(COVID-19) Situation Report

Home , Bangka Belitung Islands, Central Java, Central Kalimantan, Central Sulawesi, East Java, East Kalimantan

Coronavirus Disease 2019 (COVID-19) World Health Organization Situation Report - 69 n Indonesia

25 August 2021

HIGHLIGHTS

• The region of Kalimantan recorded the highest case incidence compared to other regions in Indonesia, as of 22 August. East and North Kalimantan provinces contributed to the increase in new cases in this region over the past six weeks. As of 22 August, East Kalimantan also reported the highest weekly number of confirmed deaths per 100 000 population (13.0), followed by North Kalimantan (12.3).

• As of 23 August, provinces with the highest percentage of unvaccinated (zero dose) health workers were Papua (18.6%) and Maluku (13%). Ten provinces reported a proportion of unvaccinated older populations greater than or equal to 90%: Aceh, West Sumatra, North Maluku, Papua, Lampung, West Papua, West Sulawesi, Southeast Sulawesi, Central Sulawesi and South Kalimantan. Continued efforts to further improve the accessibility and awareness of the benefits of COVID-19 vaccination among older and high-risk populations remain critical to reduce mortality.

Fig. 1. Geographic distribution of confirmed COVID-19 cases reported in the last seven days per 100 000 population in Indonesia across provinces reported from 19 to 25 August 2021. Source of data

Disclaimer: The number of cases reported daily is not equivalent to the number of persons who contracted COVID-19 on that day; reporting of laboratory-confirmed results may take up to one week from the time of testing.

1 WHO Indonesia Situation Report - 69 who.int/indonesia GENERAL UPDATES

• On 19 August, Indonesia received close to 1.6 million doses of Pfizer-BioNTech COVID-19 vaccine, which was the first consignment of 50 million doses the government has procured from the manufacturer.1 On the same day, Indonesia also received an additional 450 000 doses of AstraZeneca vaccine from the Netherlands. The Minister of Foreign Affairs stated that this was the first batch of a total of three million doses of AstraZeneca vaccine committed to Indonesia through COVAX’s dose-sharing mechanism.2 On 23 August, the DKI Jakarta Provincial Health Office (PHO) reported that the province has received a total of 232 824 doses of Pfizer-BioNTech COVID-19 vaccine allocated by the Ministry of Health (MoH) and has begun to administer the vaccine to its residents.3

• As the government eased several mobility restrictions on public activities, an increasing trend in community mobility was observed over the past several weeks. On 18 August, the government’s spokesperson for the COVID-19 response, Dr Reisa Broto Asmoro, noted that the government has recorded over one million public visits to shopping centres through the PeduliLindungi application (developed by the government to support COVID-19 response and mobility tracking). She urged the public to remain alert to a potential increase in the number of confirmed cases in subsequent weeks as an impact of increased mobility and to strictly adhere to the health protocols.4

• Amid the declining trend in COVID-19 cases reported at the national level, the COVID-19 Task Force (Satuan Tugas (Satgas)) noted that Bangka Belitung Islands and East Kalimantan still reported bed occupancy rates (BOR) of isolation rooms and intensive care units (ICUs) above 80% as of 17 August. Satgas also reported that at district/city level, BOR was still above 80% in 27 out of 514 districts/cities, particularly those outside Java. Another 78 districts/cities reported a BOR above 60%.5

1 https://jakartaglobe.id/business/first-pfizer-vaccine-delivery-arrives-in-indonesia 2 https://nowjakarta.co.id/people/commitment/the-netherlands-to-donate-3-million-vaccine-doses-to-indonesia 3 https://en.tempo.co/read/1497813/jakarta-officially-rolls-out-pfizer-vaccinations 4 https://en.antaranews.com/news/184666/spokesperson-cautions-of-covid-19-case-surge-in-upcoming-three- weeks 5 https://www.antaranews.com/berita/2335958/satgas-covid-19-dua-provinsi-masih-memiliki-bor-diatas-80- persen 2 WHO Indonesia Situation Report - 69 who.int/indonesia SURVEILLANCE

• On 25 August, 18 671 new and 4 026 837 cumulative cases were reported nationwide. The weekly number of cases from 16 to 22 August was 125 102, a decrease of more than 30% compared to the previous week. As of 25 August, Indonesia reported 1041 new and 129 293 cumulative number of COVID-19 deaths. The weekly number of new deaths from 16 to 22 August was 8784, a decrease of 16% compared to the previous week (Fig. 2).

