Jakarta’s “Transitional PSBB” open doors to new Covid-19 clusters
IO, Jakarta – To accelerate the handling of Covid-19, the government has issued Government Regulation No. 21/2020 on the Large- Scale Social Restrictions (PSBB), which seeks to limit the mobility and activities of the population within a certain area suspected of being widely infected by Covid-19, to prevent further spread of the virus. The decision to implement PSBB should be made only after going through many steps, in accordance with Health Minister Decree No. 9/2020. Jakarta was the first urban location in Indonesia to impose PSBB, in the quest to contain the pandemic.
Article 16 point 1 and 2 of the Health Minister Decree stipulates that during PSBB the governor/ regent/mayor is responsible for recording and reporting the situation with Covid-19 in each of their respective regions. Jakarta has seen the number of positive cases continue to grow, since the arrival of Covid-19 on Indonesian shores was announced on March 2, 2020. On Monday (1/6/2020), Covid-19 positive cases in Jakarta stood at 7,383 with 2,246 recoveries and 521 fatalities.
A team from Universitas Indonesia’s Faculty of Public Health has ascertained that during the PSBB in Jakarta, the effective reproduction number (Rt) of Covid-19 as of May 31, 2020 was still at 1.0. This means that one Covid-19 patient can potentially transmit the virus to one other person. According to Dr. Pandu, MPH, PhD, PSBB must continue to be implemented until the Covid-19 pandemic is intirely over. (FIGURE.1)
Work From Home (WFH) Policy
The end of PSBB in Jakarta, extended until June 4, 2020, became a crucial phase in the transition toward new normal. Jakarta Governor Anies Baswedan said that after PSBB was implemented the Covid-19 situation in the capital has improved significantly. The number of positive cases, which averaged around 4.7% in May declined to 3.8% in June, and the reproductive number from 4 to 1.1. This was achieved through public participation, as residents began to obey the rules set forth by the government to break the COVID-19 transmission chain.
But while the effective reproduction number is still not below one, the PSBB has been relaxed. Since June 5, 2020, DKI Jakarta Governor Anies Baswedan has designated the extension of PSBB as a transitional period, dubbed Phase One Jakarta PSBB Transitional Period. This is reinforced by the issuance of the Jakarta Governor Regulation No. 51/2020 on the Implementation of Large Scale Social Restrictions During the Transition to a Healthy, Safe and Productive Community on June 4, 2020, as a sign that Jakarta has officially entered a transitional PSBB, further bolstered by Jakarta Governor’s Decree No. 563/2020 on the Stages and Implementation of PSBB Activities During the Transitional Period which regulates the types of activities that can be carried out during the transition to a “new normal”. Since then, the effective reproduction number (Rt) in Jakarta has gradually crept upward.
Indonesia seems to be forced to ready itself for the new normal amid the still raging coronavirus pandemic. Health protocols in the workplace or offices have been prepared so that the economy can restart in a safer and more conducive environment. There needs to be optimal mitigation and workplace preparedness in order to adapt to a new normal during the pandemic.
The extension of the Phase One transitional PSBB took effect on June 5 to July 2, 2020. This means that offices in Jakarta have begun to adapt to the new normal. This policy is in line with the official statement by the Head of the Covid-19 Task Force Doni Monardo issued on Friday (6/5/2020). “President Joko Widodo has instructed the Task Force to look at the reopening of sectors that have a positive impact on people’s lives. The government, in preparation for the new normal, wants to ensure that society remains productive, but with health protocols still being implemented to prevent the transmission of Covid-19. The priority is to deal with Covid-19 while still taking social and economic factors into account,” explained Doni.
