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| Photo by Nice Guys |
Indonesia has pretty much low rates of COVID-19, if the report from the news are to be believed. Or as the government confirmed it.
This low number raises question among us. How is that possible for a country who has more than 1.92 million visitors in 2019 from mainland China, including more than 90.000 travelers from Wuhan between December 2018 and November 2019, has zero confirmed case as per early February?
Some people take the news with skepticism. As for myself, I am curious (and confused at the same time) because of all the Indonesians that being rescued from Wuhan, they were declared survived from infection. Not to mention, the 69 Indonesians crew in Diamond Princess was declared corona-free.
There was also suggestion that Indonesians are strong enough to cope with the virus. That the virus can't live under tropical weather, which later quashed by the WHO as it has no solid evidence.
I have no background in this issue. Hence, other than being curious, partially I was happy if the zero case was true. But I grew anxious and wonder whether are we really free, or protected from the virus?
After a while, I come up with conclusion that there are several issues that could be the reasons of our low rates of COVID-19. It's all hypothetical so it could be wrong. It's a ramble, after all!
Testing, Testing
So what is COVID-19? As of I'm writing this, 106,211 people are infected, with 3,600 people dead. It's a large numbers and it's scary. But take it into different context, it only killed 6% of them. Additionally, 60,213 people have recovered from it. So it's not that bad after all. Or is it?
We must realize that this virus is relatively new. Since it first appearance as an outbreak in Wuhan, I genuinely think the China government along with their scientists and experts, had tried their best to cure them all. But numbers are numbers, and they're still going strong all over the world despite they're going down slowly in China.
The WHO can't still giving verdict on what can really protect us from the virus just yet. It's still a new thing that needs time to work on. What we only know today is that we should wash our hands for 20 seconds straight, don't touch our pretty faces and that's about it. They even estimated that the first vaccine 'could' be ready in 18 months. That's quite some time, I imagine.
And how about Indonesia? I didn't think Indonesian people including many public officials were really understand about COVID-19 and how to handle it. And it's pretty much justifiable by taking China and WHO experiences into account.
This opinion is based on my firsthand experience during my transits (twice) at Changi, Singapore, first week of February 2020. At that time, Singapore just declared that they were on Code Orange in facing COVID-19. Or one level below Code Red, the most dangerous alert.
During my two 3 - 4 hours stays at Changi, I saw serious attempt by Singapore authority in checking us who just arrived from everywhere with Thermal Scanner. Thankfully, I, along with my colleagues, walked through that scanner and we could confirmed that we're COVID-19 free.
In Changi, there were a lot of people, including people who looked a lot like they work in Medical Department. There were even some soldiers standing nearby those health officers (not sure what they are doing, though).
Contrary to Indonesia, when I was about to depart from Changi to Jakarta, the airport officers gave us yellow paper for us to fill in. The paper contains forms and we must write our identity, travel information as well as our health condition. Prior to my arrival in Jakarta, I already had flu and that lasted for 2 weeks after I arrived in Jakarta. And I wrote my condition in that yellow paper, that I felt flu and a little bit of fever.
By the time I arrived in Soekarno-Hatta, I saw people, perhaps public officials from Ministry of Health or could just be volunteers, collecting our yellow papers. However, there was no thermal scanner. Granted, Thermal Scanner might not be the most accurate measurement but at the end of the day, it's still better than doing nothing.
To be honest, that left me scratching my head. I wonder what's the purpose of that paper? Will there be any follow ups? Or was that just a gimmick to make us feel a little safer?*) I actually didn't like the idea to write and write everything after our arrival: customs declaration and now this health information.
*) The later part sounds cruel but it is what it is.
About that yellow paper, I finally found the answers few weeks ago. A random twitter account appeared in my timeline tweeted that she wasn't feeling well when she arrived at Soekarno-Hatta, and she wrote it on that paper. Then some officials were actively asking her condition through phone call (I forgot who they were actually. It seemed like they were State Hospital officers near the girl's house). However, I didn't get any call from anyone regarding my condition. So it was a nice act, but limited to a few.