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Weekly number of confirmed COVID-19 cases Weekly number of confirmed COVID-19 deaths

Fig. 2. Weekly number of confirmed COVID-19 cases and deaths reported in Indonesia, as of 22 August 2021. Source of data Disclaimer : Prior to 10 February 2021, SARS-CoV-2 diagnosis was conducted using polymerase chain reaction (PCR). Afterwards, confirmed cases include those who tested positive using nucleic acid amplification test (NAAT) (e.g. PCR) and antigen-detecting rapid diagnostic test (Ag-RDT). The number of cases reported daily is not equivalent to the number of persons who contracted COVID-19 on that day and might be influenced by the number of people tested on that day (see Fig. 9); reporting of laboratory -confirmed results may take up to one week from the time of testing. Therefore, caution must be taken in interpreting this figure and the epidemiological curve for further analysis, both at the national and subnational level.

3 WHO Indonesia Situation Report - 69 who.int/indonesia

• As of 22 August, the weekly case incidence per 100 000 population nationwide, in Java-Bali region and in provinces outside of the region (non-Java-Bali) were 66.6, 61.1 and 74.0, respectively (Fig. 3). An overall declining trend was observed. However, the weekly case incidence has remained at the level of high incidence (CT3) over the past eight weeks in Java-Bali region and the past five weeks in non-Java-Bali region. Province and district-level analyses are imperative to evaluate these trends.

165 CT4 (150+) 150 135 120 105 90 CT3 (50 - <150) 75

Case Case incidence 60 45 30 CT2 (20 - <50) 15 CT1 (<20)

17/08 - 23/0817/08- 20/0914/09- 18/1012/10- 13/0419/04- 27/0403/05- 11/0517/05- 25/0531/05- 08/0614/06- 22/0628/06- 06/0712/07- 20/0726/07- 03/0809/08- 31/0806/09- 28/0904/10- 26/1001/11- 09/1115/11- 23/1129/11- 07/1213/12- 21/1227/12- 04/0110/01- 18/0124/01- 01/0207/02- 15/0221/02- 01/0307/03- 15/0321/03- 29/0304/04- 12/0418/04- 26/0402/05- 10/0516/05- 24/0530/05- 07/0613/06- 21/0627/06- 05/0711/07- 19/0725/07- 02/0808/08- 16/0822/08-

Non-Java-Bali region Java-Bali region National

Fig. 3. Incidence of COVID-19 per 100 000 population per week averaged over a two-week period reported at national and subnational levels (Java-Bali and non-Java-Bali) from 13 April 2020 (when Indonesia first reported community transmission in the country) to 22 August 2021, classified by level of community transmission (CT): CT1: low incidence; CT2: moderate incidence; CT3: high incidence; CT4: very high incidence. Source of data

Disclaimer: There are seven categories for transmission classification: (1) no (active) cases; (2) imported/sporadic cases; (3) cluster of cases; (4) community transmission 1 (CT1); (5) community transmission 2 (CT2); (6) community transmission 3 (CT3); and (7) community transmission 4 (CT4).

Caution should be exercised when interpreting this indicator due to limitations listed in the WHO interim guidance. Other epidemiological indicators also need to be evaluated to decide on the level of community transmission. This disclaimer applies to indicators at national (Fig. 3) and subnational levels (Fig. 4-5).

4 WHO Indonesia Situation Report - 69 who.int/indonesia

• During the week of 16 to 22 August, six provinces (highlighted in light red) remained at the highest level of community transmission (CT4), with incidence rates per 100 000 population of 354.0 in North Kalimantan, 232.0 in East Kalimantan, 220.9 in Bangka Belitung Islands, 213.7 in DI Yogyakarta, 195.5 in Bali and 176.2 in Central Sulawesi (Fig. 4). Based on the WHO interim guidance, this means that there was a very high risk of COVID-19 infection for the general public and a very high number of locally acquired, widely dispersed cases detected in the past 14 days. There were 16 provinces at community transmission level 3 (CT3).

North Kalimantan East Kalimantan Bangka Belitung Islands DI Yogyakarta Bali Central Sulawesi West Papua South Kalimantan East Nusa Tenggara Riau Central Kalimantan Riau Islands DKI Jakarta North Sulawesi Central Java Gorontalo West Sumatra West Sulawesi South Sulawesi North Sumatra Jambi Bengkulu East Java West Kalimantan Aceh Papua West Java North Maluku Lampung South Sumatra West Nusa Tenggara Southeast Sulawesi Banten Maluku 0 100 200 300 400 500 Weekly case incidence

CT 1 (<20) CT 2 (20-<50) CT 3 (50 - <150) CT 4 (150+)

Fig. 4. Incidence of COVID-19 per 100 000 population per week averaged over a two-week period by province in Indonesia during 16 to 22 August 2021, classified by level of community transmission (CT): CT1: low incidence; CT2: moderate incidence; CT3: high incidence; CT4: very high incidence. Source of data

5 WHO Indonesia Situation Report - 69 who.int/indonesia

• As of 22 August, the region of Kalimantan recorded the highest case incidence compared to other regions in the country. East and North Kalimantan provinces contributed to the increase in new cases in this region in the last six weeks. Sulawesi and Sumatra regions also showed a significant increase in case incidence from late June until the second week of August. From 19 July to 15 August, case incidence plateaued in Nusa Tenggara-Maluku-Papua region and has since been decreasing. In Java-Bali a downward trend has been observed over the past four weeks (Fig. 5). Details of case incidence in each province are available here.