Nine economic sectors are set for reopening, namely, mining, oil, manufacturing, construction, plantation, farming and animal husbandry, fisheries, logistics, and transportation of goods considered low risk from Covid-19 infection. Furthermore, these nine sectors have the potential to employ large numbers of workers and their economic impact is quite significant. Those sectors will play a crucial role in national economic recovery, as well as supporting the livelihood of many people. Taken together, they contribute around 55.5 percent of Indonesia’s Gross Domestic Product in the first quarter of 2020. The Ministry of Industry, as the main stakeholder responsible for the industrial sector, has been preparing to support these sectors during the transitional PSBB. There needs to be closer coordination with all local governments to monitor the activities of these sectors during the period. In order to prevent Covid-19 transmission, they will be required to implement health protocols which apply to all their workers, such as social distancing, wearing a mask, and embracing a hygienic and healthy lifestyle.
Indicators of economic recovery can be seen from the higher inflow of foreign capital into government bonds in recent weeks which, according to Bank Indonesia’s records, amount to Rp7.01 trillion in the first week of June 2020. This is higher than Rp2.97 trillion, Rp6.15 trillion and Rp2.54 trillion recorded in the preceding three weeks. This is taken as evidence that investors have started to show confidence in Indonesia’s economic recovery.
Jakarta during the transitional period
Since June 8, 2020, Jakarta has shifted to a new normal dynamic after eight weeks of PSBB. There was a queue of people wearing masks at commuter train and MRT stations. In the transition period, the public are expected to heed and adhere to work guidelines in office and factory issued by the Health Ministry; among others, a company’s management must form a Covid-19 Handling Team, comprising the head of the HR department, the health and safety division chief (K3), and health workers. Companies are required to always monitor and provide update on coronavirus information in their vicinity. The leadership or employer must also establish policies and procedures for workers to report any suspected COVID-19 case based on apparent symptoms to be later monitored by health workers. Whenever possible, the government still advises people to work from home or work different shifts.
Resurgence of Covid-19
On the other hand, the reopening of economic sectors is like a doble-edge sword, with consequences to be borne. When a portion of economic activities begins to go back to normal, it is feared that people’s mobility risks pumping the spread of Covid-19.
Governor Anies Baswedan decided to extend Phase Two transitional PSBB for 14 days until July 16, because there was no indication of the cases slowing down. In the past 55 days, the number of positive cases has continued to increase leading to the conclusion that PSBB relaxation has stimulated the spread of Covid-19. It is noteworthy that positive cases have surged by six-fold with the emergence of new clusters. The term “cluster” refers to infectious disease cases that are linked to a particular incident or locale.
The cluster with the highest infection rate is hospitals. Of total cases, the largest contributor was hospital patients (42%), followed by community (39%), returning Indonesian ship crews and migrant workers (5.8%), traditional markets (4.3%) and offices (3.6%).
Traditional market clusters which emerged in early July were quite worrisome due to a rapid viral spread. This was discovered after a series of tests, ranging from rapid tests to swab tests in the markets. Regional head of the Indonesian Traditional Market Traders Association (IKAPPI) Miftahudin revealed 305 Covid-positive vendors have been diagnosed, across 46 markets in Jakarta, with 45 markets already shut down by the Jakarta Provincial Administration. IKAPPI reported that 237 traders in 45 markets tested positive as of Tuesday, July 15. The majority of the cases were found in Kramat Jati Market, East Jakarta, with 49 infected vendors, followed by Cempaka Putih Market, also in East Jakarta, with 41 infected vendors.
Lately, offices have become the new cluster in the spread of Covid-19. Before, the number of Covid-19 positive cases in the office cluster was only 43 people. From June 4 to July 26, the government recorded that there were 90 office clusters in Jakarta with a total of 459 positive cases. Offices cluster make up around 3.6% of total positive cases in Jakarta.
