CONTROLLING THE COVID-19 SPREAD

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Illustration by: Agung Wahyudi/IO

Implementation of Large-Scale Social Restrictions (PSBB) meets conflicting government regulations

IO – The Spread of Coronavirus Disease 2019 (Covid-19) has expanded to almost all regions in Indonesia, and has had an impact on various aspects, namely social, economic, health, and community welfare. A Polemic on the implementation of a “regional quarantine” has been recommended by many parties to be enforced nationally. Many people call for lockdowns to prevent the extensive spread of Covid-19. 

The economic considerations must also be continued in this situation, and finally the government has taken the option to impose Large-Scale Social Restrictions (PSBB), because implementation of a “regional quarantine” can result in a greater impact on society and the economy. 

If we look at Law Number 6 Year 2018 on Health Quarantine, articles 53-59 explain that there are several types of health quarantine, namely Home Quarantine, Regional Quarantine, Hospital Quarantine and Large- Scale Social Restrictions. 

Large-scale social restrictions, abbreviated as PSBB, imply an emergency response to public health by limiting certain activities of residents in an area suspected of being infected with Covid-19 in such a manner to prevent its spread. In implementing the PSBB, the government has issued Government Regulation No.21 of 2020 concerning Large Scale Social Restrictions. 

The existence of the PSBB Policy encourages many regulations in support. In Government Regulation No.21 of 2020 the concept or procedure for implementing the PSBB is stated, namely establishing school emergency holidays and workplace vacancies. This is reinforced by the Circular Letter of the Minister of Education and Culture of the Republic of Indonesia Number 4 of 2020 concerning the Implementation of Education Policy in the Emergency Spread of Coronavirus Disease (Covid-19). 

Circular letter of the Minister of Industry Number 4 of 2020, concerning the Implementation of Factory Operations in the Coronavirus Disease 2019 Public Health Emergency. 

For the State Civil Servants, the Minister of State Administrative Utilization has issued Circular Letter No. 34 of 2020 regarding adjustment of the work system of the state civil servants in the effort to prevent the spread of Covid-19 in government agencies. 

In addition, the PSBB regulates restrictions on religious activities in places of worship, as stipulated in the Ministry of Religion Circular Letter No. 6 2020 concerning the guidelines for the worship of Ramadan and Eid al-Fitr in the midst of the plague. In addition to Muslims, Christians also worship from home, or online. 

Finally, what is regulated in the PSBB is the limitation of activities in public places or facilities such as events that invite crowds, namely weddings, music events, sporting events – all to be stopped temporarily. This is done so the social distancing or maintaining distance between individuals can be done effectively. 

Implementation of PSBB in the Jakarta metropoitan area – Jabodetabek 

DKI Jakarta is the first province to get approval from the Ministry of Health to implement large-scale social restrictions (PSBB), which begin on Friday, April 10, 2020, from 00.00 West Indonesia Time to April 23, 2020, throughout the Capital Region. The Provincial Government of DKI issued Governor Regulations Number 33 of 2020 as the Legal Basis for implementing PSBB, in line with the Minister of Health Regulation number 9 of 2020 

A number of regulations have been enforced, such as the implementation of emergency holiday of school and workplace activities, the temporary suspension of religious activities in places of worship, as well as the closure of public facilities. DKI Jakarta Governor Anies Baswedan said that there were only eight sectors that were still allowed to operate during this PSBB period. These sectors are health, food, energy, communication, finance and banking, logistics, daily necessities, along with other strategic industries. 

This regulation also covers public transportation schedules, for example railroad transport, limiting its operating hours from 6:00 to 18:00 WIB. Four-wheeled vehicles are also limited by the number of people, which is a maximum of 50% (fifty percent) of their transport capacity and two-wheeled vehicles may carry passengers provided they have the same address printed on their identification card. 

In this governor’s regulation, Governor Anies appealed to all the people of Jakarta for the past two weeks to remain indoors, and reduce or even eliminate activities outside. The aim is to cut down the chain of transmission of Covid-19, to save ourselves, family, neighbors, colleagues, so that we can control this virus. 

During the first three days, the implementation of the PSBB was seen to be running well; this is because it coincided with a national holiday, Good Friday and Easter, both Christian religious holidays. 

New Complexity Arise 

Large-Scale Social Restrictions (PSBB) in DKI Jakarta are threatened with difficulty of success due to ambiguous regulations, namely two Ministerial Regulations, one Minister of Health Regulation No. 9 of 2020 as outlined in DKI Governor Regulation No. 33 of 2020 and the Regulation of the Minister of Transportation No. 18 of 2020. 