165 CT4 (150+) 150

135 Kalimantan 120

105 CT3 (50 - <150) 90 Sulawesi 75 Sumatra Case Case incidence 60 Java - Bali Nusa Tenggara- Maluku-Papua 45 CT2 (20 - <50)

15 CT1 (<20)

01/03 - 07/0301/03- 11/0405/04- 01/0826/07- 04/0110/01- 11/0117/01- 18/0124/01- 25/0131/01- 01/0207/02- 08/0214/02- 15/0221/02- 22/0228/02- 08/0314/03- 15/0321/03- 22/0328/03- 29/0304/04- 12/0418/04- 19/0425/04- 26/0402/05- 03/0509/05- 10/0516/05- 17/0523/05- 24/0530/05- 31/0506/06- 07/0613/06- 14/0620/06- 21/0627/06- 28/0604/07- 05/0711/07- 12/0718/07- 19/0725/07- 02/0808/08- 09/0815/08- 16/0822/08-

Java-Bali Sumatra Kalimantan Sulawesi Nusa Tenggara-Maluku-Papua

Fig. 5. Incidence of COVID-19 cases per 100 000 population per week averaged over a two-week period in five regions in Indonesia (Java-Bali, Sumatra, Kalimantan, Sulawesi and Nusa

Tenggara-Maluku-Papua), from 4 January to 22 August 2021, classified by level of community transmission (CT1): CT1: low incidence; CT2: moderate incidence; CT3: high incidence; CT4: very high incidence. Source of data

6 WHO Indonesia Situation Report - 69 who.int/indonesia

• Nationwide test positivity proportion increased sharply in December 2020 and reached its first peak of 28.8% in late January 2021. It declined thereafter and varied between 9% and 20% between mid-March and end of June (corresponding to CT3 – high incidence). Since then, however, the positivity proportion increased rapidly and reached CT4 (very high incidence). As of 22 August, the positivity proportion slightly declined from 21.4% in the previous week to 18.2% (Fig. 6). The percentage of positive samples can be interpreted reliably only with comprehensive surveillance and testing in the order of one person tested per 1000 population per week. As of 22 August, 27 out of 34 provinces have reached this minimum case detection benchmark (Table 2. Weekly Risk Assessment, page 21).

4.5 35%35.0% 4.0 30%30.0% 3.5 CT 4 25%25.0% 3.0

2.5 20%20.0%

2.0 15%15.0% 1.5 CT 3 10%10.0%

1.0 Test Test positivity proportion

People People tested/1000 population/week 5%5.0% 0.5 CT 1 CT 2

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01/03 - 07/03 - 01/03 27/04 - 27/04 03/05 - 25/05 31/05 - 22/06 28/06 - 20/07 26/07 - 17/08 23/08 - 14/09 20/09 - 12/10 18/10 - 09/11 15/11 - 07/12 13/12 - 04/01 10/01 - 01/02 07/02 - 29/03 04/04 - 26/04 02/05 - 24/05 30/05 - 21/06 27/06 - 19/07 25/07 - 16/08 22/08

People tested/1000 population Test positivity proportion

Fig. 6. Weekly test positivity proportion and people tested per 1000 population per week at the national level, as of 22 August 2021, classified by level of community transmission (CT): CT1: low incidence (<2%); CT2: moderate incidence (2% - <5%); CT3: high incidence (5% - <20%); CT4: very high incidence (20%+). Source of data Disclaimer : Caution should be exercise when interpreting this indicator due to limitations listed in the WHO interim guidance. Other epidemiological indicators also need to be evaluated to determine the level of community transmission.

7 WHO Indonesia Situation Report - 69 who.int/indonesia

• As of 22 August, East Kalimantan reported the highest weekly number of confirmed COVID-19 deaths per 100 000 population, followed by North Kalimantan, DI Yogyakarta, Bangka Belitung Islands, Central Java, Bali, Central Sulawesi, Riau Islands and East Java, which remained at the highest level of community transmission (CT4) since mid-July (Fig. 7).

