IO – Since late December 2019, the world has been grap- pling with Coronavirus Disease 2019 (Covid-19), said to be caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus, previously dubbed 2019- nCoV. The virus was rst diag- nosed in a seafood market work- er in Wuhan, China, and has spread throughout the world, until the World Health Organi- zation (WHO) nally declared it a global pandemic on March 11, 2020. Based on a global tally per September 13, 2020, con rmed Covid-19 cases have reached 28,938,095, with the death toll at 924,558.
is one of the coun- tries most severely affected by the pandemic. Based on data
of Covid-19 Handling Task Force on September 12, 2020, con rmed Covid-19 cases
are 214,746 and death toll at 8,650. Jakarta is the province with the highest
caseloads in Indonesia, at 52,840 cases or nearly a quar-
of the total national tally. The novelty of this disease, coupled by
limitations in pub- lic health system, has caused widespread panic among the
general public. Various policies were implemented to reduce the virus’ rate of
transmission, one of which being the implemen- tation of Large-Scale Social Restrictions
PSBB is often associated with lockdown. Lockdown is a term often
used to describe an effort to control the spread of infection within a certain
area, which requires restriction on access or mobility. However, the de nition
of lockdown itself is still vague and there is no glob- ally accepted
consensus. The implementation of lockdown in each country or region has
different protocols. Lockdown severely limits economic activ- ities, whereas
PSBB according to the Health Minister Regula- tion No. 9/2020 is a limitation
on certain activities and peo- ple’s mobility in an area sus- pected of being
infected with Covid-19 to prevent further
infection, the recommendation of which is to be made by heads of
local government. PSBB com- prises shutting down school and of ces and
restrictions on religious activities, activities in public places, social and
cultur- al activities, transportation ser- vices and other activities related
to defense and security. PSBB, in a nutshell, aims to keep the economy running
while putting a number of restrictions (health protocol) in place to prevent
the spread of Covid-19.
rst total PSBB was im- plemented in Jakarta in three periods –April 10-23,
April 24 – May 22 May, and May 22 – June 4 during which the public is re-
quired to follow health protocols to contain the transmission of Covid-19.
Outside activities are limited, as per Governor Regu- lation No. 33/2020. The
total PSBB was then changed to tran- sitional PSBB starting on June 5, and was
extended ve times before nally reverting to total PSBB on September 14. The im-
plementation of the transitional PSBB has actually resulted in an increase in
the number of cases, at a rate of 2,000 – 3,000 con- rmed cases per day.
opinion is split be- tween the “health-versus-econ- omy” argument. Assuming
that the economy can recover with- out rst bringing Covid-19 un- der control is
illogical. The high number of cases will strain al- ready-thin resources. Health
should be the priority; then the economy can recover, because humans are the
economic ac- tors.
The current condition in Ja- karta is worrisome. In the past
week, the number of Covid-19 positive cases has increased rap- idly, reaching
more than 1,000 per day. Central Jakarta, West Jakarta, North Jakarta, South
Jakarta and East Jakarta are now in the red zone category, while Thousand
Islands regency is agged orange. The death rate, while still below national and
global gures, is rising rapidly.
This has put extraordinary burden on limited isolation beds and
Intensive Care Units (ICU) at referral hospitals. As of September 9, based on
data from the Jakarta Health Agency, 77% of the total 4,053 isolation beds for
Covid-19 patients are fully occupied and 83% of the total 528 ICU beds are
lled. The availability of ICU beds is of particular concern, because they are
needed to treat patients in critical condition. It should be noted that the
relatively low number of Covid-19 deaths pres- ently is due to adequate
isolation rooms and ICU capacity. If this capacity quickly lls up with new
Covid-19 patients, the death rate would increase dramatical- ly. This does not
even include deaths in non-Covid patients whose treatment is “neglected” due to
the spike in Covid-19 pa- tients.
Currently the local govern- ment has increased the number of
referral hospitals and isolation beds. But this must also go in tandem with the
increase in the number of health workers, med- icines and all supporting equip-
Jakarta is currently in a state of emergency, facing a rising
death toll, limited isolation beds, and the lack of ICUs. There needs to be an
increased sense of aware- ness and urgency that we are in a health and economic
crisis. A solution to deal with both the crises needs to be found now.
