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Jakarta Post

What comes next after COVID-related scandals

Health experts must lead and non-health politicians must assist them in our fight against the pandemic.

Winda Liviya Ng and Kevin Aristyo (The Jakarta Post)
Jakarta
Tue, May 11, 2021

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What comes next after COVID-related scandals

A series of events over the last few months seem to be warning us that the COVID-19 pandemic is getting out of control.

The celebratory parade of the Jakmania soccer fan club, the crowds at Tanah Abang Market, the relentless attempts of our filial citizens to return home despite the ban on mudik (exodus), the used antigen test kit scandal, the false PCR test results, the 2,090 travelers with COVID-19 who arrived at Soekarno-Hatta airport armed with negative test results, the COVID-19 relief aid corruption scandal and the quarantine breach by travelers from India are just a few of them.

Similar incidents are occurring everywhere, and it matters less that some of these scandals are being widely reported by the global media. What matters more is how we are handling the situation. To quote a famous Stoic philosopher: “It’s not what happens to you, but how you react to it that matters.”

What we do next will show where we stand in mankind’s fight against a common enemy. The details may vary, but we believe our country’s response to the recent scandals must adhere to a set of fundamental principles.

First, actions have consequences. Say that we have a 10-year-old at home, and we catch him eating sweets after midnight, which we had clearly told him not to do. However, since it is his first time, we simply scold him and then send him back to bed.

What is most likely to happen next? You will catch him doing the same thing again, because his first “violation” did not result in any negative consequences for him. So he will just try again, but this time in a smarter way so no one finds out. This is analogous to the mudik ban. “All roads lead to Rome”, as it’s said, and if we fail at trying one way, nothing is stopping us from trying another. We have heard of others who have made their way home, despite the government ban.

A similar analogy applies to the used test kits, breaching the mandatory quarantine and other incidents, but these are much more serious and cannot be compared to stealing sweets. The consequences of these improper and unlawful actions must be delivered quickly and announced widely to discourage similar actions in the future.

Second, there must be a plan; we can’t just wing it. We need to accept the fact that many have travelled across the country by now, either by leaving before the ban was enacted or by way of jalan tikus (backstreet) or by travelling under the guise of a “business trip”, you name it.

So what are we going to do when they come back from mudik? What should employers do to reduce the impending risk of an infection at the workplace? We should not just wait and see until another cluster breaks out.

Third is to make fewer exceptions and maintain more policy consistency. If we are quarantining overseas arrivals to Indonesia, why aren’t we quarantining interregional domestic travelers? If mudik is banned, why are we allowing foreign nationals to enter our country? There cannot be too many exceptions to the rule, because people love to be “exceptional”.

Fourth, fish swim and birds fly; these are not interchangeable. It would be naive for us to ask politicians to step away. We need politicians to work across the aisles and mediate across different departments. However, the pandemic is first and foremost a public health problem. Health experts must lead and non-health politicians must assist them in our fight against the pandemic.

These roles are not interchangeable. If health experts had had a say in the COVID-19 policies, they wouldn’t have lifted the capacity restrictions for shopping centers, especially not ahead of an extended holiday and at a time when new waves of infection are overwhelming other countries around the world.

Fifth, aim higher. Everyone must be aware that we quarantine people from overseas for five days upon their arrival at Soekarno-Hatta airport, but do you know where this number comes from? It is likely based on the research done by Lauer et al. that estimated the median incubation period to be approximately five days for SARS-CoV-2, the virus that causes COVID-19. This means that 50 percent of the people who catch SARS-Cov-2 will develop their first symptom on day 5 or earlier. But this is only 50 percent!

Compare this to countries like Taiwan and Singapore, which respectively apply a 14-day and 21-day quarantine rule for overseas arrivals. This means they can catch as much as 99 percent of all cases! No wonder they’re so far ahead in the game, because they’ve aimed higher.

The argument for a five-day quarantine was that arrivals to Soekarno-Hatta would already have their results from a polymerase chain reaction (PCR) test they took in their country of origin, and would be tested again at the end of their quarantine. However, we know from experience that test results from a traveler’s country of origin cannot be trusted 100 percent and that they could have caught the disease en route.

Furthermore, according to an article written by Sethuraman et al. published in The Journal of the American Medical Association, the detection of the SARS-Cov-2 antigen through PCR is only plausible one week after exposure, with the chances increasing in the following week. Given the record-breaking tragedy that’s happening in India and now Nepal, we can and should do better in building our barricades.

A similar principle applies to other guidelines and rules, such as the 1-meter social distancing protocol. Did you know that the actual guideline is 6 feet, or 1.8 m, and that this is based on research from the 19th century? Moreover, recent studies have shown that the SARS-Cov-2 can travel for up to 8 m when an infected person coughs or sneezes. This means we are aiming too low with our 1 m rule, leaving us to pedal harder to get over this pandemic sooner.

Sixth is enforcement. Policies, protocols and guidelines must be enforced nationwide without discrimination and rigorously. It is the greatest challenge, but it will get easier with time, especially if strong examples of actions and their consequences are set from the start.

We may be tired and desensitized by the whole calamity caused by the pandemic, but we can also view it as an opportunity for growth, a chance for our country to fix our chronic flaws that have been magnified and enhanced by the pandemic. We can work to nip corruption in the bud, reduce bureaucracy, improve our health system, increase the nation’s general hygiene and elevate our moral standing.

Who knows? Perhaps we’ll come out of this better than we were before.

 ***

Winda Liviya Ng has a doctorate in epidemiology and preventive medicine from Monash University, Australia, and is general manager at PT Winida Ayu Lestari and an expert panel member at Global Wellness Force. Kevin Aristyo is a graduate of the University of Indonesia medical school and coordinator of the COVID-19 research team at Persahabatan National Respiratory Referral Hospital, Jakarta.

 

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