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WHO Indonesia Situation Report - 20
who.int/indonesia
Situation Report - 7
INDONESIA Situation Report 19
Internal for SEARO
Data as of 07 May 2020
• As of 12 August, the Government of Indonesia
announced 130 718 confirmed cases of
COVID-19, 5 903 deaths and 85 798 recovered
cases from 481 districts across all 34
provinces1.
• WHO handed over 253 800 viral transport
media and swabs, amounting to US$ 532 980
to the Ministry of Health (MoH) to enhance
case finding (page 14).
• The government, WHO and partners continue
to work together to mitigate the impact of
COVID-19 on essential immunization
programmes (pages 19-23).
1
https://infeksiemerging.kemkes.go.id/
HIGHLIGHTS
Figure 1: Geographic distribution of cumulative number of confirmed COVID-19 cases in Indonesia across the
provinces reported between 06 to 12 August 2020. 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.
Coronavirus Disease 2019 (COVID-19)
World Health
Organization
Indonesia
12 August 2020
Coronavirus Disease 2019 (COVID-19)
Coronavirus Disease 2019 (COVID-19)
Situation Report - 20
World Health
Organization
Indonesia
2
WHO Indonesia Situation Report - 20
who.int/indonesia
• President Joko Widodo has ordered nationwide enforcement of COVID-19
protocols, such that violations are subject to legal sanctions. The rules
established by the Presidential Instruction (Inpres) No. 6/2020 seek to
improve public compliance with health protocols to reduce the spread of
COVID-19. All regional heads – governors, mayors and regents – are
required to formulate and issue policies for the prevention of COVID-19 and
to enforce sanctions for violations of policies. The sanctions may range from
a written warning and community service to fines and temporary suspension
of businesses and organizations2.
• On 07 August, the government issued a revised joint ministerial decree to
allow schools in yellow zones to reopen. A month earlier, the government
had decided to allow schools only in COVID-19 green zones – areas with
no recorded COVID-19 transmission – to reopen. Over the month, the
number of confirmed COVID-19 cases in Indonesia has surged, partially
due to an increase in testing. The decision to allow students in yellow zones
to return to school risks worsening local transmission, putting a heavier
burden on the nation’s limited healthcare facilities and workers and, in the
long term, slowing down the economic recovery. Currently, 43% of
Indonesian students live in green and yellow zones across 276 regencies
and cities3. Globally, from 24 February through 12 July 2020, the proportion
of confirmed cases aged zero to four years has increased seven-fold while
there has also been a six-fold increase of cases aged five to 24 years4. Data
show that children in the age group of five to 14 years account for 6.8% of
the total number of recorded cases in Indonesia3 – well above the global
average of 2.5%, based on COVID-19 WHO surveillance4. The figure could
rise if face-to-face lessons resumes3.
• On 08 August, Jakarta reported the highest daily case count with 721 new
confirmed COVID-19 cases. An epidemiologist from the University of
Indonesia stated that the transitional period to the ‘new normal’ applies to a
yellow zone and Jakarta is still in the red zone (high risk of transmission).
Therefore, it was suggested to strictly implement large-scale social
restrictions (PSBB)5.
2
https://www.thejakartapost.com/news/2020/08/06/jokowi-orders-nationwide-enforcement-of-covid-
19-protocols-sanctions.html
3
https://www.thejakartapost.com/paper/2020/08/09/school-reopening-risky.html
4
https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200805-covid-19-sitrep-
198.pdf?sfvrsn=f99d1754_2
5
https://en.tempo.co/read/1374166/jakarta-still-in-first-wave-of-covid-19-epidemiologist-slams-govts-
psbb
GENERAL UPDATES
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• On 12 August, 1 942 new and 130 718 cumulative confirmed COVID-19
cases were reported (Fig. 2). The average for the last seven days was 1 978
cases per day, which was higher than the previous seven-day average of
1 777 per day.
• As of 12 August, most confirmed COVID-19 cases were in DKI Jakarta and
East Java, followed by Central Java, South Sulawesi, West Java, South
Kalimantan and North Sumatra. Java contributed 57.5% of the total cases
in Indonesia. The cumulative number of confirmed COVID-19 cases by
province is shown in Figure 3.
SURVEILLANCE
Figure 2: Daily and cumulative number of confirmed COVID-19 cases reported in
Indonesia, as of 12 August 2020. Source of data
Disclaimer: The number of cases reported daily is not 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. Therefore, caution must be taken in interpreting this
figure and the epidemiological curve for further analysis.
0
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25-May
31-May
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5-Aug
11-Aug
Cumulativenumber
Dailynumber
Daily number of confirmed COVID-19 cases Cumulative number of confirmed COVID-19 cases
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Figure 3: Cumulative number of confirmed COVID-19 cases by province in Indonesia, as of 12 August
2020. Source of data
Disclaimer: Data from DKI Jakarta include patients isolated or hospitalized in Wisma Atlet (RSDC: Rumah
Sakit Darurat COVID-19), which is the biggest national makeshift hospital for COVID-19; some patients
may not be residents of DKI Jakarta. The same may apply to other provinces.
0 5000 10000 15000 20000 25000 30000
East Nusa Tenggara
Bangka Belitung Islands
Jambi
Central Sulawesi
Bengkulu
West Sulawesi
North Kalimantan
Lampung
West Kalimantan
West Papua
Riau Islands
Aceh
Riau
Yogyakarta
Southeast Sulawesi
West Sumatra
Maluku
Gorontalo
North Maluku
Central Kalimantan
East Kalimantan
Banten
West Nusa Tenggara
North Sulawesi
Papua
South Sumatra
Bali
North Sumatra
South Kalimantan
West Java
South Sulawesi
Central Java
East Java
DKI Jakarta
Cumulative number of confirmed COVID-19 cases
Province
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• As of 12 August, DKI Jakarta had the highest confirmed COVID-19 mortality
per one million population, followed by South Kalimantan, North Sulawesi,
East Java, North Maluku and South Sulawesi (Fig. 4).
Figure 4: Cumulative deaths per one million population by province in Indonesia, as of 12 August 2020.
Source of data
Disclaimer: Based on data availability, only confirmed COVID-19 deaths have been included. As per WHO
guideline COVID-19 related death is defined as death resulting from a clinically compatible illness in a
probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be
related to COVID-19 (e.g. trauma). There should be no period of complete recovery between the illness
and death.
0 10 20 30 40 50 60 70 80 90 100
East Nusa Tenggara
West Kalimantan
Jambi
Bangka Belitung Islands
Lampung
Riau
Central Sulawesi
North Kalimantan
Aceh
West Sulawesi
West Java
Southeast Sulawesi
West Sumatra
Yogyakarta
West Papua
Banten
Papua
Riau Islands
Bali
Bengkulu
Maluku
North Sumatra
East Kalimantan
Central Java
South Sumatra
West Nusa Tenggara
Gorontalo
Central Kalimantan
South Sulawesi
North Maluku
East Java
North Sulawesi
South Kalimantan
DKI Jakarta
Death per one million population
Province
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• As of 12 August, the daily number of specimens and suspected cases
tested were 26 248 and 13 698, respectively (Fig. 5). The weekly average
number of specimens and suspected cases tested in the last seven days
were 25 699 and 12 745, respectively. The fifth revision of national
guidelines on COVID-19 prevention and control has adopted the WHO
guidance for discharge criteria6, which is expected to narrow the gap
between specimens and suspected cases tested. Therefore, it is important
to evaluate the implementation of the revised guidelines at all administrative
levels to monitor this trend.
6
Source: https://www.who.int/publications/i/item/clinical-management-of-covid-19
Figure 5: The daily number of specimens and suspected cases tested in Indonesia, from 01 May
to 12 August 2020. Source of data
Disclaimer: Due to the transition to a new data management application, there may have been
reporting issues in timing. Therefore, on certain days the number of specimens tested is almost
the same as the number of people tested, which might not have been the situation.
0
5000
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35000
1-May
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1-Aug
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Dailynumber
Number of specimens tested Number of suspected cases tested
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Table 1: Assessment of epidemiological criteria for six provinces in Java for the
3-week period from 20 July to 09 August.
