HIGHLIGHTS Coronavirus Disease 2019 (COVID-19) Situation Report 77
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Coronavirus Disease 2019 (COVID-19) World Health Organization Situation Report n - 77 Indonesia 19 October 2021 HIGHLIGHTS • As of 19 October, the Government of Indonesia reported 4 236 287 (903 new) confirmed cases of COVID-19, 143 049 (50 new) deaths and 4 076 541 recovered cases from 510 districts across 34 provinces.1 As of the same date, the number of people fully vaccinated per 100 total population was 23.6 nationwide; DKI Jakarta reported the highest number among all provinces (78.7). The weekly number of COVID-19 vaccine doses administered from 11 to 17 October was 11 372 005 doses.2 • As of 17 October, the weekly incidence per 100 000 population nationwide, in Java-Bali and non-Java-Bali regions was 3.2, 2.8 and 3.7, respectively. The weekly incidence remained at a low level of community transmission (CT1). Fig. 1. Geographic distribution of confirmed COVID-19 cases reported in the last seven days per 100 000 population in Indonesia across provinces, from 13 to 19 October 2021. Source of data Disclaimer: The number of cases reported daily is not equivalent to the number of persons who contracted COVID-19 on that day; reporting of laboratory-confirmed results may take up to one week from the time of testing. 1 https://covid19.go.id/peta-sebaran-covid19 2 https://vaksin.kemkes.go.id/#/vaccines 1 WHO Indonesia Situation Report - 77 who.int/indonesia
GENERAL UPDATES • On 15 October, the Ministry of Health (MoH) spokesperson for COVID-19 vaccination reported that more than 50% of the target population in Indonesia have been vaccinated with at least one dose of the vaccine. She appreciated the active participation from the public and continuous support from various stakeholders, including from the private sector. The MoH spokesperson highlighted that the government will continue to implement strategies to accelerate vaccination in the country to reach the remaining target population, in collaboration with relevant partners and stakeholders. She reiterated the importance of continuous improvement of vaccination coverage as one of the efforts to curb COVID-19 transmission and provide protection to the community. 3 • The Government of Indonesia reopened Bali for international tourists on 14 October. The decision was implemented as one of the strategies to support the acceleration of national economic recovery. The Deputy Governor of Bali said that strategies have been developed and preparations have been made to anticipate the incoming tourists and to control COVID-19 transmission in the province. As of 14 October, no international arrivals via the I Gusti Ngurah Rai International Airport were recorded. The Deputy Governor expected that more international tourists will come to Bali by the end of October 2021 or early next year.4 • On 13 October, the National COVID-19 Task Force (Satuan Tugas (Satgas)) issued a new Circular No. 14 of 2021 on ‘Entry Point, Quarantine Place, and Mandatory Reverse Transcription-Polymerase Chain Reaction (RT-PCR) Test for Indonesian Citizens from Abroad’. According to the circular, seven points of entry (PoEs) have been designated for Indonesian citizens coming from abroad to enter the country: the Soekarno-Hatta International Airport in Banten, Sam Ratulangi International Airport in North Sulawesi, Batam Central Harbour and Tanjung Pinang Harbour in Riau Islands, Nunukan Harbour in North Kalimantan, and the Aruk and Entikong Cross-Border Posts in West Kalimantan. Upon arrival, Indonesian citizens coming from countries with low COVID-19 transmission are required to undergo a mandatory quarantine for five days; those coming from countries with high COVID-19 transmission are required to undergo mandatory quarantine for 14 days. Centralized quarantine facilities have been prepared by the government, especially for Indonesian migrant workers, government officials returning from official travel, and students returning to the country. This circular is effective until 31 December 2021.5 3 https://www.kemkes.go.id/article/view/21101500002/vaksinasi-covid-19-dosis-pertama-lampaui-50- persen-sasaran-terima-kasih-masyarakat-indonesia.html 4 https://en.tempo.co/read/1517772/foreign-tourists-likely-to-swarm-bali-in-octobers-end 5 https://www.cnbcindonesia.com/news/20211014085432-4-283785/satgas-covid-tetapkan-7-pintu- masuk-wni-ke-ri-ini-daftarnya 2 WHO Indonesia Situation Report - 77 who.int/indonesia
