The Great Disconnect: poor early response against COVID-19 puts Indonesia on a worrisome trajectory

Photo courtesy of Indonesian Health Ministry

We are approaching the end of March. 2020 has been brutal, huh? It feels like we have been at this social distancing thing for so long and it’s already creeping into a point where we’d all very much like this to be over soon. Realistically speaking, of course — we are not quite near the end of the tunnel, I don’t think. In fact, it’s impossible to really pinpoint where we are exactly. Should we consider this early days still, or are we somewhere in the middle? Have we even passed through the first stage? How many stages are there in total? The uncertainties build up with each passing day, and I find myself with more questions than answers.

It feels weird to be sitting here and writing about all that is happening. I work as a journalist and most of the articles I have been writing in the past two months have been on COVID-19, so it’s not a matter of not having written about the issue before. The magnitude of this crisis makes me feel like I’m just one voice among billions; which makes me wonder if it’s even worth the time and energy to even be attempting to document this happening from my tiny perspective, but I would have to conclude that it is. Maybe the reasons are more selfish than altruistic, yet there’s no way I am sitting still given the fact that my mind has been muddled with so many thoughts that would not and could not remain quiet.

Let’s start at the beginning.

Photo courtesy of Indonesian Health Ministry

The first real “sign” that we are about to face something huge would have been the escalation of the outbreak of this novel disease in Wuhan, China. That Chinese officials were concerned enough to take drastic measures of closing off the cities (though I think it’s important to note that the Chinese government isn’t exactly shy about efforts that risk human rights) in order to curb the spread of COVID-19 should have been indication enough for governments across the globe to pay a little more attention and prepare themselves. That this was identified as a novel coronavirus, a virus related to SARS and MERS, should have also been warning enough. This is coming from a journalist who didn’t cover health, with very little experience or knowledge to matters of public health, mind you, so I never thought of myself as being more equipped at analyzing the situation than others. Yet, just by reading up for the sake of informed reporting and out of genuine curiosity and interest in what was unfolding; I acquired a sense of urgency that tells me this isn’t something we can simply dismiss by virtue of it happening elsewhere.

I was shocked to realize that the world does not have a global protocol on how to handle a global health emergency, and this was before it was officially declared a pandemic by the World Health Organization. When we are talking about a highly infectious disease of human to human transmission, in a world as connected as ours have increasingly been; many leaders unfortunately did not take the possibility seriously enough to equip them with the necessary tools and knowledge to handle a crisis of this scale. Not only is it a huge disappointment, it is also foolish. As the epidemic made its way through different parts of the world, we learned that virologists and epidemiologists have actually warned officials for years that something like this will happen, only to have their warnings fall on deaf ears.

The SARS outbreak took place in 2003, whereas the first phase of the MERS outbreak occurred in 2012. We cannot say that there wasn’t more than enough time since the first coronavirus outbreak appeared to actually come up with some kind of plan at least? Evidently, our leaders were busy having their heads stuck in other places. There are exceptions, with countries like Singapore which has developed a robust infrastructure to deal with pandemics after the horrors of SARS and proved to be effectively handling the crisis. But others have been scrambling with shockingly gruesome incompetence. Yes, there’s all that “sovereignty” issue and even arguments on how challenging it is for countries to cooperate that may have stalled an actual plan rooted in global solidarity, perhaps even more so on matters that is largely invisible to the naked eye.

I suppose that ought to tell us how flawed we are as human beings and our seeming inability to learn from our mistakes, how the systems we have put in place have not worked in favor of the people who will need it the most, and how our leaders have truly failed in anticipating the extraordinary loss of lives that could have been minimized, if not altogether prevented. And we will forgive, because I believe it is in our nature as human beings, but the people making most of the calls right now only deserve our forgiveness if they can set the course and do things right to prevent the outbreak from escalating even further.

How Indonesia botched its early response

In late January and all throughout February, while concerns over this public health crisis and its global implications began to escalate around the world, as reports coming in from Italy, Iran and South Korea showcase the damning severity of the situation even after China had closed off Wuhan, Indonesian officials were still busy downplaying everything. There was no lack of creativity in how they dismissed rightful concerns about an infectious disease that’s already infected tens of thousands by then. As an example, the country’s Health Minister, Terawan Agus Putranto, said in mid-February that the power of prayers have shielded Indonesia from COVID-19.

Those types of comments came from different officials, too, in all sorts of foolish ways, illustrating a level of incompetence that is downright infuriating; especially when real data suggest that no country, especially at the current scale of global travel, is immune to the disease. It was never a matter of if, but when.