East Kalimantan North Kalimantan DI Yogyakarta Bangka Belitung Islands Central Java Bali Central Sulawesi Riau Islands East Java Central Kalimantan South Kalimantan Gorontalo Lampung Riau DKI Jakarta South Sumatra North Sulawesi West Sumatra East Nusa Tenggara West Sulawesi South Sulawesi Aceh West Java Bengkulu West Papua Jambi North Sumatra West Kalimantan North Maluku Southeast Sulawesi Banten Papua West Nusa Tenggara Maluku 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0

Weekly number of confirmed COVID-19 deaths per 100 000 population CT 1 (<1) CT 2 (1 - <2) CT 3 (2 - <5) CT 4 (5+)

Fig. 7. Number of confirmed COVID-19 deaths per 100 000 population per week averaged over a two-week period by province in Indonesia during 16 to 22 August 2021, classified by level of community transmission (CT): CT1: low incidence; CT2: moderate incidence; CT3: high incidence; CT4: very high incidence. Source of data Disclaimer : Based on data availability, only confirmed COVID-19 deaths have been included. As per WHO definition, however, death resulting from a clinically compatible illness in a probable or confirmed COVID-19 case is a COVID-19-related death, unless there is a clear alternative cause of death that cannot be related to COVID-19 (e.g. trauma); there should be no period of complete recovery between the illness and death. Evaluation of excess mortality is also beneficial to complement information on COVID-19 death. 8 WHO Indonesia Situation Report - 69 who.int/indonesia

• At national level, during the week of 16 to 22 August, the number of confirmed COVID-19 deaths in Indonesia was 3.8 deaths per 100 000 population, compared to 4.2 deaths in the previous week. Nationwide, a rapid increase in the number of deaths was observed from late June until the first week of August. Similar increasing trend was observed until the week of 2 to 8 August in Java-Bali region, and the week of 9 to 15 August in non-Java-Bali region. During the week of 16 to 22 August, the weekly number of confirmed COVID-19 deaths per 100 000 population remained at CT3 (high incidence) in both Java-Bali and non-Java-Bali regions (Fig. 8).

CT4 (5+) 5

3 CT3 (2 - <5)

CT2 (1 - <2) Deaths Deaths per 000 100 population 1 CT1 (<1)

13/0419/04- 27/0403/05- 11/0517/05- 25/0531/05- 08/0614/06- 22/0628/06- 06/0712/07- 20/0726/07- 03/0809/08- 17/0823/08- 31/0806/09- 14/0920/09- 28/0904/10- 12/1018/10- 26/1001/11- 09/1115/11- 23/1129/11- 07/1213/12- 21/1227/12- 04/0110/01- 18/0124/01- 01/0207/02- 15/0221/02- 01/0307/03- 15/0321/03- 29/0304/04- 12/0418/04- 26/0402/05- 10/0516/05- 24/0530/05- 07/0613/06- 21/0627/06- 05/0711/07- 19/0725/07- 02/0808/08- 16/0822/08-

Non-Java-Bali region Java-Bali region National

Fig. 8. Weekly number of confirmed COVID-19 deaths per 100 000 population at national level and in Java-Bali and non-Java-Bali regions, as of 22 August 2021. Source of data

Disclaimer: Based on data availability, only confirmed COVID-19 deaths have been included. As per WHO definition, however, death resulting from a clinically compatible illness in a probable or confirmed

COVID-19 case is a COVID-19-related death, unless there is a clear alternative cause of death that cannot be related to COVID-19 (e.g. trauma); there should be no period of complete recovery between the illness and death.

9 WH O Indonesia Situation Report - 69 who.int/indonesia

HEALTH OPERATIONS

• Since the beginning of the implementation of emergency restrictions on public activities (Pemberlakuan Pembatasan Kegiatan Masyarakat (PPKM) Darurat) on 3 July 2021, a substantial increase in testing has been reported at the national and subnational levels. Currently, antigen-detecting rapid diagnostic tests (Ag-RDT) and nucleic acid amplification tests (NAAT) have been used to diagnose COVID-19. In the last seven days, a decrease in new confirmed cases and number of people tested was observed (Fig. 9). As of 23 August, the number of people tested using NAAT decreased significantly to 21 178, compared to the highest recorded number on 15 July (119 586). In this same time period, the proportion of people tested by NAAT (vs. Ag-RDT) also decreased from 64.5% to 28.5%. It is crucial to identify underlying reasons behind the decrease in the proportion of testing using NAAT, and to evaluate the current capacity of NAAT laboratories and Ag-RDT implementation.

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12-Jul 15-Jul 18-Jul 21-Jul 24-Jul 27-Jul 30-Jul

11-Aug 14-Aug 17-Aug 20-Aug 23-Aug NAAT Antigen RDT Confirmed COVID-19 cases

Fig. 9. Number of confirmed COVID-19 cases and people tested per day, from 3 July to 23 August 2021. Source of data

10 WHO Indonesia Situation Report - 69 who.int/indonesia

• As of 22 August, the number of COVID-19 cases hospitalized in DKI Jakarta has slightly increased to 2947 cases from 2901 cases in the previous week. As of the same day, the number of cases in self-isolation decreased to 5584 cases from 6755 cases on 15 August. The number of cases hospitalized has decreased by 86.3% since 15 July, while the number of cases in self-isolation has decreased by 88.8% since 1 July (Fig. 10).

