There was a surprise that made a lot of news at the end of 2023. Cases of COVID-19 sufferers increased again, after several months of slowing down. However, said the Director of Persahabatan Hospital, Prof. Dr. dr. Agus Dwi Susanto, SpP(K), FISR, FAPSR., people don't need to panic. Because this case is still under control and the government and related agencies have taken precautions. Including Persahabatan Hospital which is a reference for this disease.

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Since the government lifted the status of the COVID-19 pandemic on June 21 2023, cases of this disease, which claims many victims, have decreased relatively. Agus Dwi Susanto also admitted this, in fact at one time there were no COVID-19 patients being treated at Persahabatan Hospital. In fact, previously none of the 400 rooms available for COVID-19 were available.

According to Agus Dwi Susanto, an increase in COVID-19 cases has been observed since early October 2023, then increased until late November and early December 2023. This spike in cases occurred both domestically and internationally. As of December 31, the number of cases throughout Indonesia monitored by the Ministry of Health was; 318 were confirmed, 128 have recovered, 2 patients have died and the total cases are 2,606.

Agus said there were four factors causing the increase in COVID-19 cases. “This increase is a fact on the ground. There are several factors that are the cause, firstly, people's immunity is starting to decline even though they have been vaccinated. Second, population mobilization is now as high as before the pandemic occurred. This is what makes the virus easily transmitted from one person to another. Then thirdly, currently health protocols (prokes) have been relaxed, especially since the pandemic status was lifted. "And fourth, the emergence of a new variant in the COVID-19 infection," he stressed.

Even though cases are increasing, people don't need to panic. But you have to stay alert. When we do activities in public areas or travel by public transportation, wear a mask. After your activities, don't forget to wash your hands if you come into contact with a public place with lots of people. Also provide hand sanitizer in each bag. That's the simplest thing you can do.

“Currently the virus is still there, but the risk of mortality (death) is very small. But to anticipate we must continue to carry out health procedures. "So protect yourself, especially for those who have comorbidities, the protection must be even stricter," said Agus Dwi Susanto to Edy Suherli and Rifai from VOI who visited him at the Persahabatan Hospital office, Rawamangun, East Jakarta recently. Here is an excerpt from the full interview.

After several months of slowing down, COVID-19 cases are increasing again, what is really happening?

Indeed, if we look at the data and news abroad and in Indonesia, in recent times there has been an increase in cases of COVID-19 infection. This increase is a fact on the ground. There are several factors that are the cause, firstly, people's immunity is starting to decline even though they have been vaccinated. Second, population mobilization is now as high as before the pandemic occurred. This is what makes the virus easily transmitted from one person to another. Then thirdly, currently health protocols have been relaxed, especially since the pandemic status was lifted. And fourth, the emergence of a new variant in the COVID-19 infection. This is what has caused another increase in COVID-19 cases.

What should you do if this happens?

What can be done is to carry out a third booster vaccination to increase the body's immunity against COVID-19 infection. Then adopt a clean and healthy lifestyle (PHBS); get enough rest, eat and drink enough, avoid food intake that is not good for the body, and do exercise. If this is done, it can help maintain a person's immune system.

What else can be done?

What is no less important is carrying out health procedures in special conditions, such as people who have acute respiratory infections, and those who have influenza, who must wear masks so as not to transmit the virus to other people. Also, those who are at risk or at high risk when in closed public spaces must also wear masks. Also for those who are elderly, or those who have comorbidities; heart disease, stroke, chronic lung disease, and cancer. Don't forget to wash your hands frequently after carrying out activities in public areas. The problem is that hands are the medium for transferring viruses and the most common infections occur. So apart from the air, contaminated hands are also the most common means of transmitting viruses.

Can COVID-19 actually be destroyed or not?

We learn from the experience of previous pandemics, starting from the Spanish flu pandemic, bird flu pandemic, etc. These things cannot be destroyed, but what happens is mutation. So the virus is still there. This mutation makes the virus weaker, the symptoms it causes are not as severe as before.

What is the role of antivirus?

In accordance with guidelines from WHO and the Ministry of Health, as well as professional organizations, administration of antivirals is indicated in certain conditions. If it's still light, you don't need an antivirus. Unless there is a visible risk of worsening for the patient. For example, there is a mild infection but the patient has severe comorbidities or is an elderly patient. Then you should use antivirals for moderate and severe patients.

To date, how many patients have had COVID-19 detected at Persahabatan Hospital. Of that number, how many people are still being treated?

