Global surge
After the WHO reported the emergence of the Omicron in South Africa on November 24, 2021, cases started to crop up in many parts of the world. Due to its higher virulence, it has infected a very large number of people in a relatively shorter time and could soon become the most dominant strain worldwide. This raises the specter of a new pandemic wave and undermines the global vaccination campaign. Europe, which has the highest vaccination rates in the world, has seen a surge in daily cases, as Omicron overcomes the immunity from infection or vaccines.
On January 13, 2022, it was reported that Omicron has driven case counts in Denmark to rise 132.54%, followed by France at 115.44% and the UK at 70.62%. Meanwhile, Canada has seen a spike of 110.24%, followed by the America at 102.49%.
Omicron has also started to trigger new waves of infections in Southeast Asia. Many countries in the region have prepared for the worst scenario in case Omicron drives an explosion of cases.
By early 2022, Singapore had reported 2,692 Omicron cases and counting. Its first suspected cluster was detected in a gym. Singapore Health Minister Ong Ye Kung has pleaded with citizens of the island city-state to prepare for a surge by getting themselves fully vaccinated and boosted. Malaysia Health Minister Khairy Jamaluddin has also sent out a warning of Omicron inundating the country’s health care system. Many of the Omicron cases in the country was linked to umrah pilgrims returning from Saudi Arabia. Malaysia has reported 122 Omicron cases. By January 15, 2022, it recorded 3,270 new cases, with 18 deaths.
Omicron made a landfall in the Philippines on December 5, 2021. In response, the Philippine government swiftly reimposed strict Covid curbs in the capital Manila. The Philippine Health Undersecretary Leopoldo Vega predicted that Omicron would lead to explosion of cases in the next three to four weeks, accounting for 50% to 90% of total caseload. Even though Omicron dominates, the Delta variant will remain in circulation.
Thailand detected its first Omicron local transmission in the Kalasin province on December 24, 2021. A Belgian couple, who entered the country through the Test & Go travel scheme early in the month, sparked a cluster infection of 21 people. Several health experts forecast cases would shoot up as more people traveled during the extended New Year holiday. By January 15, 2022, the country has recorded a total of 2,338 Omicron cases.
Omicron is currently driving India’s third wave. On January 13, 2022, the country reported 247,417 fresh infections daily — a 30-fold increase over the previous month — the highest since the brutal Delta-fueled second wave in April-May last year. New Delhi, the capital of 20 million people, has seen daily cases spiked to more than 27,500 on January 12. However, hospitalization rates remain relatively low.
Complicating the situation was religious festivals. Tens of thousands of Hindu pilgrims gathered to celebrate Makar Sankranti in the northern Indian city of Prayagraj as Omicron wave was firmly underway. They congregated on the banks of the Ganges to bathe which they believe would wash away their sins. Last year, another huge religious festival Kumbh Mela, held in Uttarakhand, was thought to exacerbate the disastrous second wave which brought the nation’s healthcare system to its knees with dire shortage of hospital beds, oxygen and medicines. The state of Uttar Pradesh’s insistence to give the festival the go-ahead has experts worried about the impact the event will have on public health. (FIGURE-4)
Omicron arrival in Indonesia
Omicron made a landfall in Indonesia on December 15, 2021. According to Health Minister Budi Gunadi Sadikin, the first case was detected from a janitor who worked at the Wisma Atlet Kemayoran emergency Covid-19 hospital in Central Jakarta. Contract tracing found five probable cases and two confirmed cases in two Indonesians who had just returned from England and South America. In the next three days, 16 fresh cases were found in Indonesian travelers who had just visited Malaysia, Congo, Turkey, Japan, South Korea and Saudi Arabia. A day later, three fresh cases t came from Indonesian citizens who had just returned from Malaysia and Congo. Friday, December 24, 2021, there were as many as 11 new cases originating from travelers from Turkey, Japan, South Korea and Saudi Arabia. Those were the imported cases.
On December 28, 2021, the Health Ministry announced the findings of a local transmission in a patient from Medan who dined at a restaurant in the Sudirman Central Business District (SCBD) in South Jakarta. When he was about to fly back to Medan, his rapid antigen test result showed that he was positive with COVID-19, confirmed by a PCR test taken the following day. The specimen was sent for Whole Genome Sequencing analysis and the patient was declared infected with Omicron. On January 12, 2022, the Health Ministry announced 66 more Omicron cases, consisting of 33 imported cases and 33 local transmissions, bringing the total to 572 cases.