Acting Minister of Transportation, through the Minister of Transportation Regulation in Article 11 paragraph (1) letter c: “Application-based two-wheeled transportation (2) is limited to the use of goods transported only, Article 11 paragraph (1) letter d:” in certain things for the purpose of serving the interests of the community and for personal interests, motorbikes can transport passengers on the condition that they must meet health protocols such as the implementation of disinfection, the use of masks, gloves, and the driver is not sick “. 

Meanwhile, the Minister of Health Regulation No. 9 of 2020 Article 13 paragraph (10) letter a, in which the passenger of both private and public vehicles must set a certain distance. In line with DKI Governor Regulation no 33 of 2020 article 6 that includes application-based two-wheeled transportation facilities with restrictions only for transporting goods and not for passengers. This is an effort in carrying out social distancing. 

The Governor’s Regulation No. 33 of 2020 is problematic and makes the authorities look ambiguous in carrying out legal actions. Without law enforcement, the implementation of PSBB is of no use because Covid-19 transmission can still take place through two-wheeled passenger transportation, both for commercial and private vehicles. When in fact, a number of online public transportation operators on the first day of the PSBB removed the passenger transport feature. 

The ambiguity of government policy became even more complex after last Tuesday (7/4), Minister of Industry (Menperin), Agus Gumiwang Kartasasmita issued a Circular Letter (SE) of Minister of Industry No. 4/2020 concerning Implementation of Factory Operations in the Public Health Emergency Period of Coronavirus Disease 2019 ( Covid-19) (SE Minister of Industry No. 4/2020) to keep operational. 

This circular letter aims to support industry to keep it going in a productive state, but it must be done in accordance to the health protocol recommended by the WHO. Thanks to the Circular Letter of the Minister of Industry, many factories / industries including 200 non-essential industries are still operational in this state of emergency. How can the DKI Jakarta Provincial Government impose sanctions to close down industry, if the industry is still operating because there is a permit from the Minister of Industry. The ambiguity of government regulations results in all parties blaming each other, public confusion, all while the level of people in monitoring (ODP), patients under surveillance (PDP) – who are dying continues to grow, especially in the red zone. Strangely, the source of the error is the failure of the PSBB regulation system which was affected by the transportation sector, especially the Jabodetabek KRL (Commuter Line), according to Agus Pambudio, Public Policy Observer and Consumer Protection. 

How will Jabodetabek KRL passengers be able to set physical distancing if the passenger density is still hundreds of thousands at peak hour as a result of other sectors not stopping their operations? How will the DKI Jakarta Provincial Government (Pemprov) impose sanctions to close the industry, if industry is still operating because there is a permit from the Minister of Industry? Do not blame Jabodetabek KRL in the downstream sector, if the upstream sector is still operating. This conflicting regulation shows the weak aspects of communication and coordination between government agencies in implementing PSBB, which has resulted in different and conflicting policies. 

PSBB has entered its second week, but there are still many people who do not obey the government’s appeals to carry out social distancing, stay at home, and to worship at home. The streets in the capital city are still crowded by vehicles, there isn’t much difference from the period when PSBB had not yet been enacted. The market is still crowded with shoppers, particularly housewives. This indicates that the PSBB is difficult to implement. At this state we can’t expect any positive result if we want to be able to suppress the spread of Covid-19 numbers. 

The implementation of PSBB in Jakarta must also be supported by the surrounding supporting zones, namely Bogor, Depok, Tangerang and Bekasi. 

We need to change the strategy so that PSBB can work and be able to immediately break the chain of transmissive spread of the Covid-19. The government needs to give a broad and continuous understanding and simpler ways of delivering information about the concepts and objectives of the PSBB in language that are easily understood by the community. All is done in order to grow awareness of each person to look after each other and remind the dangers of not obeying the appeal of the government. In this case the government needs to realize that the people, especially in Jakarta, are diverse, both in education, ethnicity and religion. So it is necessary to find the right way to convey information by cooperating with community leaders, religious leaders, village officials or artists, influencers and perhaps also holding a cooperation with mass media, both television, radio, and online news to continuously deliver messages from the government. 

If the community has been given an understanding but still does not heed the appeal of the community, then it should be given a deterrent effect. As stated in Law number 4 of 1984 concerning infectious disease outbreaks, quoting from Chapter VII Criminal Provisions, article 14 paragraph (1) to paragraph (3), who intentionally obstructs the implementation of epidemics as regulated in this Law, threatened with imprisonment for 1 (one) year and / or a maximum of one million Rupiah fine. 

But in addition to applying punishment to those who violate it, the government must still pay attention to the people affected by the implementation of this PSBB, because their jobs are affected by this regulation and it will significantly affect their means of survival. The government’s effort to overcome this is the provision of direct cash assistance that is right on target, so that the community can continue to eat and can stay at home during the implementation of PSBB. 