From that explanation alone, at least we know one thing: there's a difference between Singapore authority and Indonesian authority in handling the virus. They are more proactive in testing any potential victims. At least on that airport.
Do you want to know how many people are infected in Singapore? As of this writing, 138 cases with no death. With 90 people were successfully recovered. This could be because that proactive approach and spontaneous medical checkup without any prior symptoms.
The Korean Way
Going up north, South Korea is having 7,134 people infected as of this writing. Or right behind China. The numbers were rapidly increasing few days ago. Then I wonder, why is that so?
In Changi, there were a lot of people, including people who looked a lot like they work in Medical Department. There were even some soldiers standing nearby those health officers (not sure what they are doing, though).
Contrary to Indonesia, when I was about to depart from Changi to Jakarta, the airport officers gave us yellow paper for us to fill in. The paper contains forms and we must write our identity, travel information as well as our health condition. Prior to my arrival in Jakarta, I already had flu and that lasted for 2 weeks after I arrived in Jakarta. And I wrote my condition in that yellow paper, that I felt flu and a little bit of fever.
By the time I arrived in Soekarno-Hatta, I saw people, perhaps public officials from Ministry of Health or could just be volunteers, collecting our yellow papers. However, there was no thermal scanner. Granted, Thermal Scanner might not be the most accurate measurement but at the end of the day, it's still better than doing nothing.
To be honest, that left me scratching my head. I wonder what's the purpose of that paper? Will there be any follow ups? Or was that just a gimmick to make us feel a little safer?*) I actually didn't like the idea to write and write everything after our arrival: customs declaration and now this health information.
*) The later part sounds cruel but it is what it is.
About that yellow paper, I finally found the answers few weeks ago. A random twitter account appeared in my timeline tweeted that she wasn't feeling well when she arrived at Soekarno-Hatta, and she wrote it on that paper. Then some officials were actively asking her condition through phone call (I forgot who they were actually. It seemed like they were State Hospital officers near the girl's house). However, I didn't get any call from anyone regarding my condition. So it was a nice act, but limited to a few.
Do you want to know how many people are infected in Singapore? As of this writing, 138 cases with no death. With 90 people were successfully recovered. This could be because that proactive approach and spontaneous medical checkup without any prior symptoms.
The Korean Way
Going up north, South Korea is having 7,134 people infected as of this writing. Or right behind China. The numbers were rapidly increasing few days ago. Then I wonder, why is that so?
The answer maybe is that, just like The Singaporeans, they are far more active in testing their people. Not just people with the symptoms, or suspects, but also people in some particular regions, or those who have potential to be infected, even if they are not showing any symptoms. The quality of South Korea authority in handling COVID-19 is second to none, both in preparing their machinery and the methods they are using. Perhaps that is the reason why their infection numbers are so high.
They, the South Korea government and its citizens, fully aware of the virus. They have that COVID-19 lab check almost everywhere that check even healthy people with no symptoms. Even a drive-thru check!
All the doctors and experts around the globe are quickly praising South Korea for that matter. Not because they have a lot of people infected, but because the numbers of people infected suggest how effective their methods are. And they are so open about it.
Latrophobia
I believe in statistics. It's one of the most, if not the most, verifiable ground for academic research.
But I personally think that's not the case for this low COVID-19 numbers in Indonesia. Just like any other human-made instruments, stats can go wrong if you're doing it wrong. And if COVID-19 really has similar symptoms with flu, we're totally screwed up. Simply because how Indonesians handling flu like it's nothing. A lot of people when they are suffering from flu, they are just taking pills.
Most of the time, I didn't even take any pills or medicine just because I believe that by drinking much water, I would be fine.
Another story is that, Indonesian people, especially the baby boomers, are so reluctant to visit medical help for any kind of symptoms. Some of them are still hugely relying on traditional medication.