Province Decline in the number of
confirmed COVID-19 cases
since the latest peak*
Decrease in the
number of
confirmed and
probable case
deaths for the
last 3 weeks**
DKI Jakarta Latest peak last week No
West Java Latest peak last week Yes
Central Java Less than 50% since latest peak No
Yogyakarta More than 50% for one week Yes
East Java Latest peak last week No
Banten Latest peak last week Yes
*date of latest peak differs for each province (see Figs. 6 to 11 for details)
**decrease in deaths is calculated from 20 July to 09 August 2020 (see Fig. 13 for
details)
Criterion 1: Decline of at least 50% over a 3-week period since the latest peak and
continuous decline in the observed incidence of confirmed and probable cases
• None of the provinces in Java have shown a decline of at least 50% for
three weeks since the latest peak (Figs. 6 to 11). Four provinces in Java
(DKI Jakarta, West Java, East Java and Banten) experienced an increase
in the number of confirmed COVID-19 cases.
EPIDEMIOLOGICAL CRITERIA TO ASSESS COVID-19 TRANSMISSION
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Figure 6: Weekly and cumulative number of confirmed COVID-19 cases in DKI Jakarta, as of
09 August 2020. Source of data
Figure 7: Weekly and cumulative number of confirmed COVID-19 cases in West Java,
as of 09 August 2020. Source of data
0
5000
10000
15000
20000
25000
30000
0
500
1000
1500
2000
2500
3000
3500
4000
Cumulativenumber
Weeklynumber
DKI Jakarta
Number of confirmed COVID-19 cases Cumulative number of confirmed COVID-19 cases
0
1000
2000
3000
4000
5000
6000
7000
8000
0
200
400
600
800
1000
1200
1400
1600
Cumulativenumber
Weeklynumber
West Java
Number of confirmed COVID-19 cases Cumulative number of confirmed COVID-19 cases
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Figure 8: Weekly and cumulative number of confirmed COVID-19 cases in Central Java,
as of 09 August 2020. Source of data
Figure 9: Weekly and cumulative number of confirmed COVID-19 cases in Yogyakarta,
as of 09 August 2020. Source of data
0
2000
4000
6000
8000
10000
12000
0
200
400
600
800
1000
1200
1400
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Cumulativenumber
Weeklynumber
Central Java
Number of confirmed COVID-19 cases Cumulative number of confirmed COVID-19 cases
0
100
200
300
400
500
600
700
800
900
1000
0
50
100
150
200
250
Cumulativenumber
Weeklynumber
Yogyakarta
Number of confirmed COVID-19 cases Cumulative number of confirmed COVID-19 cases
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Figure 10: Weekly and cumulative number of confirmed COVID-19 cases in East Java,
as of 09 August 2020. Source of data
Figure 11: Weekly and cumulative number of confirmed COVID-19 cases in Banten,
as of 09 August 2020. Source of data
0
5000
10000
15000
20000
25000
30000
0
500
1000
1500
2000
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3000
Cumulativenumber
Weeklynumber
East Java
Number of confirmed COVID-19 cases Cumulative number of confirmed COVID-19 cases
0
500
1000
1500
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2500
0
50
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150
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250
Cumulativenumber
Weeklynumber
Banten
Number of confirmed COVID-19 cases Cumulative number of confirmed COVID-19 cases
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Criterion 2: Less than 5% of samples positive for COVID-19, at least for the last 2
weeks, assuming that surveillance for suspected cases is comprehensive
• The percentage of positive samples can be interpreted only with
comprehensive surveillance and testing of suspected cases, in the order
of one per 1 000 population per week. DKI Jakarta has achieved this
minimum case detection benchmark (Fig. 12). There is a significant
difference between the number of suspected cases tested in Jakarta
compared to the rest of Indonesia.
Figure 12: Positivity rate of cases, and suspected cases tested per 1 000 population per week:
Week 1: 20/07/20 - 26/07/20; Week 2: 27/07/20 - 02/08/20; Week 3: 03/08/20 - 09/08/20
For surveillance purposes, positivity rate is calculated as the number of confirmed cases
divided by the number of people tested for diagnosis. Source of data: Indonesia, DKI Jakarta
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
0.00
0.50
1.00
1.50
2.00
2.50
3.00
3.50
4.00
4.50
5.00
1 2 3 1 2 3 1 2 3
Indonesia DKI Jakarta Indonesia without DKI
Jakarta
Weeks
Positivityrate
Suspectedcasestested/1000population/week
Suspected cases tested/1000 population/week Positivity rate
Benchmark: One suspected case tested
per 1000 population per week Threshold positivity rate <5%
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Criterion 3: Decline in the number of deaths among confirmed and probable cases
for the last 3 weeks
31
73 87
117
84
127
0
50
100
150
200
250
20/07/20 -
26/07/20
27/07/20 -
02/08/20
03/08/20 -
09/08/20
DKI Jakarta
Other death with COVID-19 protocol
Death-Confirmed-Case
16 4 18
73
63
8
4
0
20
40
60
80
100
20/07/20 -
26/07/20
27/07/20 -
02/08/20
03/08/20 -
09/08/20
West Java
Death-Confirmed-Case Death-PDP Death-ODP
95
166 135
88
85 139
0
50
100
150
200
250
300
20/07/20 -
26/07/20
27/07/20 -
02/08/20
03/08/20 -
09/08/20
Central Java
Death-Confirmed-Case Death-PDP
5
3
0
3
00
2
4
6
8
10
20/07/20 -
26/07/20
27/07/20 -
02/08/20
03/08/20 -
09/08/20
Yogyakarta
Death-Confirmed-Case Death-Probable-Case
187
135 141
166
98 99
0
60
120
180
240
300
360
20/07/20 -
26/07/20
27/07/20 -
02/08/20
03/08/20 -
09/08/20
East Java
Death-Confirmed-Case Death-Probable-Case
4 3
0
4 5
00
2
4
6
8
10
20/07/20 -
26/07/20
27/07/20 -
02/08/20
03/08/20 -
09/08/20
Banten
Death-Confirmed-Case Death-PDP
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Figure 13: Deaths among confirmed COVID-19 cases, patients under investigation
(PDP) and persons under observation (ODP) per week over the last three weeks from
20 July to 09 August 2020 in six provinces in Java. Source of data: DKI Jakarta, West
Java, Central Java, East Java, Yogyakarta, Banten.
Disclaimer: The data are provisional. As of 20 July, some provinces have adopted case
definitions based on the fifth revision of the national guidelines on COVID-19 prevention
and control. There may be a discrepancy in the number of deaths of confirmed COVID-
19 cases between national and provincial data sources.
• On 07 August, the fifth and final batch of webinars for the ‘Tagana’
(community volunteers for responding to disasters) was completed for East
Nusa Tenggara on how to establish quarantine and isolation facilities at
community level, including the role of community volunteers in case finding
by implementing a screening system. WHO presented the health protocols
of quarantine and isolation facilities at community level. The series of
webinars covered five priority provinces (Central Java, East Nusa
Tenggara, East Java, South Kalimantan and West Java).
• The number of confirmed COVID-19 cases hospitalized in DKI Jakarta since
the beginning of June gradually decreased until 07 July; however, since 08
July, the number has been progressively increasing, with a slight decrease
over the past two days (Fig. 14).
HEALTH SYSTEM CRITERIA TO ASSESS COVID-19 TRANSMISSION
Figure 14: Number of confirmed COVID-19 cases hospitalized in DKI Jakarta from 01
June to 09 August 2020. Source of data
Disclaimer: Data from Wisma Atlet are not included.
0
500
1000
1500
2000
2500
3000
1-Jun 8-Jun 15-Jun 22-Jun 29-Jun 6-Jul 13-Jul 20-Jul 27-Jul 3-Aug
NumberofconfirmedCOVID-
19caseshospitalized
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• As reported by the government on 12 August, the number of suspected
cases tested for COVID-19 with polymerase chain reaction (PCR) was
13 698 and the cumulative number of suspected cases tested was
1 012 104 (Fig. 15).
• On 04 August, WHO handed over 253 800 viral transport media and
swabs, amounting to US$ 532 980, to the Directorate of Surveillance and
Health Quarantine, MoH, to support case finding. These items will be
distributed to all 34 provinces.
