The Jakarta Post
Suspected cases and close contacts of confirmed coronavirus cases, especially those without symptoms, are left to their own means to find out their infection status as the government still lacks the ability to provide testing in many parts of the country.
Agustinus Anom Prabowo, a 38-year-old graphic designer and his family of 11 in South Tangerang, Banten, had to pay Rp 9.9 million (US$701.70) for all of them to get tested on Nov. 25, after they came into close contact with confirmed cases several days prior.
Anom’s relatives who tested positive were his uncle and cousin, who had visited Anom's family house. Both families live in South Tangerang, but no local health authorities or contact tracers have been by to check on them.
Even so, everyone in his family, even those who showed no symptoms, decided to self-quarantine. Not willing to take any risks, with his elderly mother living in the house and with several family members suffering from asthma, Anom and his siblings decided to get tested the week after his uncle and cousin got their results.
Only Anom's 6-year-old daughter tested positive, he said, but even after informing local community leaders, there had yet to be any contact-tracing or monitoring efforts made or even clear information from health authorities on when his daughter could be released from self-isolation.
"The total cost of the swab tests was quite high — yet still reasonable [...] I think most people would rather take a rapid [antibody tests] because it’s more affordable. But my family wanted [more accurate] and thorough results, so we took the swab test," he said.
The government has promised to pay for all COVID-19 treatment, including tests, but there are limitations to what it can cover.
The latest COVID-19 guidelines issued by the Health Ministry in July said that close contacts did not need to be tested unless they showed certain symptoms. Those who asymptomatic should only self-quarantine for 14 days under the close watch of local health authorities. This means that even if Anom and his family had asked for free tests, they would likely not have gotten them.
The same guidelines also phased out retesting requirements for asymptomatic COVID-19 patients and those with mild to moderate symptoms in order to be discharged from isolation.
Some health experts have criticized the criteria. Tonang Dwi Ardyanto of clinical pathologist association PDS PatKlin said it would be hard to implement them in the field.
"Because such criteria absolutely require discipline […] It’s certainly not easy.”
Similar criteria set forth by the United States' Center for Disease Control and Prevention in August sparked outcry from public health officials and experts, and were later reversed in September, Reuters reported.
Tonang said that as a result, demand for individually paid testing increased, especially when there were communities and offices that required negative test results. The price of testing could then become an issue, he said, while laboratories and hospitals only received assistance in the form of reagents and consumables from the government and had to bear other operational costs on their own.
Following prolonged protests on the high price of Polymerase chain reaction (PCR) tests, the gold standard test to diagnose COVID-19, Indonesia set its price ceiling at Rp 900,000 in October, seven months into the epidemic. Prior to that, people to pay millions for such a test.
Raflesia Sukma, 25, said her family of four in Malang, East Java, paid Rp 1.6 million to get a test for each of them in late September. It was her father who first developed relatively severe symptoms and they decided to pay for testing after failing to receive a quick response from a community health center (Puskesmas), she said.
After her father's result came back positive, Raflesia and her family started to self-quarantine and informed the Puskesmas, only to be suggested to self-quarantine and offered rapid antibody tests as they did not show symptoms. They decided to pay for PCR tests, considering that rapid antibody tests are "not [as] effective" and that her 57-year-old mother has hypertension.
"It was so expensive, I felt like crying [...] It was tough, but I didn't have any other options," Raflesia said.
Masdalina Pane of the Indonesian Epidemiologists Association (PAEI) said Indonesia’s testing capacity still lagged behind the number of suspected patients who should be tested right away. The number continues to grow, reaching 71,074 as of Wednesday when only 41,861 tests were conducted on new suspected patients.
Masdalina said that while ideally, all close contacts must be tested, this would be difficult to do as not all people showing symptoms had even been able to gain access to testing.
She suggested that all government-run and private health care facilities be integrated to refer suspects to certain labs for free tests. Indonesia should also start producing testing kits, she said, arguing that as long as it was still relying on imports, it would have to be more efficient.
There are also potential problems related to self-isolation and self-quarantine, she added, such as when a suspected patient has no funds to buy food or doesn’t receive food assistance from the government.
"We can't blame the people for not being disciplined [in following health protocols]. Try being in their shoes and siding with their interests. Some people can’t afford to follow health protocols.”
Syauqi Stya Lacksana, 24, said he decided to pay Rp 2 million for his parents' PCR tests in August after they came into contact with several infected people and no surveillance efforts were made by health authorities. They first approached a Puskesmas but were told it had no more PCR tests, he said.
Syauqi said taking such a proactive measure relied heavily on one's awareness, especially as some of his other family members avoided testing over fears of being stigmatized.
"The price ceiling is still [quite high for some people]. At times like these, the cost of a PCR test can pay for weeks’ worth of meals — not just days," he said.
The COVID-19 task force spokesperson said on Tuesday that the country had reached 90 percent of its testing target set by the World Health Organization of 267,000 people per week.