Indonesia’s COVID-19

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Illustration: IO/Agung Wahyudi

Vague orders, uncertainty and lack of clear communication add to the pandemic confussion

 IO – The World Health organization (WHO) announced that the new Coronavirus Disease 2019 a Pandemic on March 11, 2020, meaning that countries around the world must immediately respond, suppress and deal with the novel Coronavirus Pandemic or COVID-19. Unfortunately, the Indonesian Government was late in responding to the threat, late in declaring a Public Health Emergency and implementing Large-Scale Social Restrictions as stipulated in Government Regulation no 21 of 2020, in the framework of Accelerating the Management of novel CoronaVirus Disease-2019 (COVID-19). 

Large-Scale Social Restrictions, often abbreviated as PSBB, are interventions that encompass restrictions on a number of certain population movements in an area suspected of being infected with COVID-19. These restrictions include, at a minimum, the dismissal of school and workplace movement, then limiting religious activities by carrying out worship at home, limiting movement in public places including limiting socio-cultural ones where many gather, limiting modes of transportation, and limiting other movements specifically related to defense aspects and security, as well as emphasizing the community must keep their social distancing. Large-Scale Social Restrictions are part of the Public Health Emergency response. 

The government’s reason for implementing Large-Scale Social Restrictions is based on epidemiological considerations, as well as political, economic, social, cultural, defense and security considerations. The government focuses on three main policies implemented in handling COVID-19. First, focus on the health sector against the coronavirus pandemic. Second, implementing social safety nets to help the community. Third, establishing economic survival for the foundation of the Indonesian economy. 

In implementing this PSBB policy, the Government, through the Ministry of Health, issued Ministry of Health Regulation Number 9 of 2020 concerning Large-Scale Social Restriction Guidelines in the framework of Accelerating the Handling of COVID-19. The Ministry of Health Regulations regulates the procedure to establish Large-Scale Social Restrictions in an area. In submitting a regional PSBB, the governor / regent / mayor must prepare an application letter accompanied by data that includes an increase in the number of cases over time; spread cases over time; and local transmission events. This has caused commotion in the community, because it implies a complicated, lengthy process to implement the PSBB policy in a region. 

The Problems in Implementation 

DKI Jakarta is the first province in Indonesia to get an approval letter from the Ministry of Health to implement PSBB. It’s still clear in our mind of how the state of implementation of the first day of PSBB in Jakarta was like. There are a number of notes on the first day of the implementation of PSBB in DKI Jakarta; there were still many residents who did not obey the PSBB rules, such as riding in a vehicle with a large number of passengers to not wearing a mask when leaving the house. There were religious activities still going on at the mosque, such as Friday prayers, even though temporarily prohibited. The market is still crowded with people shopping. Overall, the impact of the PSBB is almost evenly distributed among all sectors, ranging from non-essential offices that must be closed during PSBB, to an immediate impact of this situation as felt by people who work in the informal sector, especially suffering an extreme income reduction for people who worked mainly in the online transportation services (ojol) industry. It is estimated that around 2 million public transportation riders, who mainly use motorcycles, operate in Jakarta and its surroundings. This is due to the government prohibiting application-based two wheels transportation services from carrying passengers: they may only transport goods. This prohibition is contained in an Attachment to the Regulation of the Minister of Health of the Republic of Indonesia Number 9 Year 2020 Regarding the Guidelines for Large-Scale Social Restrictions in the Context of the Handling of new Coronavirus Disease-2019 (COVID-19), application-based two-wheeled vehicles with a restrictions only for transporting goods and not passengers and not to escort people; this is in line with DKI Jakarta Governor Regulation Number 33 of 2020 concerning the Implementation of Large-Scale Social Restrictions in Handling the new Coronavirus Disease 2019 (COVID-19) In DKI Jakarta, set out in article 18 paragraph 6, which was promulgated on 9 April 2020. 

