Tighten social restrictions – PPKM in Java and Bali: Will it make a difference?

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IO – As we enter 2021, the world is still struggling with Covid-19 pandemic, beginning in late December 2019. The virus, first discovered in a seafood market in Wuhan, China, and spread throughout the world until the World Health Organization (WHO) finally declared it a global pandemic on March 11, 2020, Covid-19 is classified as a non-natural disaster. The virus originating from the coronavirus mutation in animals and can easily jump to humans. Later, a new, more infectious strain of SARS-CoV-2 was discovered which can potentially accelerate

the spread of Covid-19. Based on data as of January 12, 2020, there are more than 790,000 daily confirmed Covid-19 around the world. In Indonesia alone, the number of new cases continues to increase at a rate of 8,000-10,000 new cases per day. On Friday, January 8, the number of daily confirmed cases exceeded 10,000. This indicates that Indonesia has not been able to bring Covid-19 under control. This has subsequently put pressure on the capacity of our health care facilities. Hospitals are running out of beds, intensive care units (ICU) are difficult to find, even the Covid-19 designated cemeteries are overwhelmed. The Covid-19 pandemic has also further disrupted essential health services, leading to another “health crisis”, as can be seen from the decrease in vaccination for children under five and routine hospital visits by patients of other diseases. The public, government and medical personnel are exhausted from the prolonged pandemic that seems to never end, both physically and psychologically.

But Covid-19 also has an upside in terms of the huge contribution of knowledge from scientists studying the nature of the disease. Based on available data, there are several things associated with the rising Covid-19 confirmed cases in Indonesia. For example, long

vacations that saw movement of people to out-of-town holiday destinations tend to cause a significant spike in caseloads. On the other hand, the large-scale social restrictions (PSBB) implemented in Jakarta were able to reduce the rate of transmission. We also have a better understanding on how Covid-19 is transmitted and what situations are at higher risk of becoming a superspreading event, the socalled 3K (close contact, crowds, and closed rooms). We also know more about 3T (Testing, Tracing, Treatment) and 3M (mask wearing, hand washing, and social distancing) considered the two most effective ways to curtail Covid-19 spread. This valuable knowledge should be reflected in the policies taken by the governmental authority, not only local but also central government.

One of the policies being implemented is the Enforcement of Restrictions on Public Activities (PPKM) for Java and Bali (a new Covid-19 restriction), which took effect on Monday, January 11, 2021. The legal basis for this is Home Minister Instruction No. 01/2021 signed on January 6, 2021. Broadly speaking, PPKM is similar to PSBB but with several additional regulations. PPKM seeks to:

Reducing work from office (WFO) by 25% and conducting work from home (WFH) by 75%. Carry out teaching-learning activities online  

Essential sectors related to basic needs of the community can fully operate with more stringent restriction on operating hours, capacity and implementation of health protocols.  

Dine-in restaurant capacity is reduced to 25 percent and takeaway is recommended.  

Shopping centers must close at 19.00.  

Construction can fully operate with more stringent health protocols.  

Places of worship can open only at 50% activity  

This restriction shall be imposed in areas where the death rate and active case rate are above the national average as well as in areas where the bed  occupancy rate exceeds 70%.

Although many still doubt the effectiveness of PPKM in reducing the rate of infection, the data show that the implementation of PSBB indeed has proven effective in reducing the rate of Covid-19 spread. The number of daily confirmed cases actually went down during the first PSBB. However, in the second PSBB, the decline was not as dramatic. This is probably due to the community’s non-compliance during its implementation. PPKM must be implemented strictly under strict penalties for flouters if the Java- Bali PPKM is to be successful. It has to be strict, massive, and consistent. There should be no room for negotiation or leeway in its implementation. No exceptions may be granted to anyone, including state officials or public figures. 

The success of PPKM also necessitates close synergy between the government and the private sectors. Restrictions on activities, both in the form of PSBB and PPKM, will definitely exert an adverse impact on the economy economy, especially if they last longer than expected. If the effort fails due to society’s non-compliance and lack of discipline, there is a high probability that PPKM 2, PPKM 3, and so on will be reimposed in the future. The government plays a crucial role, not only in enforcing the rules and regulations, but also in lending support to the private sector to survive an economic downturn during the period of restrictions. The private sector and business players also have to adapt and comply with health protocols, for example by utilizing information and communication technology or implementing flexible work arrangements.

The good news from the health sector is the discovery of several alternative vaccines that have been proven to be safe and effective in preventing the transmission of Covid-19. But a vaccine is not a magic bullet that can solve the problem immediately. It may be harder for someone who is vaccinated to be infected, but immunity is not guaranteed. Moreover, people who have been vaccinated can still become a spreader if they do not carry out the 3M properly, for instance, contaminated hands can still  spread the virus indirectly. Vaccine distribution and production are also factors that need to be considered. It will take years to vaccinate all Indonesian citizens. In addition, it is not yet certain exactly how long immunity will last.

The implementation of 3T (Testing, Tracing, Treatment) and 3M (mask wearing, hand washing, and social distancing) as well as avoiding 3K (close contact, crowds, and closed rooms), remain the primary “weapons” in battling Covid-19. PPKM and vaccination are only tools. Through strong cooperation and a caring attitude from all parties, onty then we can overcome Covid-19. (Dr Erlina Burhan MSc. Sp.P (K)

Dr Erlina Burhan MSc. Sp.P (K) is a pulmonologist with over 16 years of experience in pulmonology and respiratory medicine. She is a faculty member of the Department of Pulmonology and Respiratory Medicine FKUI/Persahabatan Hospital (RSUP). She is also chairwoman of the Indonesian Society of Respirology (PDPI) Jakarta, and Head of the working group for infection PDPI and team leader of Covid-19 Treatment at Persahabatan Hospital. Erlina also serves in the Covid-19 Task Force of the Indonesia Medical Association (IDI).