by dr. Syahrizal Syarif, the FKM UI’s Epidemiologist
Finally, on March 2, 2020, President Jokowi announced two confirmed cases in Indonesia. This addresses three issues circulating in the community. First, it is false that Indonesian genetics be familiar with the COVID-19. Second, it is false that the tropical climate makes the virus unable to live. Third, it dismisses doubts that the Health Research and Development Laboratory is not capable of diagnosing the COVID-19.
These emerging two cases should not be surprising in the midst of the fact that the global outbreak coming from Wuhan, China and entering the 9th week has spread to 64 countries and regions as well as one cruise ship. It is only a matter of time when Indonesia has a confirmed case. From these two cases, we learn that the cases were not found from arrival gates, such as the port health office, or from hundreds of crew that we quarantined in Sebaru Island, but started from the social activity of a dance club consisting of multi-nationals. The appearance of clinical symptoms in the forms of fever, cough and shortness of breath urged the case number 1 and 2 to go to the hospital. This is where the real problem starts. The speed of COVID-19 transmission between humans is at 2-3, which means that an infected and symptomatic person is able to transmit the disease to 2-3 other people. Therefore, it becomes very important – in an effort to prevent the spread in the community by finding all those infected, as they are the source of transmission. Those who must be found this time are all members of the dance social club who attended the activity on February 14, 2020. They are categorized as social contacts whose current health status must be known in the period of February 14-28, 2020. The second group is the group of health workers treating the case number 1 and 2 before the two patients were referred to Sulianti Saroso Infectious Diseases Hospital. This group can be categorized as close contacts because they made contact with the two patients, at times when they were not aware that the patients were suffering from the COVID-19.
Their current health status must be known and they must take a self-quarantine for 14 days by not having contact with other family members. Confirmed cases from the quarantine of the Diamond Princess Cruise Ship in Yokohama taught us about the great 20-50 percent of cases without symptoms, where the lab results showed positive, but those concerned experienced no symptoms. It is better for the 71 health workers who are currently being monitored to go for a lab test.
The emerging case should be a concern for the government, because the real war has just begun. It needs a special taskforce at the national level; firm budget support to execute early detection job – finding suspects at arrival gates: airports, seas and borders; an ambulance that meets requirements for transporting suspected patients, active surveillance, contact tracing. For hospitals, it is necessary to improve abilities to take and deliver appropriate specimens in addition to the readiness of adequate isolation rooms. Health workers, medical and paramedics need to pay attention to personal safety in services and carry out active surveillance of influenza like illness, with special attention to cases of broncho-pneumonia and pneumonia.
People need to maintain hygiene, cancel visits to severely-affected countries such as South Korea, Iran and Italy, wash hands often, avoid crowds in areas where there will be confirmed cases such as Depok City, wear a mask if getting cough and cold, eat and sleep enough, follow the rules and regulations that the government will set if the situation gets worse.