LABORATORY
Figure 15: Daily and cumulative number of people tested with polymerase chain
reaction (PCR) in Indonesia, as of 12 August 2020. Source of data
0
200000
400000
600000
800000
1000000
1200000
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7-Mar
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9-May
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30-May
6-Jun
13-Jun
20-Jun
27-Jun
4-Jul
11-Jul
18-Jul
25-Jul
1-Aug
8-Aug
Cumulativenumber
Dailynumber
Reporting date
Daily number of suspected COVID-19 cases tested with PCR
Cumulative number of suspected COVID-19 cases tested with PCR
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• As of 12 August, the proportion of people that recovered among the total
confirmed COVID-19 cases was 65.6% (Fig. 16). As of the same date, there
were 39 017 confirmed COVID-19 cases under care or in isolation7.
• On 06 August, WHO and MoH conducted the first meeting to orient
participants from hospital management teams and Province Health Offices
(PHOs) on the ‘oxygen survey’. On 13 August, WHO and MoH will meet
PHOs to discuss plans for subsequent orientations and trainings. There will
be three batches of socialization meetings, followed by training for the
surveyors during the last week of August. The training will be divided into
three batches, based on regions (western, central, eastern), to
accommodate the large number of participants (close to 850 surveyors).
• On 07 August, WHO published an information note on ‘Substandard/
Falsified medical devices and personal protective equipment (PPE) used in
the context of the COVID-19 pandemic’. The note advises the users of
medical devices and PPE, procurement entities, customs officials, national
programme managers and their implementing partners, laboratories, MoH
and national regulatory authorities on actions to be taken to identify and
7
https://covid19.go.id/
CASE MANAGEMENT
Figure 16: Cumulative number of recovered cases and percentage recovery
from COVID-19 in Indonesia, as of 12 August 2020. Source of data
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
100000
1-Apr
7-Apr
13-Apr
19-Apr
25-Apr
1-May
7-May
13-May
19-May
25-May
31-May
6-Jun
12-Jun
18-Jun
24-Jun
30-Jun
6-Jul
12-Jul
18-Jul
24-Jul
30-Jul
5-Aug
11-Aug
Percentage(%)
Cummulativenumber
Cumulative number of recovered cases Percentage recovery
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prevent distribution of substandard/falsified medical devices and PPE for
COVID-19. It also provides classification of substandard, falsified and
unregistered or unlicensed medical devices.
• On 06 and 07 August, WHO supported the MoH to conduct an orientation
for the facilitators of the Intra-Action Review (IAR). The facilitators
presented a summary of their desk review for each pillar (country-level
coordination; planning and monitoring; risk communication and community
engagement (RCCE); surveillance, case investigation and contact tracing;
points of entry; the national laboratory system; infection prevention and
control (IPC); case management and knowledge sharing about innovations
and the latest research; operational support and logistics in the
management of supply chains and the workforce; and maintaining
essential health services during the COVID-19 outbreak). The desk review
covered, for instance, the timeline of the response in each pillar, standard
operating procedures, available guidelines, selected trigger questions for
the IAR and drafts of best practices, challenges and recommendations.
The orientation was a simulation of the IAR that will take place from 11 to
14 August. WHO delivered inputs for the selected trigger questions and
briefed the participants on facilitating techniques, in line with WHO
guidance on ‘Conducting a country-level COVID-19 IAR’.
• On 07 August, WHO convened a meeting with MoH and the Hasanuddin
University to discuss the feedback on the field assessment tool and
prepare for the assessment that will take place during the last week of
August. Feedback was collected through field testing of the tools, i.e.,
checklists for PHOs, District Health Offices (DHOs), provincial laboratories,
hospitals, port health posts, COVID-19 Task Force, puskesmas and
community health posts (posyandu). WHO incorporated inputs from the
nine provinces in which the tools were piloted. The enumerators for the
upcoming field assessment exercise will be trained on information
collection, compilation and analysis for two weeks during mid-August; the
field assessment will take place at the end of August and in early
September.
PLANNING, RISK AND NEEDS ASSESSMENT
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• The results of the field assessment and the IAR will be used to identify
strengths, best practices, gaps and challenges, of the COVID-19 response
to date and will subsequently guide the development of national and
province-specific recommendations when updating the provincial and
national COVID-19 response plans.
• On 07 August, WHO participated in a coordination meeting to discuss
strengthening the laboratory network for influenza-like illnesses (ILI) and
severe acute respiratory infections (SARI) sentinel sites. It was
recommended to include public health laboratories in the influenza sentinel
surveillance network under the existing Global Influenza Surveillance and
Response System (GISRS). The samples from influenza sentinel sites
should be tested for both influenza and COVID-19. WHO reiterated the
procedures for COVID-19 sentinel surveillance using the GISRS.
• MoH is developing a risk assessment tool for mass gatherings during
COVID-19. WHO provided input to the tool in line with the WHO guidance
on ‘WHO mass gathering COVID-19 risk assessment tool – Generic
Figure 17: WHO field staff interviewed port health staff in Manado, North Sulawesi,
during piloting of the tool for field assessment, July 2020. Credit: Veronika/WHO
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events’. The tool has been translated to Indonesian, adapted to the country
context, and will be finalized soon.
• WHO is regularly translating and sharing important health messages on the
website and social media platforms – Twitter and Instagram – and has
recently published:
- Infographics:
▪ Five on breastfeeding and COVID-19
▪ Six on recommendations for management at the workplace,
in collaboration with the Indonesia Global Compact Network
(IGCN), the International Labour Organization (ILO) and the
United Nations Development Programme (UNDP) (Fig. 18).
RISK COMMUNICATION
Figure 18: An infographic from the workplace infographic series, developed
and published by WHO and partners, August 2020.
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- Animations:
▪ Six on ‘Stay healthy at home’
▪ One on ‘How to protect yourself from COVID-19’
- Questions and answers on contact tracing
• WHO is supporting the government for programme analysis of various
essential health services to ensure their continuity during the pandemic.
Highlights of the initial immunization programme analysis can be found in
WHO Situation Report 13. Updates from the programme are presented
below:
i. There has been an increase in monthly vaccination coverage for all
available vaccine preventable diseases (VPDs), ranging from 3 to 41%,
from May 2020 to June 2020. However, the overall coverage in June
2020 remained 10 to 20% lower than in June 2019, excluding measles-
containing-vaccine 2 (MCV2) (Fig. 19). There has been an increase in
the national DPT-HB-HiB 3 (vaccine for Diphtheria, Pertussis, Hepatitis
B, Haemophilus Influenza Type B – third dose) coverage from April to
June 2020 (Fig. 20).
CONTINUITY OF ESSENTIAL HEALTH SERVICES
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0
20
40
60
80
100
2019 2020 2019 2020 2019 2020 2019 2020 2019 2020 2019 2020
BCG HB0 OPV 4 DPT-HB-HiB 1 DPT-HB-HiB 3 MCV2
Coverage(%)
Vaccinated Unvaccinated
Figure 19: Cumulative coverage of routine immunization from March to June 2020 compared
to the same period in 2019. Source: Expanded Programme on Immunization (EPI) Unit,
Ministry of Health (unpublished data)
BCG: Bacillus Calmette–Guérin vaccine against meningitis and disseminated tuberculosis in children
HB0: Hepatitis birth dose to prevent hepatitis-B transmission from mother to child
OPV 4: Oral Polio Vaccine
DPT-HB-HiB 1: Vaccine for Diphtheria, Pertussis, Hepatitis B, Haemophilus Influenza Type B – 1st dose
DPT-HB-HiB 3: Vaccine for Diphtheria, Pertussis, Hepatitis B, Haemophilus Influenza Type B – 3rd dose
MCV2: Measles-containing-vaccine – 2nd dose
Figure 20: National DPT-HB-HiB 3 (vaccine for Diphtheria, Pertussis, Hepatitis B,
Haemophilus Influenza Type B – 3rd dose) coverage from March to June 2020, showing
annual target population of below one-year old children. Source: Expanded Programme on
Immunization (EPI) Unit, Ministry of Health (unpublished data)
17.7
21.6
26.5
33.4
0
5
10
15
20
25
30
35
40
45
50
0
1
2
3
4
5
6
7
8
Mar Apr May Jun
Cumulativepercentage(%)
Monthlycoverage(%)
Monthly coverage Cumulative coverage
Monthly target 7.9%
21
WHO Indonesia Situation Report - 20
who.int/indonesia
ii. On 09 July, the Director General of Disease Prevention and Control
issued a circular letter on the continuity of school-based immunization
as scheduled in August and November. The strategy will be adjusted
with local transmission of COVID-19. If the schools remain closed, there
will be an option to coordinate with puskesmas to arrange frequent,
smaller, vaccination sessions to vaccinate children in the empty school
premises. All health workers, caregivers and students will be expected
to comply with health protocols during vaccination sessions which will
be conducted through scheduled appointments.
