An Archipelelago in the Ocean of Corona

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An Archipelelago in the Ocean of Corona
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        http://ubudnowandthen.com/archipelago-ocean-corona/
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        In English

        There’s a parallel war going on right now, smack in the middle of Indonesia’s expanding covid19 battlefields. There are odd alliances, running skirmishes and outright mutinies. And that war is distracting us from dealing properly with covid-19. As the full brunt of the pandemic is set to impact the country, politicians are taking up positions on either side of a line. On one side is President Jokowi and his advisers; on the other are a number of provincial governors and sub-provincial regents.

        The dividing line was never so clearly demarcated as when the President issued his decision on the locking down of the annual ‘Mudik’ migration of people going home for the Idul Fitri celebrations at the end of the upcoming fasting month of Ramadan. This annual event is one of the biggest annual mass migrations in the world. Though no comparison to China’s New Year migrations, from an epidemiologist’s point of view, having 10 to 20 million people hit the road back home at the same time in a semi-organized melee is a nightmare.

        Not only is travel cited as one of the biggest contributors to the spread of this corona virus, but the fact is that the greater part of the masses will be leaving from Jakarta, which currently is the number one hotspot in Indonesia with a recorded and confirmed thousand cases plus. That’s nearly half of Indonesia’s 2092 confirmed cases as this is being written. These are conservative numbers based on those actually tested or reported to have the symptoms.

        Though there were protests about shutting down Mudik, some people had already made up their mind not to go home as a gesture of responsibility. It seemed like people were softening their stance, a lockdown on travel was becoming more palatable, and governors were coming around. Though stopping short of issuing a fatwa against Mudik, the secretary general of the Ulama’s council MUI, Anwar Abbas, voiced his opinion that the Mudik migration in times of a pandemic was ‘haram’.

        So it came as a bit of a surprise that despite these supportive sentiments appearing in the public domain, the President once again seemed to choose a weak compromise by issuing a statement saying: “there is no interdiction to going, but if you go you must self quarantine 14 days when you get there, and 14 days again when you get back.”

        It was classic Jokowi: not taking a firm stand and setting up a situation which finally has to be resolved (or not) by others. Politically compromised as he is, due to his increasing reliance on military and PDIP party approval, it is nonethess still astounding (and upsetting) to see the lack of rational leadership here. It is hard to imagine people going straight into quarantine as they arrive home to see loved ones they haven’t seen for months. And if they did a total of 28 days quarantine, plus travel, how much time would be left for family time? How much time would be left for their jobs? How would their employers react?

        On the other side of the line the rebelling governors have put their foot down. It’s not a cohesive picture by any means. Some have totally locked down their regions: Papua for one totally closed down its ports, and the regent of Mamberamo Tengah denounced Coordinating Minister Luhut, key advisor to Jokowi, for meddling and not caring for Papuan lives. Even the sub-provincial regent of Tegal locked down his regency in defiance. One mayor (in Prabumulih, S Sumatra) initially refused to shut down schools. Meanwhile Governor Ganjar of Central Java is emerging as a firm, rational leader of a statesman-like stature: he has ordered the preparation of quarantine centers, even riding a motorcycle to check up on conditions; he has created his own social media campaign to raise awareness of preventative measures and so forth. And most importantly he has set aside a budget of a minimum of Rp 1,4 trillion for pandemic response.

        In Bali Governor Koster has issued a number of decrees, including one regarding the closure of ports to all but essential travel. The fact that ports are actually under the control of the central government Ministry of Transportation and not the provincial government didn’t deter him. He even dispatched the head of the Bali Task Force to check on the SOP of screening at Gilimanuk. But Koster has left a lot of leeway for local authorities to make their own decisions, with, again, uneven results.

        Inside Bali itself, some banjars communities are even enforcing their own lockdowns. The Balinese traditional adat community is now mulling total lockdown for three days from the 18 to the 20thof this month. It’s worrisome because the science isn’t sound. What will three days do? And what medical competence do adat leaders actually have?

        Others like the governor of Jakarta, Anies Baswedan, who has presidential ambitions of his own, are chafing at new regulations requiring them to clear all their procedures first with the Ministry of Health before implementing them. To be fair, it seems ridiculous in the time of a pandemic to insist on formalities, especially as the ministry hasn’t been that forthcoming in the last month. To put some perspective on that, the Minister of Health Terawan scoffed publicly at the idea that corona virus had hit Indonesia as late as the 11thof February, going so far as to challenge Harvard University to prove it.

        Obviously much of this is politicized; it’s not like these governors had been proactive before it became painfully obvious that the central government was going to side step the problem. The fact that Indonesia has no proper social security net in place for those living at poverty level, whose day-to-day subsistence is the most at risk, has put greater pressure on local leaders.