When COVID-19 was at its peak in 2020/2021, almost all of our rooms, there were 400 or so, were in use. In 2023, when the government declares that there is no longer a pandemic, we will be empty, there will be no COVID-19 patients. At the end of November and early December 2023, when there was a spike in COVID-19 cases in Indonesia, we again accepted patients. From the data, we have treated 19 patients. The details are 1 patient mild, 16 moderate and 2 severe. Of those, 13 were outpatients, and 2 died. The remaining 4 are still being treated in the COVID-19 isolation room.

So far, has it been detected which variant of COVID-19 the patient here is suffering from?

We have sent samples for examination to the Ministry of Health laboratory and to date we have not received the results. At the end of 2022, the average patient we treat will be infected with the omicron variant of COVID-19. 

The government, through the Minister of Tourism Sandiaga Uno, is calling on the public not to visit Singapore just yet when COVID-19 cases are increasing again, how bad are the conditions there?

If we look at the news and existing data, the current cases in Singapore are quite extraordinary, the number is thousands of people infected. Of course this is a concern for the government. In an effort to reduce the occurrence of infection in our population, we are avoiding these areas. If you don't go there the risk is smaller. So the advice is absolutely right.

Apart from Singapore, which other countries do we need to watch out for?

In fact, almost 93 countries reported cases of COVID-19 with the new variants EG.2 and EG.5, which are subvariants of omicron. For Southeast Asia, Singapore and Malaysia are quite serious.

According to your analysis, why do these two countries have high cases?

As I said earlier, there are 4 factors causing the increase in COVID-19 cases in Indonesia. In Singapore and Malaysia it is also like that; decreased immunity, high community mobility, decreased health protocols and new variants that spread more quickly. These two countries are transit points, so people who stop by have contact with the local community and this spreads to local residents.

What is the anticipation from Persahabatan Hospital regarding the increase in COVID-19 cases?

We are following directions from the Ministry of Health. We have long been appointed to treat COVID-19, and to this day the decree has not been revoked. We have been anticipating since there was an increase in COVID-19 cases. The preparations we made were to prepare a special room for handling infection cases. When there was an increase in cases, we expanded in 4 stages. First we open 5 rooms, then 15 and then 50, then 100 and finally to maximum capacity (400 rooms).

Apart from that, what else do you do?

We are reopening the COVID-19 vaccination service for those who want to do a booster. Previously, boosters had also been provided for health workers. We also reviewed the SOP for treating COVID-19 patients at Persahabatan Hospital, from the emergency room, inpatient room to the operating room. The last thing is to provide antiviral drugs such as remdesivir, molnupiravir, and paxlovid, because we have received referrals from many hospitals for COVID-19.

Apart from these medical measures, we also educate the public about COVID-19. We have held webinars and talk shows on how to deal with COVID-19. How to understand the symptoms and carry out treatment.

For this new variant of COVID-19, what are the symptoms like?

The EG.2 and EG.5 variants are milder than the previous ones, with symptoms such as cough, runny nose, sore throat, fever, headache. So the symptoms are mild to moderate.

The government has not yet imposed travel restrictions on the public, what advice do you have for those who are forced to do activities in public areas?

When we do activities in public areas or travel by public transportation, wear a mask. After the activity, wash your hands if you come into contact with a public place with lots of people. Provide hand sanitizer in each bag. That's the simplest thing you can do.

Currently the virus exists, but the risk of mortality (death) is very small. But to anticipate we must continue to carry out health procedures. So protect yourself, especially for those who have comorbidities, the protection must be even stricter.

So the current conditions are not worrying yet?

Yes, but caution is important. As stated by the Ministry of Health, the public does not need to panic. The government has taken steps and efforts to prepare for a spike in COVID-19 cases, but the public must also increase vigilance.

Recently, a prosecutor in the State of Texas, USA, sued Pfizer, claiming the efficacy of their vaccine was 95 percent, what do you think about this?

It is legal for someone to question or challenge a medicinal product, because everyone has the right to express their opinion. We'll see what the results are like. Because if we come from the medical world, what we understand is that there is no vaccine that can protect 100 percent. Vaccines are just an effort to prevent by increasing immunity against a disease by giving vaccinations. Because the lawsuit process is still ongoing, we'll just have to wait and see what the results are.

Indonesia already has the red and white vaccine, has it been used at Persahabatan Hospital?

In this increase in COVID-19 cases, we have used the Red and White vaccine for vaccines 1, 2, 3 and booster.

