Endless first wave: How Indonesia failed to control coronavirus

JAKARTA/SYDNEY — Only last week Luhut Pandjaitan, Indonesia’s maritime minister and close confidant of the country’s president, touted herbal mangosteen juice as a coronavirus remedy.

His suggestion was the latest in a string of unorthodox treatments put forward by the president’s cabinet over the past six months, ranging from prayer to rice wrapped in banana leaf to eucalyptus necklaces.

The remedies reflect the unscientific approach to battling the coronavirus in the world’s fourthmost populous country, where the rate of testing is among the world’s lowest, contact tracing is minimal, and authorities have resisted lockdowns even as infections spiked.

Indonesia has officially reported 6,346 deaths from COVID-19 (coronavirus disease 2019), the disease caused by the new coronavirus, the highest overall toll in Southeast Asia. Including people who died with acute COVID-19 symptoms but were not tested, the death toll is three times higher.

Indonesia shows no signs of containing the virus. It now has the fastest infection spread in East Asia, with 17% of people tested turning out positive, rising close to 25% outside the capital, Jakarta. Figures above 5% mean an outbreak is not under control, according to the World Health Organization ( WHO).

“This virus has already spread all over Indonesia. What we are doing is basically herd immunity,” said Prijo Sidipratomo, dean of the Faculty of Medicine at the National Veterans Development University in Jakarta. “So, we should just dig many, many graves.” Herd immunity describes a scenario where a large proportion of the population contracts the virus and then widespread immunity stops the disease from spreading.

Government Spokesman Wiku Adisasmito did not respond to detailed questions from Reuters. He said the number of infections was “a warning for Indonesia to continuously improve its handling effort,” and that positive cases per capita in Indonesia were lower than most countries. President Joko Widodo’s office did not respond to questions sent by Reuters.

To be sure, Indonesia’s confirmed 144,945 infections out of a population of 270 million are much less than the millions reported in the United States, Brazil and India, and below the neighboring Philippines, which has less than half Indonesia’s population. But the true scale of Indonesia’s outbreak may still be hidden: India and the Philippines are testing four times more per capita, while the United States is testing 30 times more.

Statistics from Our World in Data, a nonprofit research project based at the University of Oxford, show Indonesia ranked 83rd out of 86 countries surveyed for overall tests per capita.

“Our concern is that we have not reached the peak yet, that the peak may come around October and may not finish this year,” said Iwan Ariawan, an epidemiologist from the University of Indonesia. “Right now we can’t say it is under control.”

‘PURE NONSENSE’

At the outset of the pandemic, Indonesia’s government was slow to respond and reluctant to reveal what it knew to the public, according to more than 20 government officials, test laboratory managers and public health experts who spoke to Reuters.

Despite surging cases in neighboring countries and having 3,000 polymerase chain reaction (PCR) test kits — the WHO- approved test for detecting the coronavirus — ready by early February, the government said fewer than 160 tests were conducted by March 2.

On March 13, Mr. Widodo said the government was withholding information so as not to “stir panic.” During the first two weeks of March, the government concealed at least half of the daily infections it was aware of, two people with access to the data told Reuters. The two people said they were later restricted from seeing the raw data.

A call in March by Mr. Widodo for a massive expansion of rapid diagnostic testing may have undermined the country’s testing regime, according to Alvin Lie, a commissioner in the office of the Indonesian Ombudsman, an official government watchdog.

Scientific studies have shown rapid tests, which test blood samples for antibodies, were found to be far less accurate than the PCR method, which tests swabs from the nose or throat for genetic material. Mr. Widodo’s push to use a less reliable test diverted resources away from PCR tests, three lab managers told Reuters.

Mr. Lie told Reuters that importers of the rapid tests, including large state-owned enterprises and private companies, made “huge profits” by charging consumers up to 1 million rupiah ($68), even though each test costs only 50,000 rupiah ($3.50).

By mid-April, provincial governments said rapid testing in the provinces in West Java, Bali and Yogyakarta produced hundreds of false negatives and false positives.

But the tests continued to be widely used and it took until July for imports of rapid tests to be halted and for the government to introduce a price cap of 150,000 rupiah ($10). In July, Indonesia also formally advised provincial governments and others not to use rapid testing for diagnostic purposes in their updated guidelines for COVID-19 prevention and control.

But Mr. Lie said there is a huge stockpile and rapid tests are still being broadly deployed, including for screening office workers and travelers to allow them to move freely for 14 days.

“That is like saying for the next 14 days after the rapid test they are free from the virus. That’s pure nonsense. All it indicates, and not very accurately, is they were free from the virus when the sample was taken,” said Mr. Lie.

Mr. Adisasmito declined to comment on whether the president’s call for rapid testing undermined its overall testing efforts. He did acknowledge the inaccuracies of rapid testing but said it was still useful in some situations where the capacity to use PCR tests is limited, including screening travelers. He did not directly answer questions about companies making large profits from tests.

The central government does not disclose the level of national rapid testing. But data from West Java, Indonesia’s largest province with 50 million people, shows that it has conducted 50% more rapid tests than PCR tests.

Government officials say 269 labs with PCR machines are now operating. However, the labs are increasingly unable to meet demand as infections rise. The number of suspected cases — those with COVID-19 symptoms who have not been tested — has doubled to 79,000 in the past month, according to government data.

Part of the problem is that lab capacity is far from being fully utilized, according to four health officials. One senior health ministry official, Achmad Yurianto, told Reuters Indonesia was able to test 30,000 people per day, more than twice the daily average of 12,650 people tested over the past month. —