On the same date, as the government was very aggressive in forcing people to do physical distancing, the Ministry of Transportation issued Minister of Transportation Regulation Number PM 18 of 2020 concerning Transportation Control in order to prevent the spread of COVID-19 signed by the Ad interim (Acting) Minister of Transportation Luhut Binsar Pandjaitan. Article 11 paragraph c says that it is the same as stated in the regulation above, namely, that application-based motorbike transportation services are restricted to the transportation of goods only, but in paragraph D it says that for certain things which intended for the purpose of serving the interests of the public and for personal interests, motorbikes can transport passengers, but with the provision that it must be done according to health protocol. This of course creates confusion for online motorcycle taxi drivers. 

From the point of view of law enforcement in the field, the Ministry of Transportations Regulations can certainly create ambiguity among authorities in enforcing legal actions in an area where Large Scale Social Restrictions is being implemented. According to a spokesman for the Ministry of Transportation, online transportation services can carry passengers, but with the condition that they must run a health protocol. Drivers are required to wear masks, gloves, and then use disinfectants to clean their vehicles before or after carrying passengers. Of course, this is burdensome for online motorcycle taxi drivers, because they must provide disinfectant materials themselves, and especially because this kind of protocol cannot be monitored effectively in the field. In doing so, this crisis is not being responded well enough by Online Transportation Companies, they finally chose to run the regulations that have been stipulated in DKI Jakarta Governor Regulation Number 33 of 2020, by eliminating applications for transporting passengers. 

The Enforcement of Large-Scale Social Restrictions (PSBB) 

As stipulated in the PSBB regulation: Large-scale Social Restrictions are restrictions on certain movements of residents in an area suspected of being infected with new Coronavirus Disease 2019 (COVID-19) in such a way as to prevent the possibility of spreading it further. The policy is aimed to anticipate the spread of the new Coronavirus out of the Jabodetabek (Greater Jakarta) area. PSBB does not only apply to DKI Jakarta we note that most of the regions on Java have implemented some kind of PSBB, and no one has yet revoked the regulation. Instead, it has extended the PSBB’s validity period. This is because the curvature for the number of positive cases in COVID-19 has not flattened out yet. 

According to data taken from the FKM UI team report titled “the effect of social restrictions” in DKI Jakarta, the PSBB effect can clearly be seen, namely an increasing trend of residents staying home, followed by a decrease in the trend for COVID-19 cases. This can illustrate that the effect of the PSBB, when implemented with high discipline from the community to remain at home, can flatten the COVID-19 curve. 

‘ Mudik ’or Homecoming 

The effects of this PSBB are also felt by lower-middle-class people whose survival depends on daily wages; there is also the danger of massive layoffs. The need for daily neceseties in the affected community continue. The supply of daily needs is running low, the cost of daily meals and paying rent is increasingly burdensome. So, they choose to return home because they feel safer and more comfortable in their hometown. It’s better than living far away, where they cannot find food or work until an unclear time limit. 

In fact, the government has appealed to the public not to go home for Eid Al-Fitr Holiday 2020. The policy of banning homecoming is a humanitarian operation, in order to break the chain of the Coronavirus pandemic. Moreover, the Directorate General of Land Transportation on March 23, 2020 issued a ban for free homecoming movement, which is usually an annual program implemented by the Ministry of Transportation, SOEs and the private sector; this appeal is in line with the Ministry of Transportation which urges the public not to go back to their hometown, especially on Eid al-Fitr 2020. 

A closed meeting led by President Jokowi on March 30, 2020 discussed the matter of homecoming. According to him, the appeals that have been submitted by regional officials and figures have not been forceful enough to reinforce the prohibition of going home, so they ask for more stringent steps to prevent the movement of people into the region; this is necessary for the sake of mutual safety. 

