Blind Groping In Face of Corona
Data fumbling has been occurring since the coronavirus pandemic started in Indonesia in March. The Covid-19 task force began its work in total blindness for lack of data. Tracing people who had been in contact with positive patients met with obstruction. Lately it has been revealed, the Covid-19 death toll is far higher compared to official data announced by the government spokesperson.
ADDRESSING President Joko Widodo at the Merdeka Palace on Wednesday, June 24, Wiku Bakti Bawono Adisasmito presented information about developments on the handling of the Coronavirus Disease 2019, or Covid-19. The chair of the expert team for the Covid-19 mitigation acceleration task force reported on their work of the last three months. “Indonesia is not in a worse off position compared to other countries, in fact we are relatively neutral,” said Wiku in a video uploaded on the Presidential secretariate’s YouTube account.
After less than 10 minutes presentation, Wiku gave way for expert team member, Dewi Nur Aisyah, who presented data integration related to the coronavirus. Dewi exhibited a system named the Bersatu Lawan Covid (BLC—United Against Covid), which integrates disparate data regarding the corona pandemic, such as the number of corona positive patients and available logistic supplies. The BLC integrates data from the health ministry, among others from Hospitals Online, a hospital data reporting system under the directorate-general of health services, the health research and development agency laboratorium network, and the public health emergency operating center, under the directorate-general for disease prevention and control.
Presiden Joko Widodo listening to the explanation from the Covid-19 mitigation acceleration task force’s head of expert team Wiku Adisasmito at the Merdeka Palace, Jakarta, June 24. ANTARA/Sigid Kurniawan
As Dewi presented the system, the screen monitor behind her displayed rows of figures showing the numbers of people under observation, asymptomatic persons, patients under surveillance, and patients who overcame the virus. Slipped among the rows, in a far smaller box, was the total number of deaths, at 11,477 people. That same day, the government spokesperson in charge of Covid handling, Achmad Yurianto, reported the number of deaths at 2,500 persons.
Data from Hospitals Online displayed in the BLC obtained by Tempo showed that a discrepancy also occurred on June 17. That day, the number of deaths recorded was at 10,735. Meanwhile, total deaths officially announced was 2,276. On July 3, total deaths by Covid-19 was at 13,885, over four times the death toll announced, at 3,036. In the same sequence, there were also a higher number of positive cases. On June 17, 46,809 positive cases were recorded, higher than that announced by Achmad Yurianto, at 41,431.
Referring to BLC data on July 3, the death toll by coronavirus in Indonesia totalled 51.5 people per 1 million population. This is a far higher figure compared to the one appearing on the Covid-19 task force website at 11 persons per 1 million population. Holding the figure of 51.5 persons, Indonesia’s death toll is higher than India and China, each at three and 14 per 1 million population. This also means Indonesia has the highest death toll rate in Southeast Asia.
This higher death toll is in accord with the definition instructed by the World Health Organization (WHO). On April 11, WHO defined death caused by Covid-19 as patients with positive contagion of the coronavirus based on lab tests and those who died of clinical symptoms similar to corona cases. In Indonesia, this last criteria would cover those under observation and patients under surveillance.
Body temperature check at a mass Covid-19 rapid test in the Werdi Bhuana village hall, Mengwi, Badung Regency, Bali, last May. TEMPO/Johannes P. Christo
Reservations about the validity of official government data has been voiced time and again by many parties both in-country and abroad. Two Tempo sources, both officials from an in-country organization and an international institution said, WHO had at times queried the accuracy of coronavirus data from Indonesia. This hesitancy is reflected in the list of safe countries—and allowed to enter Europe—released by the European Union on June 30. Indonesia is not on the list. Meanwhile, our neighbor, Thailand, is.
Government Covid-19 spokesperson Achmad Yurianto said information he announces daily is derived from surveillance by the public health emergency operating center at the health ministry and the ministry’s health research and development agency lab network. This data is sent to the health ministry center for data and information for verification.
According to Yurianto, data on numbers of people being monitored and patients under surveillance who died, is not requested by the WHO. “Why would I report something not required?” said Yurianto, who is also the director-general of disease prevention and control of the health ministry.