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0 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-Jul 1-Aug

Hospitalized Self-isolation

Fig. 10. Number of COVID-19 cases hospitalized and in self-isolation in DKI Jakarta, from 1 September 2020 to 22 August 2021. Source of data

• Based on data published by MoH, the overall BOR in COVID-19 referral hospitals has decreased at the national level. As of 22 August, BOR at the national level was 33%, compared to 52% on 8 August. As of the same day, ICU BOR was 47%, compared to 64% on 8 August. As of 23 August, the total number of isolation beds available has increased to 126 211 (almost three times higher than the 47 056 beds available on 17 May). However, it is important to note that BOR continues to 6 increase in several provinces.

6 https://www.kemkes.go.id/article/view/21081700003/Data-Ketersediaan-Tempat-Tidur-RS-COVID-19.html 11 WHO Indonesia Situation Report - 69 who.int/indonesia • Supported by WHO, MoH has distributed 582 oxygen concentrators to Bengkulu, DKI Jakarta, South Sulawesi, South Sumatra, West Nusa Tenggara and West Sumatra as of 24 August. These oxygen concentrators are part of the 700 concentrators procured by WHO. On 23 August, a total of 35 oxygen concentrators were also distributed to Muhammadiyah COVID-19 centres in DKI Jakarta and two hospitals in Bulukumba and Sidrap Districts of South Sulawesi.

RISK COMMUNICATION

• WHO continues to translate and share important health messages on its website and social medial platforms – Twitter and Instagram – and has recently published:

Infographics: - Do it all - Authorized vaccines

Posters - 3 Factors

Fig. 11. WHO infographics on ‘Authorized vaccines’, August 2021.

12 WHO Indonesia Situation Report - 69 who.int/indonesia

VACCINATION

• As of 23 August, 90 270 274 vaccine doses have been administered in the national COVID-19 vaccination campaign; 58 023 024 people have been partially vaccinated, and 32 247 250 people have been fully vaccinated (Fig. 12). The weekly trend of COVID-19 vaccine doses administered from 16 to 22 August was 6 148 626 doses, a decrease compared to 7 142 979 doses in the previous week.

100 90 80 70 60 50 40 30 20 10

Bali

Riau

Aceh

Jambi

Papua

Banten

Maluku

East Java East

Lampung

Bengkulu

West Java West

Gorontalo

DKI Jakarta DKI

Riau Islands Riau

Central Java Central

West Papua West

Numberpeople of per 100 population

DI Yogyakarta DI

NorthMaluku

West Sumatra West

North Sumatra North

West Sulawesi West

South Sumatra South

South Sulawesi South

NorthSulawesi

EastKalimantan

Central Sulawesi Central

West Kalimantan West

South Kalimantan South

NorthKalimantan

SoutheastSulawesi

Central Kalimantan Central

East Nusa Tenggara EastNusa

West NusaTenggara West Bangka Belitung Islands Belitung Bangka Fully vaccinated per 100 population Partially vaccinated per 100 population Unvaccinated per 100 population Fig. 12. Number of people fully vaccinated, partially vaccinated and unvaccinated (zero dose) for COVID-19 per 100 total population by province in Indonesia, as of 23 August 2021. Source of data

Note: Source of population data: Target population for health programme 2021, Center of Data and Information, Ministry of Health, unpublished data.

Table 1. COVID-19 vaccination by each target population in Indonesia, as of 23 August 2021. Source of data

Number of Number of Target Total target Number of partially % fully % % population population unvaccinated vaccinated vaccinated

Health workers 1 468 764 118 876 8.1 1 511 295 102.9 0 0

Older people 21 553 118 1 518 756 7.0 3 614 799 16.8 16 419 563 76.2

Essential public service 17 327 167 11 434 298 66.0 17 704 985 102.2 0 0 workers

13 WHO Indonesia Situation Report - 69 who.int/indonesia Number of Number of Target Total target Number of partially % fully % % population population unvaccinated vaccinated vaccinated

General 141 211 181 11 200 966 7.9 7 723 544 5.5 122 286 671 86.6 population

Children aged 26 705 490 1 173 422 4.4 1 292 357 4.8 24 239 711 90.8 12-17

Eligible target 208 265 720 25 775 774 12.4 32 247 250 15.5 150 242 696 72.1 population

Note: General population includes vulnerable groups (e.g. persons with disabilities, marginalized groups, etc.). Disclaimer: Vaccination coverage greater than 100% is due to differences in actual versus estimated target population.

• As of 23 August, provinces with the highest percentage of unvaccinated (zero dose) health workers were Papua (18.6%) and Maluku (13%). 30 out of 34 provinces reported that more than 60% of their older populations remained unvaccinated. Ten provinces reported a proportion of unvaccinated older populations greater than or equal to 90%: Aceh, West Sumatra, North Maluku, Papua, Lampung, West Papua, West Sulawesi, Southeast Sulawesi, Central Sulawesi and South Kalimantan.

