April 3, 2020
Some countries apply any policy to mitigate pandemic Covid-19, and Indonesia prefers involving social and physical distancing. This policy has not been enough to reduce the spreading of the pandemic Covid-19, proven by the rapid growth of the positive cases. Mass test as the other approach needs to be applied along with considering Indonesian socio-economics problems and also medical instrument preparedness.
On March 9th, 2020, Italy’s Prime Minister, Giuseppe Conte, announced a national lockdown policy. It has been noted that day there were 9,100 Covid-19 positive cases and 463 deaths in Italy. Any public activity is prohibited, included school, theatre, and sports. There are only a department store, clinic services, and few key businesses such as bank and post office allowed to open. Any travel activity is banned, but an exception, any important sector, and medical business still open in order to slow the spread of Covid-19. Italy applies a minimum of three months to three years of criminal punishment for Covid-19 suspects who were traveling outside their house.
The Italian government is in limited ability to give pressure in the sense of the spread of Covid-19. Flights from and to China have been banned since January 31st, 2020. However, this response unexpectedly is not adequate to prevent the spread of Covid-19. When three suspects have diagnosed, Italy did not take any severe action. Flight from and to China was banned but not applied to other countries.
The citizen also expresses such responses from the government. Vernor Silver, in his article, wrote that Italian is not fully aware of distancing their physical contact with Covid-19 suspects in the early Covid-19 spread. Then they started to not believing but fear when it has been in their cluster. When the infection became worst, they will be suddenly in a panic.
The Center for Systems Science and Engineering at John Hopkins University shows the data on March 20th, 2020 that the total of Covid-19 positive cases in Italy grew four times to 41,035 cases. The death rate in Italy becomes the highest in the world, passed Chine in behind, it was 3,405 people death. This significant growth impacts on available medical experts, the doctor, and nurses. They all are in the limit. It becomes a worse problem. Moreover, doctors, today need to prioritize selecting who must alive.
By the growth of Covid-19 cases, the Italian government took a lockdown policy to be applied. In the early time, the lockdown applied for fifteen central regions of pandemic contagion. However, the spread of Covid-19 still proliferates. For such reason, the government applied lockdown for every region with more than sixty billion citizens.
Italy’s lockdown policy harms economic conditions. Closing the tourism place and physical distancing cause the national income turns down. If the lockdown situation does not change, it was predicted that Italy’s GDP would decrease by 3% until the end of March. The prediction shows Italy will lose its income by 8.3 billion USD from tourism sectors. However, the tourism sector infuses more than 6% of the national GDP. Nevertheless, the consideration of the total positive cases and high Covid-19 spreading potency made the lockdown policy must be applied.
On the contrary to Italy, South Korea prefers applying mass test policy to the lockdown policy. According to Kim Woo Joo, a disease expert from the University of Korea, the lockdown was not the right option to be applied because South Korea is a democratic nation. It makes Korea must grasping the resolution from any group of society. On the other hand, South Korea’s medical facility is more capable than Italy, so they need not lockdown. The president of South Korea, Moon Jae-in, also stated that the lockdown policy would not be taken. The government will maximize finding the Covid-19 infection by applying the mass test.
There are 5,200 per 1 billion people who had done the test. In one day, the test could be held by 15,000 tests spreading in 43 service posts with the contactless. Drivers who pass the service posts will be tested. The sample was taken only for two to three minutes. The services post will send the sample, working for 24 hours, and the suspects will be contacted by phone for the result.
Also, some laws allow the government to access certain personal information from positive patients. The government can trace interactions that patients have had through cell phone GPS traces, credit card history, even through surveillance cameras or CCTV. This information is then published so that a person can immediately take the test if they think they have had contact with a patient who has tested positive.
The international media widely praised the mass test conducted by South Korea. South Korea’s response is considered fast and has succeeded in reducing the infection rate without making any significant sacrifices to the economic sector. However, a large number of tests increases the error rate. With a test result accuracy of 98%, there are 2% possible errors. This figure is meaningless if the number of samples tested is small. However, with a sample size of 200,000, this error reaches 4000 people. Another concern is that there is a lag between the test and the notification of results. During this interval, free community activities provide a bigger space for infection.
