Indonesia grapples with lockdown dilemma

By Todd Elliott, Senior Analyst

The central government appears to be giving some ground to the growing chorus of voices calling for a lockdown in Indonesia as the current policy of social distancing is failing to arrest the spread of the coronavirus.

Since the first two infections of the disease were confirmed in Indonesia on March 2, President Joko Widodo has remained adamant about not imposing lockdowns due to social stability and economic concerns. He has instead repeatedly called on the public to stay at home and urged authorities to push for more rapid testing to map the spread of the disease.

But over the past four weeks, the number of confirmed infections in Indonesia has skyrocketed. Indonesia also has one of the highest fatality rates in the world at just under 10%, according to current official statistics, but many experts attribute this grim statistic to an overall lack of testing.

While public clamor for the central government to implement a national lockdown is growing, government officials say such a move would be a last resort, citing the severe economic impact such a move would have on the economy, especially the tens of millions of Indonesia who rely on daily wages in the informal sector.

Sources in the government also tell Concord Strategic that Widodo and his allies are concerned about the likelihood that social unrest and mob violence could breakout if full lockdowns are implemented, especially among the lower classes which are feeling the immediate brunt of the negative economic aspects of the pandemic, including lost wages, higher unemployment and spikes in the prices of many basic necessities.

One official close to the State Palace said the president is also worried that his political opponents and opportunists within the government will try to take advantage of the coronavirus outbreak to undermine the administration.

Regional quarantines

In an apparent bid to appease local leaders demanding lockdowns, the country’s top security minister on March 28 said the central government would allow regional authorities to impose “regional quarantines” to control the spread of the coronavirus.

The change of tack came as a number of local governments unilaterally imposed lockdowns.

Sources also said the government is worried it could become deprioritized or left ineligible for future donor assistance from world cooperation bodies if it does not implement more stringent measures in an attempt to slow the spread of the coronavirus.

“The new quarantine regulation will provide measures and requirements for regions and cities that want to quarantine themselves,” Coordinating Minister for Political, Security and Legal and Affairs Mahfud M.D. said.

The minister refused to use the word “lockdown” to describe the situation, preferring instead to call it a “regional quarantine,” as stipulated in the 2018 Health Quarantine Law.

“The government has been preparing a regulation on regional quarantines and it will coordinate the procedures and requirements for a region to be allowed to restrict movements,” he said.

According to the draft, if a provincial coronavirus taskforce considers it necessary to impose a lockdown, the central government will bring the matter to an inter-ministerial team involving the Transportation Ministry, the Health Ministry and the Trade Ministry for approval.

The flow of basic commodities will be exempt from restrictions and grocery stores and other essential businesses such as pharmacies will continue to operate under strict supervision from the government, Mahfud said.

The regulation aims to provide common guidelines if any regional government intends to impose a lockdown during the pandemic, Mahfud said.

The minister said several regencies and cities have informed the central government about lockdown plans. “We cannot leave them on their own if they decide to quarantine,” Mahfud said.

Papua last week closed its borders over concerns that the provincial authorities are unprepared to handle any significant number of coronavirus infections. However, the transportation of goods is exempt from the policy.

The move was taken after the province announced its first two coronavirus infections on March 23. The lack of medical facilities in the province was a concerning factor, local officials said, given that Papua has 45 hospitals, only 15 of which can handle coronavirus cases.

Papua Governor Lukas Enembe was adamant that the restriction was not a lockdown. “However, we are considering whether it is necessary to completely block access to Papua to protect Lapago, Meepago and Animha because they are particularly vulnerable,” he said on March 27.

The Tegal administration in Central Java on March 27 decided to lock the city down to protect its residents from the coronavirus outbreak.

The measure will be implemented for four months from March 30 to July 31, Tegal Mayor Dedy Yon Supriyono said. “We plan for a full lockdown. All borders will be closed for the safety of all residents.”

Many individual villages and hamlets have also taken it upon themselves to implement lockdowns to restrict the movement of people, especially outsiders.

Residents of Sleman regency, Yogyakarta, have limited access to several hamlets across the regency. For example, Randu hamlet in Hargobinangun village, Pakem district, has blocked all roads leading to the area.

Mahfud said he could not give a timeline on when the new regulation will come into force.

“In the meantime, the central government continues communicating with the regional governments to issue urgent policies that can be implemented immediately in their favor,” Mahfud said.