        It’s worth stepping back and seeing how the initial response, or to be more precise, the lack of initial response created such a chaotic situation, and to compare it to two other countries. Whereas months ago Vietnam had started an effective awareness campaign, we were glossing it over. Months ago New Zealand devised a tiered alert level system – each level with protocols to put into action. In her press conference on the eve of lockdown, NZ’s PM Jacinda Ardern explained clearly how now that the situation had reached alert level 4 and the recommended measures would be taken for lockdown – including the announcement of a budget to support citizens affected economically and guaranteeing food supplies. I realized that this system had been well explained and socialized to the NZ public weeks before. I’m very much reminded here of a discussion I had with Devy Kamil Syahbana who heads the disaster mitigation for geological and volcanological emergencies in Indonesia’s PVMBG. He pointed out that each of the different levels of warnings for volcanoes is clearly tied to a set protocol, so as to provide an appropriate response according to the level of danger etc, and must be explained publicly. This same system then applies to any region in the entire country.

        Such alert level systems allow flexibility and interventions appropriate to each situation, yet they’re still coherent on national scale. This minimizes confusion, saves time, saves lives, uses resources efficiently etc. The real issue is that we here in Indonesia simply can’t seem to be galvanized into action until we are right on the cliff’s edge.

        Back in mid February the government released 283 students who had been evacuated from Wuhan after 14 days of quarantine. None were tested. That was a time we should have consulted with WHO, and defined the different levels of alert we needed to create, adapted them to current Department of Health epidemic guide lines, and then implemented the necessary protocols to enact at each of those levels specifically for corona virus throughout February and March. But as it panned out, we had to wait till the 10th of March when the director general of WHO had to request firmly that Indonesia declare a national emergency.

        Right now, we have governors taking things into their own hands, applying what they think is appropriate even if not prescribed by a central planning scheme, and some, like the governor of Jakarta, have their own political ambitions to fulfill; others are genuinely concerned what the fallout would be if they don’t act. On the other hand, the central government is determined to maintain final control, and the power struggle continues. It’s almost like the proverbial kindergarten sandbox. Unfortunately few of these actions have clearly thought-out scientific rationale behind them.

        So in the end we have a battle of opinions, not much more elevated than the ridiculous spats on social media. It leaves the people confused, misinformed, waiting for the next set of arguments, and finally taking matters into their own non-expert hands. Is all this better than the head-butting on Facebook? There we have people denying that covid19 is a problem; and then there are the cure-alls. One person who produces virgin coconut oil insisted there was nothing to worry about as long as we bolstered our immune system with VCO. When it was suggested that this was fine, but please continue to social distance etc., the answer came back “What Farma do you represent?” Unfounded conspiracy theories are rife, eating away at people’s confidence in effective measures of containment. People believe anything that’s posted, and as a result the attempt at a rational, well thought-out response becomes a mess.

        Regarding the stats, there is another huge hole, which leaves us filled with uncertainty. We know now that asymptomatic carriers can be contagious. WHO is currently projecting that up to 50% of those infected by covid19 are asymptomatic – and they too go through a contagious phase. That expands the probable number of those infected considerably. Only a handful per million in Indonesia actually gets tested. Waiting until we know exact numbers will not delay the spread. Already there was a mysterious, unaccounted for 40% spike in funerals in Jakarta last month.

        Stop-gap measures aren’t going to work on a large scale – think 250 million people over 15,000 islands. At a certain point Jokowi announced he was importing chloroquine, and that it would be handed out door to door (at least that’s what the media reported). In reality the prescription and dosage of chloroquine has to be carefully administered according to several factors – body mass, medical history etc. It has not yet even been proven effective for covid19, and in fact is a dangerous drug still undergoing clinical trials. The prospect of thousands of people self-administering is chilling. Yes, there are a host of more promising other things going on, such as testing TB vaccines and so forth. But all that won’t be ready for months to come.

        As the political battles rage on, both sides dig in. The other day the Chief of Police announced a regulation that made insulting the president or other ranking officials during the corona virus crisis a crime. It’s really hard to understand how that is going to make things better or clearer. What is clear is that this is not a just a battle between two differing political points of view, it’s once again politics versus science. Both of those warring political sides are undermining science and our chances to significantly reduce the harm.

        We need to have decisive action pre-empting the impact on the archipelago, and the government needs to suck up the costs of supporting the poor and keeping the economy somewhat viable. We can’t continue to grasp at straws; waiting for a miracle is not an option. What we do know is that reducing time outside the home and social distancing are effective, and much more effective is stopping travel. While elements of the government continue to do battle with each other, Mudik is almost upon us. We need firm leadership based on good science now. Meanwhile more than 24 frontline doctors have succumbed to the disease. How many more have to die until we get our act together?

        In Balinese

        In Indonesian