“It's meant to be a helpful signaling of something that needs to be looked at,” Marc Lipsitch, a Harvard professor, said in an interview published on Thursday in response to the Indonesian government's downplaying of a study that suggests there could be undetected cases of the coronavirus in the country.

Lipsitch and three of his colleagues conducted research to determine locations around the world that could have undetected cases of the virus imported from abroad.

“The purpose of our study is to look at whether the detected cases are really representative of the total number of cases. So, to do that we examined the statistical relationship between the number of travelers to a country to the number of cases detected. 

"There was an international average of 14 travelers per day associated with one detection of a case during the whole period we studied. By that standard, Indonesia would have been expected to have five cases, approximately, but it had zero during that period,” Lipsitch said, referring to the study published by the Medrxiv preprint service for medicine and health sciences, adding that the estimation was based on the extensive link between Indonesia and China, including the epicenter of the outbreak, Wuhan, via air transportation.

In response, Health Minister Terawan Agus Putranto claimed the study was an "insult" to the country and its ability to handle the virus, saying the research was only a model prediction of how the virus could spread.

Nadhira Afifa, an Indonesian student in the master of public health program at Harvard University, shared a link to her interview with Lipsitch on her YouTube channel with The Jakarta Post.

Lipsitch is a professor of epidemiology who works in the department of epidemiology and the department of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health in Boston, Massachusetts.

In the interview, Lipsitch said his team conducted the study with the goal of helping countries understand how the coronavirus could spread. 

Prior to publishing the research online, Lipsitch said the team had shared its research with the WHO and several of their contacts in Indonesia.

Lipsitch said that even Singapore, which has one of the highest detection frequencies in the world, had found cases it could not trace.

“Which means they have missed some introductions. So, missing introductions is not an insult […]. It is just a red flag — something that we need to be aware of [...]. What public health is supposed to do, among other tasks, is to find potential problems and signal them to people who can deal with them. That doesn’t mean that every problem that’s detected is a real one but we have to have some alarms,” he said.  

The government continues to maintain that not a single confirmed coronavirus case has been recorded in the country. Lipsitch said that although this was possible, the probability was very low.

“It would be very strange, particularly because even the countries that are finding many cases are probably also missing cases,” he said.

If indeed there were cases in Indonesia, Lipsitch said the best response was not to track importations but to find where cases were circulating in the country.

“The more cases [there are] locally, the less it matters whether they're imported. The solution is not to crack down on imports. Look for local transmission,” he added.

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