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(COVID-19) Situation Report Coronavirus Disease 2019 (COVID-19) World Health Organization Situation Report - 64 Indonesia 21 July 2021 HIGHLIGHTS • As of 21 July, the Government of Indonesia reported 2 983 830 (33 772 new) confirmed cases of COVID-19, 77 583 (1 383 new) deaths and 2 356 553 recovered cases from 510 districts across all 34 provinces.1 • During the week of 12 to 18 July, 32 out of 34 provinces reported an increase in the number of cases while 17 of them experienced a worrying increase of 50% or more; 21 provinces (8 new provinces added since the previous week) have now reported the Delta variant; and the test positivity proportion is over 20% in 33 out of 34 provinces despite their efforts in improving the testing rates. Indonesia is currently facing a very high transmission level, and it is indicative of the utmost importance of implementing stringent public health and social measures (PHSM), especially movement restrictions, throughout the country. Fig. 1. Geographic distribution of cumulative number of confirmed COVID-19 cases in Indonesia across the provinces reported from 15 to 21 July 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 https://covid19.go.id/peta-sebaran-covid19 1 WHO Indonesia Situation Report - 64 who.int/indonesia GENERAL UPDATES • On 19 July, the Government of Indonesia reported 1338 new COVID-19 deaths nationwide; a record high since the beginning of the pandemic in the country. The National COVID-19 Task Force informed on the same day that the highest daily count of deaths was reported in East Java (359), followed by Central Java (278) and DKI Jakarta (250).2 • The Head of the Federation of Indonesian Labour Unions (Federasi Serikat Buruh Persatuan Indonesia (FSBPI)) reported on 19 July that thousands of day workers in textile, garment, shoe and leather industries across Indonesia have contracted COVID-19 within a span of two weeks. This alarming number was mainly due to workers reporting to work even when they developed mild symptoms. Their main concern was the loss of daily wage as a result of self-isolation or quarantine. Urgent attention is needed to control COVID-19 transmission in these industries.3 • On 18 July, the Deputy Head of the Indonesian Medical Association (Ikatan Dokter Indonesia (IDI)) reported that hospitals in Java and Bali continued to struggle with the surge of COVID-19 patients. IDI requested the government to extend the implementation of the emergency restrictions on public activities (Pemberlakuan Pembatasan Kegiatan Masyarakat (PPKM) Darurat) to curb the transmission and reduce the burden to the health system. In addition, IDI highlighted that implementation of emergency PPKM also needs to be expanded to other provinces experiencing the similar upward trend of COVID-19 cases4. IDI also reported that a total of 114 doctors have died due to COVID-19 between 1 and 17 July. With the continued increase in cases, IDI noted that the Indonesian health system may soon collapse if stringent measures are not urgently implemented.5 2 https://www.cnnindonesia.com/nasional/20210719170949-20-669677/kematian-covid-19-ri-pecah-rekor-jatim- penyumbang-terbanyak 3 https://www.cnbcindonesia.com/news/20210719154151-4-262064/pekerja-positif-covid-gentayangan-klaster- pabrik-meledak 4 https://nasional.kompas.com/read/2021/07/19/14070201/masih-terjadi-overload-pasien-di-rs-idi-minta- pemerintah-perpanjang-ppkm?page=all 5 https://www.reuters.com/business/healthcare-pharmaceuticals/indonesia-reports-record-number-doctor- deaths-covid-19-july-2021-07-18/ 2 WHO Indonesia Situation Report - 64 who.int/indonesia SURVEILLANCE • On 21 July, 33 772 new and 2 983 830 cumulative cases were reported nationwide (Fig. 2). From 15 to 21 July, the average number of new cases per day was 44 826 cases. This was approximately 36% higher than the previous week (41 521 cases per day). 