iii. MoH plans to conduct subnational supplementary immunization
activities for inactive polio vaccine (IPV) targeting children below 15
years of age and catch-up immunization of all vaccines for children
below three years of age in North Kalimantan. Starting in August, these
activities aim to mitigate transmission risk of the ongoing outbreaks of
circulating vaccine-derived poliovirus type 1 (cVDPV1) and circulating
vaccine-derived poliovirus type 2 (cVDPV2) from nearby Malaysia and
Philippines. Furthermore, chronic low coverage of immunization and
suboptimal acute flaccid paralysis (AFP) surveillance has increased the
risk to these outbreaks. The Indonesian Technical Advisory Group on
Immunization (ITAGI) released a recommendation to support the
activities.
To mitigate the impact of COVID-19 and maintain essential immunization
programmes, the government, WHO and partners are carrying out the following
interventions:
i. Piloting an online dashboard for monitoring the Expanded Programme
on Immunization (EPI) and VPD surveillance in Lampung in July 2020.
The dashboard provides an update on various indicators, for instance,
monthly EPI coverage, vaccine stocks, immunization sessions, monthly
VPD surveillance performance and the involvement of EPI and VPD
surveillance officers in the COVID-19 response. The dashboard will be
expanded to all provinces this month.
ii. Continuation of virtual meetings and workshops in all provinces for
capacity building of EPI and VPD officers in puskesmas, DHOs and
PHOs. As of August 2020, more than 2 000 health workers have been
trained using online platforms.
22
WHO Indonesia Situation Report - 20
who.int/indonesia
iii. To address low vaccination coverage and reporting of VPD cases, MoH
conducted a workshop on 23 and 24 July in North Maluku to discuss a
strategy for catch-up immunization. The workshop aimed to strengthen
capacity of health workers in identifying children below three years of
age who missed routine immunization using defaulter tracking tools and
developing microplanning to reach the immunization target. WHO
supported MoH and PHOs to prepare for the workshop, develop the
materials, and facilitate workshop discussions.
Figure 21: Vaccination session, adhering to appropriate infection prevention
and control measures, at a community health post in North Maluku. Credit:
Hermansyah/WHO
23
WHO Indonesia Situation Report - 20
who.int/indonesia
iv. The updated VPD surveillance technical guidance during the COVID-
19 pandemic, in line with WHO guidance, is being finalized and will be
released this month. The recommendation by national experts on
integration of VPD and COVID-19 surveillance has been adopted.
v. A total of 700 vials (10 000 international units per vial) of diphtheria anti-
toxin were procured and delivered to MoH. These will be distributed to
provinces with high transmission of diphtheria such as Aceh, DKI
Jakarta, East Java and West Java.
• On 07 August, WHO convened the fifteenth meeting of key development
partners to discuss and coordinate COVID-19 response activities. The
Asian Development Bank (ADB), the Australian Department of Foreign
Affairs and Trade (DFAT), the British Embassy, the Canadian Embassy, the
European Union (EU), the Japan International Cooperation Agency (JICA),
the United Nations Children’s Fund (UNICEF), the United States Agency for
International Development (USAID), the World Bank (WB), and the World
Food Programme (WFP) participated in the meeting. WHO provided
important national COVID-19 response-related updates, presented on the
COVID-19 epidemiological and health system situation in the country and
informed partners on the technical assistance provided to government
counterparts. DFAT has delivered 20 non-invasive ventilators to East Java,
from a total of 100 that arrived in Indonesia; ADB has delivered 200 boxes
of N-95 masks to the government. JICA is collaborating with the national
police to support management of dead bodies along with provision of
disposable PPE. UNICEF shared its report from the rapid assessment on
the effects of COVID-19 on maternal, newborn and child health (MNCH)
services to identify gaps, gather perceptions of health workers, prepare for
the resumption and safe scale up of MNCH activities. WB is continuing to
assess the economic impact of the response, along with support related to
tracking government expenditure.
• WHO continues to collaborate with IGCN, ILO and UNDP for the second
webinar of the ‘Business Unusual in the New Normal’ series. The first
webinar, on 06 August, discussed WHO protocols and government policies
in Indonesia for prevention of COVID-19 in workers in general, alongside
challenges faced by companies and workers in implementing the health
protocols. The second webinar, on 13 August, will focus on food businesses
PARTNER COORDINATION
24
WHO Indonesia Situation Report - 20
who.int/indonesia
(Fig. 22). WHO will present the WHO guidance on ‘COVID-19 and food
safety’. Other resource persons include: the Ministry of Cooperation and
Small-Medium Enterprises; the United Family Food (UNIFAM); the
Indonesian Catering Employers Association; and the Traditional Market
Association. The webinar aims to facilitate dialogue between UN agencies,
government stakeholders, business associations, employers and workers
on challenges and experiences in implementing the health protocols in food
businesses during the COVID-19 pandemic.
Figure 22: Poster of the webinar for food businesses in the ‘new normal’, 13 August 2020.
Credit: Indonesia Global Compact Network (IGCN).
25
WHO Indonesia Situation Report - 20
who.int/indonesia
• Overall funding request for WHO operations and technical assistance is
US$ 46 million (27 million for response and 19 million for recovery phase),
based on estimated needs as of August 2020 (Fig. 23).
Data presented in this situation report have been taken from publicly available data from the MoH
(https://infeksiemerging.kemkes.go.id/), BNPB (http://covid19.go.id) and provincial websites. There
may be differences in national and provincial data depending on the source used. All data are
provisional and subject to change.
Figure 23: WHO funding situation for COVID-19 response, August 2020
26
WHO Indonesia Situation Report - 20
who.int/indonesia
Online WHO COVID-19 courses:
• Operational planning guidelines and COVID-19
• Clinical management of severe acute respiratory infections
• Health and safety briefing for respiratory diseases – eProtect
• Infection prevention and control
• Emerging respiratory viruses, including COVID-19
• Design of severe acute respiratory infection treatment facility
WHO guidance:
• Safe Eid-al-Adha practices in the context of COVID-19
• Doing things that matter
• Considerations for school-related public health measures
• Cleaning and disinfection of environmental surfaces
• Guiding principles for immunization activities during the COVID-19
pandemic
• Maintaining a safe and adequate blood supply during the COVID-19
pandemic
Infographics:
• Take care in your workplace
• Safe travel during COVID-19
• Tuberculosis and COVID-19
• Nutrition tips
• Three places to avoid
• ‘Be Active’
• Is dexamethasone a treatment for all COVID-19 patients?