In the case of Italy and South Korea, it can be seen that there are various policy avenues to tackle a pandemic. Each policy path has its advantages and disadvantages. The path chosen also depends on many things that need attention, including the condition of health infrastructure, the economy, and the condition of the wider community. Indonesia itself chooses to pursue a policy of keeping distance. According to Kompas, the primary step to maintain distance came from President Joko Widodo’s speech. He emphasized that all study and work activities should start at home. Besides, people also need to avoid activities in the crowd, including in terms of worship.
Similar movements have also come from the ranks of local government and local initiatives. Based on Katadata’s report, Anies Baswedan as the Governor of DKI Jakarta has given the Covid-19 emergency status along with five appeals to limit various kinds of social interactions. Existing forms of restrictions include limiting the quota for public transportation passengers to prohibiting all types of joint worship activities. Also, he created a mapping of sufferers who were grouped by region through the official online government website.
From Jakarta moving to the east, the Bogor Government has determined an Extraordinary Event (KLB) in the city. It was implemented after the mayor, and three of his residents were infected Covid-19. The Tegal government also carries out limited isolation to reduce the rate of migrants from outside. Elements of Indonesian society have also started to lockdown locally. Several villages in Pakem Subdistrict, Sleman have also implemented closure of their territories by blocking entrances.
Although various initiatives have emerged from various elements of the state and society, there are still policy violations by several parties. Some offices still tell workers to remain present at the office even though the Work From Home (WFH) has been enforced. Besides, several people under surveillance (ODP) also committed violations. There have been several cases in which patients with suspected Covid-19 escaped from the hospital. For example, one case occurred because the patient wanted to go home first. These violations indicate that the policies made by the government are still not being taken seriously by some people.
Realizing this, the government has also provided a policy response. For example, the government stated that it would begin to crack down on anyone who was still in direct contact. The Task Force for the Acceleration of Handling Covid-19, both at the national and regional levels, will decide and imply the action.
The government’s preferred distancing policy is not without risks. Long-term distancing orders can slow down economic production activities (supply shock). Limitation of social interactions can reduce the amount of production of this essential item. It applies to production both at home and abroad. As a result, the level of activity and demand for the economy as a whole will also be disrupted. Estimates of global economic losses from these disruptions are also modest. Reporting from Katadata, the Asian Development Bank (ed.) Stated that global economic losses due to Covid-19 could range from US $ 76-347 billion. It is equivalent to a 0.4 percent reduction in world economic activity.
Knowing the risks that exist and their impact on the country, the Government of Indonesia has taken several steps to deal with this pandemic. Nevertheless, in its implementation, the Government of Indonesia still focuses on prevention and restriction policies. The government’s priorities have not yet fallen on ways to overcome and improve. Examples of existing coping policies can be seen in the provision of aid packages in the form of subsidies to poor people. The subsidies are provided to ensure that they can still live normally, even though they do not work directly. This step should be appreciated, given their vulnerability in the socio-economic context. However, this step is considered unable to overcome the long-term impact of the Covid-19 pandemic.
Apart from economic risks, the readiness of the health sector in Indonesia also needs attention. Although there are more than sixty referral hospitals for Covid-19 treatment, the majority of these hospitals still do not have sufficient capabilities to handle patients. The World Health Organization’s (WHO) Global Data Observation Report states that Indonesia only has 1.6 hospital beds per ten thousand people. Indonesia also only has four medical doctors per ten thousand of its population. The inspection and handling process also tends to be slow. The supply of personal protective equipment and paramedics still cannot match the surge in patients. The hospital management was equally unprepared. Some of them also rejected Covid-19 referral patients.
Problems in the health sector and economic risks can be overcome with several policies. This policy needs to emerge both in the form of economic instruments and reforms in handling pandemics. It should be emphasized that these two things have a close reciprocal relationship. Existing economic instruments need to support pandemic response measures. Instead, handling a pandemic will only be effective if it is supported by strong economic support. Consequently, both are important to be moved simultaneously and mutually reinforcing.
