Official data in Indonesia shows a Delta-powered second wave of COVID-19 that made the Southeast Asian country the global epicenter of the pandemic in July and August.
But some of the country’s biggest epidemiologists say that poor testing and tracking capabilities, inaccurate estimates of the death toll and deliberate falsification of data mean that there is no clear picture of the Indonesian pandemic and that a third wave could occur. .
At the height of Indonesia’s second wave in July, a staggering one in three people tested for COVID-19 in the country showed a positive result.
But the average seven-day positivity rate has now dropped to 3.64 percent and is still falling, according to the National Board for Disaster Management. This is the lowest positivity rate the country has reported since the onset of the pandemic, and a number that is well within the 5 percent benchmark used by the World Health Organization (WHO) as an indication that countries are in control of the virus.
The daily incidence in Indonesia – which peaked at 56,757 new cases on July 15 and where hospitals are bursting with patients on the most densely populated island of Java – dropped to 2,577 on Monday. Meanwhile, the official number of daily deaths, which was more than 2,000 in July, dropped to 276 on the same day.
“The second wave in Indonesia looks like history,” said Professor Uiyaana Gusti Ngurah Mahardika, the most senior virologist in Bali, where daily confirmed cases dropped from more than 1,500 last month to 122 on Monday.
Test and detect problems
Mahardika, who told Al Jazeera last year that there is ‘no data transparency’ in Indonesia, says ‘the data is much better than even a month or two ago’. But he adds that it is still unreliable because the average number of close contacts detected after an individual delivers a positive test result is “less than five and sometimes zero”. According to the WHO, a minimum of 15 close contacts should be detected and tested when a person tests positive for COVID-19, but the optimum is 30.
Mahardika also criticizes the government’s continued use of ‘substandard’ rapid antigen tests instead of ‘gold standard’ pfanonolymerase chain reaction or PCR tests: ‘If all samples were tested by PCR, more positive results would be revealed.’
Kawal Covid-19, an independent data initiative in Jakarta, agrees. The data show that only 1 percent among the 98,900 people who were tested with rapid antigen tests on Monday showed a positive result. Among the 21,700 people tested with PCR tests on the same day, 7.6 percent were positive.
“Antigen tests are not as accurate as PCR tests, as they have a smaller window to show positive cases,” said Septian Hartono, medical scientist and data coordinator at Kawal Covid-19. ‘If we were to perform all the tests with PCR, we would get a greater number of cases. But the downward trend shown by the official data is still accurate. ”
Hartono believes the situation in Indonesia is similar to India, where there has been a very sharp rise and a very sharp decline as the Delta variant runs out of fuel. “
‘The reproduction rate for Delta was originally six to eight, but emergency restrictions have reduced it. Another thing that reduced it was the large number of people who became infected, because once a person is infected, they have a much less risk of becoming infected again. The reproduction rate has now dropped to three or four, similar to the Alpha variant, ”he says.
Deaths at home
Dr Dicky Budiman, an epidemiologist who predicted Indonesia’s second wave a month before its peak, admits the government has “made some progress” in suppressing the pandemic.
‘I am pleased with what is happening in Jakarta and other cities [the main island of] “Java where officials there are diligent and their data is transparent,” he said.
But outside of Java, he says, it’s a different story: ‘The trend for new cases in Indonesia has shifted from cities to towns and from Java to outlying islands where they do not have enough capacity to test. Most of these areas performed poorly for a year and a half, but suddenly in two months they showed a great improvement. That’s why I’m not convinced of their data. ”
An epidemiologist advising the ministry, who spoke on condition of anonymity because they are not authorized to speak to the media, said the data outside Jakarta was unreliable, a ‘massive understatement’.
“Jakarta is the only government that does its best to collect and submit data,” they said. “Most provincial governments are incompetent because they do not do a very good job in terms of data collection, while one or two do their best to hide the data so that their provinces are not locked up.”
Budiman adds that the decline in the national positivity rate also reflects the declining use of PCR tests: “PCR tests decreased from about 60,000 per day to about 20,000 per day in the first week of September, which is very worrying in a country with a large population like Indonesia, ”he said, referring to the most recent WTO situation report on Indonesia.
Budiman says Indonesia’s official death toll is also inaccurate because the government’s definition of coronavirus death does not follow WHO guidelines. “This only includes victims who have died and received a positive response from a PCR test,” he said. “This is a narrow definition and supports my conclusion that Indonesia does not yet provide the kind of clear and convincing data that shows that it has control over the pandemic.”
Hartono agrees: ‘From June to August, the official death toll for COVID-19 in Jakarta was 6,000. But in the same period, 18,000 excessive deaths were recorded in the city because there were thousands of people who died at home without being tested as they could not even get to the hospital. ”
Health Ministry spokeswoman Dr Nadia Wikeko denied test numbers were declining, telling Al Jazeera that Indonesia has a narrower definition of a COVID-19 death “because we want to confirm the cause of death and the valid data want to get. “
A third wave?
A conservative, poorly organized, corruption- and flood-sensitive archipelago housing the fourth largest population in the world, Indonesia would never be easily vaccinated. To date, only 20 percent of the target adult population of 181.5 million have been fully vaccinated, with another 35 percent partially vaccinated. This raises a question: is a deadly third wave threatening the horizon in Indonesia?
Using a pattern showing that the coronavirus reaches a peak every six months in Indonesia, the Mahardika of Udayana University says the next wave could strike in January. But “it doesn’t matter if things explode again,” he said. What is important is “vaccines will be effective in combating hospital admissions and deaths.”
The Sinovac vaccine from China is the most widely used jab in Indonesia, having participated in late-stage trials with the drug. The latest major phase-three trial in Brazil showed that the Chinese-made vaccine has an efficacy rate of 51 percent for symptomatic cases, compared with 76 percent for AstraZeneca and well above 90 percent for the Pfizer and Modern mRNA vaccines.
Medical experts agree that any vaccine is better than no other, but Indonesia is stepping up its efforts by giving at least eight million modern boost shots to pregnant women and medics, as well as millions more people Pfizer and the Astra Zeneca shots given by foreign gifts are given countries.
Hartono of Kawal Covid-19 says a third wave could be prevented in Indonesia if the government conducts a huge nationwide “seroprevalence” study: “Seroprevalence testing tells us the total number of people infected and the number of people vaccinated and there “Of course, there will be some overlap. Based on estimates that 40 to 50 percent of the country is infected, I believe the seroprevalence rate in Indonesia is about 60 percent.”
With this data in hand, Hartono explains, the government will have a clear picture of the pandemic and can use it to make a data-based decision on the restriction imposed in July. “The central government has been traumatized by what happened in Indonesia, so they are doing very careful things now,” he said. ‘But if they lift all restrictions, the rate will rise again.
Dr Wikeko of the Ministry of Health said the government could accurately predict and was prepared for a possible third wave, but would need ‘the support and co-operation of the people’ to tackle it effectively.
But her colleague at the ministry, who wished to remain anonymous, told Al Jazeera nothing could be further from the truth: “If the next wave is as big as the one we had in July, I do not think the country is better prepared.
He adds: ‘I am not saying that the government is not doing anything. The ministry is very energetic and insists on increasing the detection and testing. But the fact is that we have a very limited ability to influence the provincial governments in Indonesia. We can only issue regulations. We have no power to enforce it. ”