60000 3500000 50000 3000000 2500000 40000 2000000 30000 1500000 Daily number 20000 1000000 number Cumulative 10000 500000 0 0 6-Jul 1-Jul 2-Jan 4-Oct 7-Apr 2-Apr 7-Feb 24-Jul 19-Jul 9-Nov 2-Mar 8-May 20-Jan 18-Jun 13-Jun 22-Oct 25-Apr 20-Apr 16-Sep 25-Feb 15-Dec 11-Aug 29-Aug 27-Nov 20-Mar 15-Mar 13-May 31-May 26-May Daily number of confirmed COVID-19 cases Cumulative number of confirmed COVID-19 cases Fig. 2. Daily and cumulative number of cases reported in Indonesia, as of 21 July 2021. Source of data Disclaimer: Since 10 February 2021, confirmed cases include those who tested positive using nucleic acid amplification test (NAAT) (e.g. polymerase chain reaction (PCR)) or 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. 17); 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, either at the national or subnational level. 3 WHO Indonesia Situation Report - 64 who.int/indonesia • During the week of 12 to 18 July, 32 out of 34 provinces experienced an increase in the number of cases compared to the previous week, and 17 of those provinces experienced an increase of 50% or more. Of which, six provinces experienced an increase of more than 150%: Banten (540%), North Sumatra (238%), Papua (233%), South Kalimantan (196%), East Java (187%) and Jambi (152%) (Fig. 3). This suggests an urgent need for stringent public health and social measures (PHSM), especially movement restrictions, to be implemented throughout the country. Banten North Sumatra Papua South Kalimantan East Java Jambi South Sumatra West Nusa Tenggara Gorontalo West Kalimantan Central Sulawesi East Kalimantan North Sulawesi Bangka Belitung Islands Bengkulu Bali West Sulawesi Riau DI Yogyakarta West Papua West Java South Sulawesi Central Kalimantan Lampung Riau Islands East Nusa Tenggara West Sumatra Southeast Sulawesi Central Java North Maluku North Kalimantan DKI Jakarta Aceh Maluku -100% 0% 100% 200% 300% 400% 500% 600% Percentage change of weekly number of confirmed cases Fig. 3. Percentage change of weekly number of confirmed cases by province during 12 to 18 July 2021 compared to the previous week. Source of data Disclaimer: The number of weekly confirmed cases is calculated taking into consideration the daily number of reported cases. It is important to conduct further investigation if there is a substantial change in new cases, especially in provinces with a change of 50% or more. Other factors, such as testing and contact tracing, may help elucidate the reasons behind substantial changes. Additional indicators, including case incidence and mortality, should be considered to guide adjustment of PHSM. 4 WHO Indonesia Situation Report - 64 who.int/indonesia • During the week of 12 to 18 July, the incidence6 of COVID-19 cases in Indonesia increased substantially from 67.1 per 100 000 population in the previous week to 95.6 per 100 000 population (Fig. 4). The incidence has been rapidly increasing in the country since mid-May and is more than three-fold greater than the previously recorded highest incidence in February (31.5 per 100 000 population). 100 90 CT3 (50 - <150) 80 70 60 50 40 CT2 (20 - <50) Case incidenceCase 30 20 CT1 (<20) 10 0 13/04 - 19/04 27/04 - 03/05 11/05 - 17/05 25/05 - 31/05 08/06 - 14/06 22/06 - 28/06 06/07 - 12/07 20/07 - 26/07 03/08 - 09/08 17/08 - 23/08 31/08 - 06/09 14/09 - 20/09 28/09 - 04/10 12/10 - 18/10 26/10 - 01/11 09/11 - 15/11 23/11 - 29/11 07/12 - 13/12 21/12 - 27/12 04/01 - 10/01 18/01 - 24/01 01/02 - 07/02 15/02 - 21/02 01/03 - 07/03 15/03 - 21/03 29/03 - 04/04 12/04 - 18/04 26/04 - 02/05 10/05 - 16/05 24/05 - 30/05 07/06 - 13/06 21/06 - 27/06 05/07 - 11/07 Fig. 4. Incidence of COVID-19 per 100 000 population per week averaged over a two-week period reported in Indonesia from 13 April 2020 (when Indonesia first reported community transmission in the country) to 18 July 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. 4) and subnational levels (Figs. 5 to 11). 6 Weekly incidence of COVID-19 is calculated as the number of new cases per 100 000 population per week averaged over a two-week period. Source of population data 5 WHO Indonesia Situation Report - 64 who.int/indonesia • During the week of 12 to 18 July, six provinces, as opposed to two provinces in the previous week, were at the highest level of community transmission (CT4).
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