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Jakarta Post

Beware of possible missing cases of novel coronavirus

Jakarta   /   Fri, February 28, 2020   /   12:13 pm
Beware of possible missing cases of novel coronavirus A resident walks in front of the videotron displaying information on coronavirus prevention at Eka Hospital Hospital, Bogor, West Java, on Monday February 3, 2020. (Antara/Yulius Satria Wijaya)

It has been almost two months since the public announcement of the novel coronavirus outbreak, first detected in Wuhan, China. The virus has infected more than 82,000 people worldwide and has caused the deaths of 2,738 people in mainland China as of Thursday, but Indonesia has not reported any confirmed infections from within the country. This contradicts the results of a study by Mark Lipsitch of Harvard University who calculated the risk of the virus’ spread given the inflow and outflow of travelers. By his estimates, Indonesia should have had at least five cases of coronavirus. However, to date there remain zero positive reported cases in Indonesia.

COVID-19, which belongs to the same group as the Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) viruses shows a different pattern of transmission. The latest report of cases from the Diamond Princess cruise ship found that, of the 634 passengers who tested positive for the virus, most did not show any symptoms. Nine out of the 78 Indonesian crew members have tested positive.

This raises a question. Are there asymptomatic cases in Indonesia? Given proven cases of people who look and feel healthy while carrying the virus, medical professionals worry about the potential for such individuals to unknowingly spread the disease to others. This character of disease transmission is quite distinct from SARS, which becomes contagious only when symptoms appear.

Indonesia continues to screen people based on their clinical symptoms. Airport officers, for instance, screen anyone with symptoms of fever or respiratory complaints. Travelers are also asked to report to the officers if they feel any symptoms. However, this method of case finding may be ineffective for the current outbreak, as asymptomatic individuals may carry the virus and spread the disease before they realize they are infected.

The decision to quarantine travelers from Wuhan, China, and merely monitor their physical and clinical symptoms without actively testing for the virus is inadequate and risks continued transmission. As long as the outbreak lasts, more meticulous measures — including public screenings of everyone traveling — are needed. The scarcity and high price of the viral testing kit used to diagnose COVID-19 understandably makes governments reluctant to check all those who have visited or lived in Wuhan. However, there are lingering possibilities of undetected and untreated cases, including further spread of the disease and death.

We are currently unprepared to face this outbreak of viral respiratory infection. Our current medical practice has undermined the importance of diagnosing viral infection. Inflammation of the lungs, or pneumonia, can be caused by infection or inhalation of hazardous material. Commonly, when medical professionals believe pneumonia is caused by infectious agents, they will start antibiotic treatment on the patient without first evaluating whether it is bacterial or viral in origin. The lack of viral testing in many hospitals throughout Indonesia makes the diagnosis of viral pneumonia even harder.

Administering antibiotic therapy to cases with viral pneumonia in regular cases is arguably acceptable, as viral pneumonia may later expose the patient to the risk of contracting bacterial pneumonia. However, in a time of viral outbreak, such as COVID-19, our capability to diagnose viral respiratory tract infections is crucial. This is not only a matter of doctors prescribing antibiotics or not; it is a matter of deciding whether members of the public must be quarantined to protect public health.

If we continue to treat respiratory infections without considering that it might be caused by viruses, we may miss diagnoses of COVID-19. If we continue business as usual, there is a significant risk that we will miss coronavirus cases, thus endangering members of the public.

As Lipsitch cited in his study, we should consider that we might not be meticulous enough in searching for cases instead of dismissing the results of the study altogether. The study should be considered an alarm to act more carefully.

Despite tragic deaths and suffering due to the outbreak, this outbreak is also a blessing in disguise if it can push the medical profession to be much better at diagnosing viral respiratory tract infection.


Physician, host of the weekly Relatif Perspektif podcast on health issues and the lives of medical workers

Disclaimer: The opinions expressed in this article are those of the author and do not reflect the official stance of The Jakarta Post.