Coronavirus Disease 2019 (COVID-19) World Health Organization Situation Report - 67 Indonesia 11 August 2021 HIGHLIGHTS • In supporting the Ministry of Health (MoH) to increase its capacity to treat COVID-19 patients, WHO has procured 700 oxygen concentrators for Indonesia as critical medical lifesaving supplies. The first consignment arrived on 6 August. WHO also supported MoH in securing 1.6 million antigen-detecting rapid diagnostic tests (Ag-RDTs) to accelerate detection of SARS-CoV-2 and enable swift isolation of cases and timely contact tracing to reduce the transmission of COVID-19 (page 17). • More than 2000 Indonesian COVID-19 research publications from various disciplines and sectors are now accessible through the WHO COVID-19 Research Database, making them more visible and easy to search for national and global researchers, policy-makers and knowledge brokers. This worldwide access followed by systematic utilization of local and global research evidence can facilitate formulation of tailored and targeted public health decisions, evidence-informed pandemic response and systematic application and learning of good practice at national and global levels (pages 18). 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 5 to 11 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 - 67 who.int/indonesia GENERAL UPDATES • On 9 August, the Government of Indonesia announced that the implementation of level 4 restrictions on public activities (Pemberlakuan Pembatasan Kegiatan Masyarakat (PPKM)) across Java and Bali will be extended until 16 August. The decision was made amid the persistently high daily death toll in these regions. PPKM will also be extended for another two weeks in several districts and cities outside Java and Bali due to the increasing number of cases reported over the past several weeks.1 • On 9 August, during a virtual discussion on exclusive breastfeeding in Jakarta, the Head of the Public Health Division of DKI Jakarta Provincial Health Office (PHO) encouraged breastfeeding women to get vaccinated to reduce the risk of infection as per the latest recommendation from the Ministry of Health (MoH). She noted that the benefits of vaccination outweigh the potential risks for breastfeeding women.2 • The Coordinating Minister for Economic Affairs and Head of the COVID-19 Mitigation and National Economic Recovery Team (Komite Penanganan COVID-19 dan Pemulihan Ekonomi Nasional (KPCPEN)) reported an increase in the number of active cases in provinces outside Java and Bali during the week of 1 to 9 August. The highest number of cases were reported in North Sumatra, East Kalimantan, West Sumatra and Riau. The Head of KPCPEN also noted that this increase will have a significant impact on the bed occupancy rate (BOR) in intensive care units (ICU) of COVID-19 referral hospitals in these provinces. On 8 August, MoH reported that the highest ICU BOR was recorded in Gorontalo (91%), followed by West Sumatra (84%), South Sumatra (81%) and Riau (80%). 3 • As of 7 August, MoH reported that Indonesia recorded a total of 1477 COVID-19 cases with variants of concern (VOCs) . A total of 1368 cases of the Delta variant were detected in 25 out of 34 provinces, followed by 62 cases of the Alpha variant and 17 cases of the Beta variant. The majority of the Delta variant cases were reported in DKI Jakarta (425 cases), followed by West Java (281), Central Java (191) and East Kalimantan (187).4 1 https://jakartaglobe.id/news/indonesia-extends-covid-lockdown-amid-death-toll-concerns 2 https://en.antaranews.com/news/183058/jakarta-health-office-urges-breastfeeding-women-to-get-vaccinatedv 3 https://www.cnnindonesia.com/nasional/20210809210409-20-678454/kasus-aktif-luar-jawa-bali-naik-124- persen-sumut-tertinggi 4 https://go.kompas.com/read/2021/08/09/182056974/delta-variant-dominant-strain-in-indonesia-as-of-aug- 7?page=all#page2 2 WHO Indonesia Situation Report - 67 who.int/indonesia SURVEILLANCE • On 11 August, 30 625 new and 3 749 446 cumulative cases were reported nationwide (Fig. 2). From 5 to 11 August, the average number of new cases per day was 30 983; a decrease compared to the average of 34 977 cases per day in the previous week. 60000 4000000 3500000 50000 3000000 40000 2500000 30000 2000000 1500000 Daily number 20000 1000000 Cumulative number 10000 500000 0 0 8-Jul 2-Jan 4-Jun 9-Oct 5-Apr 5-Sep 5-Feb 2-Aug 16-Jul 25-Jul 2-Mar 9-May 1-May 19-Jan 12-Jun 29-Jun 21-Jun 26-Oct 22-Apr 14-Apr 22-Sep 22-Feb 16-Dec 19-Aug 11-Aug 12-Nov 29-Nov 19-Mar 11-Mar 28-Mar 26-May 18-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 11 August 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 - 67 who.int/indonesia • During the week of 2 to 8 August, 10 out of 34 provinces, all outside of Java, continued to experience an overall increase in the number of reported cases. Five provinces experienced an increase of 25% or more: East Nusa Tenggara (40%), Central Sulawesi (40%), Aceh (29%), Gorontalo (27%) and Bangka Belitung Islands (26%) (Fig. 3). Therefore, stringent public health and social measures (PHSM) should continue to be implemented throughout the country. Provinces experiencing an increase in cases are urgently called to take a swift action to increase the hospital capacity. East Nusa Tenggara Central Sulawesi Aceh Gorontalo Bangka Belitung Islands South Kalimantan West Sumatra Southeast Sulawesi North Sumatra Lampung Bali West Kalimantan North Kalimantan East Kalimantan West Sulawesi South Sulawesi North Sulawesi Jambi Central Java North Maluku Riau Central Kalimantan Riau Islands Bengkulu West Nusa Tenggara DI Yogyakarta Papua East Java West Papua Banten South Sumatra West Java DKI Jakarta Maluku -60% -40% -20% 0% 20% 40% 60% Percentage change of weekly number of confirmed cases Fig. 3. Percent change of weekly number of confirmed cases by province during 2 to 8 August 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 - 67 who.int/indonesia • During the week of 2 to 8 August, the incidence5 of COVID-19 cases decreased from 110.8 per 100 000 population in the previous week to 98.0 per 100 000 population at the national level (Fig. 4). Despite the observed decrease, the incidence was three-fold greater than the previously recorded highest incidence in February (31.5 per 100 000 population). It is important to note that, during the same period, the number of suspected cases tested decreased from 4.01 per 1000 population per week to 3.53 per 1000 population per week. 120 105 90 CT3 (50 - <150) 75 60 Case incidence 45 CT2 (20 - <50) 30 15 CT1 (<20) 0 13/04 - 19/04 11/05 - 17/05 08/06 - 14/06 06/07 - 12/07 03/08 - 09/08 31/08 - 06/09 28/09 - 04/10 26/10 - 01/11 23/11 - 29/11 21/12 - 27/12 18/01 - 24/01 15/02 - 21/02 15/03 - 21/03 12/04 - 18/04 10/05 - 16/05 07/06 - 13/06 05/07 - 11/07 02/08 - 08/08 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 8 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. 4) and subnational levels (Figs. 5 to 10). 5 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.