Risk of PSBB easing during covid

After being tightened in early September, the DKI Jakarta Government again eased the PSBB in the second week of October 2020. This is the second PSBB easing after previously being carried out in June but was tightened again due to a spike in cases.

Until now there has been no calculation regarding the success of the PSBB and the number of positive cases is still increasing. Experts think that it is not time for the PSBB to be eased because there is still a high risk of transmitting COVID-19.

It is not yet time for the PSBB to be relaxed because the risk of transmission is still high

PSBB is a regulation restricting a number of activities in an area infected with COVID-19. These restrictions include schools, offices, religious activities, restrictions on activities in public places or facilities, restrictions on transportation modes, and restrictions on other activities specifically related to defense and security aspects.

This restriction is carried out to minimize physical contact between individuals in order to reduce the transmission of COVID-19. The implementation of the PSBB does not prohibit people from leaving the house.

Those who have important needs can still leave without being sanctioned. Because PSBB is indeed looser than the concept of regional quarantine or lockdown which completely cuts off physical contact between individuals.

After one month of enactment, the government plans to relax or relax the PSBB regulations in order to carry out an economic turnaround.

On Thursday (7/5), the Ministry of Transportation has allowed land (including rail), sea and air transportation to resume operations under several conditions.

The plan for easing in the economic sector was also conveyed by the Coordinating Minister for Political, Legal and Security Affairs Mahfud MD in live on his personal Instagram on Saturday (2/5).

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PSBB relaxation is planned to start in early June by opening economic and business industrial activities. The initial PSBB relaxation study compiled by the Coordinating Ministry for the Economy has also been circulating in the mass media.

Among them are malls that can operate as before (shops may open) starting June 8, 2020, but still according to the COVID-19 health protocol.

The discourse on easing PSBB has generated a lot of criticism from doctors and experts because the risk of transmission is still high.

"It's not time (for the government) to start loosening the PSBB," said dr. Panji Hadisoemarto, an epidemiologist at Padjadjaran University, in a joint press release with the COVID-19 Report Team, Monday (11/5).

In line with dr. Panji, Eijkman-Oxford Clinical Research Unit epidemiologist Iqbal Elyazar thinks this momentum should be used by the government to tighten the implementation of the PSBB, not the other way around.

"I see this PSBB is our choice, optimization must be maintained to a minimum of 80 percent reduction in activities outside the home," said Iqbal. He is optimistic that if the PSBB optimization is successful, Indonesia will be able to reduce the pandemic curve.

This second week the PSBB was relaxed again. In addition to allowing entertainment venues and offices to resume operating on the condition that overcrowding is reduced, theaters are also planned to be allowed to operate. The cinema can be reopened again, but only 25% of the capacity can be filled.

Restrictions can be relaxed if there has been a scientific study of the success of the PSBB

Doctor Panji explained, in infectious diseases, each case is not just a case, but also a source of infection.

"As long as there are sources of transmission and there are vulnerable people, it is not safe to open economic activities, especially if it means that social activities will return to normal," explained dr. Banner.

He gave an example, the Institute for Health Metrics and Evaluation (IHME) suggested that the United States could open up economic activity if the state only had 1 case per one million population.

In his calculations, dr. Panji assessed that Jakarta could safely open economic activities if it only had 10 active cases. Meanwhile, currently there are still thousands of active cases in Jakarta.

Another consideration is that if there is an easing of the PSBB, supervision must be tighter and case detection is carried out as early as possible to reduce risks.

If this is not done, there is a concern that there will be too much virus transmission, forcing us to place restrictions and start all over again.

Meanwhile, Iqbal emphasized that in order to loosen the PSBB there needs to be a risk calculation based on scientific studies. From this calculation, we can then take a measure of when the restrictions can be relaxed and when they should be tightened.

"We hope that every decision taken by (the government) is based on science, based on data and information, and supported by a model that explains the impact of these decisions," said Iqbal.

Reporting of COVID-19 case data and incomplete death data

Another reason why the easing decision is not yet accurate is because the PSBB evaluation has not been supported by valid data.

The PSBB is considered successful if the number of cases decreases after the regulation is implemented, until the number is close to zero or there are no new cases added.

According to dr. Panji, the data on the increase in COVID-19 cases presented by the government does not match the conditions on the ground. This difference makes the claim for the success of the PSBB not yet justified.

The calculation is that the data collection process for one patient takes about 10-17 days, from sampling until it is announced.

"This delay means that the pandemic curve presented is from past data," explained dr. Banner.

The COVID-19 Report Team that reviewed the COVID-19 report data concluded that there were differences in death data between those reported by the government and all cases of deaths due to COVID-19.

"WHO (World Health Organization) as of April 11 has updated the procedure for recording deaths related to Covid-19. All deaths suspected of having COVID-19 symptoms must be recorded, until it can be proven that the death was not due to Covid-19, "said Irma Hidayana of Laporcovid19.org.

According to him, referring to WHO guidelines, there is a difference of up to 50 percent of data on deaths related to COVID-19. The problem of mazy reporting of death data due to COVID-19 is still happening.