2,535 Covid-19 patients are currently being treated at Wisma Atlet Covid-19 emergency hospital. The spike in cases driven by Omicron is mostly attributed to overseas travelers.
Omicron outbreak has again threatened in-person classes (PTM) which have just resumed in full. Six schools in East Jakarta have been forced to cancel its PTM after each of them detected a confirmed case. They will have to remain shut until a contact tracing is completed.
Indonesia’s Omicron strategy
Governments in many Asian countries are aware that it may be impossible to avoid the spread of new, ever-transmissible variant, despite tightening curbs and shutting their borders to protect their citizens. The Indonesian government has finally lifted the entry ban for foreign nationals from or who have transited in 14 countries that recorded high Omicron cases. This decision was taken because Omicron has spread to 150 out of a total of 195 countries. If stringent restrictions continued to be implemented, it is feared that this will adversely impact the still fragile national economic recovery.
This reversed previous decision to ban arrivals from 14 countries — South Africa, Botswana, Angola, Zambia, Zimbabwe, Malawi, Mozambique, Namibia, Eswatini, Lesotho, Norway, France, UK and Denmark. Now, foreign travelers may enter on condition that they must quarantine for seven days, in line with recommendation from the US Centers for Disease Control and Prevention (CDC). The government will continue to strictly monitor the quarantine process by conducting more vigorous health screenings at every entry gateway through multi-layered strategy which includes SGTF (S-gene target failure) and WGS PCR tests.
At the same time, the government is accelerating the national vaccination rollout to widen the coverage. This has resulted in Indonesia among the top five countries with the highest vaccinated population in the world, after China, India and the US. More than 166.65 million people have been vaccinated due to the joint efforts by all stakeholders, including the military and police, ministries/agencies, regional governments, community and religious organizations, business players and the general public to combat the pandemic.
To mitigate the Omicron flareups, the Indonesian government has decided to offer a third dose (booster) for all Indonesians. The program beginning January 12, 2022 with priority given to the elderly and vulnerable groups (people with comorbidities and impaired immune systems), and children.
The Indonesian Food and Drug Monitoring Agency (BPOM) has supported the government’s vaccination drive by accelerating the evaluation and issuance of Emergency Use Authorization (EUA) for Covid-19 vaccines. Five vaccine brands — CoronaVac/Bio Farma, Comirnaty by Pfzer, AstraZeneca (Vaxzevria and Kconecavac), Moderna, and Zifvax — as booster doses, whether homologous (using the same vaccine) or heterologous (combination of viral vector vaccines and mRNA vaccines). This was based on immunogenicity data from observations of the latest clinical trials which showed a significant decrease in antibody levels six months after receiving primary vaccine doses.
Super Immunity
Health Ministry spokesperson Siti Nadia Tarmizi stated that based on serological survey, 86.6% of Indonesian population have high antibody titers. It is speculated that super immunity has already been formed in Indonesian society. The survey was conducted in 100 regencies/municipalities in both agglomeration and non-agglomeration areas between November-December 2021.
The Covid-19 Task Force also found that around 73.2% of the population have had antibodies against Covid-19 even though they have never been infected or vaccinated before. Thus, the government believes that the herd immunity is quite strong. It is likely that the high antibody titers are the result of a combination of several factors, from vaccination to exposure to infections during the previous Delta surge in July 2021. However, whether this can prevent wider Omicron outbreak remains to be seen.
Containing Omicron
The obstacles faced today are mainly the still fragmented knowledge about Covid-19 between the public, clinicians and public health authorities. In addition, the policies issued sometimes do not contribute significantly to the pandemic handling efforts. Covid-19 can only be prevented and contained with strong, unwavering discipline and the spirit of mutual cooperation from all national stakeholders.
Synergistic coordination between the central and regional governments, and between healthcare service facilities must also be strengthened to deal with the Omicron threat. Given that local transmissions continue to rise, the preparedness of the central and local governments in responding to the spread of Omicron is crucial in order to prevent emergence of new clusters. The most important thing is for the general public to change their mindset and behavior in order to coexist with the virus by continuing to abide by the 5M health protocols — mask wearing, hand washing, physical distancing, crow avoidance and reducing mobility.