SURVEILLANCE • On 19 October, 903 new and 4 236 287 cumulative cases were reported in Indonesia. The weekly number of cases from 11 to 17 October was 6826, a decrease of 21% compared to the previous week. On 19 October, 50 new and 143 049 cumulative COVID-19 deaths were reported nationwide. The weekly number of new deaths from 11 to 17 October was 301, a decrease of 37% compared to the previous week (Fig. 2). 400000 14000 350000 12000 300000 10000 250000 8000 Deaths Cases 200000 6000 150000 4000 100000 50000 2000 0 0 23/03 - 29/03 13/04 - 19/04 25/05 - 31/05 15/06 - 21/06 17/08 - 23/08 07/09 - 13/09 19/10 - 25/10 09/11 - 15/11 11/01 - 17/01 15/03 - 21/03 05/04 - 11/04 07/06 - 13/06 09/08 - 15/08 30/08 - 05/09 02/03 - 08/03 04/05 - 10/05 06/07 - 12/07 27/07 - 02/08 28/09 - 04/10 30/11 - 06/12 21/12 - 27/12 01/02 - 07/02 22/02 - 28/02 26/04 - 02/05 17/05 - 23/05 28/06 - 04/07 19/07 - 25/07 20/09 - 26/09 11/10 - 17/10 Weekly number of confirmed COVID-19 cases Weekly number of confirmed COVID-19 deaths Fig. 2. Weekly number of confirmed COVID-19 cases and deaths reported in Indonesia, as of 17 October 2021. Source of data Disclaimer: Prior to 10 February 2021, SARS-CoV-2 diagnosis was conducted using polymerase chain reaction (PCR). Since this date, confirmed cases include those who tested positive using nucleic acid amplification test (NAAT) (e.g., PCR) and antigen-detecting rapid diagnostic test (Ag-RDT). The number of cases reported daily is not equivalent to the number of persons who contracted COVID -19 on that day and might be influenced by the number of people tested on that day (see Fig. 6); 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, b oth at the national and subnational level. 3 WHO Indonesia Situation Report - 77 who.int/indonesia
• From 11 to 17 October, the weekly COVID-19 incidence per 100 000 population nationwide, in Java-Bali region and in provinces outside Java-Bali region (non-Java-Bali) was 3.2, 2.8 and 3.7, respectively (Fig. 3). The weekly incidence in Java-Bali region has remained at a low level of community transmission (CT1) for the past six weeks, while the weekly incidence nationwide and in non-Java-Bali region has remained at CT1 for the past five weeks. Province and district level analyses are needed to evaluate these trends and identify new clusters if they arise. 160 CT4 (150+) 140 120 Case incidence 100 CT3 (50 -
• During the week of 11 to 17 October, North Kalimantan was the only province at a moderate level of community transmission (CT2), with an incidence of 32.4 per 100 000 population (Fig. 4). Based on the WHO interim guidance, this means that there was a moderate risk of COVID-19 infection for the general population and a moderate incidence of locally acquired, widely dispersed cases detected in the past 14 days. The remaining 33 provinces were at community transmission level 1 (CT1) during this reporting period (Fig. 4). North Kalimantan Bangka Belitung Islands East Kalimantan Bali DKI Jakarta DI Yogyakarta West Papua Central Sulawesi North Sulawesi West Kalimantan West Sulawesi East Nusa Tenggara Papua Central Kalimantan Aceh South Sulawesi Riau Islands Riau South Kalimantan West Sumatra North Maluku North Sumatra Central Java East Java Lampung Jambi Banten West Nusa Tenggara West Java Bengkulu Maluku South Sumatra Gorontalo Southeast Sulawesi 0 5 10 15 20 25 30 35 Weekly case incidence CT 1 (
• Case incidence in all regions continued to decline over the past ten weeks (Fig. 5). It is critical for each administrative level to closely monitor any possible cluster to ensure rapid response and containment of an outbreak in time. Exhaustive contact tracing activities for each identified case are essential to prevent the spread of infection. Details on incidence in each province are available here. 160 CT4 (150+) 140 120 100 CT3 (50 -
