Coronavirus Disease 2019 (COVID-19) World Health Organization Situation Reportn - 70 Indonesia 1 September 2021 HIGHLIGHTS • As of 1 September, the Government of Indonesia reported 4 100 138 (10 337 new) confirmed cases of COVID-19, 133 676 (653 new) deaths and 3 776 891 recovered cases from 510 districts across 34 provinces.1 As of the same date, the number of people fully vaccinated per 100 population was 13.4 nationwide; DKI Jakarta reported the highest number among all provinces (56.3).2 • As of 29 August, the weekly case incidence per 100 000 population nationwide, in Java-Bali and non-Java-Bali regions were 48.6, 44.0 and 54.9, respectively. The weekly case incidence in non-Java-Bali region has remained at the level of high incidence over the past six weeks. • From 23 to 25 August, WHO supported the Ministry of Health to conduct a monitoring meeting to review the implementation of Intra-Action Review (IAR) recommendations. During the meeting, achievements in response were shared, persistent challenges and gaps were identified and recommendations for the ten pillars of the COVID-19 response were formulated (page 13). 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 26 August to 1 September 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 2 https://vaksin.kemkes.go.id/#/vaccines 1 WHO Indonesia Situation Report - 70 who.int/indonesia GENERAL UPDATES • PT Mass Rapid Transit (MRT) Jakarta observed a significant increase in MRT ridership during the implementation of restrictions on public activities (Pemberlakuan Pembatasan Kegiatan Masyarakat (PPKM)) level 3 from 12 to 29 August. The President Director of PT MRT Jakarta reported that the number of Jakarta MRT passengers during this period was 127 103, an increase of more than 140% compared to 52 497 passengers recorded during the implementation of level 4 PPKM from 27 July to 11 August. The average daily number of MRT passengers has increased to 7061, compared to 3281 passengers during level 4 PPKM. According to their data, PT MRT Jakarta noted that the trend continues to increase every week.3 • The Chairman of the National Coalition on Waste (Koalisi Persampahan Nasional (KPNas)) noted that a surge in healthcare waste remains a concern as Indonesia continues to face the COVID-19 pandemic. He stated that by law, healthcare waste is classified as hazardous waste and requires incineration to prevent the spread of diseases. However, due to the lack of supervision and law enforcement, as well as insufficient certified incinerators across the country, some healthcare waste was disposed of in landfills, which are meant for household waste. According to the Indonesian Hospital Association, hospitals across the country produced around 290 tonnes of medical waste per day prior to the pandemic. The figure has since increased to 493 tonnes per day. In addition, the amount of medical waste generated from isolation facilities and households remains unknown.4 • Many COVID-19 related hoaxes continue to widely circulate in the community, including those on vaccines. During a talk show on 27 August, the government spokesperson for the COVID-19 response emphasized that it is still very important for those who have been infected by COVID-19 to get vaccinated. She explained that vaccines reduce the risk of severe illnesses and mortality. She also dismissed the notion that health protocols need not be followed post-vaccination and reiterated that vaccination does not guarantee 100% protection against the virus. Therefore, strict adherence to health protocols remains critical to prevent transmission in the community. In addition, the spokesperson debunked the false information that children are immune to COVID-19, stating that the death rate due to COVID-19 among children in Indonesia was relatively high compared to other countries.5 3 https://megapolitan.kompas.com/read/2021/08/31/16501431/jumlah-penumpang-mrt-naik-142-persen-sejak- jakarta-ppkm-level-3 4 https://www.channelnewsasia.com/asia/surge-medical-waste-public-health-problem-indonesia-covid-19-rages- 2132476?utm_source=dlvr.it&utm_medium=twitter 5 https://en.antaranews.com/news/186322/govt-spokesperson-dispels-covid-19-related-hoaxes 2 WHO Indonesia Situation Report - 70 who.int/indonesia SURVEILLANCE • On 1 September, 10 337 new and 4 100 138 cumulative cases were reported nationwide. The weekly number of cases from 23 to 29 August was 94 375, a decrease of 25% compared to the previous week. As of 1 September, Indonesia reported 653 new and 133 676 cumulative number of COVID-19 deaths. The weekly number of new deaths from 23 to 29 August was 5551, a decrease of 37% compared to the previous week (Fig. 2). 400000 14000 350000 12000 300000 10000 250000 8000 200000 Cases 6000 Deaths 150000 100000 4000 50000 2000 0 0 25/05 - 31/05 - 25/05 07/02 - 01/02 02/03 08/03 -02/03 05/04 -30/03 03/05 -27/04 28/06 -22/06 26/07 -20/07 23/08 -17/08 20/09 -14/09 18/10 -12/10 15/11 -09/11 13/12 -07/12 10/01 -04/01 07/03 -01/03 04/04 -29/03 02/05 -26/04 30/05 -24/05 27/06 -21/06 25/07 -19/07 22/08 -16/08 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 29 August 2021. Source of data Disclaimer : Prior to 10 February 2021, SARS-CoV-2 diagnosis was conducted using polymerase chain reaction (PCR). Since this date, confirmed cases include those who tested positive using nucleic acid ampli fication 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 - 70 who.int/indonesia • As of 29 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 48.6, 44.0 and 54.9, respectively (Fig. 3). Nationwide, the weekly case incidence has declined to the level of moderate incidence (CT2). A similar trend was observed in Java-Bali region. However, the weekly case incidence in non-Java-Bali region has remained at the level of high incidence (CT3) over the past six weeks. Province and district level analyses are needed to evaluate these trends. 165 CT4 (150+) 150 135 120 105 90 CT3 (50 - <150) 75 Case Case incidence 60 45 CT2 (20 - <50) 30 15 CT1 (<20) 0 28/09 - 04/1028/09 - 07/0201/02 - 13/0607/06 - 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 - 12/1018/10 - 26/1001/11 - 09/1115/11 - 23/1129/11 - 07/1213/12 - 21/1227/12 - 04/0110/01 - 18/0124/01 - 15/0221/02 - 01/0307/03 - 15/0321/03 - 29/0304/04 - 12/0418/04 - 26/0402/05 - 10/0516/05 - 24/0530/05 - 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 29 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 - 70 who.int/indonesia • During the week of 23 to 29 August, four provinces (highlighted in light red) remained at the highest level of community transmission (CT4), with incidence rates per 100 000 population of 272.6 in North Kalimantan, 171.3 in Bangka Belitung Islands, 164.5 in DI Yogyakarta and 152.9 in East Kalimantan (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 11 provinces at community transmission level 3 (CT3).