Coronavirus Disease 2019 (COVID-19) World Health CoronavirusCoronavirus Disease Disease 2019 2019 (COVID (COVID-19) -19) World Health OrganizationOrganization Situation Report - 60 Situationn Report - 7 Indonesia Indonesia 23 JuneData 2021 as of 07 May 2020 HIGHLIGHTS • As of 23 June, the Government of Indonesia reported 2 033 421 (15 308 new) confirmed cases of COVID-19, 55 594 (303 new) deaths and 1 817 303 recovered cases from 510 districts across all 34 provinces.1 • Most provinces in Java region reported an increase in the number of cases and deaths. Weekly reported cases and deaths have doubled in DKI Jakarta each week, over the last two weeks. With increased confirmation of delta variant of concern, health system capacity has been severely impacted in some provinces with more than 90% bed occupancy rates. Stricter implementation of public health and social measures (PHSM) including large-scale social restrictions (pembatasan sosial berskala besar (PSBB)) may help. Fig. 1. Geographic distribution of cumulative number of confirmed COVID-19 cases in Indonesia across the provinces reported from 17 to 23 June 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 - 60 who.int/indonesia GENERAL UPDATES • Amid the surge of cases and increasing bed occupancy rate in many COVID-19 referral hospitals in the country, the Indonesian Medical Association (Ikatan Dokter Indonesia (IDI)) reported that there has been an increasing trend of COVID-19 related deaths among health workers. As of 22 June, 974 health workers have died due to COVID-19; most were doctors (374) and nurses (311). Although there was a decrease in the number of deaths among health workers in April (11 deaths), the number has been increasing since that time to 17 deaths in May and 26 deaths in June. It is imperative to ensure optimal protection of health workers to reduce the burden to the health system.2 • Indonesia continues to experience a sharp increase in the number of COVID-19 cases in many provinces and districts in recent weeks. On 20 June, the National COVID-19 Task Force (Satuan Tugas (Satgas)) reported that the province with the highest number of new confirmed cases was DKI Jakarta (5582 cases)3. As of the same day, the highest number of confirmed COVID-19 deaths was reported in East Java, with a total of 12 074 deaths. The Satgas of East Java reported that the highest number of deaths in the province were attributed to the city of Surabaya, with a total of 1382 deaths, followed by Blitar (709 deaths), Banyuwangi (679), Malang City (650) and Sidoarjo (637)4. The national and subnational governments continue to take extra measures to strengthen the pandemic response to control transmission. Firmer restriction of community activities and movements has been implemented, including the cancellation of school reopening in several areas such as DKI Jakarta, Bogor and Bandung.5 • On 13 June, the Ministry of Health (MoH) reported that the delta variant of SARS-CoV-2 (B.1.617.2 variant, first detected in India) has been found circulating in six provinces in Indonesia, namely South Sumatra, DKI Jakarta, Central Java, East Java, Central Kalimantan and East Kalimantan. The majority of cases was reported from Central Java (80 cases), DKI Jakarta (57) and East Java (10). This variant has been reported to have a higher transmissibility. In addition, MoH reported that the alpha variant (B.1.1.7, first detected in the United Kingdom) and beta variant (B.1.351, first detected in South Africa) of the SARS-CoV-2 virus have also been detected in the country.6 2 https://www.kompas.id/baca/kesehatan/2021/06/23/nakes-meninggal-karena-covid-19-kembali-meningkat 3 https://megapolitan.kompas.com/read/2021/06/20/18391721/lagi-lagi-tertinggi-kasus-baru-covid-19-di-jakarta- hari-ini-tembus-5582 4 https://news.detik.com/berita-jawa-timur/d-5613284/kasus-kematian-covid-19-jatim-tertinggi-nasional- surabaya-terbanyak 5 https://www.cnnindonesia.com/nasional/20210620152705-20-656902/kasus-positif-covid-19-tembus-13-ribu- hari-ini 6 https://www.beritasatu.com/kesehatan/789641/ini-perkembangan-varian-delta-di-indonesia 2 WHO Indonesia Situation Report - 60 who.int/indonesia SURVEILLANCE • On 23 June, Indonesia reported the highest number of new confirmed cases since it was first reported in the country; a total of 15 308 new and 2 033 421 cumulative cases were reported nationwide. The country surpassed 2 000 000 cases on 21 June (Fig. 2). The average for the last seven days from 17 to 23 June was 13 681 cases per day, more than a 50% increase compared to 8657 cases per day reported in the previous week. 18000 2500000 16000 14000 2000000 12000 1500000 10000 8000 1000000 Daily numberDaily 6000 Cumulative number Cumulative 4000 500000 2000 0 0 2-Jan 4-Jun 9-Oct 5-Apr 5-Sep 5-Feb 2-Aug 16-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 29-Nov 12-Nov 28-Mar 19-Mar 11-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 23 June 2021. Source of data Disclaimer: The number of cases reported daily is not 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. 16); 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 - 60 who.int/indonesia • During the week of 14 to 20 June, twelve provinces experienced an increase in the number of weekly cases of more than 50% compared to the previous week: West Papua (245%), Southeast Sulawesi (121%), North Sulawesi (111%), Bali (110%), North Kalimantan (107%), DKI Jakarta (101%), Gorontalo (97%), Maluku (81%), West Java (70%), East Java (64%), East Kalimantan (64%) and DI Yogyakarta (51%) (Fig. 3). Stringent PHSM, including movement restrictions, should be considered to be urgently implemented. West Papua Southeast Sulawesi North Sulawesi Bali North Kalimantan DKI Jakarta Gorontalo Maluku West Java East Java East Kalimantan DI Yogyakarta North Maluku West Sulawesi Banten Central Sulawesi North Sumatra South Kalimantan Bengkulu Central Java Riau Islands Lampung South Sulawesi Jambi West Kalimantan Central Kalimantan South Sumatra Bangka Belitung Islands Riau Aceh West Sumatra West Nusa Tenggara Papua East Nusa Tenggara -100% -50% 0% 50% 100% 150% 200% 250% 300% Percentage change of weekly number of confirmed cases Fig. 3. Percentage change of weekly number of confirmed cases by province during 14 to 20 June 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 WH O Indonesia Situation Report - 60 who.int/indonesia • During the week of 14 to 20 June, the incidence7 of COVID-19 in Indonesia increased substantially to 23.2 per 100 000 population, compared to 16.6 per 100 000 population in the previous week (Fig. 4). The incidence has been rapidly increasing in the country since mid-May. 35 30 CT2 (20 - <50) 25 20 15 Case Case incidence 10 CT1 (<20) 5 0 17/08 - 23/0817/08 - 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 - 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 - 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 20 June 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). 7 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.