• The ‘new normal’
Questions and answers:
• COVID-19 transmission
Videos:
• Take care in your workplace
• Safe travel during COVID-19
• COVID-19 is a virus not bacteria
• Health workers and stigma
• Managing stress
• Who wears what masks when
• COVID-19 spread
For more information please feel free to contact: seinocomm@who.int
WHO Indonesia Reports
A SNAPSHOT OF WHO COURSES AND INFORMATION MATERIAL

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WHO Situation Report Corona 20 Indonesia

  • 1. 1 WHO Indonesia Situation Report - 20 who.int/indonesia Situation Report - 7 INDONESIA Situation Report 19 Internal for SEARO Data as of 07 May 2020 • As of 12 August, the Government of Indonesia announced 130 718 confirmed cases of COVID-19, 5 903 deaths and 85 798 recovered cases from 481 districts across all 34 provinces1. • WHO handed over 253 800 viral transport media and swabs, amounting to US$ 532 980 to the Ministry of Health (MoH) to enhance case finding (page 14). • The government, WHO and partners continue to work together to mitigate the impact of COVID-19 on essential immunization programmes (pages 19-23). 1 https://infeksiemerging.kemkes.go.id/ HIGHLIGHTS Figure 1: Geographic distribution of cumulative number of confirmed COVID-19 cases in Indonesia across the provinces reported between 06 to 12 August 2020. 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. Coronavirus Disease 2019 (COVID-19) World Health Organization Indonesia 12 August 2020 Coronavirus Disease 2019 (COVID-19) Coronavirus Disease 2019 (COVID-19) Situation Report - 20 World Health Organization Indonesia
  • 2. 2 WHO Indonesia Situation Report - 20 who.int/indonesia • President Joko Widodo has ordered nationwide enforcement of COVID-19 protocols, such that violations are subject to legal sanctions. The rules established by the Presidential Instruction (Inpres) No. 6/2020 seek to improve public compliance with health protocols to reduce the spread of COVID-19. All regional heads – governors, mayors and regents – are required to formulate and issue policies for the prevention of COVID-19 and to enforce sanctions for violations of policies. The sanctions may range from a written warning and community service to fines and temporary suspension of businesses and organizations2. • On 07 August, the government issued a revised joint ministerial decree to allow schools in yellow zones to reopen. A month earlier, the government had decided to allow schools only in COVID-19 green zones – areas with no recorded COVID-19 transmission – to reopen. Over the month, the number of confirmed COVID-19 cases in Indonesia has surged, partially due to an increase in testing. The decision to allow students in yellow zones to return to school risks worsening local transmission, putting a heavier burden on the nation’s limited healthcare facilities and workers and, in the long term, slowing down the economic recovery. Currently, 43% of Indonesian students live in green and yellow zones across 276 regencies and cities3. Globally, from 24 February through 12 July 2020, the proportion of confirmed cases aged zero to four years has increased seven-fold while there has also been a six-fold increase of cases aged five to 24 years4. Data show that children in the age group of five to 14 years account for 6.8% of the total number of recorded cases in Indonesia3 – well above the global average of 2.5%, based on COVID-19 WHO surveillance4. The figure could rise if face-to-face lessons resumes3. • On 08 August, Jakarta reported the highest daily case count with 721 new confirmed COVID-19 cases. An epidemiologist from the University of Indonesia stated that the transitional period to the ‘new normal’ applies to a yellow zone and Jakarta is still in the red zone (high risk of transmission). Therefore, it was suggested to strictly implement large-scale social restrictions (PSBB)5. 2 https://www.thejakartapost.com/news/2020/08/06/jokowi-orders-nationwide-enforcement-of-covid- 19-protocols-sanctions.html 3 https://www.thejakartapost.com/paper/2020/08/09/school-reopening-risky.html 4 https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200805-covid-19-sitrep- 198.pdf?sfvrsn=f99d1754_2 5 https://en.tempo.co/read/1374166/jakarta-still-in-first-wave-of-covid-19-epidemiologist-slams-govts- psbb GENERAL UPDATES
  • 3. 3 WHO Indonesia Situation Report - 20 who.int/indonesia • On 12 August, 1 942 new and 130 718 cumulative confirmed COVID-19 cases were reported (Fig. 2). The average for the last seven days was 1 978 cases per day, which was higher than the previous seven-day average of 1 777 per day. • As of 12 August, most confirmed COVID-19 cases were in DKI Jakarta and East Java, followed by Central Java, South Sulawesi, West Java, South Kalimantan and North Sumatra. Java contributed 57.5% of the total cases in Indonesia. The cumulative number of confirmed COVID-19 cases by province is shown in Figure 3. SURVEILLANCE Figure 2: Daily and cumulative number of confirmed COVID-19 cases reported in Indonesia, as of 12 August 2020. Source of data Disclaimer: The number of cases reported daily is not 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. Therefore, caution must be taken in interpreting this figure and the epidemiological curve for further analysis. 0 20000 40000 60000 80000 100000 120000 140000 0 500 1000 1500 2000 2500 3000 2-Mar 8-Mar 14-Mar 20-Mar 26-Mar 1-Apr 7-Apr 13-Apr 19-Apr 25-Apr 1-May 7-May 13-May 19-May 25-May 31-May 6-Jun 12-Jun 18-Jun 24-Jun 30-Jun 6-Jul 12-Jul 18-Jul 24-Jul 30-Jul 5-Aug 11-Aug Cumulativenumber Dailynumber Daily number of confirmed COVID-19 cases Cumulative number of confirmed COVID-19 cases
  • 4. 4 WHO Indonesia Situation Report - 20 who.int/indonesia Figure 3: Cumulative number of confirmed COVID-19 cases by province in Indonesia, as of 12 August 2020. Source of data Disclaimer: Data from DKI Jakarta include patients isolated or hospitalized in Wisma Atlet (RSDC: Rumah Sakit Darurat COVID-19), which is the biggest national makeshift hospital for COVID-19; some patients may not be residents of DKI Jakarta. The same may apply to other provinces. 0 5000 10000 15000 20000 25000 30000 East Nusa Tenggara Bangka Belitung Islands Jambi Central Sulawesi Bengkulu West Sulawesi North Kalimantan Lampung West Kalimantan West Papua Riau Islands Aceh Riau Yogyakarta Southeast Sulawesi West Sumatra Maluku Gorontalo North Maluku Central Kalimantan East Kalimantan Banten West Nusa Tenggara North Sulawesi Papua South Sumatra Bali North Sumatra South Kalimantan West Java South Sulawesi Central Java East Java DKI Jakarta Cumulative number of confirmed COVID-19 cases Province
  • 5. 5 WHO Indonesia Situation Report - 20 who.int/indonesia • As of 12 August, DKI Jakarta had the highest confirmed COVID-19 mortality per one million population, followed by South Kalimantan, North Sulawesi, East Java, North Maluku and South Sulawesi (Fig. 4). Figure 4: Cumulative deaths per one million population by province in Indonesia, as of 12 August 2020. Source of data Disclaimer: Based on data availability, only confirmed COVID-19 deaths have been included. As per WHO guideline COVID-19 related death is defined as death resulting from a clinically compatible illness in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID-19 (e.g. trauma). There should be no period of complete recovery between the illness and death. 0 10 20 30 40 50 60 70 80 90 100 East Nusa Tenggara West Kalimantan Jambi Bangka Belitung Islands Lampung Riau Central Sulawesi North Kalimantan Aceh West Sulawesi West Java Southeast Sulawesi West Sumatra Yogyakarta West Papua Banten Papua Riau Islands Bali Bengkulu Maluku North Sumatra East Kalimantan Central Java South Sumatra West Nusa Tenggara Gorontalo Central Kalimantan South Sulawesi North Maluku East Java North Sulawesi South Kalimantan DKI Jakarta Death per one million population Province