• Nationwide test positivity proportion has remained below 2% in the last four weeks. This proportion can be interpreted reliably only with comprehensive surveillance and testing rate in the order of one person tested per 1000 population per week. Since mid-May 2021, the testing rate of > 1 per 1000 population per week has been maintained; in the last five weeks, the rate has been > 4 per 1000 population per week. It is critical to ensure the continuation of a rigorous testing strategy to rapidly identify COVID-19 cases among suspected cases and close contacts. Furthermore, it is essential to conduct separate analysis of testing rate based on the purpose of testing (e.g., for suspected cases, close contacts and screening) for planning and response purposes (Table 2. Weekly Risk Assessment, page 15). 4.5 35.0% 35% 4.0 People tested/1000 population/week 30.0% 30% 3.5 CT 4 25.0% 25% 3.0 Test positivity proportion 20.0% 2.5 20% 2.0 15% 15.0% CT 3 1.5 10.0% 10% 1.0 5.0% 0.5 5% CT 2 0.0 0.0% CT 1 0% 27/04 - 03/05 18/05 - 24/05 08/06 - 14/06 29/06 - 05/07 20/07 - 26/07 10/08 - 16/08 31/08 - 06/09 21/09 - 27/09 12/10 - 18/10 02/11 - 08/11 23/11 - 29/11 14/12 - 20/12 04/01 - 10/01 25/01 - 31/01 15/02 - 21/02 08/03 - 14/03 29/03 - 04/04 19/04 - 25/04 10/05 - 16/05 31/05 - 06/06 21/06 - 27/06 12/07 - 18/07 02/08 - 08/08 23/08 - 29/08 13/09 - 19/09 04/10 - 10/10 People tested/1000 population Test positivity proportion Fig. 6. Weekly test positivity proportion and people tested per 1000 population per week at the national level, as of 17 October 2021, classified by level of community transmission (CT): CT1: low incidence (< 2%); CT2: moderate incidence (2% - < 5%); CT3: high incidence (5% - < 20%); CT4: very high incidence (20%+). Source of data Disclaimer: Caution should be exercised when interpreting this indicator due to limitations listed in the WHO interim guidance. Other epidemiological indicators also need to be evaluated to determine the level of community transmission. Disclaimer: Caution should be exercised when interpreting this indicator due to limitations listed in the WHO interim guidance. Other epidemiological indicators also need to be evaluated to determine the level of community transmission. 7 WHO Indonesia Situation Report - 77 who.int/indonesia
• During the week of 11 to 17 October, the weekly number of confirmed COVID-19 deaths per 100 000 population in North Kalimantan (1.1) remained at the moderate level of community transmission (CT2). During the same period, the weekly number of confirmed COVID-19 deaths in the remaining 33 provinces was < 1 death per 100 000 population, corresponding to a low level of community transmission (CT1) (Fig. 7). North Kalimantan Aceh Bangka Belitung Islands Papua Bali DI Yogyakarta East Kalimantan Central Kalimantan Central Sulawesi South Kalimantan Riau West Sulawesi Central Java Lampung West Sumatra Riau Islands East Nusa Tenggara North Sulawesi East Java DKI Jakarta South Sulawesi Bengkulu North Sumatra Jambi West Nusa Tenggara Gorontalo South Sumatra West Kalimantan West Java Southeast Sulawesi Banten Maluku North Maluku West Papua 0.0 0.3 0.6 0.9 1.2 Weekly number of confirmed COVID-19 deaths per 100 000 population CT 1 (
• At the national level, during the week of 11 to 17 October, the number of confirmed COVID-19 deaths in Indonesia was 0.2 per 100 000 population, compared to 0.3 deaths per 100 000 population in the previous week. Deaths in Java-Bali and non-Java Bali regions also continued to show a declining trend (Fig. 8). 6 CT4 (5+) 5 Deaths per 100 000 population 4 CT3 (2 -
