Health officials in Indonesia are blaming the emergence of the Delta variant first detected in India for a massive surge in COVID-19 that has seen the number of daily new cases more than triple in recent weeks, but some of the country’s leading infectious disease experts say the real reasons are closer to home.
“The spread of this virus variant is very fast,” Health Minister Budi Gunadi Sadikin admitted during an online seminar on Sunday, adding that the variant had got a foothold in Indonesia through its ports.
“Because many seaports in Indonesia carry goods and many also come from India, they enter from there,” he said.
But experts interviewed by Al Jazeera said the Delta variant was not the primary problem.
They say the surge is a result of travel at the end of the month of Ramadan – when many people ignored a travel ban to visit their hometowns, the absence of a cohesive health policy coupled with confused messaging, the privatisation of testing regimes and ineffective tracing.
While travel was restricted at domestic airports and ferry terminals from April 22 to May 24, the government estimated between five and six million people still moved between cities on Indonesia’s two most heavily populated islands of Java and Sumatra during the holiday period.
“All COVID variants are a concern but the Delta variant has not proven to be more deadly,” said Udayana University professor Gusti Ngurah Mahardika, Bali’s most senior virologist. “It only gets a silver medal; the champion in Indonesia is still the Alpha variant. I believe the Delta variant is being used as a scapegoat because of the government’s incapacity to control the pandemic.”
Focus on the economy
Health authorities on Thursday reported 12,624 cases – the highest daily rise since February – bringing Indonesia’s total cases to nearly two million.
Mahardika says it is almost impossible to pinpoint the reason for the surge because infection rates are “so underreported” that health data “cannot be referred to” in Indonesia, but he pointed to a number of probable causes.
“People travelling during Ramadan played a role, no question about that,” he said. “But we are a disorganised country, most of the focus is on the economy and the people are experiencing COVID exhaustion and fatigue. In the capital (of Bali) Denpasar where I live, the cafe and restaurants are full every evening.”
Ahmad Utomo, a molecular biological consultant in Jakarta specialising in the diagnosis of lung infections, agreed that the Delta variant is being used to obscure mismanagement of the pandemic.
“I absolutely agree with that. Whatever the variant is, it needs human activity to replicate,” he said. “Indonesia is doing a good job in genome tracking, which is how they know the Delta variant is here.
“But the Delta variant,” Utomo explained, “is like a sports car. It can go very fast. But even a sports car can only go as fast as the road you give it and you have to address human mobility to slow it down.”
Utomo said too many people are disobeying health protocols and travel bans and the government is making it worse by failing to invest in testing and tracing.
“When people want to travel by ferry or plane in Indonesia, they need to pay for a test, so a huge industry has sprung up to cater to demand,” he said. “But there’s no money in tracing so it’s just being ignored.”
‘It will get very bad’
Dr Dicky Budiman, an epidemiologist who has helped formulate the Indonesian Ministry of Health’s pandemic management strategy for 20 years, says while the Delta variant is more infectious than the Alpha variant, it is the latter that is driving the current outbreak.
“Currently, the spread of the Delta variant is very small, while the Alpha variant is being spread by community members who disobeyed the travel ban,” he told Al Jazeera. “I agree that the Delta variant is being used as a scapegoat. We are more than one year into the pandemic, but the government has proved it’s incapable of controlling COVID-19.”
While the Alpha variant might still be dominant, Buduman warned that it is only a matter of time before the Delta strain takes over.
He feared Indonesia could soon be facing an outbreak comparable to India’s.
“The Delta variant will lead infections next month,” he said. “I predict that in July there will be a huge caseload in the community and rising mortality in Java because 40 percent of Indonesia’s population lives on the island and this density puts them in a very dangerous situation.
“If you ask me how bad things are going to get, well, it will get very bad with much higher mortality because we can see from what happened in India that the pattern is very clear: The Delta variant impacts much harder in countries that do not have enough social distancing, mask-wearing, testing and tracing and vaccinations.”
As only 1 percent of positive cases in Indonesia have undergone genome tracking, there is no conclusive data to show the share of infections attributed to particular variants.
Dr Nadia Wiweko, the spokesperson for the Ministry of Health for COVID-19 vaccinations, admitted that travel has played a part in the accelerating outbreak.
“There is a trend of increasing cases because of community mobility from Ramadan,” Wiweko told Al Jazeera. “Previously, we had 3,000 cases per day but now we are moving past 9,000 cases.”
‘Not too late’
Developed countries have managed to suppress the pandemic with mass vaccination programmes, supported by effective testing and contact tracing.
Indonesia, which was the location of late-stage trials for China’s Sinovac jab, began its campaign in January, but has still only managed to fully vaccinate 4.3 percent of its population.
The government has been anxious about the economy since the pandemic first began late last year because it worries it cannot provide social security – let alone food packages – to its 270 million people. About 10 percent of Indonesians live below the poverty line.
Wiweko said the government is now looking at a micro-lockdown strategy to target areas of high infection.
“We have issued regulations to limit community activities on a micro-scale that is enforced in all provinces and city districts. This is like [large-scale social restrictions] but adapted to local conditions,” she said.
Wiweko said the strategy included targeted isolation and treatment, work from home regulations and limited shopping hours. Tracing is also being ramped up from five to 10 traces per positive case to 20 to 30, she added.
“We know people are worried,” she said, “but it’s not too late to prevent the peak of cases.”
But Budiman warns micro-lockdowns will prove ineffective.
“They are still focusing too much on the economic consequences but sooner or later, they are going to have to rethink their response because the experience from many other countries shows only total lockdowns combined with increase testing and tracing followed by isolation and quarantine with massive vaccination programmes are effective at containing the Delta variant,” he said.
Utomo voiced similar sentiments, “The solution is simple: enforce health protocols, test, trace and vaccinate. They must be persistent in their strategy.”
Even as cases surge, Indonesia is still talking about allowing foreign visitors to return as early as July to popular destinations like Bali, which welcomed 10 million foreigners in 2019 – the last year before the pandemic struck – in order to restart the island’s economy.
“The Lancet has published an article saying the only way to deal with outbreaks is elimination, not mitigation,” Utomo said.
“Our leaders have to crush the curve, not worry if people will vote for them at the election. Otherwise, we are never going to get out of this pandemic.”
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