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'A serious problem': Asymptomatic cases may place Indonesia at 1m infections

Sydney Morning Herald - August 4, 2020

James Massola – Indonesia is likely to have hit one million cases of coronavirus already – nearly 10 times its official number – two of the country's leading epidemiologists say.

Australia's giant northern neighbour has officially reported 113,134 cases and 5302 deaths as of Monday evening, but testing rates remain very low, at about 12,000-17,000 people per day.

But Dr Pandu Riono, a University of Indonesia epidemiologist and Dr Dicky Budiman, who has 20 years experience tackling pandemics including SARS and HIV and has worked for the ASEAN secretariat and the World Health Organisation, suggest the number of cases is likely to be one million.

Indonesia's ability to control the coronavirus outbreak is hugely consequential for its key strategic partner and ally Australia at a time of rising tensions in the South China Sea. The economic partnership is growing in importance, too, with a free trade deal entering into force in July.

In April, Prime Minister Scott Morrison expressed "great concerns about the health and wellbeing of people in Indonesia, and we send our best wishes and as much support as we can to President Widodo, and the great challenge that he has there". Australia has re-directed $21 million in aid money to fight coronavirus.

Dicky, a medical doctor who is currently writing a PhD on pandemics at Queensland's Griffith University, said that "my prediction is that the current number of Indonesians infected by COVID-19 is around one million because the majority of them are asymptomatic".

"This is a very serious problem because [being] asymptomatic doesn't mean they don't have the disease in their body. So we need to put prevention as our main priority. Prevention is still better than being infected by COVID-19," he said.

Pandu said he could not say exactly what the true number of cases was but "it's a lot, maybe 10 times the current [official] rate. I think we still don't know, it depends on assumptions because of the limited testing we have, and then the trend of new cases is increasing".

Asked why the infection rate could be so much higher than official figures showed, Pandu gave three main reasons. "There are many young people [in Indonesia], limited testing and third, transmission is still high, the positivity rate is 10 per cent or 12 per cent [of people tested]".

One million cases would mean Indonesia, home to 270 million people, is in the top five in the world for total positive cases. Official case numbers in countries of a comparable population size – for example the United States and Brazil, home to 330 million people and 210 million people respectively – have recorded 4.8 million and 2.7 million cases.

The estimates from Dicky and Pandu were backed up by diplomatic sources in Jakarta who have also told The Sydney Morning Herald and The Age they believe the real infection rates could be as high as 1 million people.

These sources cited low testing rates (particularly outside the capital Jakarta), the relatively youthful population (the average age is 30 years) and the high proportion of deaths-to-cases.

The National University of Singapore's epidemiologist Jeremy Lim, who has examined closely the arc of the pandemic in Indonesia, also believed the country was likely to have a far higher case count.

"It is substantially larger than what has been reported. That is a fair inference from all the data points, but to pin down a number, I don't have enough information at this point in time," he said. Lim would not rule out the 1million figure.

The WHO's minimum standard for testing is one suspected case tested per 1000 people, per week, but across the country Indonesia has managed less than half of one test per one thousand people. The capital, Jakarta, has managed a little over four tests per 1000 people.

These figures pale in comparison to neighbouring Singapore, Malaysia, and even the Philippines, which is the second-hardest hit in south-east Asia.

Pandu said he had revised up previous predictions that the virus could peak at 4000 cases per day in October.

If the national and provincial governments did not act to impose tougher restrictions to curb the spread of the virus, Pandu said, then "it will be more than 4000 [cases per day] and we cannot see the peak this year".

"It will still be increasing in the first quarter of next year if they don't do anything. That's on the current speed of transmission."

He has previously recommended the government promote measures known as "the three Ms": Masker, Menjaga jarak and Mencuci tangan or wearing a mask, social distancing and washing hands – to stop the spread of the disease as large scale social distancing alone had failed.

Comment has been sought from the Indonesian government.

Source: https://www.smh.com.au/world/asia/a-serious-problem-asymptomatic-cases-may-place-indonesia-at-1m-infections-20200803-p55i5v.html