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Positivity rate remains high amid drop in testing, recorded cases

Source
Jakarta Post - November 10, 2020

Ardila Syakriah, Jakarta – The rate of COVID-19 testing in Indonesia has dropped after the long weekend in late October, an occasion of increased mobility that many fear will lead to a case spike, while positivity rates remain persistently high despite Health Minister Terawan Agus Putranto's claims of expanded monitoring efforts.

The daily number of tests performed has fluctuated during the pandemic. From Oct. 26 to Nov. 8, Indonesia tested about 25,000 people daily on a 7-day average, a drop from the 28,000 and 31,000 people tested daily in the first two weeks of October.

As daily testing declined, daily confirmed cases also fell to around 3,000 from the 4,000 cases reported on most days prior to the long weekend, which lasted from Oct. 28 to Nov. 1.

Authorities have attributed the decline in testing either to the long weekend or to a purported drop in cases. Labs usually reduce operations on weekends and holidays, resulting in fewer tests processed and therefore fewer new cases reported during the time.

The ministry's acting director general for disease control and prevention, Muhammad Budi Hidayat, told The Jakarta Post on Monday that the declining testing rate was a result of a decline in the number of samples sent to labs, which in turn was the result of a decline in suspected cases in some regions.

Muhammad said he, too, was worried about a potential long-weekend COVID-19 surge, but now that a week had passed, the absence of a surge could indicate improvement in the nation's pandemic protocols, although he said any such conclusion would have to wait for weeks.

Experts, however, are worried about the persistently high positivity rate – the share of COVID-19 tests that turn out positive – regardless of the testing numbers. The ideal rate according to the World Health Organization is below 5 percent, but Indonesia's has rate never come close to that.

"The positivity rate depends on the number of samples received by labs. If it's a small number, do we have to force more?" Budi said. "One of the reasons why the number is small is because in the 5th revision of [the Health Ministry's COVID-19] guidelines, only those with symptoms are to be tested. The number of symptomatic suspected cases has decreased. That's why samples have also decreased."

"We have optimism, and we have to be optimistic that people are now adopting health protocols," he added.

Epidemiologist Laura Navika Yamani said the high positivity rate meant the government was not testing enough people and was not searching beyond the visibly sick – and their families – who were more easily traceable.

"The number of tests has increased since the start of the outbreak, with targets by President [Joko 'Jokowi' Widodo], such as 20,000 tests and 30,000 tests, already passed. [...] But that should not be a reason for complacency," Laura said.

"In reality, the positivity rate is still high in Indonesia. There must be efforts to improve the testing capacity so that the target of below 5 percent can be reached."

Last week, the daily positivity rate ranged between 11 percent and 18 percent, the highest of which occurred on Sunday when only about 20,000 people were tested. Since August, Oct. 12 and Oct. 13 were the only two days the rate has fallen to single digits, at 9.89 percent and 9.76 percent, respectively. On those two days, 33,018 and 40,012 people were tested, respectively. The latter was the highest number of daily tests the country has ever recorded.

The WHO recommends a minimum of 1 test per 1,000 people to allow for more interpretable data.

Its latest situation report, however, showed that none of Indonesia's 34 provinces – not even Jakarta, East Kalimantan and West Sumatra, which had positivity rates below 5 percent for the three weeks prior to the publication of the report on Nov. 4 – had reached the benchmark.

Jakarta's data shows its positivity rate was 10 percent on Nov. 7.

Epidemiologist Masdalina Pane of the Indonesian Epidemiology Association (PAEI) said the number of observed cases depended more on the number of tests performed than on mobility during the long weekend.

She pointed to the lingering gap between the number of tests and the suspected incidence of COVID-19, saying testing was adequate only when the former could surpass the latter.

Indonesia has been seeing suspected cases hover above 50,000 lately.

Masdalina noted that death rates sometimes exceeded 100 per day at COVID-19 facilities, which suggested the situation was not yet under control.

The decline in daily testing has coincided with Health Minister Terawan's claims that the government has improved testing and contact tracing following the Intra-Action Review (IAR), a WHO-supported voluntary review into a nation's COVID-19 response led by the country itself.

Terawan joined WHO director general Tedros Adhanom at a virtual press conference on Friday to discuss the IARs. Terawan – unlike the ministers from Thailand and South Africa who were present – did not provide COVID-19 data to support the IAR. Instead, he thanked Indonesian officials at length for conducting the multisectoral review in August.

The government had "expanded the laboratory network and referral hospitals", had conducted "mass recruitment of contact tracers" and had provided training for contact tracing, Terawan said, without providing data in support of the claim.

The ministry and the COVID-19 task force are seeking to establish an augmented contact tracing program this month by recruiting, training and deploying contact tracers to 51 cities and regencies in 10 priority provinces.

"We've pushed for [contact-tracing enhancement], but they've only started it just now," Masdalina said.

Tonang Dwi Ardyanto of clinical pathologist association PDS PatKLIn said that even with a large number of labs, testing at their theoretical maximum capacity was not guaranteed because the process depended on the lab's equipment, the number of qualified lab workers and the availability of reagents.

Source: https://www.thejakartapost.com/news/2020/11/10/positivity-rate-remains-high-amid-drop-in-testing-recorded-cases.htm

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