Telemedicine services are currently available in Greater Jakarta and major cities on the islands of Java and Bali. As of February 14, there were a total of 158,075 self-isolating patients who used telemedicine facilities in Java and Bali. Of these, 136,028 patients received consultation and prescription medicine sent to their home with as many as 85% of them receiving it the following day. From February 19 onward, the Health Ministry has expanded telemedicine services to major cities in Sumatra, Kalimantan and Sulawesi. (FIGURE-4)
While Omicron is highly transmissible, its mortality rate is not significant, especially in countries with high vaccination rates. Indeed, President Joko Widodo himself stated that most of the Omicron deaths occurred among the unvaccinated and elderly. According to the Health Ministry data per February 13, of the 1,090 Covid-related deaths, 68% have yet been fully vaccinated, 76% were over 45 years old, 49% were the elderly, and 48% had comorbidities. Deaths among children aged 0-5 from Omicron accounted for 3%. Health Ministry spokesperson Siti Nadia Tarmizi added that although current daily cases have reached 59,384 per day (per February 19), higher than the peak of 56,757 during Delta outbreak last year, the death rate was 216 per day, much lower than 2,069 per day during the second wave. (FIGURE-5)
The beginning of an end?
The spike in daily cases is associated with a fairly high mobility of the population which usually occurs after a long holiday period. Learning from past experience, the government imposed public activity restrictions (PPKM) level 3 across Indonesia from December 24, 2021 to January 2, 2022. This policy was implemented under Home Minister Decree 62/2021 on prevention and mitigation of Covid-19 during Christmas and New Year. The government claimed that it was a success owing to good cooperation and synergy among members of the community, ministries and agencies, the military (TNI), the national police (Polri) and the local administrations at all level.
In response to the recent spike and based on the evaluation of the Health Ministry, the government has again tightened the Covid curbs by extending the PPKM across Java and Bali from February 22-28 based on Home Minister Decree 12/2022. The areas where PPKM level 3 applies are major cities including Greater Jakarta, Yogyakarta, Bali, Greater Bandung, Greater Solo and Greater Semarang. Recently, PPKM alert was raised to level 4 in a number of regencies/cities in Java and Bali, namely Cirebon, Magelang, Tegal and Madiun.
Health Minister Budi Gunadi Sadikin predicted that the peak of the Omicron wave will happen at the end of February and the number of cases will quickly decline in March. However, each region will show a different trend. Each surge is triggered by several things, such as the level of people’s mobility which has started to return to pre-pandemic level and can potentially spark massive transmission in the community, loosening of health protocols, uneven vaccine uptakes, and the possibility of new mutations. There is also the notion that Omicron is harmless and the narrative that a large part of the population already has antibodies, either from previous infection or vaccination. A survey conducted by the Health Ministry across 100 regencies/cities in the period of November-December 2021 found that at least 86.6% of the population already have antibodies to SARS-CoV-2, the virus that causes Covid-19.
However, Henry Surendra, an immunologist and epidemiologist who graduated from the London School of Hygiene & Tropical Medicine, warned that it would be too risky to rely on serological survey data. Omicron is still deadly for those with comorbidities, the elderly and the unvaccinated. In fact, recently the rate of vaccination among the elderly has stagnated. In addition, letting the virus run rampant in the population means creating a fertile ground for future mutations. Indeed, there has been report about Omicron BA.2 subvariant which is suspected to be much more virulent. In response, a slew of health experts have suggested that Covid protocols should continue to be rigorously implemented to reduce infections and fatten the curve.
On the other hand, Iwan Ariawan and Pandu Riono, epidemiologists at University of Indonesia’s Faculty of Public Health are optimistic that Omicron surge in Indonesia will not cause a spike in deaths due to the fact that most of the population already acquired immunity. This is supported by a number of public officials.
Strategies to contain Omicron
Covid-19 still poses a real threat to the world’s population. The speed and efficiency of handling Covid-19 by a country indicates the resilience of its health system, as well as the adaptability of its society to emerging health crisis. Likewise, the extent of transmission also depends on how disciplined every citizen is abiding by the mandated health protocols. The government has worked to strengthen the health care facilities in anticipation of the Omicron fare up. Covid-19 referral hospitals have increased their capacity by erecting field hospital tents and converting normal treatment rooms into Covid-designate isolation rooms and ICUs. This includes stocking up on medicines and medical devices. The number of health workers — doctors and nurses — continues to be increased, working in shifts to avoid fatigue and exposure. Primary health care systems are geared towards managing and monitoring asymptomatic and mildly symptomatic patients.
In improving the public health care services, the Health Ministry has also provided telemedicine services accessible via smartphones and laptops. It provides various information and health advisory about Covid-19 online to prevent the public from panicking and neutralize the spread of fake news (hoax). More importantly, telemedicine services can prevent the public from overwhelming hospitals or health care centers so that self-isolation can be conducted effectively. In addition, it can also be extended to worst-affected regions across Indonesia. Thus, telemedicine services can be a solution to meet the need for equitable access to health care services in sprawling Indonesia and hospitals can better focus on treating moderate, severe, and critical cases so that Covid-associated deaths can be prevented or minimized.
The Health Ministry also urges the public to get fully vaccinated and boosted to prevent developing severe illness and avoiding the risk of death if infected with Covid-19. Vaccination is believed to be the key to overcoming the Omicron surge and an effective preventive measure. Increasing the rate of vaccination coverage also cannot be separated from the role of TNI/ Polri, ministries/agencies, local governments, social and religious organizations, the business sector and members of the public themselves. All elements of society must come together to ensure the success of the national vaccination campaign as key plank in the strategy to end the Covid-19 pandemic in Indonesia.
Awareness, compliance and discipline in enforcing the 5M health protocols must be continuously promoted and implemented. We can’t be complacent and reckless. We must stay vigilant. The level of compliance is quite good, but consistency and discipline are needed in practicing this new normal behavior. The public compliance with wearing masks properly can reduce the risk of Omicron transmission. (FIGURE-6)
If we fail to rein in Omicron, it could result in more complicated health problems in the future, in the forms of more, potentially dangerous, mutations. Already, WHO has identified new variants of Omicron of Pango B.1.1.529 lineages, namely BA.1, BA.2, and BA.3. BA.1 is the dominant variant globally, while BA.2, dubbed “Son of Omicron” or “Stealth Omicron” has a number of mutations in its spike protein which can make it more difficult to detect using conventional PCR test. With the emergence of even more contagious variant of the Omicron, we should be alarmed. The virus will continue to evolve to adapt with the human host. So it is too early to declare that Omicron will lead to an endemic. The word has been widely misunderstood as if Covid-19 will end naturally without intervention. Even if Covid-19 becomes endemic, it does not mean that it is less dangerous. There are many examples of endemic diseases, such as tuberculosis which still kills millions of people every year. Looking at the current number of cases, it is highly possible that a super mutant could emerge anytime. Thus, joint efforts should be taken to stem the tide, not only by the government through the tightening of restrictions, but also the people themselves. The basic measures in curbing transmission of infectious diseases, such as health protocols compliance and testing and tracking must still be carried out because the pandemic is still not over and we must not loosen our guard prematurely.