But since the beginning of the outbreak, the Indonesian government has made headlines for rejecting scientific studies aimed at forecasting COVID-19 situations in the country. Even before the pandemic, the country was not regarded as friendly toward scientists, especially those from abroad.

The Jakarta Post has looked into the government’s policies and compared them with several of the latest relevant studies.

Widespread use of rapid antibody tests

Indonesia had been relying on rapid antibody tests since March for screening cases and close contacts. The rapid tests are supposed to be confirmed further through polymerase chain reaction (PCR) tests, which remain the gold standard in detecting the virus but the country’s limited capacity for conducting the latter has made this difficult to achieve.

The rapid test only detects antibodies against the virus, which are usually created two weeks after the onset of symptoms during the recovery phase; thus, hindering health authorities in quickly containing transmission. Studies compiled by the World Health Organization (WHO) in April 2020 even suggested that some people had weak, late or absent antibody responses after contracting the coronavirus.

However, the government proceeded to require people to take the test, apart from the PCR test, prior to traveling or sitting university entrance exams.

The Association of Clinical Pathology and Laboratory Medicine specialists (PDS PatKLIn) urged the government in July 2020 to revoke the rapid antibody test requirement for travelers, citing the potential harmful impacts of false negative and positive results. A study on kits distributed in the country at the time suggested that the possibilities of false positives or negatives were high.

Despite this recommendation, the government imposed the rapid antibody test requirement for travelers until late December last year, when authorities started to replace it with a rapid antigen test, which is deemed more accurate that the rapid antibody test.

Read also: ‘False security’: WHO advises against using COVID-19 rapid test as travel requirement

Full-capacity flights permitted

Despite reporting of record daily new COVID-19 case numbers, the government started phasing out the 70 percent cap on airplane passenger capacity in early January, allowing flights to operate at full passenger capacity.

Authorities previously put a 50 percent cap on the passenger capacity in April, but changed the policy to 70 percent in June. This, however, raised concerns among lawmakers and observers that airlines had not complied with the cap.

The decision to phase out the passenger limit was issued despite global headlines on a study of possible in-flight COVID-19 transmission conducted by researchers with the New Zealand Health Ministry. The study analyzed flight seating plans, symptom onset dates and genetic analysis.

Researchers of the study highlighted the risk of transmission during flights as they found four transmissions despite the usage of masks throughout a flight. They had previously tested negative during pre-flight COVID-19 testing. The flight also only carried 86 passengers, about 20 percent of its total capacity, which provided room for social distancing.

Several studies, including one published by the United States Centers for Disease Control and Prevention (CDC), had also suggested the risk of in-flight transmissions. Meanwhile, others, including the International Air Transport Association (IATA), suggested that high airflow and the installation of air filters in aircraft would lower onboard transmission risk as they hindered droplets from spreading.

In order to prevent the risk of in-flight transmission, Indonesian authorities have required travelers to Bali to present a negative PCR test result taken at a maximum of two days before departure, or a negative antigen test result taken one day before the flight. Travelers to other regions must present a negative PCR result taken three days prior and an antigen test two days before the flight.

In-flight meals are also prohibited for flights of less than two hours’ duration.

Apart from a negative PCR result taken three days before the flight at the latest, travelers from abroad must also undergo a five-day quarantine and get tested again upon arriving in the country. If they test negative, they are allowed to go although they are still advised to self-quarantine for 14 days.

Other countries, such as the United Kingdom, Hong Kong and New Zealand, require travelers to undergo quarantine for 10 to 14 days. This quarantine policy also allows researchers in New Zealand to conduct in-flight transmission studies.

Read also: Study offers evidence of asymptomatic COVID-19 transmission on plane

Relaxed dine-in restrictions

The government allows restaurants to offer dine-in services at 50 percent of their maximum capacity under the current micro-scale public activity restrictions (PPKM Mikro) between Feb. 9 and 22. The provision is more lenient than the 25 percent occupancy limit imposed during the previous period of the general PPKM in January.

Restaurants and shopping malls are also allowed to open until 9 p.m., a change from 8 p.m. during the previous PPKM period. These changes corresponded with the demands of the country's business associations in January.

By comparison, restaurants were entirely barred from offering dine-in services and only allowed to serve takeaway or delivery under the large-scale social restrictions (PSBB) imposed in April last year.

A study published in the Journal of Korean Medical Science last November showed evidence of long-distance droplet transmission through direct airflow at a restaurant in South Korea in June. The study raised concerns about indoor dine-in transmission risks.

According to the study, two guests sitting in the airflow path of the infector were infected with the coronavirus, although they were located around 5 to 6 meters from the first case. Meanwhile, other visitors sitting closer to the infector but not within the case’s direct airflow were not infected. The restaurant had no windows or a ventilation system and used a central air-conditioning system.

Such a pattern was similar to the cases found in a study in Guangzhou, China in January 2020. The study, involving three family clusters, found that the airflow direction was consistent with droplet transmissions.

Reflecting on both studies, researchers recommend restaurants increase the distance between tables and improve ventilation. The South Korean researchers also urged authorities to update the COVID-19 guidelines given that transmissions could occur over 2 meters and after short periods of exposure.

Read also: New relaxed COVID-19 restrictions lead to more cases, protocol violations

Meanwhile, Indonesian COVID-19 guidelines stipulate close contacts are people who have been within 1 meter of probable or confirmed cases for 15 minutes or more, or those with direct contact with cases.

The guidelines also advise that asymptomatic close contacts are not required to undergo testing and only require them to undergo a 14-day self-quarantine.

Experts have opposed these provisions. The country is also lagging in terms of contact tracing.

Health Minister Budi Gunawan Sadikin said Indonesian contact tracers could only trace four contacts maximum, as opposed to the international standard of 30 contacts per confirmed case. The minister said the tracers were still doing their job manually.

Meanwhile, contact tracers in South Korea checked credit card records, closed-circuit television (CCTV) images, cellphone location data and its epidemic investigation system to track confirmed cases’ locations in analyzing COVID-19 hot spots.