There is like growing fear in many Indonesians to have medical checkup at hospital. Even the educated ones or those who have insurance. Most of them fear that the checkup could result in more serious disease (nosophobia), fear of doctor (latrophobia), fear of needle (trypanophobia) and all other types of phobia that related to checking themselves at the hospital.
Fear of paying the hospital bill is also one of the biggest reasons. Myself included.
But I personally think that's not the case for this low COVID-19 numbers in Indonesia. Just like any other human-made instruments, stats can go wrong if you're doing it wrong. And if COVID-19 really has similar symptoms with flu, we're totally screwed up. Simply because how Indonesians handling flu like it's nothing. A lot of people when they are suffering from flu, they are just taking pills.
Most of the time, I didn't even take any pills or medicine just because I believe that by drinking much water, I would be fine.
Another story is that, Indonesian people, especially the baby boomers, are so reluctant to visit medical help for any kind of symptoms. Some of them are still hugely relying on traditional medication.
There is like growing fear in many Indonesians to have medical checkup at hospital. Even the educated ones or those who have insurance. Most of them fear that the checkup could result in more serious disease (nosophobia), fear of doctor (latrophobia), fear of needle (trypanophobia) and all other types of phobia that related to checking themselves at the hospital.
Fear of paying the hospital bill is also one of the biggest reasons. Myself included.
That being said, there's a lot of error margin of health statistics for COVID-19 cases in Indonesia. In a way Indonesian people are so reluctant to report even when they are already feeling ill.
And believe me, it's not easy to report your new deadly disease or simply being open about it. People will try to get away and avoiding you because they don't want to be infected. The fear of missing out, being ignored and bullied by society can cause people tend to keep it to themselves.
And believe me, it's not easy to report your new deadly disease or simply being open about it. People will try to get away and avoiding you because they don't want to be infected. The fear of missing out, being ignored and bullied by society can cause people tend to keep it to themselves.
Are We Suffering from The COVID-19?
As I mentioned above that the health stats possibly full of misinformation or isn't factual, that could lead to another finding. That said, a lot of Indonesians, perhaps us, already suffering from COVID-19 without realizing it.
Amin Soebandrio, a microbiological expert, explained that not everyone infected by the virus will get sick. Most people will heal on their own, assuming they are healthy or have strong immune. But these people still have the potential to become a source of transmission when contacting others. And that will be deadly if it infected people with weak immune system.
Since we don't have large scale of testing, and people reluctance to visit doctor when they got flu, it's a huge possibility that it's already widespread and affected a lot of people. Maybe many of us are cured naturally. But the scary part is that perhaps a lot of death recently, were caused by COVID-19. We just don't know it because we're simply not there yet.
Another thing that comes to mind is quite hypothetical and a bit like fairy tale-ish. Please bear with me.
I recently read a good book, The Cost and Benefit Revolution written by Cass R. Sunstein. The co-author of Nudge: Improving Decisions about Health, Wealth, and Happiness promotes the importance of cost and benefit analysis in policy making. Sunstein believes that in the future, cost and benefit will be used more often, and should be used more often to achieve greater good.
Sunstein believes that any policy will be easier to justify if the benefit outweigh the loss. And it will be harder to accept if the loss outweigh the benefit.
I recently read a good book, The Cost and Benefit Revolution written by Cass R. Sunstein. The co-author of Nudge: Improving Decisions about Health, Wealth, and Happiness promotes the importance of cost and benefit analysis in policy making. Sunstein believes that in the future, cost and benefit will be used more often, and should be used more often to achieve greater good.
Sunstein believes that any policy will be easier to justify if the benefit outweigh the loss. And it will be harder to accept if the loss outweigh the benefit.
In terms of COVID-19, the first popular reaction from the government was how to stabilize the economy through domestic travel incentives. Thanks to declining foreign tourists, economy in certain tourism destinations are declining as well.
