zeneca donated by foreign countries. nation.
Hartono of Kawal Covid-19 said that if the government conducts large-scale “seroprevalence” studies across the country, the third wave of epidemics can be prevented: “The seroprevalence test tells us the total number of people who have been infected and the number of people who have been vaccinated. And of course there will be some overlap. It is estimated that 40% to 50% of the country has been infected, and I believe the seroprevalence rate in Indonesia is about 60%.”
Hartono explained that with these data, the government will have a clear understanding of the pandemic and can use it to make data-based decisions on whether to further relax the restrictions introduced in July. He said: “What happened in Indonesia has traumatized the central government, so they are now doing things in a very cautious manner.” “But if they remove all restrictions, interest rates will rise again.”
Earlier this month, during a vaccination campaign in Debord, a medical worker was preparing a dose of Pfizer-BioNTech COVID-19 vaccine.The Indonesian government is speeding up its vaccination campaign [File: Mast Irham/EPA]Dr. Wikeko of the Ministry of Health said that the government can accurately predict and prepare for a potential third wave of epidemics, but it needs “people’s support and cooperation” to effectively respond.
But her colleague from the Ministry of Foreign Affairs, who wishes to remain anonymous, told Al Jazeera that this is not the case: “If the next wave is as big as ours in July, I don’t think this country is better prepared.
He added: “I’m not saying that the government does nothing. The ministry is very dynamic and promotes increased tracking and testing. But the fact is that our ability to influence the Indonesian provincial government is very limited. We can only issue rules. We can only issue rules. There is no power to enforce them.”
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