There are a number of factors that contribute to the increased risk of coronavirus transmission in a closed space, such as in an office due to poor air circulation. Thus, the virus can easily remain airborne in a room and infect many people. A study published in the journal Emerging Infectious Diseases found that the rate of coronavirus infection in high-rise buildings with closed air circulation is as high as 43.5 percent. According to Hong Kong University epidemiologist Benjamin Cowling, as cited in Scientific American magazine, the likelihood of being infected indoors is higher than outdoors, especially if the room is poorly ventilated. (FIGURE.2)
Many have advised that companies reintroduce the Work From Home (WFH) policy. If this is not possible, they must limit the number of employees working in the office, cutting numbers by 50%. This is in accordance with the recommendation of the Head of the Jakarta’s Manpower, Transmigration and Energy Office through Circular Letter No. 14/ SE/2020 on advice to work from home. Ironically, some companies don’t abide by these regulations because the policy is seen as detrimental to their performance, thus their employees are still required to continue working to achieve targets. Some companies even take the opportunity to reduce their employees’ salaries because of the WFH policy.
The other contributing clusters are hospitals, community health centers, nursing homes and prisons. However, the number of infected is lower, compared to the previously-mentioned clusters.
Recently, it was reported that 40 students of a theological school in Central Jakarta were infected. The new cluster emerged after the dorm manager relaxed the rules for participating in outside activities during the transitional PSBB.
There are two anomalous and extraordinary cases which have led to a significant increase in the number of positive cases in West Java and whose source of transmission is still unknown. They occurred in two military education institutions, namely, the Army’s Officer Candidate School (Secapa) in Bandung and the Army’s Military Police Training Center (Pusdikpom) in Cimahi, which is the Covid-19 hotspot in West Java. 1,262 students and a coach at Secapa tested positive for Covid-19. Only 17 people were hospitalized, while the rest are asymptomatic, so they just needed to do self-isolation. In addition, 99 people at Pusdikpom tested positive, consisting of 74 students and 25 military staff. All of them were asymptomatic.
Pandu Riono, an epidemiologist from Universitas Indonesia (UI), Riono believes the increase in cases was due to the increased effort by the Jakarta Provincial Government to massively conduct rapid tests and swab tests. “Since more people are tested, logically the number of positives will also increase. The positivity rate of Covid-19 cases in Jakarta in the past week was 6.6%. The positivity rate is the ratio between the number of people whose test results came back positive and the total number of tests. In comparison, the national positivity rate is 13.9%”, he noted.
The success of other countries in curbing Covid-19
After reaching it peak in mid-February 2020, new Covid-19 cases in China gradually declined by the end of February 2020. A joint report by the World Health Organization (WHO) and the Chinese Government published on February 28, 2020 detailed the success of the People’s Republic of China in overcoming the epidemic. According to WHO, the key to China’s success in curbing the coronavirus outbreak was its massive efforts in providing test kits, determining key parameters for transmission, mass screening , as well as intensive care for patients. On March 19, 2020, China reported no new infections for the first time in a week. This resulted in the Chinese government gradually relaxing restrictions on residents and eventually removing the lockdown status – imposed January 25 – in Hubei Province (excluding Wuhan) on March 26, 2020. The Chinese government has also intensified its campaign to raise awareness about the virus so that its citizens can be more disciplined in keeping themselves and others healthy. This has been effective in preventing further spread of the virus.
In 2003, Vietnam was the first country recognized by the World Health Organization (WHO) for its historical success in being SARS-free, which serves as an invaluable experience in dealing with the emerging Covid-19 pandemic. The main efforts Vietnam pursued to curb the spread of Covid-19 were contact tracing and quarantine measures. Testing is used as a tool for detection and contact tracing. Vietnam’s contact tracing strategy is very comprehensive, spanning multiple generation intervals, starting from F0 (infected person), F1 (those who have close contact with F0 or are suspected of being infected), F2 (close contact with F1), and so on up to F5.
Vietnam also imposed a nationwide lockdown for 21 days in 28 of its 63 provinces. Some lessons that other countries can learn from Vietnam are strengthening public health infrastructure, closing borders to limit community movements, comprehensive contact tracing and quarantining people at risk of being infected. The Vietnamese government also improved its communication strategy with clear, consistent and serious messages. In the decision-making process, the government embraced the whole community, involving multi-sectoral stakeholders. Public trust in the government in responding to this pandemic is the main asset it had in overcoming the health crisis.