#KawanKabinet, selamat berakhir pekan. Sambil menikmati pagimu, mari simak apa saja arahan Presiden @jokowi saat memimpin Ratas Terbatas terkait Dampak Virus Covid-19 terhadap Perekonomian Indonesia.#SetkabAkhirPekan pic.twitter.com/7pcKsgiYBj— Sekretariat Kabinet (@setkabgoid) February 29, 2020
In my opinion, what the government did in terms of economic strategy in facing COVID-19, was a subtle way to tell people that: "we're alright, no need to fear about coronavirus". In my wild imagination, the government did understand the virus has been here. And they also understand the psychological and sociological effect that caused by it. It could cause fear and chaos, and damage the economy.
The COVID-19 phobia is also reaching an absurd-level. People fighting each other over masks, food supply, and even toilet paper (thank God Indonesians don't count on it). Perhaps that's one of the reasons why the government appeared so calm, avoiding any unnecessary or even reckless reactions from the people caused by the fear from it. However, it raised outrage among the internet. In this case, we can understand that the government is prioritizing economic growth as a parameter of their work. Perhaps President and his team had calculated the potential loss that this country will face if the outbreak happened. However, to many people, it was not the right move to do. At least from moral perspective, economy isn't everything that should be prioritized.
The COVID-19 phobia is also reaching an absurd-level. People fighting each other over masks, food supply, and even toilet paper (thank God Indonesians don't count on it). Perhaps that's one of the reasons why the government appeared so calm, avoiding any unnecessary or even reckless reactions from the people caused by the fear from it. However, it raised outrage among the internet. In this case, we can understand that the government is prioritizing economic growth as a parameter of their work. Perhaps President and his team had calculated the potential loss that this country will face if the outbreak happened. However, to many people, it was not the right move to do. At least from moral perspective, economy isn't everything that should be prioritized.
So how should the President react? Saving lives first or saving economy?
At this point, it's easy to say that saving lives is more important. But such consideration is merely based on value that we believe. It is expressive and based on intuition, not calculation.
This is where I think it's important to take cost and benefit consideration before deciding what to do. There should be a comprehensive yet quick calculation before the government can confirm what they want to do.
The key of cost and benefit study needs is that the government must be open and honest about the facts, potential benefit and potential loss - not made up. For now, it's easier to measure all the information into monetized cost and monetized benefit. Not only because people tend to agree with financial standpoint, but also because as Sunstein suggests, we don't have welfare meter just yet.
In terms of saving economy, let's say if we don't give this incentive to tourism, there will be many job losses and a lot of industry will suffer. For example airplanes, hotels, airports, restaurants, and souvenirs. These potential loss should be converted into something that can be calculated for cost and benefit analysis. For example, the monetized potential loss if we don't give incentive could reach Rp 1,000,000,000,000,- in deficit. Then, if the incentive that the government will spend is less than Rp 1,000,000,000,-, let alone half of it, the people might be agree because it cost less than its benefit. But we need to calculate all the relevant facts, and the facts must be accountable - not made up.
The government must also measure the potential cost of the protest and outrage from prioritizing economy over saving lives. If they really do so, instead of spending on health coverage, medical facility, technology to contain COVID-19, or reduce the spread of infections, there will be a lot of lives loss as well. It might not be easy to monetize life. Obviously, not everything can be monetized. But it definitely is a huge loss. Which technically can be calculated, or at least as a point of consideration.
The cost and benefit analysis is also open to possibility for both saving lives and saving economy go hand in hand. In the end, whatever result where the benefit exceed the cost, is the result that should be taken by the government. And if there's another alternative policy with the same benefit but lower cost, should be prioritized
After continuous criticize from a lot of people, it looks like saving economy might not be the first priority anymore. However, The Health Minister confirmed that budget efficiency was still a concern and that lab tests would only be done on those with symptoms, who also had travel records and contacts with infected countries or people. Although recently, there were people infected with no prior travel history at all.
