Jakarta Experiences of Covid-19*

By: Dadang Solihin**

Introduction

The first two positive cases of COVID-19 in Indonesia were announced by the President of the Republic of Indonesia on March 2, 2020, the mother and child of a dance trainer from Depok, who were confirmed to have been infected by a participant in a Japanese national dance event domiciled in Malaysia, which later became the beginning of Jakarta's struggle. The "war" against COVID-19.

Jakarta Province with a population of more than eleven million people (July 2020), consists of five administrative city areas and one administrative district. As of July 31, 2020, 21,201 COVID-19 patients were reported in Jakarta, of which 13,208 (62.3%) had been declared cured and 836 (3.9%) other COVID-19 patients were declared dead. The spread of COVID-19 until this period has been found in all districts in Jakarta, recorded in the period 16-30 July 2020, the highest Incident Rate (IR) speed was in Johar Baru, South Seribu Islands and Kemayoran sub-districts.

In order to prevent and control the spread of COVID-19, the Provincial Government of Jakarta implements an integrated "end to end process" strategy which includes the processes of Planning, Testing, Tracing & Tracking, Treating, and Monitoring & Evaluation. This activity is carried out in the form of collaboration with various parties including the Central Government, cross-sector in Jakarta Province (OPD), Professional Organizations, Educational Institutions/Academics, Community/ Religious Leaders and the private sector.

Planning

The strategic steps taken from the start were to carry out internal consolidation of the Jakarta Provincial Government which began with a meeting of the governor's regarding the mitigation of the novel coronavirus and marked by the formation of the Task Force for the Acceleration of Handling COVID-19 on March 16, 2020.

In order to collect COVID-19 data, both from health facilities and public reports, the Provincial Government of Jakarta has directly provided the COVID-19 extraordinary event (KLB) Command Post which is integrated with the COVID-19 Command Center. High public interest in accessing the KLB Post was accompanied by the use of the latest information technology. Apart from providing phone hunting services at 112 and WhatsApp number 081112112112 with 24-hour standby officers, Jakarta has also utilized an artificial intelligence (AI)-based chatbot service to answer community questions via the WhatsApp message channel.

In preparing for the availability of beds for COVID-19 patients, the Jakarta Provincial Government continues to develop the capacity of COVID-19 services by building a network of Public and Private Hospitals, so that at the beginning of the handling of COVID-19 there are 8 referral hospitals with a capacity of 904 beds increasing to 67 hospitals with a capacity of 4,556 beds.

The increase in hospital capacity must of course be balanced with the addition of health personnel. For this reason, the Jakarta Provincial Government recruits health workers to strengthen existing health services. A total of 306 health workers were successfully recruited and then placed in hospitals, community Health centers (Puskesmas), sub-district health offices, health offices and regional health laboratories.

The Jakarta Provincial Government is not necessarily complacent but continues to innovate in health services, one of which is by providing a place to live for health workers and volunteers who handle COVID-19 in several hotels owned by BUMD and BUMN in Jakarta, the aim is other than to provide convenience for health workers in on duty, also to reduce the risk of transmission from health workers after work to their respective places of residence.

Apart from residential accommodation, Jakarta Provincial Government is working with the transportation sector, namely PT. Trans Jakarta, UP Angkutan Sekolah and DAMRI to provide transportation services for health workers handling COVID-19.

Various trainings related to handling COVID-19 have also been carried out since the beginning of the spread of COVID-19 until now. Technical training such as swab-taking techniques, use of Personal Protective Equipment (PPE), including training on corpse screening involving police officers, funeral officers and health workers.

Testing

The capacity of the corona virus test in Indonesia continues to be under the spotlight of the World Health Organization (WHO). The world health agency implements the standard number of PCR tests of 1 person per thousand population per week. This means that Jakarta must carry out PCR examinations on 10,645 people (not specimens) every week or 1,521 people per day. Currently, according to WHO, only Jakarta Province has met the standards set by WHO, even every week the number of PCR checks performed by Jakarta has reached more or less four times the WHO standard.

In addition, WHO also sets the standard for the percentage of positive cases of no more than 5%. The percentage of positive cases is the number of people who are found to be positive compared to the number of people who have tested for PCR. However, this percentage of positive cases is only considered valid if the minimum number of tests performed has been met. Jakarta's positivity rate is recorded at 4.9% (as of 3 August 2020), still below the standard set by WHO.

