Is Indonesia a COVID-19 Outlier?

May 2020

Commentary by Wayne Forrest

Reading the press must be troubling for Indonesian leaders. Many accounts describe an out-of-control virus, compromised healthcare system, and an impotent government reaction.  Typical is this comment by a Carnegie Endowment scholar: “The government’s disregard for data, reliance on military personnel for crisis management, and political score-settling steered it away from a balancing act between the economy and health toward a strategy that has delivered worse results for both.” Furthermore, “More disturbingly, [the] administration used this flawed data to defer critical interventions. The delayed timing of ongoing measures to improve detection by distributing new testing equipment to regional labs compromises their effectiveness. Amid already high infection rates, testing may not stem contagion unless supplemented with mass isolation facilities for infected persons in densely populated cities, where people live in close quarters with large families.”  You get the point.  Most of the reports consider Indonesia incompetent and mistrust the officially reported results.  I don’t agree.

What bothers me is that the press -and other opinion writers such as the one quoted above– do not adequately analyze the available data-especially 7-day moving averages– which present a counter narrative. This data, while incomplete, is strong enough for useful analysis.    Looking at total case figures-which continue to rise– is misleading.   Indonesia, whether by virtue of current containment efforts, past vaccination regimens, climate, population age, or pure luck; is plain out not experiencing an exponential growth in cases or deaths.  Rates are linear and appear to be flattening.  Consider these encouraging signs: (courtesy Reformasi Weekly and The NY Times)

  • 7 day moving averages (average of previous 7 days on any given day) have flat-lined: Officially confirmed deaths from Covid-19 nationwide fell by four percent during the week ending 30 April, relative to the previous week. The daily toll touched a record low of eight on 30 April, versus a high of 60 recorded on 14 April. On a seven-day moving average basis, deaths during the week ending 30 April fell by 12 percent.   Similarly, the seven-day moving average of new COVID-19 cases ended at 335 (per day) on 30 April; it has ranged between 318 and 344 for the past 14.
  • Active Cases: (Net of people who have recovered or died).  These numbers continue to rise but the weekly growth rate has been declining steadily since early April, from a high of 69 percent on 11 April to a low of 20 percent on 30 April.  Hardly exponential
  • Total Jakarta cemetery burials:  2019 average was 2700 per month and spiked to 4400 in March. April’s figure was 4377.  Assuming the differential is attributable mostly to COVID-19, comparing these figures to official death rates suggest the under-reporting or undiagnosed cases (by a factor of 3) mentioned by critics. But they coincide with the flattening of death rates. Projected across all of Indonesia, the current official death toll of 872 would be closer to 3,000.   Compared to the US death toll of over 70,000, Indonesia’s, a nation of similar population whose pandemic began about the same time, is starkly lower.
  • Molecular testing: PCR testing expanded significantly during the last week of April, but the rate of detection of new Covid-19 cases fell by more than two-thirds.   The tests prioritize patients with symptoms associated with the virus.  On April 24 25% tested positive; by April 30 the rate had dropped by two thirds to 8%
  • Tuberculosis prevention: Indonesia, like many current and former developing countries, continues to inoculate infants against tuberculosis with the Bacillus Calmette-Guerin vaccine, developed a hundred years ago. This may explain, in part, the numbers presented above.  An April 3 NY Times article reported: “BCG is still widely used in the developing world, where scientists have found that it does more than prevent TB. The vaccine prevents infant deaths from a variety of causes, and sharply reduces the incidence of respiratory infections… There is little evidence yet that the vaccine will blunt infection with the coronavirus, but a series of clinical trials may answer the question in just months.”
  • 4 deaths in Bali:  In January and February 5 flights a day from Wuhan (the epicenter of COVID-19) brought thousands pf Chinese tourists to Bali, one of the wealthiest and most socially cohesive provinces of Indonesia.  One would think Bali would have many more cases and fatalities.  Perhaps the lack of air conditioning and the fact that most Balinese are outside for part of their days is a factor. (sunshine ultraviolet rays and heat may affect COVID-10). Perhaps its Balinese spiritual power.
  • The Youth Factor:  With over 50% of its population under the age of 30, Indonesia’s youth may be its largest protection. “Young people are more likely to contract mild or asymptomatic cases that are less transmissible to others, said Robert Bollinger, a professor of infectious diseases at the Johns Hopkins School of Medicine. And they are less likely to have certain health problems that can make Covid-19, the disease caused by the coronavirus, particularly deadly, according to the World Health Organization.” (NY Times, May 3)

Make no mistake, Indonesia is not out of the woods with COVID-19; its spread continues and current lock down measures instituted in mid-March remain relevant. Its economy is suffering. But COVID-19, although a major threat, is hardly out of control.  Ad hominem attacks on Indonesia’s competency are misplaced and misguided.
(The writer’s opinions do not necessarily reflect those of the American Indonesian Chamber of Commerce