The action taken by Jakar- ta Governor to implement an
“emergency brake” policy by re- storing the rst PSBB is aimed at curbing the
transmission rate of Covid-19, which steadily in- creased during the
transitional PSBB period.
a consequence, several ac- tivities will be restricted, includ- ing educational
institutions (re- placed by online learning), of ces (replaced by work from
home), religious activities in places of worship, activities in public fa-
cilities, reducing the capacity of public/private transportation, including
online motorcycle tax- is. Only 11 business sectors are allowed to operate with
strict health protocols, namely health, food, energy, communication &
information technology, nance, logistics, hospitality, construc- tion,
strategic industries, public utilities, and basic services and industries
designated vital na- tional objects.
question now is how effec- tive will the “emergency brake” policy be in slowing
down the Covid-19 infection. If we look at the of cial data, the previous PSBB
implemented from April 10 – June 4 was successful in re- ducing the number of
cases. In March 2020, the actual transmis- sion rate (Rt) of Covid-19 in Ja-
karta was 4, meaning one infect- ed person is able to spread the virus to four
other people. With the implementation of the PSBB, this gure declined. In the
period May 4-17, the value was 1.08 – 1.11. By June 5, it decreased fur- ther
to 0.99, indicating that the outbreak was under control. The rate began to increase
again to 1.3 after the PSBB was relaxed.
indicator is the daily positivity rate indicating the per- centage of people
who test posi- tive using the PCR swab method. Data from the Jakarta Health
Agency which can be accessed on www.corona.jakarta.go.id/id showed the daily
positivity rate on April 10 at 7.1%. This gure was trending down during PSBB
implementation (4% on May 22, then 3% on June 4). When tran- sitional PSBB was
implemented, the positivity rate began to in- crease again. By the end of the
transitional PSBB Phase One (August 27), the daily positivity rate was 9.4% and
as of Septem- ber 10 it jumped almost twofold, to 15.8%. This increase could be
to two factors, namely, more specimens were examined and the number of infected
people was increasing.
proved that during the relaxation of PSBB in the tran- sitional period and the
low-level of public obedience in following health protocol have contribut- ed
to the increase in infection and caseloads in Jakarta. The “emergency brake”
policy, which put in place the same or even stricter level of restrictions, is
expected to suppress the trans- mission rate and number of cases. It is also
hoped that this measure will be able to prevent the collapse of the public
health system in Jakarta. Otherwise, it is highly likely that there will be
over ow of Covid-19 patients in Jakarta. This is not an exagger- ation, because
many hospitals have been strained by the in- ux of Covid-19 patients. Also,
many health workers have lost their lives ghting the invisible enemy. Based on
data from the Indonesian Medical Association (IDI) per September 13, 115
doctors have fallen victim na- tionwide, with 13 of them from Jakarta.
death of medical person- nel must not be taken lightly, because of their vital
role in combating the outbreak, espe- cially considering the relatively low
ratio of doctors per popu- lation in Indonesia, which is 4 to 10,000
population. With the death of 115 doctors, it can be said that 287,500 people
doctors due to Covid-19. Training a doctor takes a long time and enormous
resources. Complicating the matter, many doctors who have died are sub-
specialists, some even lecturers and professors. The material and immaterial
losses incurred are enormous. In addition, losing doctors will adversely affect
the quality and capacity of health- care facilities. It is feared that this
could have a domino effect on our battle against Covid-19.
role of healthcare facili- ties, especially hospitals, is so central because
they not only treat Covid-19 patients, but also patients suffering from other
ail- ments. Many chronically-ill pa- tients are afraid to visit a hospi- tal
for fear of being infected with Covid-19. The government’s well- worn “mantra”
of “safety through health protocols” is for many people an abstract concept:
they see lack of or no synergy between the central government, local
government, and the communi- ty in dealing with the pandemic.
countries that have been quite successful in dealing with the pandemic include
Hong Kong, Singapore and Taiwan. Since the rst cases were identi- ed on January
23 in Hong Kong and Singapore and January 21 in Taiwan – all of them import- ed
cases – the local government immediately imposed strategic policies.