To be fair, Indonesia did close its doors to travelers from China since early February and may have simply thought that they’d cut the problem at its roots by doing so. They were visibly more concerned about the loss of tourism from the second-largest group to have visited Indonesia last year, especially in places like Bali. Still, it’s excruciating to see that our officials hadn’t even consider the fact that the disease was first detected at the close of last year and the incubation period of COVID-19 was 14 days. There were plenty of gaps before the restrictions came into force that could have meant the disease might have already arrived undetected, and this became a huge concern for those who were paying attention, as well as experts. In fact, a study by researchers at the Harvard T.H. Chan School of Public Health suggested that Indonesia should have confirmed cases of the viral outbreak by early February, considering the high air-travel volume from Wuhan, the epicenter of the outbreak in China, to the country. The same study, however, was later dismissed by our Health Ministry.

By the end of February, there were over 83,000 recorded COVID-19 cases in more than 50 countries (I will note here that nearly 79,000 of the cases were recorded in China, according to data from WHO). The rising number of cases outside of China and the fact that dozens of countries were already affected, the government should have had enough data on their hands to prepare for a public health crisis. It boggles my mind that it was also around this time that the Indonesian government actually came up with an economic plan instead to deal with what they already termed as “impacts from COVID-19.” This, to me and many others, signifies a great disconnect between what was really going on and what our government was prioritizing.

There are those who may excuse this as an attempt to nab a crucial opportunity when an economic slowdown is imminent, but in actuality it just shows how deeply misguided our officials had been. Travel restrictions, by that point, will only soon be more commonplace, and to instead market Indonesian destinations as a “safe alternative” is deeply irresponsible. Yet that is what they have done. The provincial government in Bali, where I am based, even went as far as to actually launch something called “We Love Bali” movement that is meant to reassure visitors and attract them to the island. At that point, Indonesia had already confirmed positive cases of the novel coronavirus, which should have been enough to propel the country to take this more seriously — but their actions say otherwise. Sure, they implemented screenings on ports of entries, but they were just one small measure that is not entirely reliable, either.

The threat of COVID-19 spread in Indonesia is monumental, given the state of our public health system and not to mention there is presently no cure nor vaccine for this viral disease. Preventive measures should have always played a key role in our strategy, but everything has been ad-hoc even from the very beginning. This sets dangerous precedent for what is to come, which may be worse than feared. I don’t say that without context, for we already have Italy and Iran as examples, with the United States now appearing to be heading down a similar path (though let us hope not). Indonesia is not far behind, and given the fact that we have yet to actually conduct mass testing — we’re really just missing the official numbers to truly understand the massive shit we are in. And sadly, no, our country is NOT well-equipped to handle a massive outbreak that would result in thousands of people needing to be hospitalized. Recent reports are already suggesting that how the system has already compromised many healthcare workers, who are literally on the frontlines in the fight against COVID-19.

Where’s the urgency?

Photo courtesy of Indonesian Health Ministry

Everything is connected.

Across the globe, people look to their leaders for guidance, competence and leadership. In democracies, they are elected out of trust and faith that they have our best interest at heart. The same rings true — even more so, might I add — during a crisis. Right now, as we, too, face this pandemic in Indonesia, little to none of these qualities seem to be present in our leaders.

It started with the government downplaying the enormity of this public health crisis when it had weeks to strengthen our systems in preparation of what should have been perceived as inevitable. It continued with the terrible handling of the first two confirmed cases of COVID-19 in Indonesia, in which the patients found out about their positive status by watching President Joko “Jokowi” Widodo announce it on television and followed with their personal information leaking to the public. Then, somewhat inexplicably, the president decided to prevent the people from panicking by deliberately withholding information.

These are not all there is, unfortunately for us Indonesians, but it should be more than enough to illustrate why there is a significant lack of trust in the government at this point, which seems to only be growing by the day.

On March 15, President Jokowi called on Indonesians to “work from home, study from home and worship from home,” echoing social distancing suggestions made by experts as part of an effort to contain the spread of COVID-19. It was, I’m not going to lie to you, a huge relief. I naively took it as a signal that he’s finally grasped what we are up against, which should mean that we will see a more rigorous and effective approach in the days to come. It honestly took me too long to realize that the suggestion, although still welcomed, is void of anything real and actionable. The truth is, only a handful of Indonesians would truly be able to implement the suggestion — working from home is a privilege only some of us can afford, after all. Informal workers — store clerks, motorcycle taxi drivers, local market sellers — don’t have the option at all. Their jobs depend on them “showing up,” and doing otherwise means they will be deprived of valuable income that their families rely on.