• A decrease in the weekly trend of vaccine doses administered was observed in most provinces compared to the previous week. In particular, a declining trend of weekly vaccine doses administered among older populations was observed in most provinces. As of 23 August, provinces which showed a high increase in their weekly trend were: DI Yogyakarta (20.3%), North Sumatra (6.7%) and East Java (6.5%). Details of vaccination by province and target populations are available here.

• On 13 and 18 August, WHO assisted MoH to conduct virtual training sessions to disseminate the guideline on handling procedure and management of Pfizer-BioNTech COVID-19 vaccine, including management of ultra-cold chain and thermal shipper as well as vaccine administration. The sessions were attended by representatives from District Health Offices (DHOs), PHOs and healthcare providers. The first batch of the vaccine which has arrived in the country on 19 August is being distributed to health facilities in DKI Jakarta, Bogor, Depok, Tangerang and Bekasi.

14 WHO Indonesia Situation Report - 69 who.int/indonesia PARTNER COORDINATION

• On 20 August, WHO convened the 36th meeting of key development partners to discuss and coordinate the COVID-19 response in Indonesia. The meeting was attended by Asian Development Bank (ADB), British Embassy, the Australian Government Department of Foreign Affairs and Trade (DFAT), the European Union (EU), Japan International Cooperation Agency (JICA), United Nations Children’s Fund (UNICEF), United States Agency for International Development (USAID), United States Centers for Disease Control and Prevention (US CDC) and the World Food Programme (WFP). WHO presented COVID-19 updates, discussed the latest epidemiological situation at national and subnational levels, and presented the key WHO activities in support of the national pandemic response. In addition, the key points of discussion among partners included COVID-19 vaccination logistics, vaccine effectiveness studies, and support of oxygen and other medical supplies.

• On 19 August, WHO participated in the fifth United Nations (UN) in Indonesia Townhall Meeting, which virtually connected over 550 colleagues from UN organizations across the country. The WHO Representative to Indonesia Dr N. Paranietharan presented the COVID-19 situation, vaccination trends and weekly risk assessment by province.

• The overall funding request for WHO operations and technical assistance is US$ 46 million (US$ 27 million for response and US$ 19 million for recovery phase), based on estimated needs as of August 2021 (Fig. 13).

Fig. 13. WHO funding situation for COVID-19 response, August 2021. 15 WHO Indonesia Situation Report - 69 who.int/indonesia COVID-19 AND MOBILITY ANALYSIS

• Mobility analysis can be used as a proxy to monitor population mobility during the implementation of movement restriction policies. Increased mobility may lead to increased interactions among people, which may affect COVID-19 transmission. More information on movement restriction policies implemented in Indonesia and previous analyses on mobility trends in Java and Bali are available in WHO Situation Report 63 (pages 27-31), Situation Report 64 (pages 34-38), Situation Report 65 (pages 30-33), Situation Report 66 (pages 29-33), Situation Report 67 (pages 24-28) and Situation Report 68 (pages 20-24). Updates on mobility analysis in DKI Jakarta, Banten and Central Java are presented in Fig. 14-16. Updates on mobility analysis in other provinces in Java and Bali are available here.

• Considering the current epidemiological situation at national and subnational levels, on 23 August, the Government of Indonesia announced the continuation of implementation of level 3 and 4 PPKM until 30 August in Java and Bali and 6 September in provinces outside Java and Bali. Level 4 PPKM will be implemented in 52 districts in Java-Bali and 34 districts outside Java-Bali.

• An increasing trend in community mobility was observed in all provinces in Java and Bali, particularly in transit stations and retail and recreation. A notable increase in community mobility in retail and recreation was observed particularly in Banten and Central Java, where pre-pandemic mobility levels have been reached. Formulation of a concrete plan is necessary to anticipate and mitigate the possible impact of increased mobility on transmission and health system capacity at national and subnational levels.

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Fig. 14. Mobility analysis in DKI Jakarta, as of 21 August 2021

Holiday periods: 1. Eid al-Fitr 2020; 2. Eid al-Adha 2020; 3. Mawlid (Prophet Muhammad’s Birthday) 2020; 4. Christmas and New Year 2021; 5. Eid al-Fitr 2021; 6. Eid al-Adha 2021.

Note: The baseline day is the median value from the 5-week period from 3 January to 6 February 2020 (prior to the first reported cases in Indonesia). Mobility is calculated for the report date (unless there are gaps) and reported as a positive or negative percentage change compared to the baseline day. Source of data: mobility; cases.

Disclaimer: Mobility analysis cannot demonstrate a cause and effect relationship between mobility and COVID-19 cases; interpretation should be based on the use of proxy measures for mobility to examine association with cases. This note and disclaimer apply to Fig. 14-16.