  • 6. 6 WHO Indonesia Situation Report - 20 who.int/indonesia • As of 12 August, the daily number of specimens and suspected cases tested were 26 248 and 13 698, respectively (Fig. 5). The weekly average number of specimens and suspected cases tested in the last seven days were 25 699 and 12 745, respectively. The fifth revision of national guidelines on COVID-19 prevention and control has adopted the WHO guidance for discharge criteria6, which is expected to narrow the gap between specimens and suspected cases tested. Therefore, it is important to evaluate the implementation of the revised guidelines at all administrative levels to monitor this trend. 6 Source: https://www.who.int/publications/i/item/clinical-management-of-covid-19 Figure 5: The daily number of specimens and suspected cases tested in Indonesia, from 01 May to 12 August 2020. Source of data Disclaimer: Due to the transition to a new data management application, there may have been reporting issues in timing. Therefore, on certain days the number of specimens tested is almost the same as the number of people tested, which might not have been the situation. 0 5000 10000 15000 20000 25000 30000 35000 1-May 5-May 9-May 13-May 17-May 21-May 25-May 29-May 2-Jun 6-Jun 10-Jun 14-Jun 18-Jun 22-Jun 26-Jun 30-Jun 4-Jul 8-Jul 12-Jul 16-Jul 20-Jul 24-Jul 28-Jul 1-Aug 5-Aug 9-Aug Dailynumber Number of specimens tested Number of suspected cases tested
  • 7. 7 WHO Indonesia Situation Report - 20 who.int/indonesia Table 1: Assessment of epidemiological criteria for six provinces in Java for the 3-week period from 20 July to 09 August. Province Decline in the number of confirmed COVID-19 cases since the latest peak* Decrease in the number of confirmed and probable case deaths for the last 3 weeks** DKI Jakarta Latest peak last week No West Java Latest peak last week Yes Central Java Less than 50% since latest peak No Yogyakarta More than 50% for one week Yes East Java Latest peak last week No Banten Latest peak last week Yes *date of latest peak differs for each province (see Figs. 6 to 11 for details) **decrease in deaths is calculated from 20 July to 09 August 2020 (see Fig. 13 for details) Criterion 1: Decline of at least 50% over a 3-week period since the latest peak and continuous decline in the observed incidence of confirmed and probable cases • None of the provinces in Java have shown a decline of at least 50% for three weeks since the latest peak (Figs. 6 to 11). Four provinces in Java (DKI Jakarta, West Java, East Java and Banten) experienced an increase in the number of confirmed COVID-19 cases. EPIDEMIOLOGICAL CRITERIA TO ASSESS COVID-19 TRANSMISSION
  • 8. 8 WHO Indonesia Situation Report - 20 who.int/indonesia Figure 6: Weekly and cumulative number of confirmed COVID-19 cases in DKI Jakarta, as of 09 August 2020. Source of data Figure 7: Weekly and cumulative number of confirmed COVID-19 cases in West Java, as of 09 August 2020. Source of data 0 5000 10000 15000 20000 25000 30000 0 500 1000 1500 2000 2500 3000 3500 4000 Cumulativenumber Weeklynumber DKI Jakarta Number of confirmed COVID-19 cases Cumulative number of confirmed COVID-19 cases 0 1000 2000 3000 4000 5000 6000 7000 8000 0 200 400 600 800 1000 1200 1400 1600 Cumulativenumber Weeklynumber West Java Number of confirmed COVID-19 cases Cumulative number of confirmed COVID-19 cases
  • 9. 9 WHO Indonesia Situation Report - 20 who.int/indonesia Figure 8: Weekly and cumulative number of confirmed COVID-19 cases in Central Java, as of 09 August 2020. Source of data Figure 9: Weekly and cumulative number of confirmed COVID-19 cases in Yogyakarta, as of 09 August 2020. Source of data 0 2000 4000 6000 8000 10000 12000 0 200 400 600 800 1000 1200 1400 1600 Cumulativenumber Weeklynumber Central Java Number of confirmed COVID-19 cases Cumulative number of confirmed COVID-19 cases 0 100 200 300 400 500 600 700 800 900 1000 0 50 100 150 200 250 Cumulativenumber Weeklynumber Yogyakarta Number of confirmed COVID-19 cases Cumulative number of confirmed COVID-19 cases
  • 10. 10 WHO Indonesia Situation Report - 20 who.int/indonesia Figure 10: Weekly and cumulative number of confirmed COVID-19 cases in East Java, as of 09 August 2020. Source of data Figure 11: Weekly and cumulative number of confirmed COVID-19 cases in Banten, as of 09 August 2020. Source of data 0 5000 10000 15000 20000 25000 30000 0 500 1000 1500 2000 2500 3000 Cumulativenumber Weeklynumber East Java Number of confirmed COVID-19 cases Cumulative number of confirmed COVID-19 cases 0 500 1000 1500 2000 2500 0 50 100 150 200 250 Cumulativenumber Weeklynumber Banten Number of confirmed COVID-19 cases Cumulative number of confirmed COVID-19 cases
  • 11. 11 WHO Indonesia Situation Report - 20 who.int/indonesia Criterion 2: Less than 5% of samples positive for COVID-19, at least for the last 2 weeks, assuming that surveillance for suspected cases is comprehensive • The percentage of positive samples can be interpreted only with comprehensive surveillance and testing of suspected cases, in the order of one per 1 000 population per week. DKI Jakarta has achieved this minimum case detection benchmark (Fig. 12). There is a significant difference between the number of suspected cases tested in Jakarta compared to the rest of Indonesia. Figure 12: Positivity rate of cases, and suspected cases tested per 1 000 population per week: Week 1: 20/07/20 - 26/07/20; Week 2: 27/07/20 - 02/08/20; Week 3: 03/08/20 - 09/08/20 For surveillance purposes, positivity rate is calculated as the number of confirmed cases divided by the number of people tested for diagnosis. Source of data: Indonesia, DKI Jakarta 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 0.00 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 5.00 1 2 3 1 2 3 1 2 3 Indonesia DKI Jakarta Indonesia without DKI Jakarta Weeks Positivityrate Suspectedcasestested/1000population/week Suspected cases tested/1000 population/week Positivity rate Benchmark: One suspected case tested per 1000 population per week Threshold positivity rate <5%
  • 12. 12 WHO Indonesia Situation Report - 20 who.int/indonesia Criterion 3: Decline in the number of deaths among confirmed and probable cases for the last 3 weeks 31 73 87 117 84 127 0 50 100 150 200 250 20/07/20 - 26/07/20 27/07/20 - 02/08/20 03/08/20 - 09/08/20 DKI Jakarta Other death with COVID-19 protocol Death-Confirmed-Case 16 4 18 73 63 8 4 0 20 40 60 80 100 20/07/20 - 26/07/20 27/07/20 - 02/08/20 03/08/20 - 09/08/20 West Java Death-Confirmed-Case Death-PDP Death-ODP 95 166 135 88 85 139 0 50 100 150 200 250 300 20/07/20 - 26/07/20 27/07/20 - 02/08/20 03/08/20 - 09/08/20 Central Java Death-Confirmed-Case Death-PDP 5 3 0 3 00 2 4 6 8 10 20/07/20 - 26/07/20 27/07/20 - 02/08/20 03/08/20 - 09/08/20 Yogyakarta Death-Confirmed-Case Death-Probable-Case 187 135 141 166 98 99 0 60 120 180 240 300 360 20/07/20 - 26/07/20 27/07/20 - 02/08/20 03/08/20 - 09/08/20 East Java Death-Confirmed-Case Death-Probable-Case 4 3 0 4 5 00 2 4 6 8 10 20/07/20 - 26/07/20 27/07/20 - 02/08/20 03/08/20 - 09/08/20 Banten Death-Confirmed-Case Death-PDP
  • 13. 13 WHO Indonesia Situation Report - 20 who.int/indonesia Figure 13: Deaths among confirmed COVID-19 cases, patients under investigation (PDP) and persons under observation (ODP) per week over the last three weeks from 20 July to 09 August 2020 in six provinces in Java. Source of data: DKI Jakarta, West Java, Central Java, East Java, Yogyakarta, Banten. Disclaimer: The data are provisional. As of 20 July, some provinces have adopted case definitions based on the fifth revision of the national guidelines on COVID-19 prevention and control. There may be a discrepancy in the number of deaths of confirmed COVID- 19 cases between national and provincial data sources. • On 07 August, the fifth and final batch of webinars for the ‘Tagana’ (community volunteers for responding to disasters) was completed for East Nusa Tenggara on how to establish quarantine and isolation facilities at community level, including the role of community volunteers in case finding by implementing a screening system. WHO presented the health protocols of quarantine and isolation facilities at community level. The series of webinars covered five priority provinces (Central Java, East Nusa Tenggara, East Java, South Kalimantan and West Java). • The number of confirmed COVID-19 cases hospitalized in DKI Jakarta since the beginning of June gradually decreased until 07 July; however, since 08 July, the number has been progressively increasing, with a slight decrease over the past two days (Fig. 14). HEALTH SYSTEM CRITERIA TO ASSESS COVID-19 TRANSMISSION Figure 14: Number of confirmed COVID-19 cases hospitalized in DKI Jakarta from 01 June to 09 August 2020. Source of data Disclaimer: Data from Wisma Atlet are not included. 0 500 1000 1500 2000 2500 3000 1-Jun 8-Jun 15-Jun 22-Jun 29-Jun 6-Jul 13-Jul 20-Jul 27-Jul 3-Aug NumberofconfirmedCOVID- 19caseshospitalized
