Indonesia is currently suffering from the third wave of COVID-19 infection, predominantly due to the Omicron strain. First detected in Indonesia at the end of November 2021, it has rapidly spread, creating a more enormous wave than the Delta variant surge in mid-2021, peaking at 64,718 new cases per day on 16 February 2022. Despite this new record, the bed occu-pancy rate of hospitals remained low at 38% during the peak, the rate of hospitalization and severe disease and the mortality rate is comparably less than the delta surge in mid-2021.1 The total number of deaths caused by Omicron is only 15% of the number of deaths caused by the delta variant surge in mid-2021.2 The healthcare system collapse was not observed in this Omicron surge. However, the nation remains vigilant and sees the need to prepare for the worst.
Up to 19 February 2022, the total number of deaths in Indonesia caused by Omicron is 2,484, 46% were in patients with comorbidities, 53% in the elderly population, and 73% in the population who had not completed the two-dose COVID-19 vaccinations.3 Booster vaccinations have been deployed, free and accessible for every Indonesian aged over six years old. A total of 6.3 million boosters have been injected into the population.
Since the peak at 64,718 cases per day in Indonesia, the trend has decreased. However, we also observed a decreased amount of testing in the population. Indonesia’s minister of health, Budi Guna Sadikin, announced a possibility of COVID-19 becoming an “endemic” in Indonesia, but reaching an endemic state has several challenges. Indonesia should have at least 70% of the population vaccinated with two doses, and Indonesia should not have new surges of COVID-19 infection. Currently, ~50% of the Indonesian population has received the two-dose vaccination, so there is still a significant gap.4 Vaccination remains an essential tool to control the spread of Omicron in Indonesia. In non-vaccinated individuals who had no comorbidities, the mortality rate is 7.5%. This is far higher than the mortality rate of fully vaccinated individuals, at 0.5%.1 Hence, despite the de-creased severity compared to the Delta variant, we should remain vigilant, especially towards the population with comorbidities, the elderly, and the unvaccinated. As long as Omicron still circulates, the susceptible population remains at significant risk for severe COVID-19 disease and considerable morbidity and mortality. It is important to note that due to Omicron’s increased transmissibility, it is possible for the asymptomatic young population to infect the susceptible population.
As Omicron continues to spread in Indonesia, there have been 252 confirmed cases of variant BA.2 “Son of Omicron,” which is reported to have 1.5-7 times greater transmission capability compared to BA.1, the original omicron variant. The difference of severity between these two omicron variants remains unknown.5 As COVID-19 continues to circulate, there is always a possibility of the emergence of a new variant.
Stopping the spread of Omicron requires the involvement of multisectoral efforts between healthcare workers, policymakers, and the population itself. The 5M protocol should still be implemented to minimize the number of infections and decrease the COVID-19 exposure to the susceptible population. Today we observed that the population is becoming more lenient and disobedient with the COVID-19 protocols. This may be caused by an opinion formed by some parts of the population that since Omicron is not severe, it is OK to be infected by Omicron.
In addition, the two-dose vaccination coverage should be increased to achieve herd immunity, and boosters should be administered as much as possible to the citizens of Indonesia. This includes battling vaccine inequity in the nation, where a quarter of Papua is not yet vaccinated, despite over 70% of the whole of Indonesia having received the first dose.
In conclusion, the COVID-19 cases in Indonesia are decreasing, and the testing is adequate. However, there is still a lot of work that needs to be done in order to call the COVID-19 an “endemic” in our beloved nation. The health protocol should remain implemented to prevent surges of new cases, and vaccination coverage needs to be increased to achieve herd immunity. Healthcare workers and policymakers should work together to ease the implementation of the health protocol in Indonesia. Caution must be observed when dealing with the elderly, the immunocompromised, and the unvaccinated population. Stopping COVID-19 requires the effort of every individual, working together with all stakeholders. No one is safe until everyone is safe.