HEALTH OPERATIONS • On 17 October, the reported number of COVID-19 cases hospitalized in DKI Jakarta was 348, a decrease from 438 cases one week prior. In the same time period, the reported number of cases in self-isolation decreased from 1285 to 998 cases (Fig. 9). 120000 110000 100000 90000 Number of active cases 80000 70000 60000 50000 40000 30000 20000 10000 0 1-Sep 1-Oct 1-Nov 1-Dec 1-Jan 1-Feb 1-Mar 1-Apr 1-May 1-Jun 1-Jul 1-Aug 1-Sep 1-Oct Hospitalized Self-isolation Fig. 9. Number of COVID-19 cases hospitalized and in self-isolation in DKI Jakarta, from 1 September 2020 to 17 October 2021. Source of data • The overall bed occupancy rate (BOR) in COVID-19 referral hospitals has continued to decline. On 16 October, BOR at national level remained at 5%, compared to the week before on 9 October.6 In the same time period, BOR in intensive care unit (ICU) wards was 8% compared to 10%, respectively.7 6 https://www.kemkes.go.id/downloads/resources/download/Ketersediaan-Tempat-Tidur-RS- Covid19/BOR-RS-16-OKTOBER-2021.pdf 7 https://www.kemkes.go.id/downloads/resources/download/Ketersediaan-Tempat-Tidur-RS- Covid19/BOR-RS-9-OKTOBER-2021.pdf 10 WHO Indonesia Situation Report - 77 who.int/indonesia
RISK AND NEEDS ASSESSMENT, AND PLANNING • On 15 October, WHO supported MoH to conduct a virtual workshop to review the COVID-19 operational plans of eight priority districts in Riau Islands, Lampung, West Java, Central Java, Bali, East Kalimantan and North Sulawesi. More than 60 representatives from MoH and relevant Provincial and District Health Offices (PHOs and DHOs) attended the workshop. WHO presented the ‘COVID-19 Strategic Preparedness and Response Plan Operational Planning Guideline ’, which highlighted the ten pillars of the COVID-19 response plan: (1) Coordination, planning, financing, and monitoring; (2) Risk communication, community engagement and infodemic management; (3) Surveillance, epidemiological investigation, contact tracing, and adjustment of public health and social measures; (4) Points of entry, international travel and transport, and mass gatherings; (5) Laboratories and diagnostics; (6) Infection prevention and control, and protection of health workforce; (7) Case management, clinical operations, and therapeutics; (8) Operational support and logistics, and supply chains; (9) Strengthening essential health services and systems; and (10) Vaccination. WHO urged districts and provinces to review their COVID-19 response plans on a regular basis to monitor indicators and achievements, as well as to identify gaps and challenges to further improve the response plans. 11 WHO Indonesia Situation Report - 77 who.int/indonesia
VACCINATION • As of 19 October, 173 949 386 vaccine doses have been administered in the national COVID-19 vaccination campaign; 45 219 980 people (21.7 % of the target population) have been partially vaccinated8 and 64 364 703 people (30.9% of the target population) have been fully vaccinated. The weekly number of COVID-19 vaccine doses administered from 11 to 17 October was 11 372 005 doses, a 13.2% increase compared to 10 046 352 doses in the previous week. As of 19 October, the number of people fully vaccinated per 100 total population was 23.6 nationwide; DKI Jakarta reported the highest number of fully vaccinated per 100 population (78.7), followed by Bali (64.6), Riau Islands (42.9) and DI Yogyakarta (35.8) (Fig. 10). 100 90 per 100 population Number of people 80 70 60 50 40 30 20 10 0 Bengkulu Riau Islands Gorontalo Maluku East Java DI Yogyakarta Lampung Jambi Banten Central Java Bali Riau Bangka Belitung Islands DKI Jakarta West Java North Sumatra Southeast Sulawesi Central Kalimantan West Nusa Tenggara Central Sulawesi Aceh Papua North Maluku South Kalimantan East Nusa Tenggara West Papua West Kalimantan North Kalimantan South Sulawesi West Sulawesi North Sulawesi South Sumatra West Sumatra East Kalimantan Fully vaccinated per 100 population Partially vaccinated per 100 population Unvaccinated per 100 population Fig. 10. Number of people fully vaccinated, partially vaccinated and unvaccinated (zero dose) for COVID-19 per 100 total population by province in Indonesia, as of 19 October 2021. Source of data Note: Source of population data: Target population for health programme 2021, Center of Data and Information, Ministry of Health, unpublished data. Disclaimer: Data are recorded based on the location of the vaccination site. Total population is calculated based on provincial data (national identif ication number (Nomor Induk Kependudukan (NIK)). 8 Partially vaccinated: number of people who have received only the first dose of a two -dose vaccine regimen (calculated as the number of people who have received the first dose subtracted by the number of people who have received the second dose). 12 WHO Indonesia Situation Report - 77 who.int/indonesia