March 13, 2020 (around 50 days from when the rst case was identi ed), Singapore
had187 cases with zero deaths (pop- ulation around 5.7 million peo- ple),
Taiwan had 50 con rmed cases with 1 death (population around 23.6 million) and
Hong Kong had 131 con rmed cas- es with 4 deaths (population around 7.5
general, the policies put in
by the three countries cen- tered around:
- Travel restriction to pre- vent
- Aggressive mass testing and contact
tracing, strict lockdown
- Rigorous social distanc- ing,
self-isolation and im- proving hygiene
implementing those poli- cies, each country follows a dif- ferent approach.
Singapore, for example, imposed ight restric- tions as well as self-isolation
upon arrival, building special isolation facilities, aggressive and extensive
contact tracing, prohi- bition of large-scale gatherings, regular monitoring of
worker health, compensation scheme for furloughed workers, and edu- cating the
public on preventative measures. In Taiwan, there are sanctions and nes in
place for violators.
Indonesian government is not as strict in tackling the pandemic, as evidenced
by its ever-changing policies. Likewise, the public are not as compliant and
disciplined, as one can still see many not wearing masks and/or keeping safe
distance when performing outside activ- ities.
study in Beijing to examine the effectiveness of using masks, washing hands and
maintaining social distancing found that us- ing face masks and disinfectants
are highly effective (up to 80%) in preventing Covid-19 transmis- sion. On the
contrary, frequent or close contact increased the risk of transmission by about
18 times. The study also found that there was a high risk of trans- mission
from Covid-19 patients before symptom onset. Wearing face masks after symptoms
doesn’t appear to signi cantly prevent transmission. In other words, it is
crucial that everyone observe preventive measures such as mask wearing, social
distancing and hands washing.
one needs to keep in mind that wearing masks and social distancing is a last
re- sort measure when one needs to perform urgent activities out- doors. It’s
still best to do activity from home. The health sector should be prioritized in
handling Covid-19. The implementation of PSBB, as part of the health policy
will have a positive domino effect on other sectors, such as the economy,
education, and social life. Health is essential because if people are healthy,
society will function optimally.
question then moves to how to deal with the Covid-induced economic downturn.
Keep in mind that Covid-19 cases are growing exponentially, much faster than
the rate of econom- ic growth when business activ- ities are as normal. The
longer the transmission of Covid-19 is left unchecked, the steeper the growth
rate of new cases will be.
with higher Covid-19 cases in the future will be far costly than suppressing
its cur- rent growth, so the only logical step to take now is to do what it
takes to reduce the rate of trans- mission, even though it means economic
growth will suffer. The “Covid-19 debt” with high inter- est must be paid off
before fur- ther investment can be made. If there is a one thing regrettable
about the Jakarta Governor’s “emergency brake” policy, it is that it wasn’t
Short term pain for long term gain, as the saying goes. This aptly describes
the situation that is taking place in Indonesia, in particularly Jakarta.
Covid-19 is a bitter pill that must be swal- lowed as quickly as possible so
that the bitter taste doesn’t lin- ger in the mouth. Recessions are common in
many regions and various sectors have been par- alyzed by this deadly disease.
As an archipelago, Indonesia is facing an uphill battle compared to other
countries. So long as the vaccine is not yet available, Covid-19 transmission
must be prevented through total enforce- ment of PSBB and proper health
protocols. The recommended approach is called 3T (Testing, Tracing, and
Treatment) and 3M (wearing mask, keeping safe dis- tance, and washing hands).
It is time for Indonesia to unite together, helping one an-
other and playing one’s role and responsiveness as much as possible. This is
not the time to point ngers and indulge in prej- udice. If we can come together
During this dif cult time, Indo- nesia will surely recover. Strict government
and an obedient so- ciety are the keys to successfully overcoming this
Dr Erlina Burhan MSc. Sp.P (K) is a pulmonologist with over 16 years experience in pulmonology and re-
spiratory medicine. She is a faculty member of the Department of Pul- monology
and Respiratory Medicine FKUI/Persahabatan Hospital (RSUP). She is also
chairwoman of the Indo- nesian Society of Respirology (PDPI) Jakarta, and Head
of the working group for infection PDPI and team leader of Covid-19 Treatment
at Per- sahabatan Hospital. Concurrently, Erlina also serves in the Covid-19
Task Force of the Indonesia Medical Association (IDI).