  • 14. 14 WHO Indonesia Situation Report - 20 who.int/indonesia • As reported by the government on 12 August, the number of suspected cases tested for COVID-19 with polymerase chain reaction (PCR) was 13 698 and the cumulative number of suspected cases tested was 1 012 104 (Fig. 15). • On 04 August, WHO handed over 253 800 viral transport media and swabs, amounting to US$ 532 980, to the Directorate of Surveillance and Health Quarantine, MoH, to support case finding. These items will be distributed to all 34 provinces. LABORATORY Figure 15: Daily and cumulative number of people tested with polymerase chain reaction (PCR) in Indonesia, as of 12 August 2020. Source of data 0 200000 400000 600000 800000 1000000 1200000 0 2000 4000 6000 8000 10000 12000 14000 16000 18000 20000 7-Mar 14-Mar 21-Mar 28-Mar 4-Apr 11-Apr 18-Apr 25-Apr 2-May 9-May 16-May 23-May 30-May 6-Jun 13-Jun 20-Jun 27-Jun 4-Jul 11-Jul 18-Jul 25-Jul 1-Aug 8-Aug Cumulativenumber Dailynumber Reporting date Daily number of suspected COVID-19 cases tested with PCR Cumulative number of suspected COVID-19 cases tested with PCR
  • 15. 15 WHO Indonesia Situation Report - 20 who.int/indonesia • As of 12 August, the proportion of people that recovered among the total confirmed COVID-19 cases was 65.6% (Fig. 16). As of the same date, there were 39 017 confirmed COVID-19 cases under care or in isolation7. • On 06 August, WHO and MoH conducted the first meeting to orient participants from hospital management teams and Province Health Offices (PHOs) on the ‘oxygen survey’. On 13 August, WHO and MoH will meet PHOs to discuss plans for subsequent orientations and trainings. There will be three batches of socialization meetings, followed by training for the surveyors during the last week of August. The training will be divided into three batches, based on regions (western, central, eastern), to accommodate the large number of participants (close to 850 surveyors). • On 07 August, WHO published an information note on ‘Substandard/ Falsified medical devices and personal protective equipment (PPE) used in the context of the COVID-19 pandemic’. The note advises the users of medical devices and PPE, procurement entities, customs officials, national programme managers and their implementing partners, laboratories, MoH and national regulatory authorities on actions to be taken to identify and 7 https://covid19.go.id/ CASE MANAGEMENT Figure 16: Cumulative number of recovered cases and percentage recovery from COVID-19 in Indonesia, as of 12 August 2020. Source of data 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 0 10000 20000 30000 40000 50000 60000 70000 80000 90000 100000 1-Apr 7-Apr 13-Apr 19-Apr 25-Apr 1-May 7-May 13-May 19-May 25-May 31-May 6-Jun 12-Jun 18-Jun 24-Jun 30-Jun 6-Jul 12-Jul 18-Jul 24-Jul 30-Jul 5-Aug 11-Aug Percentage(%) Cummulativenumber Cumulative number of recovered cases Percentage recovery
  • 16. 16 WHO Indonesia Situation Report - 20 who.int/indonesia prevent distribution of substandard/falsified medical devices and PPE for COVID-19. It also provides classification of substandard, falsified and unregistered or unlicensed medical devices. • On 06 and 07 August, WHO supported the MoH to conduct an orientation for the facilitators of the Intra-Action Review (IAR). The facilitators presented a summary of their desk review for each pillar (country-level coordination; planning and monitoring; risk communication and community engagement (RCCE); surveillance, case investigation and contact tracing; points of entry; the national laboratory system; infection prevention and control (IPC); case management and knowledge sharing about innovations and the latest research; operational support and logistics in the management of supply chains and the workforce; and maintaining essential health services during the COVID-19 outbreak). The desk review covered, for instance, the timeline of the response in each pillar, standard operating procedures, available guidelines, selected trigger questions for the IAR and drafts of best practices, challenges and recommendations. The orientation was a simulation of the IAR that will take place from 11 to 14 August. WHO delivered inputs for the selected trigger questions and briefed the participants on facilitating techniques, in line with WHO guidance on ‘Conducting a country-level COVID-19 IAR’. • On 07 August, WHO convened a meeting with MoH and the Hasanuddin University to discuss the feedback on the field assessment tool and prepare for the assessment that will take place during the last week of August. Feedback was collected through field testing of the tools, i.e., checklists for PHOs, District Health Offices (DHOs), provincial laboratories, hospitals, port health posts, COVID-19 Task Force, puskesmas and community health posts (posyandu). WHO incorporated inputs from the nine provinces in which the tools were piloted. The enumerators for the upcoming field assessment exercise will be trained on information collection, compilation and analysis for two weeks during mid-August; the field assessment will take place at the end of August and in early September. PLANNING, RISK AND NEEDS ASSESSMENT
  • 17. 17 WHO Indonesia Situation Report - 20 who.int/indonesia • The results of the field assessment and the IAR will be used to identify strengths, best practices, gaps and challenges, of the COVID-19 response to date and will subsequently guide the development of national and province-specific recommendations when updating the provincial and national COVID-19 response plans. • On 07 August, WHO participated in a coordination meeting to discuss strengthening the laboratory network for influenza-like illnesses (ILI) and severe acute respiratory infections (SARI) sentinel sites. It was recommended to include public health laboratories in the influenza sentinel surveillance network under the existing Global Influenza Surveillance and Response System (GISRS). The samples from influenza sentinel sites should be tested for both influenza and COVID-19. WHO reiterated the procedures for COVID-19 sentinel surveillance using the GISRS. • MoH is developing a risk assessment tool for mass gatherings during COVID-19. WHO provided input to the tool in line with the WHO guidance on ‘WHO mass gathering COVID-19 risk assessment tool – Generic Figure 17: WHO field staff interviewed port health staff in Manado, North Sulawesi, during piloting of the tool for field assessment, July 2020. Credit: Veronika/WHO
  • 18. 18 WHO Indonesia Situation Report - 20 who.int/indonesia events’. The tool has been translated to Indonesian, adapted to the country context, and will be finalized soon. • WHO is regularly translating and sharing important health messages on the website and social media platforms – Twitter and Instagram – and has recently published: - Infographics: ▪ Five on breastfeeding and COVID-19 ▪ Six on recommendations for management at the workplace, in collaboration with the Indonesia Global Compact Network (IGCN), the International Labour Organization (ILO) and the United Nations Development Programme (UNDP) (Fig. 18). RISK COMMUNICATION Figure 18: An infographic from the workplace infographic series, developed and published by WHO and partners, August 2020.