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Fig. 15. Mobility analysis in Central Java, as of 21 August 2021. Source of data: mobility; cases.

Fig. 16. Mobility analysis in Banten, as of 21 August 2021. Source of data: mobility; cases.

18 WHO Indonesia Situation Report - 69 who.int/indonesia WEEKLY RISK ASSESSMENT

Table 2. Weekly risk assessment by province in Indonesia, as of 22 August 2021.

Change in Change in Testing rate Weekly 2nd dose 2nd dose Cumulative Case New cases New death new cases in new death in (per 1000 positivity rate vaccination vaccination number of Delta Province incidence in last 7 in last 7 last 7 days last 7 days population in the last 7 among target among older variant cases trend days days (%) (%) per week) days (%) population (%) population (%) reported Aceh Increase 2644 19% 132 36% 0.96 50.6% 9.5% 2.9% 18 North Sumatra Increase 7663 -20% 205 -15% 1.89 27.5% 12.4% 15.2% 29 West Sumatra Increase 2393 -37% 92 -32% 2.59 16.8% 8.7% 3.4% 75 Riau Increase 4794 -31% 235 -25% 2.17 31.0% 14.0% 11.1% 6 Jambi Increase 1845 -17% 51 -15% 1.16 43.1% 15.6% 17.3% 1 South Sumatra Increase 1703 -42% 158 -17% 1.17 17.0% 11.6% 12.2% 9 Bengkulu Increase 624 -48% 48 20% 0.86 35.8% 11.2% 12.0% 3 Lampung Increase 2279 -24% 294 -16% 0.52 51.4% 7.5% 5.7% 3 Bangka Belitung Islands Increase 2434 -27% 98 -30% 2.41 66.5% 14.6% 22.6% 5 Riau Islands Decrease 1271 -32% 100 -22% 3.75 15.1% 27.5% 27.9% 3 DKI Jakarta Decrease 5490 -39% 151 -40% 8.03 6.4% 59.5% 72.9% 576 West Java Decrease 14062 -22% 1112 13% 0.95 29.7% 11.5% 13.5% 280 Central Java Decrease 15056 -53% 2329 -16% 1.50 28.8% 13.3% 23.1% 190 DI Yogyakarta Decrease 6150 -30% 285 -27% 8.24 19.2% 20.3% 28.6% 20 East Java Decrease 14354 -31% 1570 -26% 1.30 27.7% 15.2% 13.3% 20 Banten Decrease 2252 -43% 77 -51% 1.30 13.1% 14.0% 15.5% 20 Bali Increase 6113 -38% 406 51% 7.89 17.7% 47.2% 33.0% 23 West Nusa Tenggara Decrease 1334 -24% 39 400% 0.91 28.6% 8.3% 9.4% 42 East Nusa Tenggara Increase 3499 -32% 78 -43% 1.39 45.5% 11.1% 7.1% 102 West Kalimantan Increase 2176 -14% 95 53% 1.65 25.6% 10.4% 8.5% 28 Central Kalimantan Increase 2052 -23% 47 -71% 2.20 33.7% 15.5% 21.1% 3 South Kalimantan Increase 4238 -7% 207 6% 2.37 41.5% 11.2% 6.9% 1 East Kalimantan Increase 5471 -39% 374 -22% 4.89 29.5% 14.9% 21.7% 187 North Kalimantan Increase 2050 -27% 61 -47% 4.85 55.0% 11.9% 15.4% 16 North Sulawesi Increase 1474 -25% 43 -34% 1.47 39.7% 14.7% 10.5% 8 Central Sulawesi Increase 4159 -25% 172 -17% 1.34 100.0% 10.0% 6.4% 20 South Sulawesi Increase 3844 -38% 152 -16% 2.37 18.2% 13.6% 7.8% 14 Southeast Sulawesi Increase 562 -27% 25 -22% 0.71 28.6% 11.2% 5.0% 0 Gorontalo Increase 581 -39% 52 -10% 1.62 29.4% 12.7% 5.8% 1 West Sulawesi Increase 656 -41% 32 0% 0.91 51.2% 9.4% 4.3% 0 Maluku Decrease 157 -60% 7 75% 1.03 8.3% 8.7% 9.0% 9 North Maluku Decrease 219 -43% 21 50% 1.76 9.7% 7.6% 3.5% 0 West Papua Increase 321 -81% 16 -20% 5.88 5.6% 13.3% 5.6% 12 Papua Increase 1182 -10% 20 -33% 1.33 25.9% 10.5% 4.4% 12

Source of data: Cases, deaths and testing; vaccination

Note: Case incidence considers the trend of cases over the last three weeks. The change in new cases in the last seven days is marked as light red if there is an increase of 50% compared to the previous week. The change in new deaths is marked as light red if there is any increase in the percentage of deaths (and number of deaths ≥ 10) compared to the previous week. The testing rate is marked as yellow if it is less than 1/1000 population. Test positivity proportion is marked as light red if ≥ 20% and yellow if between 5% and 20%. The second dose vaccination is marked as light red if < 5% and yellow if between 5% and 10%. Target population for vaccination includes health workers, essential public service workers, older persons, vulnerable populations and people aged 18 years and above and children (aged 12-17 years).

