The Blind Sword Slashes Corona

Ilustrasi (Raga Granada / YOU)

Indonesia is not only missing Patients 01, 02, 03, and so on. Indonesia may lose thousands or even millions of cases of COVID-19. This can be seen from the positivity rate which in almost one year is always above the WHO standard threshold. Insufficient number of testing is one of the reasons why pandemic control in Indonesia is so bad. Even the pandemic data is considered invalid. What kind of pandemic countermeasures are not based on valid data? Still part of VOI's signature Series, "A Year of Pandemic, A Million Positives".

In mid-February, the World Health Organization (WHO) brought good news. Weekly global COVID-19 cases fell 16 percent. However, the news was not generally accepted. Southeast Asia, including Indonesia, is considered to have minimal contribution to this decline. To make matters worse, the country's epidemiological (epidemic) curve data is considered unworthy of reference because it is invalid.

A week before the good news emerged, WHO reported 81,000 deaths from COVID-19 and 2.7 million cases. Seven days later, more than 500,000 cases were recorded.

Unfortunately the good news is not generally accepted. Epidemiologist who is pursuing a PhD at Griffith University, Australia, Dicky Budiman said the Mediterranean and South-East Asia regions - which Indonesia is included in - have minimal contribution to the reduction in global COVID-19 cases.

"From the beginning of the pandemic, we also saw global data. We can see other regions, stably contributing a little to the coverage of testing. This means also in the reporting of global COVID-19 data, namely the Mediterranean and South-East Asia regions. This includes Indonesia in it," he said. Dicky when contacted by VOI.

On the other hand, the two continents that contributed the most to the decline in corona virus cases were America and Europe. "Two continental regions that have significantly contributed to the COVID-19 cases in the world, America and Europe, followed by East Asia, Asia Pacific," said Dicky.

The indicator to assess how much it contributes to the reduction in COVID-19 cases, as explained by Dicky, is to look at the initial data on the achievement and coverage of testing and tracing. That is why it is difficult for the Mediterranean and South-East Asia regions to be considered part of the global downward trend in COVID-19.

"Because since the beginning of this region (Mediterranean and South-East Asia) the coverage of testing tracing is far from adequate. It is not yet in accordance with the scale of the population and also not according to the escalation of the pandemic," he explained.

In a WHO report that mentions the trend of decreasing global COVID-19 cases, Indonesia is in the second position of countries with the most COVID-19 cases, after India in the South-East Asia region. And Indonesia ranks first in the country with the most cases of deaths due to COVID-19 while India is second.

Daily case data for COVID-19 RI (Source: covid19.go.id)

Daily case data is not a benchmark

Indeed, if you look at the data on Indonesian daily COVID-19 cases, the number has decreased in the last few days. From the beginning of February the numbers tended to decrease.

On February 1, for example. The number of daily cases of COVID-19 was recorded at 10,994 cases. A week later, February 8, the number decreased to 8,242 daily cases. The data fluctuates to reach the lowest on February 28 with 5,560 cases.

Even so, epidemiologist Dicky Budiman is skeptical of the decline in the number of daily COVID-19 cases. Especially about the positive ratio or positivity rate which in almost one year is above 10 percent, exceeding the threshold set by WHO.

The positivity rate is obtained from the number of daily cases divided by the number of daily examinations and multiplied by 100. For this reason, this data is used as a reference, because it not only calculates the addition of cases per day but also compares it with the testing rate.

"So if there is a decrease in daily cases, that is not surprising, because the testing did not increase significantly. Every epidemiologist strongly agrees that not every country should be fixated on daily figures, because it is not valid. Tracing testing is low," explained Dicky.

As is known, WHO has set a standard for examining 1: 1000 inhabitants per region in a week. With a population of 270.2 million people, Indonesia naturally checks 270 thousand people per week or 12,960,000 per year or 4.8 percent of the population. However, until March 1, the number of tests was only 7,213,192 or only 2.67 percent.

In addition to the positivity rate, Dicky said the mortality rate was also a valid measure of epidemic control. "This mortality rate is a valid indicator of the severity of a pandemic situation in a region."

Infographics (VOI / Raga Granada)

Indonesia's COVID-19 curve is invalid

The data problem of handling COVID-19 in Indonesia has almost never been resolved since the beginning of the pandemic. In fact, this data is the most fundamental thing in determining control policies. Now, it has been a year since the pandemic in Indonesia has been rolling, handling the outbreak is like being blind. The epidemiological curve data (epidemic curve) that we have cannot be used as a reference.

Before exploring why the daily case data that Indonesia currently has is not suitable for reference, we need to recall what the epidemic curve is. What makes it valid or invalid?

According to the CDC, the general epidemic curve represents the number of new cases over time. The Y-axis (vertical) shows the number of new cases, while the X (horizontal) axis indicates the time of analysis in relation to the number of new cases.

Meanwhile, according to the Eijkman-Oxford Clinical Research Unit (EOUCRU) researcher, Iqbal Elyazar et al in his writing on The Conversation, there are things that need to be considered before reading the epidemic curve.

First, from the X axis or analysis time. Ideally for COVID-19, the epidemic curve uses the benchmark date of the person infected. Then the second is related to the number of new cases. This is what needs attention. Because in addition to knowing how many people are infected, you also need to know how many people have been tested before.

So the more examinations of people who are at risk of contracting COVID-19, the better the epidemic curve will explain the reality that is happening. "In other words, the size of the number of people being screened determines how much confidence we have in the epidemic curve," wrote Iqbal et al.

We take the example of a developing country that has been successful in dealing with the COVID-19 pandemic, Vietnam. Since the beginning of the pandemic until mid-October last year, the number of tracking or testing Indonesia has never exceeded Vietnam.

As Our World in Data noted on October 15, 2020, out of 1,000 Vietnamese residents examined 12.95 people. Meanwhile, Indonesia only tested 8.96 people.

This number shows that Vietnam's screening coverage is larger than Indonesia's, so the decline in new cases in Vietnam is more convincing because they screen more people at risk.

Comparative testing data for Indonesia and Vietnam (Source: Our World in Data)

In addition, in the early period of the pandemic, out of about 8,000 people tested, Vietnam found 1 positive case of COVID-19. Meanwhile in Indonesia, out of 7 people being examined, 1 positive case was found immediately.

"This means that the claim that new cases have dropped in Vietnam is more convincing because they have tried hard to find just one positive case. Meanwhile, in Indonesia, one positive case is found simply by examining 7 people. In other words, there are still many people who are infected but have not been tested. , "wrote Iqbal et al.

The invalid data of Indonesia's epidemic curve, of course, has a bad impact on this country. This is because the tools for visualizing the situation of the spread of COVID-19 which are usually used to explain the course of a pandemic, determine the source and time of transmission, determine the peak of the pandemic, predict the end of the pandemic, and evaluate the effectiveness of control measures are inaccurate.

"It is difficult to predict, because our data is not good. The problem is the testing is inadequate, so we do not have an adequate map," said Epidemiologist Dicky Budiman.

Dicky said, one of the reasons why the COVID-19 test in Indonesia was inadequate was due to commitment and consistency. "This commitment is a strategy in a science-based pandemic, and of course this science is a basic epidemiological approach, which focuses on the health aspect as the main focus of control," he concluded.

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