Currently, Jakarta has 54 COVID-19 laboratory networks with an examination capacity of 11,267 samples per day. The ability to inspect Jakarta can be seen in the report as of July 31, 2020, as many as 5,344 people were tested for PCR or 51% of the proportion of people examined by PCR in Indonesia. However, the high number of COVID-19 checks has resulted in an increase in the number of COVID-19 cases found and this is often misinterpreted so that the Jakarta Provincial Government has failed to control the spread of COVID-19. In fact, the increase in cases was due to the massive PCR examination resulting from the Active Case Finding (ACF) activity and close contact tracing conducted by the Puskesmas. The goal is to find positive cases as soon as possible so that they can be treated immediately and break the chain of transmission; a concept that is very good and effective but politically unpopular so that not many other provinces dare to follow the steps of the Jakarta Provincial Government.

Tracing & Tracking

Tracing and tracking of COVID-19 patients are carried out not only based on reports of COVID-19 patients and the public through various complaint channels owned by the Jakarta Provincial Government, including the JAKI Application (Jakarta now), 14 Quick Community Response (CRM) complaint channels, or the COVID-19 Response Post, but also is actively implemented through close contact tracing and Active Case Finding. This policy is stated in the Circular of the Head of the Health Office on Active Case Finding.

After the Puskesmas officer finds a COVID-19 case in their area, the next step is that the patient will be referred to the Hospital or Athlete Village to get the treatment needed or can also be advised to carry out independent isolation in his place of residence.

Treating

In general, the management of COVID-19 patients in Jakarta refers to the guidelines issued by related professional organizations and colleges. Meanwhile, community health treatment refers to the guidelines for handling COVID-19 issued by the Ministry of Health and Standard Operational Procedures prepared by the Health Service Office.

Treatment with COVID-19 fixed procedures (protap) is not only given to COVID-19 patients, but also to the bodies of COVID-19 patients. The handling of the COVID-19 body is very well integrated because the Jakarta Provincial Government has a clear SOP in handling the COVID-19 body. The Jakarta Provincial Government has also appointed a Public Cemetery (TPU) designated for COVID-19 bodies, a policy that has proven effective in avoiding the possibility of local residents' rejection of COVID-19 bodies as has happened in other provinces.

Management of Medical Waste Management in Health Service Facilities owned by the Jakarta Regional Government has also received great attention from the Jakarta Provincial Government in the context of Prevention and Control of COVID-19 which is carried out regularly.

Other strategic steps were also taken by the Jakarta Provincial Government outside the health aspect, both aimed at external and internal parties, including the stipulation of activity restrictions and the closure of facilities that can invite crowds since March 5, 2020, restrictions on services in the field of licensing that involves face-to-face, as well as the formation of a licensing review team and public activities that will be carried out in the Capital City. In the field of foreign cooperation, there is a postponement of work visit activities and official trips abroad in order to anticipate the risk of transmission of COVID-19.

The same thing is seen in the field of education with the transfer of teaching and learning activities to online learning at home and the temporary closure of public places such as the Public Library Building, markets, places of worship, city parks, and tourist attractions. Campaigns for studying, working and worshiping at home are continuously socialized.

Modifications in the transportation sector were also carried out by lifting the odd-even policy and limiting the time and number of passengers in the mode of transportation.

The Jakarta Provincial Government also pays attention to Jakarta residents who are affected by the COVID-19 pandemic by providing basic necessities in the form of basic necessities, providing independent isolation places, providing free masks and providing masks at affordable prices at Pasar Jaya.

All aspects of both health and non-health receive equal attention from the Jakarta Provincial Government to ensure the health and welfare of the people of Jakarta.

Reporting

To support the process of recording and reporting COVID-19 data, the Jakarta Provincial Government is the first province to build a COVID-19 Recording and Reporting System in Indonesia. This system facilitates all health facilities in Jakarta to report COVID-19 cases quickly and accurately. The recording and reporting system developed by the Health Office is based on Epidemiological Investigation reporting in order to provide important information from both clinical and public health aspects. This recording system can be accessed at https://reporting-covid19.jakarta.go.id/.