Virus epicenter

Reports say that Jakarta is also considering a regional quarantine under the new guidelines as the majority of the coronavirus cases in Indonesia are located in the capital. According to government data, more than 630 coronavirus infections have been recorded in Jakarta and at least 62 people have died from the disease in the city.

Sources told Concord Strategic on March 29 that Jakarta Governor Anies Baswedan plans to implement a regional quarantine for the capital no later than April 24, the first day of the Muslim fasting month of Ramadhan.

The government is concerned about the movement of people and further spread of the virus ahead of the Idul Fitri holiday at the end of Ramadhan, which starts in late April.

An estimated five million people leave the capital each year to travel back to their home villages to celebrate Idul Fitri, Indonesia’s largest holiday. Hundreds of thousands of residents of Jakarta have already left the city over the past week for their home villages to find a safe haven or after losing their jobs, officials said.

Baswedan on March 28 extended the emergency status for the coronavirus outbreak in the capital. All schools in the capital will remain closed and businesses are urged to limit operating hours and allow employees to work from home. All residents are recommended to remain at their homes and practice social distancing.

Baswedan told reporters on a video conference call that the state of emergency, first imposed on Mar 20 to try to slow the spread of the virus, would be extended until April 19.

“We’re preparing ways to anticipate all possibilities that could happen in the city,” Baswedan said. “We implore people of Jakarta to not leave Jakarta, especially for their home towns.”

Experts estimate that the government would need to prepare around Rp4 trillion ($249 million) to ensure the health and safety of 9.6 million Jakarta residents during a two-week full lockdown in the capital.

Coronavirus Taskforce

In a briefing for President Widodo from the official Coronavirus Taskforce on March 28, a copy of which was seen by Concord Strategic, the group of experts said that while the increase from one to two coronavirus infections in Indonesia took four days, it would take the same time for the numbers to grow from 1,000 to 2,000.

In handling such an outbreak, there are delays which mean that the number of confirmed infections will be smaller than the actual infection spreading among the public due to the incubation period of the disease, it said.

“We have to think about what is needed for the next two or three weeks and always be prepared for a worst-case scenario. The worst-case scenario in this context is up to 70% of the Indonesian population infected with the coronavirus with a mortality rate of 1%-4%.”

The taskforce said the actual number of coronavirus cases in Indonesia is not the 1,155 confirmed cases announced by the authorities.

“The figure only represents the result of the country’s capacity in conducting highly accurate testing (with 1,439 samples per day recorded as of March 27). The number of deaths is essential in determining how big the scale of coronavirus infection is in the country along with the number of hospitals that are overwhelmed with new cases every day,” the briefing said.

“This means that the number of official confirmed coronavirus cases in Indonesia is only the tip of an iceberg. A similar situation was also reported in the Philippines where early detection was as poor as in Indonesia and this is exacerbated by a high number of fatalities among medical personnel who are dealing with the outbreak,” it added.

The briefing said the coronavirus outbreak in Indonesia is growing exponentially, not linearly. If the country is unable to handle the outbreak, at least 60% to 70% of the population (roughly 150 million people) will be infected.

The taskforce recommended significant limitations to social interaction, meaning 80% of all residents have to abide the physical distancing campaign for it to be effective.

It urged more aggressive policies, including regional quarantines to reduce the spread of the disease while giving the necessary time for authorities to identify and isolate cases that have not been detected.

“This should also be followed by curfews for residents to buy daily needs outside. A few days ago, it would be enough to only quarantine Greater Jakarta, but with the recent situation at least all of Java needs to be quarantined to prevent further spreading. This also considers the low obedience level to social distancing and recent reports of hundreds of thousands of workers leaving Jakarta and going back to their hometowns amid the outbreak. Assuming the government will continue to struggle in identifying undetected cases, we need at least one month of quarantine,” the briefing recommended.

Politics as usual

As expected, politics is also apparently affecting the country’s response to the coronavirus epidemic.

All of Indonesia’s regional administrations are scheduled to hold elections within the next three years and some local leaders’ pandemic response policies could be based on the political dynamics within their respective jurisdictions, especially among incumbent leaders.

Many local leaders appear determined to flex the authority afforded to them through decentralization to implement their own coronavirus response measures despite the policies ordered by the central government.

In Jakarta for example, sources say political distrust between Governor Baswedan and the State Palace is hampering cooperation between the related ministries and the provincial administration.

Similar dynamics are also at play between the central government and the Papuan administration, which closed its borders last week despite strong opposition to the move from Widodo and Home Affairs Minister Tito Karnavian.

