Jakarta, Indonesia – Medical experts have linked the increase in cases of coronavirus in Bali to an inaccurate, low-cost rapid antibody test kit used to deliver domestic visitors to the Indonesian resort island.
Foreign tourists were barred from entering Indonesia on April 2, and plans to reopen Bali to international tourists this week have been scrapped, while domestic air travel resumed on July 31.
Since then, the island welcomes an average of 3,000 domestic tourists daily, mostly to the country’s most densely populated neighboring island Java and also the one most affected by the epidemic.
The number of newly confirmed cases in Bali in the first half of July and August dropped to 27 on August 10, with a seven-day average of 40 new cases per case.
But two weeks after the resumption of domestic travel, the island began to spike with confirmed cases. 198 days of recording breaking five days New case. On September. By Tuesday, in Bali, 385. Were Confirmed cases and 116 deaths.
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Across the country, the total number of cases was 196,989, with 8,130 deaths.
Misinterpretation results
To enter Bali, visitors are required to present a negative rapid antibody test result that is not older than 14 days.
They should not only show external symptoms of the virus, such as a dry cough or fever, but Dr Dickey Budiman, an epidemiologist who has been helping Indonesia respond to epidemics for 20 years, says the screening protocol may have allowed more cases to enter Bali.
“Rapid antibody test kits cannot detect current infections. They only detect if a person became infected a few weeks or months ago.”
He also noted that the tests were “not specific” to COVID-19.
“If you tested positive, you could have caught a coronavirus different from your dog. For this reason, Australia, England and India all stopped using them, because it is not accurate.”
The World Health Organization in Indonesia says the use of antibody tests gives passengers with non-reactive results a “false sense of security”, as the sensitivity of COVID-1 to tests ranges from 34 percent to 80 percent.
Clinical pathology and laboratory medicine experts from the Association of Indonesia put the accuracy of these tests at less than 50 percent.
Budiman says the best way to prevent domestic tourists with COVID-19 in Bali is to change the screening protocol to a polymerase chain reaction (PCR) test – using the ‘gold standard’ to return Indonesian citizens and permanent residents to foreign countries.
At least 6,212 infections have been reported in Bali, with 105 people dying The latest central government COVID-19 count on Sunday [Made Nagi/EPA]
This is an opinion shared by Gusti Nagurah Mahardika, a senior virologist from Bali and a professor at the University of Udain.
“I have been saying since February that rapid antibody tests are not appropriate for screening people coming to Bali. This is a cheap way to check patients in the hospital, and to confirm whether they need a PCR test if the patient is reactive.” I feel, ‘he said.
Test response means that the person has antibodies to the virus, but if a person does not respond to the test it does not mean that they do not have the virus.
“They are misinterpreting the results.” Mahardika added. “Those with non-corrective results should undergo on-site PCR tests or be isolated. “
Bad policy
Ahmed Yutomo, an independent nuclear biological consultant based in Jakarta who specializes in diagnosing lung infections, agreed that the results of rapid antibody tests were being misinterpreted in Indonesia.
“If a person is reactive, they are making their own antibodies and I feel safer around them than those whose test results are inactive,” he said.
Utomo also said that testing for COVID-19 with rapid antibody tests is a bad policy.
“They’re not usually used for screening. They’re epidemiological tools used to study disease load in specific epidemiological areas. I don’t know why they insist on them.”
But they are also skeptical about whether it relates to additional tests carried out in confirmed cases in Bali. He thinks the leap is a reflection of people who fail to follow guidelines designed to prevent the spread of the virus.
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“The case is moving forward just like in East Java, it’s probably about public behavior,” he said.
“People hold public demonstrations, refuse any kind of tests, refuse to wear masks and do not practice physical distance because they do not believe the disease is real. And it is not their fault.
“About half a percent of cases in Indonesia are asymptomatic. Only half of the remaining 100 percent are intensive care and people don’t see them. It’s not like people are dying on the streets.”
Putting economics first
Given concerns about reliability – why Indonesian officials have not explained why rapid antibody tests are used as a travel requirement.
The Bali Provincial Government, the Bali Disaster Mitigation Agency and the Department of Health referred the inquiry to the Bali Civil-19 Task Force, and in turn forwarded the inquiry to the Department of Health.
The National Covid-19 Task Force and the National Disaster Management Agency in Jakarta did not immediately respond to Al Jazeera’s questions.
On Monday, Bali announced that as part of its efforts to end the epidemic, it would begin imposing a fine of Rs 100,000 (77.677) on residents who went out without a face mask.
Domestic tourism is seen as a lifeline for Bali as foreign tourists are still banned from coming across the country, where one An estimated 50 to 80 percent of the economy is linked to tourism [Made Nagi/EPA]
Epidemiologist Bodyman believes the government made the decision because “they have already bought millions of quick antibody tests from China and want to use the stock”.
But others say the use of tests is linked to the need to move the economy forward.
Educational website, conversations, Tim Mann and Tim Lindsay, experts at the University of Melbourne Indonesia, said the government was concerned that the struggling economy could “handle its crisis – and possibly further criticize social unrest”.
The economic impact is particularly felt in Bali, where estimates show at least half, and about 80 percent of potential domestic production is linked to tourism.
On September 1, President Joko Widodo acknowledged the Indonesian province with “the biggest economic contraction Bali” with a negative growth of 11 percent.
Allowing domestic tourists to return to Bali is believed to provide a much-needed economic lifeline for the island.
The cost of an antibody test is about 10 10 per person.
But PCR tests cost between $ 83 and 9 179, making them prohibitively expensive for many middle-class Indonesians who make up most of the country’s domestic tourism market.
A hotel executive in Bali, speaking on condition of anonymity, told Al Jazeera that if everyone took PCR tests, it could cost up to પરિવાર 1,000 per family.
“In those circumstances, no one will come.”
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