However, in a closed meeting with ministers on April 2 2020, President Jokowi did not prohibit going home or returning home in the middle of the corona virus or COVID-19 pandemic. Deputy III for Infrastructure Coordinating for the Ministry of Maritime Affairs, Ridwan Djamaluddin, said that although the government had not yet banned homecoming movement, the government continues to control the movement of people so that the spread of the Coronavirus from people who decided to return to their hometown on holiday will not spread even further. The implementation of a control function, for example, is that there will be distancing of passengers for each mode of transportation. In addition, transportation must not be crowded. Another scenario to limit the movement of people: Jokowi asked for the adoption of healthier and more disciplined health protocols to prevent a wider spread of COVID-19 pandemic. 

Then President Jokowi issued a statement in a closed meeting on April 21, 2020, namely, homecoming movements for the public were prohibited even though previously the homecoming ban only applied to ASN, TNI, Polri and BUMN employees. According to Luhut, this homecoming ban to be taken into effect as of Friday, April 24, 2020. There will be sanctions, but its implementation will be enforced starting May 7, 2020. Instead of the government announcing sanctions if community members still decide to come home despite the ban, the Minister of Transportation, Budi Karya Sumadi, stated that all commercial transportation modes for land, sea and air passenger transportation will resume operations starting Thursday, May 7, 2020, a statement supported by the issuance of the Minister of Transportation Regulation Number PM 25 of 2020 regarding The Control of Transportation During Coming Home Period on Eid Al-Fitr Year 1441 of Hijri Calendar In Order to Prevent The Wider Spread of the new Coronavirus Disease 2019 (COVID-19) signed by ad interim minister Luhut Binsar Panjaitan. This new regulation revokes the Regulation of the Minister of Transportation Number PM 18 of 2020, concerning restrictions on travel by air, land and sea. This regulation is only two weeks old. The issuance of the new Ministry of Transportation regulation is based on input from the Coordinating Minister for the Economy, Airlangga Hartarto, who assesses that this year’s ban on homecoming will damage the economy. 

In support of the Ministry of Transportation’s regulation, the Head of the task force for the acceleration of the handling of the COVID-19 pandemic, Doni Munardo, signed Circular Letter Number 4 of 2020 concerning the Criteria for Limiting Travel for Persons in Order to Accelerate the Handling of COVID-19 Pandemic. The regulation explains that there were a number of exceptions for people traveling during the pandemic that was promulgated on May 6, 2020. The circular stated the criteria for limiting people’s trips. 

The exclusion criteria listed are the travel of people who work in government or private institutions whose tasks have the following objectives: services which accelerate the handling of COVID-19 pandemic; defense, security and public order services; health services; basic needs service; basic support services for the provision of basic necessities; and services related to important economic functions. Travel for patients who need emergency health services or travel for people who are in mourning (there are family members such as parents, children, husband or wife who must be visited due to severe illness or death). And Indonesian Migrant Workers’ Repatriation (PMI) whose contracts have not been extended by their employers, Indonesian citizens whose residence permits have been expired, students or students who have completed their studies, and others. 

In implementing the regulation, the Ministry of Health issued circular letter SE Number SR.04.03 / II / 6689.2020 concerning the Implementation of air transportation in the context of preventing the spread of new Coronavirus disease 2019 (COVID-19), which was signed by the director general of Disease Prevention and Control, Ahmad Yurianto. This circular letter is addressed to the Head of the Port Health Service Office (KKP) in Indonesia. In the regulation it’s explicitly stated that the term ‘passenger’ refers to government officials or government staff and private agencies who carry out official duties and must show a warrant carrying out the duties of their superiors. The next point is written that the passenger must meet health requirements and have a Covid-free health certificate issued by a health service facility or hospital or can also be issued by the port health office and has been screened with non-reactive / negative rapid test results. The health protocol was again tightened by the issuance of Circular Number HK.02.01 / MENKES / 313/2020 concerning Health Protocols for the Handling of Indonesian Citizens Returning and Arrival of Foreigners from Abroad at State and Regional Entrances in the Large-Scale Social Restrictions Situations. 