Live With It
The suggestion that COVID-19 is similar to common flu is now rejected by many because it kills on quite regular basis, regardless the numbers. Especially if we consider the lack of tests conducted by many countries. However, this notion perhaps was intended to make people calm. With that in mind, rather than scaring people, some world leaders, including Donald Trump, promoted through his twitter that it's nothing more than common flu. Not even as dangerous.
I would be lying if I told you I wasn't afraid of this virus. But as it grows, I'm not too afraid anymore. Not because there are many people recovered from it. But because as WHO claimed that at least 18 months needed to find its vaccine, so we have to deal with it and live with it. For me personally, It's not like 'hey it's gonna be okay', but more like 'ok, what can I do?'.
Of course I can wash my hands more often now and learning to stop to touch my face. It's quite difficult, isn't it?
At this point, it's easy to say that saving lives is more important. But such consideration is merely based on value that we believe. It is expressive and based on intuition, not calculation.
This is where I think it's important to take cost and benefit consideration before deciding what to do. There should be a comprehensive yet quick calculation before the government can confirm what they want to do.
The key of cost and benefit study needs is that the government must be open and honest about the facts, potential benefit and potential loss - not made up. For now, it's easier to measure all the information into monetized cost and monetized benefit. Not only because people tend to agree with financial standpoint, but also because as Sunstein suggests, we don't have welfare meter just yet.
In terms of saving economy, let's say if we don't give this incentive to tourism, there will be many job losses and a lot of industry will suffer. For example airplanes, hotels, airports, restaurants, and souvenirs. These potential loss should be converted into something that can be calculated for cost and benefit analysis. For example, the monetized potential loss if we don't give incentive could reach Rp 1,000,000,000,000,- in deficit. Then, if the incentive that the government will spend is less than Rp 1,000,000,000,-, let alone half of it, the people might be agree because it cost less than its benefit. But we need to calculate all the relevant facts, and the facts must be accountable - not made up.
The government must also measure the potential cost of the protest and outrage from prioritizing economy over saving lives. If they really do so, instead of spending on health coverage, medical facility, technology to contain COVID-19, or reduce the spread of infections, there will be a lot of lives loss as well. It might not be easy to monetize life. Obviously, not everything can be monetized. But it definitely is a huge loss. Which technically can be calculated, or at least as a point of consideration.
The cost and benefit analysis is also open to possibility for both saving lives and saving economy go hand in hand. In the end, whatever result where the benefit exceed the cost, is the result that should be taken by the government. And if there's another alternative policy with the same benefit but lower cost, should be prioritized
After continuous criticize from a lot of people, it looks like saving economy might not be the first priority anymore. However, The Health Minister confirmed that budget efficiency was still a concern and that lab tests would only be done on those with symptoms, who also had travel records and contacts with infected countries or people. Although recently, there were people infected with no prior travel history at all.
Live With It
Is it safe to say that COVID-19 is not as deadly as we would have imagined? My answer would be, if there's no vaccine that can instantly (by instant I mean like two weeks or less) cure us, or an antivirus that can make ourselves completely immune from it, it's still a dangerous virus.
While that tweet seemed arrogant, the message was clear. People shouldn't be too panic. If people went panic and refused (or told) to go to work, the production will be halted. It could cause domino effect which would lead to market crash.So last year 37,000 Americans died from the common Flu. It averages between 27,000 and 70,000 per year. Nothing is shut down, life & the economy go on. At this moment there are 546 confirmed cases of CoronaVirus, with 22 deaths. Think about that!— Donald J. Trump (@realDonaldTrump) March 9, 2020
I would be lying if I told you I wasn't afraid of this virus. But as it grows, I'm not too afraid anymore. Not because there are many people recovered from it. But because as WHO claimed that at least 18 months needed to find its vaccine, so we have to deal with it and live with it. For me personally, It's not like 'hey it's gonna be okay', but more like 'ok, what can I do?'.
Of course I can wash my hands more often now and learning to stop to touch my face. It's quite difficult, isn't it?
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