Do We Need National Scale Social Restrictions? 

Large-Scale Social restrictions (PSBB) should be implemented on a national scale, because Indonesia’s case has been classified as “Nationwide Community Transmission” or inter-community transmission. There is no need for a further study to implement a national scale Social Restrictions. It’s just that the implementation of PSBB in each region can vary in intensity, and later the Ministry of Health will monitor and evaluate the increase or decrease in Covid-19 transmission rates and which will determine when the implementation of PSBB ends in an area. 

It should be remembered that the spread of Covid-19 does not recognize bureaucracy, does not recognize provincial / district / city boundaries. Keep in mind that most people with Covid-19 are asymptomatic, or they can appear healthy while being infected by the virus, this is something that needs to be examined because the infected can transmit the virus to those around them without realizing it. This uniqueness makes it easy for viruses to transmit quickly and unstoppably. The PSBB policy, which is local or only a certain district, is like “throwing salt into the sea”. 

In view of Minister of Health Regulation No. 9 of 2020 article 4, in order to establish Large-Scale Social Restrictions, it is expected that the Governor / regent / mayor submits a request for a Large-Scale Social Restrictions to the Minister to be accompanied by data on the increasing number of cases over time; spread cases over time; and local transmission events. 

This is a major obstacle in implementing PSBB that in truth needs to be implemented as soon as possible in the condition of public health emergencies. Complicated bureaucracy, even in conditions of public health urgency can encourage an increase in the number of mortalities. Public health emergencies implemented in the form of Social Restrictions should be implemented throughout Indonesia, so that the impact of the acceleration of the handling of the Pandemic in Indonesia can be realized. The government must move quickly, strategically and cut through all unnecessary bureaucracy. 

The current implementation is basically a regional level PSBB due to various reasons, such as what’s being implemented in West Java Province and Riau Province. Only parts of the city in one province that apply the PSBB. Like the province of West Java, based on the Decree of the Minister of Health number HK.01.07 / Menkes / 259/2020 regarding the establishment of large-scale social restrictions, covering the area of the city of Bandung, Cimahi, Bandung regency, West Bandung regency and Sumedang city, because from the available data it shows a significant and rapid increase and spread of Covid-19 cases followed by local transmission events. And other considerations are regional readiness in social, and economic aspects. Previously, the Minister of Health approved the Pekanbaru mayor’s proposal for large-scale social restrictions. The decision was made by the Minister on 12 April 2020, with the consideration that the city of Pekanbaru became the epicenter of the spread of the corona virus in Riau. One effort to increase supervision over the implementation of the PSBB is the closure of the General Sudirman road starting from April 21st 2020 at 20.00 to 05.00. This is done to reduce the number of crowds in the middle of the city of Pekanbaru. 

The ban on “mudik”, or homecoming, was finally issued by the central government, President Jokowi conveyed in a rationale regarding the matter of anticipating the homecoming event, so that it could suppress the spread of Covid-19. The reason for the homecoming event for the communities also varies, because they are no longer able to work in the city and they’re on the verge of entering the holy month of Ramadan. This decision was taken based on a survey conducted by the Ministry of Transportation, while social assistance has begun to be distributed to people who are economically affected due to the implementation of the PSBB. This social assistance should be able to reduce the number of people going back to their hometown. 

Intervention will be more effective if the implementation of PSBB is also accompanied by large-scope mass testing (screening), meticulous tracking on the infected, and tight isolation. While doing that, there is a need for socio-economic and psychological mitigation. 

A serious intention to reduce the spread of the virus and mortality rate needs to be supported by educating the public and making careful planning regarding the implementation of the PSBB, all in accordance with relevant regulations and continuous supervision, so that the implementation in the field is actually in accordance with existing regulations. Thus, we don’t lose any more time. At the very least, the red zone that applies to Jabodetabek will be faster in resolving this pandemic problem and quickly recovering to normal. (Pandu Riono and Tince Arniati Jovina)

Dr. Pandu Riono is a Senior Staff at the University of Indonesia, Faculty of Public Health, Dept. of Biostatistics and Population. He graduated from Fac. of Medicine, University of Indonesia, and received His Master’s degree in Biostatistics from the University of Pittsburgh. Currently he specializes in mathematical modeling of HIV / AIDS, TB, STI, HepB / C and Sexual Risk Network for HIV and STI, and also other Risk Networks for Emerging Infectious Diseases. Interest in Bayesian Statistics and dealing with epidemiology issues. 

Tince Arniati Jovina, Policy Analyst of the Indonesian Ministry of Health’s Health Research and Development Agency. Graduated with a Master’s in Public Health, Faculty of Public Health, University of Indonesia.