Table 1. COVID-19 vaccination by each target population in Indonesia, as of 19 October 2021. Source of data Number of Number of Target Total target Number of partially % fully % % population population unvaccinated vaccinated vaccinated Health workers 1 468 764 125 531 8.5 1 876 805 127.8 0 0 Older people 21 553 118 2 869 556 13.3 4 858 702 22.5 13 824 860 64.1 Essential public 17 327 167 5 749 629 33.2 22 198 350 128.1 0 0 service workers General 141 211 181 35 397 901 25.1 31 528 227 22.3 74 285 053 52.6 population Children aged 2 929 067 26 705 490 911 733 3.4 11.0 22 864 690 85.6 12-17 Gotong Royong 164 943 971 955 scheme* Note: General population includes vulnerable groups (e.g., persons with disabilities, marginalized groups, etc.); total number vaccinated includes eligible target population with Gotong Royong scheme. *The Gotong Royong scheme does not have a separate total target population from the government vaccination programme. Disclaimer: Vaccination coverage greater than 100% is due to differences in actual versus estimated target population. Due to the ongoing data cleaning process, vaccination coverage may be temporarily affected. • As of 19 October, more than 60% of the older population remains unvaccinated in 28 out of 34 provinces. Two provinces reported a proportion of unvaccinated older populations greater than 90%: West Sumatra and Papua. From 11 to 17 October, among the older population, a declining trend in the number of vaccine doses administered was observed in 15 provinces (DI Yogyakarta, Maluku, West Nusa Tenggara, Central Java, Riau, Riau Islands, North Sulawesi, North Sumatra, West Kalimantan, Gorontalo, Central Sulawesi, Jambi, West Papua, Bali and South Sulawesi). The provinces which showed an increase of > 25% of doses administered among the older population compared to the previous week were: Lampung (274.4%), West Sumatra (96.6%), North Kalimantan (71.8%), Central Kalimantan (46.7%), West Sulawesi (45.1%), West Java (37.1%), East Kalimantan (30.8%) and Aceh (26.1%). • An overall decrease in the weekly trend of vaccine doses administered was observed in 18 out of 34 provinces compared to the previous week. Details of vaccination by province and target populations are available here. 13 WHO Indonesia Situation Report - 77 who.int/indonesia
PARTNER COORDINATION • The overall funding request for WHO operations and technical assistance is US$ 46 million (US$ 27 million for response and US$ 19 million for recovery phase), based on estimated needs as of October 2021 (Fig. 11). Fig. 11. WHO funding situation for COVID-19 response, October 2021. Data presented in this situation report have been taken from publicly available data from the MoH (https://infeksiemerging.kemkes.go.id; https://vaksin.kemkes.go.id), COVID-19 Mitigation and National Economic Recovery Team (KPCPEN) (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. 14 WHO Indonesia Situation Report - 77 who.int/indonesia
WEEKLY RISK ASSESSMENT Table 2. Weekly risk assessment by province in Indonesia, 11 to 17 October 2021. Source of data: Cases, deaths and testing; vaccination Note: Case incidence trend considers the trend of cases over the last three weeks. Incidence per 100 000 population is marked as light red if > 150 and orange if between 50 to 150. Death per 100 000 population is marked as light red if > 5 and orange if between 2 and 5. The testing rate is marked as yellow if it is less than 1/1000 population. Test positivity proportion is marked as light red if ≥ 20% and yellow if between 5% and 20%. The second dose vaccination is marked as light red if < 5% and yellow if betwe en 5% and 10%. Target population for vaccination includes health workers, essential public service workers, older persons, vulnerable populations and people aged 18 years and above and children aged 12 -17 years. 15 WHO Indonesia Situation Report – 76 who.int/indonesia