At the central level, a source within the State Palace told Concord Strategic that the government’s Coronavirus Taskforce has given a greater role to Finance Minister Sri Mulyani Indrawati due to the large amount of funding involved in its operations. “Widodo does not trust some ministers with the large amount of funding as many of them have ambitions for higher political office,” the source said.

Response criticism

Indonesia’s coronavirus crisis is far worse than being officially reported and the government’s response is in disarray, the Indonesian Doctors’ Association warned on March 27.

“The government’s plans are in tatters and they appear to be avoiding a lockdown,” Indonesian Doctors’ Association spokesman Halik Malik said. “Our health system is not as strong as other countries.”

A London School of Hygiene & Tropical Medicine study warned last week that cases in Indonesia – with a population of more than 265 million people – could be vastly underreported.

The government’s official Coronavirus Task Force has estimated as many as 700,000 people were at risk of infection nationwide, but the rate of testing has been low compared with many other countries – only 2,300 were conducted before the government stopped announcing the number of tests.

“The COVID-19 situation in Indonesia is very serious and getting worse quickly,” the Canadian Embassy in Jakarta said on March 26, adding that it was urgently advising citizens to leave. “The health care system in Indonesia will soon be overwhelmed. The ultimate number of fatalities will be very high.”

Indonesia had fewer than four doctors for every 10,000 people, according to World Health Organization (WHO) data from 2017. In comparison, Malaysia had about 15 doctors and Australia had 35 per 10,000 people.

But one Jakarta-based medical expert told Concord Strategic that it is impossible to know exactly the status of Indonesia’s coronavirus outbreak.

“The government has only tested several thousand people and it is prioritizing the testing of those with severe symptoms. This means that the death rate in comparison to the confirmed infections will be much higher. If those with mild symptoms are also tested and added to the confirmed infection total, the fatality rate would be far lower,” he said.

It should also be kept in mind that most countries with the highest rates of infections and deaths generally have older populations, the expert said.

Indonesia’s population has a median age of 30.2 years, according to the World Population Review.

“In one of the hardest hit countries, Italy, 30% of the population is older than 60. Other factors should also be taken into account such as obesity, heart and lung disease, high blood pressure and diabetes. The Indonesian government is not announcing to the public how many of the coronavirus deaths involve complicating factors.”

Research has also shown that a large part of those infected with the virus around the world are “healthy carriers” – meaning they are asymptomatic. People without symptoms are also taken into account in most countries’ coronavirus infection statistics, and in some cases it is more than half of the confirmed infections, mostly younger people.

Medical researchers say it must also be remembered that the seasonal flu kills hundreds of thousands of people every year, without any massive media attention. Seasonal flu’s impact is largely spread over months during the northern hemisphere winter. The coronavirus, however, only emerged in Wuhan, China three months ago, which is exacerbating public hysteria over the new virus.

It is arguable that the extreme panic paralyzing most countries is not entirely justified and fueled in part by the myriad unknowns surrounding the virus.

While this may sound reasonable to doctors and researchers, it is a hard argument to sell to general publics who are demanding their governments do as much as possible – and what is in many cases the impossible – to fight the spread of an unstable virus.

“In a developing country like Indonesia, this is even more difficult due to infrastructure and support systems which are far below the capacities of many other countries. This is not the fault of the current government. Politicians and medical experts in Indonesia can only work with what they have or what they can acquire in a short amount of time,” the medical expert said.

This must also be gauged against the need to keep the economy afloat and ensure that millions of people already in poverty do not starve or trigger unrest because they cannot access basic necessities due to lockdowns.

While there are plenty of doom and gloom predictions for Indonesia, a situation exacerbated by the instant news cycle and rumors spread on Twitter and other forms of social media, not all experts believe that Indonesia is heading for a full-blown coronavirus catastrophe.

“Indonesia is a tropical country and it seems that the climate might have an impact, making the extent of this virus becoming widespread less likely. The country’s population is young, so the vast majority of infected people will resist well. Physical distancing is important and slows the progression of the virus, but it will in any case contaminate a large part of the population,” Frederic Guerlava from the Department of Virology, School of Medicine at the Pierre and Marie Curie University in Paris said on March 27

“The current measures taken by the government are good and the people should not panic, since it is not a modern plague. Much more drastic measures would have other equally deadly side effects: the impoverishment of the little people and a significant increase in the prices of essential materials,” Guerlava added.