Yurianto said data on the number of deaths from the Hospitals Online—which also enters into the BLC system—is not needed by the community and would only instigate panic. “What people need is information on how to wear their masks properly, wash their hands, and maintain social distancing,” he said.
DATA confusion surrounding Covid-19 has been occurring since the first coronavirus case emerged in March. Non-synchronization of available data occured because the health ministry did not yet have an integrated data system. Several managers of labs in the regions contacted by Tempo admitted to feeling overwhelmed for being burdened with the extra work for input-ing data.
Chief of the lab team for Covid-19 inspection in Bali, Ni Nyoman Sri Budayanti, said, from the very beginning, the lab at the Sanglah Hospital was overwhelmed with the behest to provide data for the health ministry and sundry health facilities. The system the health ministry had then to record data coming from the laboratory, the All Record app, had not been integrated with the hospital’s. Sri claimed she had to send specimen-test data to the health facility manually using Microsoft Excel.
Due to lack of staff, Sri finally elected to prioritize data input to health facilities because she needed quick results. “We could not handle it because of the quantity of the samples, reaching to hundreds every day,” she said.
The coordinator for polymerase chain reaction (PCR) testing at the Mataram University Hospital lab, Mohammad Rizki, said the health facilities often send samples to the lab without providing complete patient data. Some hospitals only send samples accompanied by a sheet of paper stating the patient’s name with no other information, including address and identification card number. This, he said, simply adds to the workload because the lab has to reconfirm with the hospital to avoid data duplication.
As an example, Rizki told how one day, a health facility sent a sample under the name Haji Ali. A few days later, another sample came under the name of Ali. Because they were different, the lab made inputs for two people. It turned out the sample was from one and the same person. “A single person can have more than one test. So we had to retrace the sample and data back again to the facility in question,” he said.
According to Rizki, at the time, the lab had to make reports to four different institutions, namely the health ministry, the health facility in question, and to the regency and the provincial government offices. Meanwhile the reports had to be done manually using printed paper. This manual input processing and cross-checking was purely because there was no integrated system, making lab results laggard. On top of eveything, the lab has very limited human resources.
In the confusion, at the beginning of the pandemic, that patients under surveillance or people under observation died before their lab tests had been processed. In April, for instance, in Yogyakarta a man with the status of patient under surveillance died before his lab test had come out. “The case’s report was still being processed in the lab,” said Yogyakarta Covid-19 supervision spokesperson at the time, Berty Murtiningsih.
The non-integration and bottleneck of lab results made tracing of those who had been in contact with positive patients impossible. Chief of the Infectious Diseases Prevention and Control Section of the Health Office, who is also a member of the Tracing and Prevention Surveillance Section of the Covid- 19 Task Force in Bogor, West Java, Johan Musari, admitted to this shortcoming. He said his team faced immense difficulties becasue those who had been exposed had also been in contact with many other people.
The Bogor Covid-19 task force obtained their data from the laboratorium. This data was then sent to the various health facilities to be acted upon accordingly. Chief of the Health Office cum Spokesperson for the Bogor Covid-19 Task Force, Sri Nowo Retno, verified this. But she said, the available data was not all that jumbled up. “It was simply non-optimal because everything had to be done manually,” she said.
SEEING all this confusion, the Covid-19 response acceleration task force led by Doni Monardo, launched the Bersatu Lawan Covid integrated data system on April 27. Set up from middle of March, the system contains much information related to coronavirus mitigation, including numbers of patients and logistics, such as availability of personal protective equipments and reagents in labs and health facilities. “It’s a navigation tool to accelerate coronavirus control,” said Wiku Adisasmito, head of the task force expert team.
According to two staff members of the task force, at the beginning of the corona outbreak, the institution could not obtain detailed data regarding the pandemic. And yet data was crucial for monitor the pandemic and for determining government policy. The two sources said the situation had the task force ‘work blindly’ for a spell. Only on April 14 did the health ministry provide data regarding numbers of positive patients to the task force.