19 WHO Indonesia Situation Report – 69 who.int/indonesia • Continuous action is needed to address the surge of cases, notably in provinces in light red (North Sumatra, West Sumatra, Riau, Bangka Belitung Islands, West Java, Central Java, DI Yogyakarta, East Java, Bali, East Nusa Tenggara, East Kalimantan, North Kalimantan and Gorontalo) and in yellow.

• Continuous implementation of PHSM throughout the country is important, even as the national vaccination coverage increases and expands to additional target groups. PHSM works in the context of variants of concern (VOCs) as demonstrated in India (see Situation Report 60: Lessons Learned) and has proven critical to limiting transmission of COVID-19 and reducing deaths.7

• Increased testing rates were observed in several districts and provinces during the implementation of emergency PPKM. However, as of 22 August, seven out of 34 provinces did not achieve the recommended benchmark of 1 person tested per 1000 population per week: Aceh, Bengkulu, Lampung, West Java, West Nusa Tenggara, Southeast Sulawesi and West Sulawesi. High test positivity proportion (≥ 20%) is still observed in 23 provinces and remains a concern. It is crucial to continue strengthening testing, contact tracing, timely isolation and quarantine in all provinces to break the chain of transmission.

• As of 22 August, the BOR in ICU wards remained above 70% in four provinces (East Kalimantan, Bali, Bangka Belitung Islands and Riau).8 Despite the government’s efforts to improve the situation in Bali, there was a 51% increase in the number of deaths over the past week compared to the previous week. As of the same week, East Kalimantan reported the highest weekly number of confirmed deaths per 100 000 population among all provinces and ICU BOR of 74%. It is highly important to further improve planning and actions to respond to the surge of cases and increased mortality at subnational level, including obtaining data on the needs of critical and lifesaving medical supplies such as oxygen, ventilators and medicines to treat COVID-19 patients.

• The coverage of second-dose vaccination among the older population continues to be low in most provinces. As of 22 August, only DKI Jakarta recorded above 70% coverage among this target group; 16 provinces still reported second-dose coverage below 10%. Continued efforts to further improve the accessibility and awareness of the benefits of COVID-19 vaccination among older and high-risk populations remain critical to reduce morbidity and mortality.

7 https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance-publications 8 https://www.kemkes.go.id/article/view/21081700003/Data-Ketersediaan-Tempat-Tidur-RS-COVID-19.html 20 WHO Indonesia Situation Report – 69 who.int/indonesia

RECENT AND UPCOMING WHO RESOURCE MATERIALS

Table 3. Title and details of recent WHO resource materials

Source : https://www.who.int Title Details WHO Weekly This edition includes epidemiological updates as of 22 August Epidemiological 2021 with a special focus on the phenotypic characteristics of Update on COVID-19 SARS-CoV-2 variants of concern (VOCs), Alpha, Beta, (Edition 54), Gamma and Delta, and their geographic distribution. 24 August 2021

Episode 50 of Dr Soumya Swaminathan, the Chief Scientist at WHO, explains Science in 5, WHO’s natural and vaccine-induced immunity in the context of series of COVID-19. conversations in science, 20 August 2021

21 WHO Indonesia Situation Report – 69 who.int/indonesia A SNAPSHOT OF WHO COURSES AND INFORMATION MATERIAL

Online WHO COVID-19 courses: • Clinical management of patients with COVID-19: General considerations • COVID-19 vaccination training for health workers • Standard precautions: Environmental cleaning and disinfection • Management of COVID-19 in long-term care facilities • Operational planning guidelines and COVID-19 • Clinical management of severe acute respiratory infections • Health and safety briefing for respiratory diseases – eProtect

WHO guidance: • Guidance for surveillance of SARS-CoV-2 variants: Interim guidance, 9 August 2021 • Training on handling, storing and transporting Pfizer BioNTech COVID-19 Vaccine COMIRNATY® (Tozinameran)

Infographics: • Vaccination facts • Health facilities • Vaccine facts • Asymptomatic COVID-19 • Young people and COVID-19 • Managing COVID-19 at home: Checking blood oxygen levels

Questions and answers: • How to talk about vaccines • COVID-19: Vaccines • COVID-19: Vaccine research and development • COVID-19: Vaccine access and allocation

Videos: • Science in 5: Evolution of the SARS-CoV-2 virus • Time to abide (1-10) • COVID-19 virus variants

For more information please feel free to contact: [email protected] WHO Indonesia Reports

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