The Circular, in general, included the protocols carried out for interviews with Indonesian citizens and foreigners, temperature checks, signs and symptoms of Covid-19, oxygen saturation checks, and rapid test and / or PCR. In addition, in anticipation of the entry of the COVID-19, the Indonesian Ministry of Health distributed Health Alert Cards (HAC) at every entrance to the country; this is an international standard. Passengers from overseas are required to fill out a health alert card (HAC) at the arrival terminal and this card must be kept by the passenger for 14 days. Passengers with these cards have a history of traveling to areas affected by COVID-19. “ …on the card there are instructions that within 14 days of arrival to Indonesia, if the holder of the card is feeling sick, or running a fever and symptoms of influenza, then the Ministry of Health urges them to go to the hospital or Puskesmas and show the card,” said Secretary of the Directorate General of Disease Prevention and Control of Ministry of Health, Ahmad Yurianto. 

The Relaxation of Large-Scale Social Restrictions 

Can this statement issued by the Minister of Transportation Budi Karya Sumadi be called a relaxation of the PSBB regulation? Although the public transportation ban has been reopened during the COVID-19 pandemic, and further confirmed by the Minister of Transportation, this policy is indeed not easy to implement on the ground level, so he asks for commitment from local government to take part in monitoring homecoming movements which can still be suppressed to minimum. On the other hand, the local government is also confused, because up until now the central government has been issuing the appeal not to go home, but to stay put during the pandemic. Because of this confusion, there’s a visible increase in COVID-19 cases. 

Can it be believed that the application of health protocols at the airport can filter out people who are deemed Covid-19 free because if it is only based on rapid test results which state that they are non-reactive or negative, then we can say with utmost certainty that they are Covid-19-free? it could be that the negative results shown from the rapid test are false negatives. And how effective is the health alert card? Is the health alert card given to passengers who use air transportation from abroad only? If you see several cases of health workers in health facilities testing positive for Covid-19 it is because of dishonesty of patients who traveled to the Red Zone. 

Solutions 

Policy and communication that is out of sync or counterproductive between relevant ministries or institutions makes a policy seem confusing, not only to the local government but also the people affected by the policy. And it is undeniable that the policies made must have their implications. Here the government plays an important role in being able to anticipate or mitigate these implications. And the government should prepare carefully, by first doing a simulation to test the effectiveness of the published rules, as well as monitoring and evaluating each implementation of regulations related to the PSBB, in order to maximise in their implementation and to have an impact on the acceleration of the reduction of Covid-19 cases. 

And it must be emphasized that, given the current conditions, in fact the time is not right for implementing a relaxation of Large-Scale Social Restrictions (PSBB). PSBB, as an effort to control the pandemic, needs comprehensive support. In setting a policy, you should not look at the condition of this Covid-19 pandemic for a moment, but you must see the situation continuously over a fairly long period of time. Do not let the efforts that have been carried out so far seem to be forced, because this decision can have a long-term impact, especially for groups of people that are vulnerable to the impact of COVID-19. 

The government should understand that the evaluation of the implementation of the PSBB is a strategy to support policies related to the acceleration of handling of Covid-19. If the government wants to make a relaxation policy, it should meet 3 criteria, namely: 

1. Epidemiological criteria: if there has been a trend of decreasing cases that can be observed within a certain period of time, for example within 2 weeks, and followed by a decrease in the number of PDP and a decrease in mortality. 

2. Testing should not see a decrease in both quantity and quality; the number of people tested must be increasing, and contact tracing must continue, as well as always appealing for clean and healthy living habits so that people remain compliant in carrying out healthy activities, such as washing hands, wearing masks properly, keeping a safe distance / physical distancing. 

3. Health services, both private and government hospitals as well as Puskesmas must also be ready, namely health workers, medical equipment and materials needed, including APD that complies with WHO and the Ministry of Health’s standards must be complete. The capacity of health services must be sustainable for a long period of time. (Tince Arniati Jovina)

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