Yet one day before, on April 13, President Joko Widodo had instructed that all coronavirus data be integrated within the task force. “Regarding information data, I am requesting that all data be totally integrated between the ministries and entered into the task force,” said Jokowi.
The BLC system integrates hopital and lab data. Regency and provincial administrations can also open the system and search for data. To disseminate the system, Doni conducted an online meeting with all regional office heads, labs, and hospitals at the beginning of May. PCR testing executing coordinator at the Mataram University Hospital Lab, Mohammad Rizki, said the meeting presented how the BLC worked. “I held a lot of hope for the system because it would definitely lighten the lab’s burden,” said Rizki.
Since it was launched and got underway in May, Rizki said the BLC system has helped shortcut reporting. Waiting for lab results has also been trimmed because hospital can make their own direct check through the system. Rizki no longer needs to send patient data to the health facilities. “All I need to do is input the entry date and the lab results,” he said. The hospitals also are repsonsible for complete patient data input before sending samples to the lab.
To assist in BLC data input, the task force dispatched personnel from the Indonesian Military (TNI) to health facilities and labs. Head of the Gadjah Mada Univeristy Covid-19 Lab Team, Titik Nuryastuti, admitted to being very much eased with the presence of the army personnel. She said, the soldiers completed patient data overlooked by the various hospitals.
But, only a few weeks after the system was in place, the health ministry released a circular with the order that all data reports from labs be conducted in the system run by the health ministry, the New All Record, and that the system was developed and had been integrated between health facilities and the labs. The letter dated June 9 was signed by the Director-General of Health Services Bambang Wibowo.
According to sources in the government, Health Minister Terawan Agus Putranto did contact Task Force Chief Doni Monardo not long after the BLC system got underway. Terawan requested that the reporting system be returned into the hands of the health ministry. Doni did not respond to a request by Tempo for an interveiw. Neither did Terawan respond to a request for an interview. The government Covid-19 spokesperson Achmad Yurianto, said data on health falls under the jurisdiction of the health ministry. “That’s how it is by law,” he said.
He explained that the task force is an ad hoc institution that can be disbanded any time once it is no longer needed. “Once it is dispersed, who’s to be responsible for the the data? The data has to still be stored because they are state documents,” he said.
(L-R) Coordinating Minister for Human Development and Culture Muhadjir Effendy, Health Minister Terawan Agus Putranto, and National Disaster Mitigation Agency Chief Doni Monardo at a press conference in Banjarbaru, South Kalimantan, June 7. ANTARA/Bayu Pratama S
Several labs were perplexed by the policy difference. In a WhatsApp chat between Covid-19 task force and lab personnel, it was obvious that many labs are against the health ministry policy. “Just use one door, through the BLC, will makes things easier,” wrote a member of the chat group.
Titik Nuryastuti said the BLC and the New All Record systems are similar. But the New All Record app often breaks down. “At times, our administrative staff are ready to input, and suddenly the web cannot be accessed, making it very frustrating. Then it happens again the next day. And so there’s a backlog of data inputing,” said the head of the Gadjah Mada University Covid-19 lab team.
This confusion surrounding the management of coronavirus data reached the ears of the Presidential Palace. According to a high ranking officer, President Jokowi has repeatedly asked the health ministry, also the other institutions, to improve their data systems. Yet systems improvement has been slow in progress. And it is not only about data, said the source. President Jokowi has also noted that the handling of the coronavirus by the health ministry and the other health institutions has not been optimal. The climax happened on June 18, when the President reprimanded the health ministry in a cabinet meeting. Jokowi made much of the very low absorption rate of state budget by the health ministry totalling Rp75 trillion. “The ministry has only managed to disburse 1.53 percent of that budget,” said Jokowi in a videoclip uploaded by the Presidential secretariat on YouTube on June 28.
Jokowi made a second reprimand to the health ministry on June 29. Upon opening a limited meeting on the Covid-19 mitigation, Jokowi ordered that coronavirus assistance for the needy and incentives for health workers be stepped up. He asked the health ministry simplify procedures so the incentives can quickly be disbursed. Jokowi also asked that the ministry and its institutions integrate coronavirus mitigation action.