  • 19. 19 WHO Indonesia Situation Report - 20 who.int/indonesia - Animations: ▪ Six on ‘Stay healthy at home’ ▪ One on ‘How to protect yourself from COVID-19’ - Questions and answers on contact tracing • WHO is supporting the government for programme analysis of various essential health services to ensure their continuity during the pandemic. Highlights of the initial immunization programme analysis can be found in WHO Situation Report 13. Updates from the programme are presented below: i. There has been an increase in monthly vaccination coverage for all available vaccine preventable diseases (VPDs), ranging from 3 to 41%, from May 2020 to June 2020. However, the overall coverage in June 2020 remained 10 to 20% lower than in June 2019, excluding measles- containing-vaccine 2 (MCV2) (Fig. 19). There has been an increase in the national DPT-HB-HiB 3 (vaccine for Diphtheria, Pertussis, Hepatitis B, Haemophilus Influenza Type B – third dose) coverage from April to June 2020 (Fig. 20). CONTINUITY OF ESSENTIAL HEALTH SERVICES
  • 20. 20 WHO Indonesia Situation Report - 20 who.int/indonesia 0 20 40 60 80 100 2019 2020 2019 2020 2019 2020 2019 2020 2019 2020 2019 2020 BCG HB0 OPV 4 DPT-HB-HiB 1 DPT-HB-HiB 3 MCV2 Coverage(%) Vaccinated Unvaccinated Figure 19: Cumulative coverage of routine immunization from March to June 2020 compared to the same period in 2019. Source: Expanded Programme on Immunization (EPI) Unit, Ministry of Health (unpublished data) BCG: Bacillus Calmette–Guérin vaccine against meningitis and disseminated tuberculosis in children HB0: Hepatitis birth dose to prevent hepatitis-B transmission from mother to child OPV 4: Oral Polio Vaccine DPT-HB-HiB 1: Vaccine for Diphtheria, Pertussis, Hepatitis B, Haemophilus Influenza Type B – 1st dose DPT-HB-HiB 3: Vaccine for Diphtheria, Pertussis, Hepatitis B, Haemophilus Influenza Type B – 3rd dose MCV2: Measles-containing-vaccine – 2nd dose Figure 20: National DPT-HB-HiB 3 (vaccine for Diphtheria, Pertussis, Hepatitis B, Haemophilus Influenza Type B – 3rd dose) coverage from March to June 2020, showing annual target population of below one-year old children. Source: Expanded Programme on Immunization (EPI) Unit, Ministry of Health (unpublished data) 17.7 21.6 26.5 33.4 0 5 10 15 20 25 30 35 40 45 50 0 1 2 3 4 5 6 7 8 Mar Apr May Jun Cumulativepercentage(%) Monthlycoverage(%) Monthly coverage Cumulative coverage Monthly target 7.9%
  • 21. 21 WHO Indonesia Situation Report - 20 who.int/indonesia ii. On 09 July, the Director General of Disease Prevention and Control issued a circular letter on the continuity of school-based immunization as scheduled in August and November. The strategy will be adjusted with local transmission of COVID-19. If the schools remain closed, there will be an option to coordinate with puskesmas to arrange frequent, smaller, vaccination sessions to vaccinate children in the empty school premises. All health workers, caregivers and students will be expected to comply with health protocols during vaccination sessions which will be conducted through scheduled appointments. iii. MoH plans to conduct subnational supplementary immunization activities for inactive polio vaccine (IPV) targeting children below 15 years of age and catch-up immunization of all vaccines for children below three years of age in North Kalimantan. Starting in August, these activities aim to mitigate transmission risk of the ongoing outbreaks of circulating vaccine-derived poliovirus type 1 (cVDPV1) and circulating vaccine-derived poliovirus type 2 (cVDPV2) from nearby Malaysia and Philippines. Furthermore, chronic low coverage of immunization and suboptimal acute flaccid paralysis (AFP) surveillance has increased the risk to these outbreaks. The Indonesian Technical Advisory Group on Immunization (ITAGI) released a recommendation to support the activities. To mitigate the impact of COVID-19 and maintain essential immunization programmes, the government, WHO and partners are carrying out the following interventions: i. Piloting an online dashboard for monitoring the Expanded Programme on Immunization (EPI) and VPD surveillance in Lampung in July 2020. The dashboard provides an update on various indicators, for instance, monthly EPI coverage, vaccine stocks, immunization sessions, monthly VPD surveillance performance and the involvement of EPI and VPD surveillance officers in the COVID-19 response. The dashboard will be expanded to all provinces this month. ii. Continuation of virtual meetings and workshops in all provinces for capacity building of EPI and VPD officers in puskesmas, DHOs and PHOs. As of August 2020, more than 2 000 health workers have been trained using online platforms.
  • 22. 22 WHO Indonesia Situation Report - 20 who.int/indonesia iii. To address low vaccination coverage and reporting of VPD cases, MoH conducted a workshop on 23 and 24 July in North Maluku to discuss a strategy for catch-up immunization. The workshop aimed to strengthen capacity of health workers in identifying children below three years of age who missed routine immunization using defaulter tracking tools and developing microplanning to reach the immunization target. WHO supported MoH and PHOs to prepare for the workshop, develop the materials, and facilitate workshop discussions. Figure 21: Vaccination session, adhering to appropriate infection prevention and control measures, at a community health post in North Maluku. Credit: Hermansyah/WHO
  • 23. 23 WHO Indonesia Situation Report - 20 who.int/indonesia iv. The updated VPD surveillance technical guidance during the COVID- 19 pandemic, in line with WHO guidance, is being finalized and will be released this month. The recommendation by national experts on integration of VPD and COVID-19 surveillance has been adopted. v. A total of 700 vials (10 000 international units per vial) of diphtheria anti- toxin were procured and delivered to MoH. These will be distributed to provinces with high transmission of diphtheria such as Aceh, DKI Jakarta, East Java and West Java. • On 07 August, WHO convened the fifteenth meeting of key development partners to discuss and coordinate COVID-19 response activities. The Asian Development Bank (ADB), the Australian Department of Foreign Affairs and Trade (DFAT), the British Embassy, the Canadian Embassy, the European Union (EU), the Japan International Cooperation Agency (JICA), the United Nations Children’s Fund (UNICEF), the United States Agency for International Development (USAID), the World Bank (WB), and the World Food Programme (WFP) participated in the meeting. WHO provided important national COVID-19 response-related updates, presented on the COVID-19 epidemiological and health system situation in the country and informed partners on the technical assistance provided to government counterparts. DFAT has delivered 20 non-invasive ventilators to East Java, from a total of 100 that arrived in Indonesia; ADB has delivered 200 boxes of N-95 masks to the government. JICA is collaborating with the national police to support management of dead bodies along with provision of disposable PPE. UNICEF shared its report from the rapid assessment on the effects of COVID-19 on maternal, newborn and child health (MNCH) services to identify gaps, gather perceptions of health workers, prepare for the resumption and safe scale up of MNCH activities. WB is continuing to assess the economic impact of the response, along with support related to tracking government expenditure. • WHO continues to collaborate with IGCN, ILO and UNDP for the second webinar of the ‘Business Unusual in the New Normal’ series. The first webinar, on 06 August, discussed WHO protocols and government policies in Indonesia for prevention of COVID-19 in workers in general, alongside challenges faced by companies and workers in implementing the health protocols. The second webinar, on 13 August, will focus on food businesses PARTNER COORDINATION
  • 24. 24 WHO Indonesia Situation Report - 20 who.int/indonesia (Fig. 22). WHO will present the WHO guidance on ‘COVID-19 and food safety’. Other resource persons include: the Ministry of Cooperation and Small-Medium Enterprises; the United Family Food (UNIFAM); the Indonesian Catering Employers Association; and the Traditional Market Association. The webinar aims to facilitate dialogue between UN agencies, government stakeholders, business associations, employers and workers on challenges and experiences in implementing the health protocols in food businesses during the COVID-19 pandemic. Figure 22: Poster of the webinar for food businesses in the ‘new normal’, 13 August 2020. Credit: Indonesia Global Compact Network (IGCN).
  • 25. 25 WHO Indonesia Situation Report - 20 who.int/indonesia • Overall funding request for WHO operations and technical assistance is US$ 46 million (27 million for response and 19 million for recovery phase), based on estimated needs as of August 2020 (Fig. 23). Data presented in this situation report have been taken from publicly available data from the MoH (https://infeksiemerging.kemkes.go.id/), BNPB (http://covid19.go.id) and provincial websites. There may be differences in national and provincial data depending on the source used. All data are provisional and subject to change. Figure 23: WHO funding situation for COVID-19 response, August 2020
  • 26. 26 WHO Indonesia Situation Report - 20 who.int/indonesia Online WHO COVID-19 courses: • Operational planning guidelines and COVID-19 • Clinical management of severe acute respiratory infections • Health and safety briefing for respiratory diseases – eProtect • Infection prevention and control • Emerging respiratory viruses, including COVID-19 • Design of severe acute respiratory infection treatment facility WHO guidance: • Safe Eid-al-Adha practices in the context of COVID-19 • Doing things that matter • Considerations for school-related public health measures • Cleaning and disinfection of environmental surfaces • Guiding principles for immunization activities during the COVID-19 pandemic • Maintaining a safe and adequate blood supply during the COVID-19 pandemic Infographics: • Take care in your workplace • Safe travel during COVID-19 • Tuberculosis and COVID-19 • Nutrition tips • Three places to avoid • ‘Be Active’ • Is dexamethasone a treatment for all COVID-19 patients? • The ‘new normal’ Questions and answers: • COVID-19 transmission Videos: • Take care in your workplace • Safe travel during COVID-19 • COVID-19 is a virus not bacteria • Health workers and stigma • Managing stress • Who wears what masks when • COVID-19 spread For more information please feel free to contact: seinocomm@who.int WHO Indonesia Reports A SNAPSHOT OF WHO COURSES AND INFORMATION MATERIAL