As a form of data and information transparency, the Jakarta Provincial Government has created a website that displays the latest information about COVID-19 and its handling in the Jakarta area. This website, which can be accessed via corona.jakarta.go.id, is open to the public. There is a lot of information here, from information about the disease to data on case progress, disease trends, case spread, and others.

This official page is very useful in disseminating information not only to the people of Jakarta, but also to people outside Jakarta, including the world community, because it is proven that this page is accessed by many general public, news agencies, academics, and others abroad.

Health Promotion and Risk Communication

One form of handling COVID-19 carried out by the Jakarta Provincial Health Office is a promotional effort by making various health promotion media related to COVID-19. This effort aims to increase public awareness of the dangers of COVID-19 and provide accurate information about preventive actions that people can take to avoid COVID-19. The products produced by the Health Service Office include posters, banners, infographics, and videos.

Monitoring and Evaluation

The Health Office periodically conducts assessments of the current situation to be able to produce data-based recommendations for policy making. All activities that have been planned will be reviewed whether they are effective, efficient, and have a positive impact on the community.

The Jakarta Provincial Health Office monitors the target areas in each region down to the sub-district, village, citizens association (RW) and neighborhood association (RT) levels. Among them are monitoring pregnant women, toddlers, and children who are positive for COVID-19 in Jakarta, monitoring health facilities, coaching isolation houses, auditing the readiness of health facilities, and monitoring the availability of personal protective equipment (APD).

Cross Sector Collaboration

In order to increase awareness of the risk of transmission of COVID-19 infection in the Jakarta Province, Jakarta Provincial Government involves the role of all sectors within the Jakarta Provincial Government in handling COVID-19 as collaborators to support and carry out socialization and risk control activities in accordance with Governor Instruction Number 16/2020 concerning Increased Alertness to the Risk of Transmission of COVID-19 Infection.

Lesson Learnt

If you look at the national task force, the smallest data is at the city level, which is different from Jakarta, which has data down to the village level that can be accessed quickly. Thus, the Jakarta Provincial Government uses the incidence rate (IR) at the city, sub-district and village levels to be a part that must be evaluated, including the speed of the IR rate. This is important to do because the total large-scale social restrictions (PSBB) cannot be enforced continuously, so that the Jakarta Provincial Government must have some kind of emergency drill that is smaller in nature, so that a kind of lockdown can be carried out, or tight control in an area.

Now, the Jakarta Provincial Government can report the IR rate once a week and once every two weeks. The basis for the rate of IR is issued to the village level, then the city-level task force team together with the sub-district health center and the kelurahan and RW level task force teams select the RW that is most at high risk, which is determined in a meeting decision at their level. Then came the RW which had to be closely monitored to avoid negligence. The Jakarta Provincial Government continues to say that the implemented PSBB has not yet been completed, but there are several transition periods that need more attention than others. On the other hand, Jakarta Provincial Government also carries out planning by modeling or estimating cases, which are not carried out by other provinces.

Here, strict supervision remains in place. Of course, that does not mean a total lockdown or total quarantine at the RW. Now, every Monday the Health Office together with the provincial level task force team conducts an evaluation meeting with each setting, presenting the progress of policies made for other interventions in accordance with existing conditions in the field. Those are some of the strategies carried out by the Jakarta Provincial Government as an integrated learning of handling COVID-19. By handling COVID-19 in an integrated manner, including planning, testing, tracing, treating, reporting, monitoring, and evaluating, Jakarta continues to carry out various activities in an effort to reduce the spread of COVID-19, with the hope of maintaining the safety of its citizens.

The many obstacles and challenges that come and go and occur every day make the COVID-19 pandemic look still difficult to predict when it will end. Jakarta has no choice but to keep trying to prevent the spread of COVID-19.

Closing

Finally, thank you for this good opportunity to share Jakarta experiences and good practices in combating COVID-19 pandemic. This new normal era has given us more important role to create a stronger and resistance cities in a Post COVID-19 World. I would like to conclude my speech by expressing my hope that through this forum, together we can build sustainable communities and will have a meaningful impact to recover from the global pandemic.

*Sources: SpeakerDeck

**PPRA49