All existing policy planning also needs to be accompanied by sufficient government funding. Several steps need to be taken to ensure budget resilience for the program. First, the government needs to change the priority of budget spending that needs to be allocated, dealing with a pandemic and its impact on vulnerable groups. Second, the government needs to loosen up the deficit limitations when the domestic budget is insufficient. For now, handling a pandemic is vital to prioritize even though the economy is deteriorating, and the budget deficit is getting bigger.
Handling a pandemic can be started by optimizing the controlling distance policy. One of them is that the government can stop production activities, but still provide compensation for workers’ salaries for companies. This policy can reduce the possibility of dismissal and the cost of seeking new workers (job turnover costs). Germany has implemented this kind of policy in the Kurzarbeit program. Through temporary production stoppages with compensation, the government can safeguard business continuity and the safety of workers at the same time.
Similar policies can also be applied in Indonesia for several sectors which are deemed to be postponed. The temporary suspension of economic activity without a lockdown may not be commonplace. However, this stoppage could have a positive impact on the economy in the long run. Correia, Luck, and Verner found that an immediate suspension of economic activity could accelerate economic growth once the pandemic is over. Short-term sacrifices are necessary for the long-term sustainability of the economy.
The next step that the government can take is to ensure that the supply and distribution of essential goods and medicines are adequate. The government can ensure stocks by checking conditions and allocating funds to meet market demand in critical times. Besides, the government needs to strengthen online market supervision to prevent price gouging practices. Prevention of price manipulation is put in place to ensure that each community can fulfill their primary needs during the distancing period, namely masks and raw food. This supervision also needs to be followed by law enforcement.
It should also be emphasized that maintaining the condition of the community during the distance guard period is not enough. The government also needs to have a long-term economic plan to reduce the negative impact of this pandemic. It can be done by prioritizing the budgeting of several economic sectors. An example of this priority can be reflected by allocating spending on health infrastructure, especially for the availability of goods and research purposes.
In general, the priority for research in a pandemic is not uncommon. Moreover, the state budget is already in deficit, and the country’s priority is overcoming it. However, this is particularly important as disease analysis, and research can guide future public policy. Kelly-Cirino et al. state that this guide can be used to determine the appropriate implementation of policies, both in terms of time and allocation of required resources. The allocation of funds for research will also secure long-term economic conditions through pandemic management planning.
In addition to implementing a guarding distance policy, the government on March 19th, 2020 stated that it would adopt a policy of mass testing. However, the decision to carry out this mass test should be accompanied by clear procedures. Mapping who needs to be tested is an urgent task for the government to increase the precision of test results. Tracking the history of positive patient interactions needs to be optimized so that there are no undetected cases that cause a more sweeping pandemic. Testing only those who show symptoms is likely to be less costly. However, the presence of symptomless positive patients needs to be taken into account so as not to aggravate the pandemic.
Furthermore, the question arises: are health facilities in Indonesia capable of implementing these measures? Until mid-March, there was news that said a hospital in the Bekasi area had abandoned a positive Covid-19 patient. Rejection of patients who are indicated to be positive for Covid-19 is also often encountered in other hospitals. The hospital argued that the patient did not have enough symptoms so that there was no need for other tests and treatments. If this continues, the detection of positive cases of Covid-19 will be hampered. The consequence is that there will be a wider spread of the virus.
Not to mention considering the number and distribution of medical personnel in Indonesia which is uneven and tends to be concentrated in Java. Indonesia also still has a deficit of 6,192 public health workers in 2019. The policy of conducting mass tests which tend to be followed by a drastic increase in the number of positive cases is feared that the current health facilities will not be able to overcome. The drastic increase in the number of positive cases will become a problem if the number of medical personnel is not proportional to the number of patients.
The mass testing policy in Indonesia is expected to have a significant impact on the handling of the Covid-19 pandemic such as South Korea. However, mass testing also needs to be accompanied by a priority for countermeasures and improvements. So far, these two things have not been realized through policies that have been issued by the government. The government must focus on existing economic resources on these two priorities. It may lead to a temporary decline in economic performance. Nevertheless, short-term economic tradeoffs are needed to prevent a population crisis resulting from the pandemic. On the other hand, if this outbreak is not handled with additional steps, there may be long-term damage across all sectors of the country.
Author: Adit S dan Megantara Agustina P
Editor: Beby Pane
Translator: Fahmi Sirma Pelu