What are your hopes for the government in handling COVID-19 which is increasing again?

The government and parties who play a role in dealing with COVID-19 must be consistent in carrying out continuous monitoring so that they know how big the increase is and which areas are most affected. So that anticipatory and intervention steps can be taken to reduce COVID-19 cases. Apart from that, we must be ready to provide facilities to the community in dealing with the increase in COVID-19. Such as  providing a place for vaccinations, preparing health facilities for patients. Learning from yesterday's case, medicines must also be prepared. Diagnostic facilities must also be ready, such as for swabs. Lastly, there must be coordination in handling this case from all related parties.

Agus Dwi Susanto: Sing, Food and Commitment

Apart from his busy schedule as a doctor and also as Director of Persahabatan Hospital, Prof. Dr. dr. Agus Dwi Susanto, SpP(K), FISR, FAPSR., has a hobby of singing. But it's just a hobby to release stress and relieve fatigue. Who wants to sing while swaying?

What would happen if Doctor Agus pursued his singing hobby since childhood? Maybe he will be a competitor to doctors who also have a profession as a professional singer, like Doctor Tompi, who is famous as a jazz singer with a melodious voice.

"It's just a hobby for me in the midst of my busy schedule as a doctor and also the Director of a hospital. Not bad after singing can relieve the fatigue of work. "This is also my way of releasing stress when the workload piles up," he admitted.

What songs are often sung? "Yes, any song, pop kerocong to dangdut is okay," said the man who dares to sing on stage at invitations or at office events. "But most often we do karaoke at home with our family," added the General Chair of the Indonesian Lung Doctors Association.

Agus inherited this singing talent from his father who had a keroncong music group in Kudus, the city where he grew up. "Almost every day listening to my father play music with members of the old keroncong, dangdut and pop music groups, made me like music without realizing it. So I can sing accompanied by music," added the man who also loves writing.

Healthy Life

Apart from pursuing his hobbies of singing and writing papers in his current field, Agus Dwi Susanto also never forgets to maintain his health by living a healthy lifestyle.

“Exercise is very important, even though I can't do it every day, I exercise at least three times a week. I usually take a morning walk around the housing complex and its surroundings to stretch my muscles. "It's not too heavy, the important thing is to sweat," said Agus, who completed his BA in Medicine at UI in 1998, and continued his Masters in the Specialist Medical Education Program (PPDS) in Pulmonology and Respiratory Medicine at the same campus, graduating in 2005.

Apart from that, you must also consume foods with balanced nutrition. “Our dinner plate must contain carbohydrates, protein, vegetables and fruit. "You don't need a lot, the important thing is just balanced nutrition," said  Agus, who received a Doctorate in Health Sciences from the Faculty of Medicine, Gadjah Mada University (2014).

What is also good for maintaining health is to avoid substances or ingredients that are harmful to the body. "I don't smoke, I don't drink alcohol, because it can be dangerous for the body," emphasized this professor at the Faculty of Medicine, University of Indonesia.

When it comes to eating, he doesn't have many restrictions. Since childhood, Agus has not been able to eat four-legged animals. “I don't know why I can't eat four-legged animals. If you try, you will feel nauseous, then vomit. So my choice of side dishes is chicken, fish, tofu and tempeh. "For fish, I can only eat fried ones," he said.

Time for Family

Even though he is busy, Agus Dwi Susanto is committed to sharing his time with his wife and two children who are growing up. “I've been busy with office matters from morning to evening. In the evening I try to have dinner with my wife and children at home. "That's been my commitment from the beginning," he said.

On weekends, I usually make time for my family. "Yes, just eating together at a restaurant or walking at the mall accompanying your wife and children," he continued.

Educational Affairs Agus and his wife free their children to achieve their dreams. “My eldest daughter is studying in the sixth semester at the Faculty of Medicine at Padjadjaran University, Bandung. If his younger brother is still in grade 1 of junior high school, he really likes technology and digital. "I just support him wherever he wants to go," he said.

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To achieve your goals, Agus Dwi Susanto emphasized that you need commitment. “The most important thing  is commitment, a commitment to serious learning. Without commitment, the ideals we hope for will be difficult to achieve. Then focus on your goals. Next there must be effort. "And finally accompanied by a prayer to the Almighty," he concluded. 

"Currently the virus exists, but the risk of mortality (death) is very small. But to anticipate we must continue to carry out health procedures. So protect yourself, especially for those who have comorbidities, the protection must be even stricter."