Then there are those who have yet to take things seriously, be it officials or members of the public, who are not practicing social distancing, regular hand-washing and all the other necessary precautions in their lives. Not only is it frustrating to see, it’s also a real endangerment to our public health. But we reap what we sow. For millions of people who have had other things to worry about, such as their daily survival, the threat of a virus cannot magically sink in. The government failed to instill a sense of caution among its people in those early days when it masked the scale of the outbreak, and now there’s a considerable chunk in the population who have yet to understand the urgency of our situation: why we need to distance ourselves from others.

As of this afternoon (March 25), official data from Indonesia’s Health Ministry confirmed 790 cases of COVID-19, including 58 deaths and 31 recoveries. However, the real scale of infections may be higher, given that we have a low rate of testing and a high mortality rate. A report from Reuters, published today, suggest that hospitals are already overwhelmed with only hundreds of people hospitalized for coronavirus. In Indonesia, eight doctors and one nurse have reportedly died from the coronavirus, according to the Indonesian Doctors Association. To put things in perspectives, in Italy — where there have been more than 6,000 deaths to the disease — 23 doctors have died.

This has been my primary concern from the very beginning. It wasn’t the disease itself, per se, but the fact that the Indonesian healthcare system is not ready to handle this type of emergency situation. It sure as hell wasn’t ready without preparation, and it wouldn’t be ready now when the cases are already at the door, and expected to increase.

What’s next?

Photo courtesy of Cabinet Secretariat

I have always worried for my country, often to the confusion of my friends and family. Should it really be a surprise that many of us who are outspoken critics of the government actually harbor a lot of love for this nation, flaws and all?

For weeks I have been angry and frustrated, concerned with how COVID-19 will impact Indonesia. I am anxious, for the most part, but I also rejoice at the little triumphs; such as the announcement of an incoming rapid testing, even when it is not yet in fruition. I salute regional leaders who have stepped up to protect their respective provinces, who I hope are truly doing all they can to help contain the disease within their capacities. I think of and pray for our healthcare workers, those who are on duty and those who have passed, for their sacrifice and dedication. I worry for all the people who would be hit hardest by the economic slowdown and my heart goes out to those who have been infected, those who have lost their loved ones to the disease and who couldn’t say their goodbyes properly because of the circumstances.

My mind has gone through multiple scenarios, wondering just how things will unfold, not just in Indonesia but also the rest of the world. We will come out of this different, won’t we? And there is no telling what that is going to look like.

Right now, strict measures would be key in breaking the chain of the coronavirus spread. However, a lockdown seems unlikely in Indonesia, if we are to judge by what President Jokowi has already said a couple of times now, and that worries me greatly.

What, exactly, are we waiting for? Are we waiting for the numbers to show a huge spike? Are we seriously risking the possibility of even more infections and even more deaths to a disease that has no cure and no vaccine? Is the government waiting on some kind of a cruel benchmark from which they would start implementing a more rigorous approach?

Personally, I am uncomfortable with the idea of a “lockdown.” It gives too much power to the state, military and police, and would literally grind most of society to a halt. No one wants to live in quarantine, and for those of us already staying at home we can at least reason that we are doing this out of our personal willingness and not because we are forced to. There’s a marked difference. And yes, I am aware of the economic implications, though perhaps not as thoroughly as an expert, but it shouldn’t be a priority when actual lives are at risk, right? Do we live in a country willing to sacrifice people’s lives for the sake of the economy, which would not be able to function either without a healthy population?

It is worth considering that a premature approach may not be as effective as it was intended, but there’s also too much at risk here in Indonesia — a country of nearly 270 million people — not to take on preventive measures early on, while it still can. Let’s back up a bit and say it doesn’t need to be a nationwide lockdown, but something at a regional scale. Maybe more strict measures can be imposed in places where high number of cases have been recorded, such as Jakarta and West Java. We have yet to halt domestic travels, why aren’t we doing that at least? There’s plenty that can be done from a public health perspective, and no, it does not seem the government is doing enough. It seems that the concerns, as it has been from the beginning, is wrongly placed on investment and the economy; endangering our collective well-being as a nation.

Call me impatient, but yes, the urgency of the situation calls for overprotectiveness; and I’d really appreciate it if those who are supposed to lead our country would overprotect us from this coronavirus.

Writer’s note: There’s plenty of statistics and references that I did not include in this essay, such as the study estimating that Indonesia may actually have as many as 34,300 cases at this point, reported in this insightful Reuters article (also linked above). The depth of my understanding and concern comes from all the readings and reporting I have done in the past two months with regards to COVID-19, and this is my way of expressing both my frustration and anger. I do not consider myself as an expert, but a journalist and deeply concerned citizen.

Indonesian journalist, currently based in Bali.

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