With very strong support from its citizens, the South Korean government was able to act quickly and decisively. Learning the lesson from its failure to deal with the Middle East Respiratory Syndrome (MERS) outbreak in 2015, the government has reformed the country’s healthcare system to increase its preparedness. In addition, a functioning national health insurance system, adequate human resources and infrastructure, as well as close collaboration between key institutions (such as the President Office, the Ministry of Health, and the Korea Centers for Disease Control and Prevention), have proven highly effective in containing the pandemic. South Korea aggressively conducted large-scale testing and contact tracing since the early days of the outbreak.
Germany is also praised for its vigilance and preparedness in dealing with the pandemic. Under the leadership of Chancellor Angela Merkel, the government has been actively monitoring the situation, even before the virus reached its shores. For example, the country’s airport authority was strictly monitoring passengers departing to and arriving from China. As recommended by the World Health Organization (WHO), information related to Covid-19 was widely distributed at airports and other public places. At the same time, Germany began developing its own Covid-19 test kits.
Effective public communication plays a crucial role. Chancellor Angela Merkel was very firm and realistic in communicating the situation as Covid-19 began spreading across the world. All the facts up to the worst-case scenario were clearly explained, based on scientific data that can be verified. All information related to Covid-19 can be accessed easily through print, electronic and social media in a transparent, accurate and comprehensive manner, from what the symptoms are and how to prevent transmission. As a result, the German public took the threat the virus posed to the country’s healthcare system and economy seriously. The government was well aware that the mitigation effort would be highly dependent on its citizens’ cooperation. This transparent model of leadership is very effective in ensuring public compliance.
Is there a solution out of this fraught situation?
Judging from the country’s testing capacity, Indonesia is still far behind what is suggested by the WHO, which is 1,000 tests per one million population every week. The most important requirement in relaxing PSBB is to increase testing capacity. (FIGURE.4)
It is hoped that Indonesia can learn from the experience of other countries that have succeeded in containing the Covid-19 pandemic. The government needs to conduct active surveillance, which involves testing, tracing and isolation. As per the Health Ministry recommendation, testing should be carried out using rT-PCR instead of rapid tests because authorities need to detect people with viruses. Contact tracing of people who have been in close contact with the infected must be done properly and comprehensively. Close contact is defined as face-to-face contact for 15 minutes or more, within two meters of a confirmed Covid-19 patient.
Contact tracing is the primary means to control and prevent further spread of the virus. The aim of contact tracing is to provide a quick response to newly infected or suspect patient and monitor them closely. The follow-up to contact tracing is testing, and if a suspect is confirmed positive they must be quarantined, which involves limiting their mobility or activities. Those who might have been exposed should also be isolated for early detection and monitoring.
The government should provide accurate information from reliable sources to the public so that they will have confidence in its policies made and measures taken.
Addition, the government must improve its efforts in educating the public so that information can be fully understood and obeyed, for example by using simple language that can be easily comprehended. This way, public awareness can be heightened and they are willing to change their behaviors according to the health protocol, dubbed 3M (wearing a mask, washing one’s hands and keep a safe distance). (FIGURE.5)
Based on the finding from a number of studies, the 3M campaign should continue to be implemented massively in daily life because it can reduce the risk of contracting Covid-19 by 1.6%.
Indonesian people should never underestimate the virulence of Covid-19. To reduce its spread, start by maintaining self-discipline by implementing 3M. Active participation from society is extremely critical in containing the spread of COVID-19. This problem cannot only be solved by the government but also is highly dependent on behavioral modification on the part of the public. (Drg. Tince Arniati Jovina, MKM.)
Drg. Tince Arniati Jovina, MKM, Is a policy analyst at the Research and Development Agency of the Indonesian Health Ministry. She is a graduate of Universitas Indonesia Public Health Faculty with a Master’s degree in Public Health.