SINGAPORE: Since the novel coronavirus (2019-nCoV) outbreak was declared on Dec 31, 2019, Indonesia’s Ministry of Health and the World Health Organization’s (WHO) Indonesia Country Office have been working in unison.
They have also collaborated to strengthen response measures in anticipation of the coronavirus with the first public information release on Jan 8.
As the situation worsened in mid-Jan before the Lunar New Year holiday with the lockdown of specific cities in the Hubei province, Indonesian Minister of Health Terawan Agus Putranto announced that a budget had been allocated specifically to tackle the situation, ensuring that adequate training, logistics and standard operating procedures were provided or updated to anticipate the detection of positive cases.
The Ministry had also carried out webinars since Jan 24 to increase the awareness and detection of the 2019-nCoV across the public sectors including health agencies, laboratories, hospitals and environment agencies within local provincial government authorities.
As part of containment efforts, the government had placed mobile containers designed to prevent containment on standby at major ports should they detect any passengers fitting the case definition and presenting with symptoms. These passengers will be transported in these containment units to pre-identified hospitals and treated appropriately.
A public information portal has been established to provide daily updates on the situation.
The public can also access information through their Facebook, Instagram and Twitter pages with the following hashtag: #WaspadaVirusCorona.
The Ministry of Health, through the Bureau of Communication and Community Services and together with the Directorate of Health Promotion and Community Empowerment, has issued many risk communication materials and posters online and via media broadcasts.
Buoyed by the confidence in his country’s preparations in handling the virus, Putranto declared on Jan 30 that “all (steps) have been taken to make sure that there is no outbreak (in Indonesia).”
According to the latest reports on Feb 1, there are no detected cases in Indonesia reported yet.
Sentiments among Indonesians and on social media, however, suggest some scepticism about these bold claims.
One reason for this disbelief is the close links between Indonesia and China. The world’s second-largest economy is a major investor in Indonesia, which happens to be Southeast Asia’s largest economy. In the first half of 2019, Chinese investments in Indonesia reached US$2.3 billion, making up for 16.2 per cent of total foreign investment in the country.
These close links also suggest a strong presence of Chinese citizens in Indonesia. According to Statistics Indonesia, from January to November 2019, Chinese tourists to Indonesia numbered 1.92 million, forming 12.87 per cent of all incoming tourists into the country.
At the time of Putranto’s statement, there was no restriction on Chinese travelling into Indonesia. The presence of many Chinese tourists made his claim that there will be no outbreak in the country incredulous, since it is impossible to detect Chinese tourists with latent or asymptomatic infections.
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As an anticipatory measure, the Ministry of Health had already tightened screening at airports and ports, especially for passengers who came from China.
Indonesian Director-General of Disease Prevention and Control Dr Anung Sugihantono had earlier announced on Jan 27 that the Ministry of Health had stepped up alertness early to check the body temperature of passengers arriving from China via plane or ship with a thermal scanner arriving through all ports.
Such measures may have given authorities the confidence that there was no need to restrict travellers from China into the country.
However, with the WHO declaring the virus an international emergency last Friday (Jan 31), the ground has shifted beneath Indonesia.
On the same day that WHO chief Tedros Adhanom Ghebreyesus confirming that the global body had revised its risk assessment after crisis talks, in Indonesia more than 40,000 workers at a vast Chinese-controlled industrial complex in Sulawesi were quarantined in anticipation to reduce the risk of exposure to the community.
That Friday, Indonesia also announced that it was preparing to evacuate nationals stranded in Wuhan with 238 people subsequently evacuated with four stating that they were comfortable with staying behind and three not being able to pass the screening to be fit to travel.
The evacuated passengers, along with the flight crew, have been quarantined at a military facility on the Natuna Besar Island, near the waters where the Indonesian navy had a stand-off with Chinese vessels only last month over a territorial incursion incident.
Although, on Feb 6, the authorities said they had yet to test those quarantined in Natuna for the virus as they are not showing any symptoms. The cost for carrying out tests can also be prohibitive, the health ministry noted.
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On Feb 2, Indonesia also announced that it will temporarily stop flights to and from mainland China starting Wednesday (Feb 5) and bar visitors who have been in China for 14 days from entering or transiting in the country.
Although there is no certainty that these efforts can stand up to the spread of an infectious disease, Indonesians should take comfort that its government is not ignoring the risks of an outbreak occurring.
There is apprehension that detection may be lacking in Indonesia but the capabilities and capacity in the country’s health system are adequate to pick up any cases so there should be little reason to doubt their ability in this regard.
“Indonesia has a functioning early warning system and 100 hospitals in various locations that serve as referral [centres] and can handle cases with proper measures as well as effective infection prevention,” WHO representative for Indonesia, Navaratnasamy Paranietharan, told Indonesian media last week.
In the larger scheme of things, the response measures carried out by Indonesia’s health ministry thus far is in line with the escalation recommendations as outlined in WHO’s online course for the 2019-nCoV.
The WHO Country Office for Indonesia had supported the government on technical issues such as risk communication materials, clinical guidelines and response measures recommendations.
Moreover, based on WHO’s report thus far, patients with the 2019-nCoV infection may present a wide range of symptoms.
Most seem to have mild symptoms, with only 20 per cent progressing to a severe disease, including pneumonia, respiratory failure and in some cases death.
There may be reports of asymptomatic persons being infectious and would likely fuel the spread of the disease. However, most of these cases thus far had presented only mild symptoms despite being detected with severe viral infection.
Given the high human traffic volume and trade between these countries, the novel coronavirus is likely to present itself in Indonesia in the near future. But the government has taken all the necessary steps to give the country a fighting chance against the epidemic.
Qing Yuan Pang served an epidemiologist with the World Health Organisation in Bangladesh and had previously spent time in Indonesia working on disaster monitoring and analysis for the ASEAN Coordinating Centre for Humanitarian Affairs (AHA Centre) and was extensively involved in the emergency efforts for the Central Sulawesi earthquake and tsunami in 2018.