• Continuous implementation of public health and social measures (PHSM) throughout the country is important, even as the national vaccination coverage increases and expands to additional target groups.9 • Increased testing rates were observed in several districts and provinces during the implementation of emergency restrictions on public activities (Pemberlakuan Pembatasan Kegiatan Masyarakat (PPKM) Darurat) from 3 to 25 July 2021. As of 17 October, all provinces have achieved the recommended benchmark of one person tested per 1000 population per week. All provinces showed a weekly test positivity proportion below 5% during the current reporting period. • The coverage of second-dose vaccination among the older population continues to be low in most provinces. As of 17 October, only DKI Jakarta recorded above 70% coverage among this target group. Eleven provinces continue to report second-dose coverage below 10% among the older population: Aceh (4.8%), West Sumatra (5.2%), North Maluku (5.7%), Papua (6.4%), Southeast Sulawesi (6.8%), West Sulawesi (7.3%), West Papua (8.2%), Lampung (8.2%), Gorontalo (9.5%), South Kalimantan (9.3%) and Central Sulawesi (9.8%). Continued efforts to improve the accessibility to and awareness of the benefits of COVID-19 vaccination among older and high-risk populations remain critical to reduce morbidity and mortality. 9 https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance-publications 16 WHO Indonesia Situation Report – 76 who.int/indonesia
RECENT AND UPCOMING WHO RESOURCE MATERIALS Table 3. Title and details of recent WHO resource materials Source : https ://www.who.int/ Title Details COVID-19 vaccine The COVID-19 vaccine tracker and landscape compiles detailed tracker and information of each COVID-19 vaccine candidate in development landscape, by closely monitoring their progress through the pipeline. The 15 October 2021 vaccine tracker: provides summary tables of COVID-19 vaccine candidates in both clinical and pre-clinical development; provides analysis and visualization for several COVID-19 vaccine candidate categories; and tracks progress of each vaccine from pre-clinical, Phase 1, Phase 2 through to Phase 3 efficacy studies, and Phase 4 registered as interventional studies. The database is updated regularly. Landscape of This document provides an overview of the different observational observational studies studies that are being conducted to assess the effectiveness of on the effectiveness COVID-19 vaccination, including key features in terms of study of COVID-19 design, sample size, study population, key outcomes measured vaccination (draft), and location of study. 15 October 2021 17 WHO Indonesia Situation Report – 76 who.int/indonesia
A SNAPSHOT OF WHO COURSES AND INFORMATION MATERIAL Online WHO COVID-19 courses: • Clinical management of patients with COVID-19: General considerations • COVID-19 vaccination training for health workers • Standard precautions: Environmental cleaning and disinfection • Management of COVID-19 in long-term care facilities • Operational planning guidelines and COVID-19 • Clinical management of severe acute respiratory infections • Health and safety briefing for respiratory diseases – eProtect WHO guidance: • COVID-19 vaccine tracker and landscape • Landscape of observational studies on the effectiveness of COVID-19 vaccination (draft) • ACT-Accelerator Strategic Review • WHO SPRP 2021 Mid-term Report - WHO Strategic Action Against COVID-19 • WHO COVID-19 SPRP: Updated Appeal September 2021 - March 2022 • Antigen-detection in the diagnosis of SARS-CoV-2 infection (interim guidance) Infographics: • Rumours to bust • Back to school (for parents) • Vaccine effectiveness • Vaccine protection • Precaution Questions and answers: • How to talk about vaccines • COVID-19: Vaccines • COVID-19: Vaccine research and development • COVID-19: Vaccine access and allocation Videos: • Vaccines, variants & doses • Vaccines, variants & mass gathering • Pregnancy & COVID-19 • Post COVID-19 condition • Transmission indoors and outdoors For more information please feel free to contact: seinocomm@who.int WHO Indonesia Reports 18 WHO Indonesia Situation Report – 76 who.int/indonesia
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