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Endless first wave: How Indonesia failed to control coronavirus | Coronavirus pandemic News

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Only last week, Luhut Pandjaitan, Indonesia‘s maritime minister and close confidant of the country’s president, touted herbal mangosteen juice as a coronavirus remedy.

His suggestion was the latest in a string of unorthodox treatments put forward by members of Joko Widodo’s cabinet during the past six months, ranging from prayer to rice wrapped in banana leaf to eucalyptus necklaces.

The remedies reflect the unscientific approach to battling the coronavirus in the world’s fourth-most populous country, where the rate of testing is among the world’s lowest, contact tracing is minimal, and authorities have resisted lockdowns even as infections spiked.

Indonesia has officially reported 6,346 deaths from COVID-19, the disease caused by the new coronavirus, the highest overall toll in Southeast Asia. Including people who died with acute COVID-19 symptoms but were not tested, the death toll is three times higher.

Indonesia shows no signs of containing the virus. It now has the fastest infection spread in East Asia, with 17 percent of people tested turning out positive, rising close to 25 percent outside the capital, Jakarta. Figures above 5 percent mean an outbreak is not under control, according to the World Health Organization.

“This virus has already spread all over Indonesia. What we are doing is basically herd immunity,” said Prijo Sidipratomo, dean of the Faculty of Medicine at the National Veterans Development University in Jakarta. “So, we should just dig many, many graves.” Herd immunity describes a scenario where a large proportion of the population contracts the virus and then widespread immunity stops the disease from spreading.

Government spokesman Wiku Adisasmito did not respond to detailed questions from Reuters. He said the number of infections was “a warning for Indonesia to continuously improve its handling effort,” and that positive cases per capita in Indonesia were lower than most countries. President Joko Widodo’s office did not respond to questions sent by Reuters.

To be sure, Indonesia‘s confirmed 144,945 infections out of a population of 270 million are much less than the millions reported in the United States, Brazil and India, and below the neighbouring Philippines, which has less than half Indonesia‘s population. But the true scale of Indonesia‘s outbreak may still be hidden: India and the Philippines are testing four times more per capita, while the US is testing 30 times more.

Statistics from Our World in Data, a nonprofit research project based at the University of Oxford, show Indonesia ranked 83rd out of 86 countries surveyed for overall tests per capita.

“Our concern is that we have not reached the peak yet, that the peak may come around October and may not finish this year,” said Iwan Ariawan, an epidemiologist from the University of Indonesia. “Right now, we can’t say it is under control.”

‘Pure nonsense’

At the start of the pandemic, Indonesia‘s government was slow to respond and reluctant to reveal what it knew to the public, according to more than 20 government officials, test laboratory managers and public health experts who spoke to Reuters.

Despite surging cases in neighbouring countries and having 3,000 polymerase chain reaction (PCR) test kits – the WHO-approved test for detecting the coronavirus – ready by early February, the government said fewer than 160 tests had been conducted by March 2.

On March 13, Widodo said the government was withholding information so as not to “stir panic”. During the first two weeks of March, the government concealed at least half of the daily infections it was aware of, two people with access to the data told Reuters. The two people said they were later restricted from seeing the raw data.

A call by Widodo in March for a massive expansion of rapid diagnostic testing may have undermined the country’s testing regime, according to Alvin Lie, a commissioner in the office of the Indonesian Ombudsman, an official government watchdog.

Scientific studies have shown rapid tests, which test blood samples for antibodies, were found to be far less accurate than the PCR method, which tests swabs from the nose or throat for genetic material. Widodo’s push to use a less-reliable test diverted resources away from PCR tests, three lab managers told Reuters.

Lie told Reuters that importers of the rapid tests, including large state-owned enterprises and private companies, made “huge profits” by charging consumers up to one million rupiah ($68), even though each test costs only 50,000 rupiah ($3.50).

By mid-April, provincial governments said rapid testing in the provinces in West Java, Bali and Yogyakarta produced hundreds of false negatives and false positives.

But the tests continued to be widely used and it took until July for imports of rapid tests to be halted and for the government to introduce a price cap of 150,000 rupiah ($10). In July, Indonesia also formally advised provincial governments and others not to use rapid testing for diagnostic purposes in their updated guidelines for COVID-19 prevention and control.

But Lie said there is a huge stockpile and rapid tests are still being broadly deployed, including for screening office workers and travellers to allow them to move freely for 14 days.

“That is like saying for the next 14 days after the rapid test they are free from the virus. That’s pure nonsense. All it indicates, and not very accurately, is they were free from the virus when the sample was taken,” said Lie.

Adisasmito declined to comment on whether the president’s call for rapid testing undermined its overall testing efforts. He did acknowledge the inaccuracies of rapid testing but said it was still useful in some situations where the capacity to use PCR tests is limited, including screening travellers. He did not directly answer questions about companies making large profits from tests.

The central government does not disclose the level of national rapid testing. But data from West Java, Indonesia‘s largest province with 50 million people, shows that it has conducted 50 percent more rapid tests than PCR tests.

Government officials say 269 labs with PCR machines are now operating. However, the labs are increasingly unable to meet demand as infections rise. The number of suspected cases – those with COVID-19 symptoms who have not been tested – has doubled to 79,000 in the past month, according to government data.

Part of the problem is that lab capacity is far from being fully utilised, according to four health officials. One senior health ministry official, Achmad Yurianto, told Reuters Indonesia was able to test 30,000 people per day, more than twice the daily average of 12,650 people tested during the past month.

Five lab managers and consultants contacted by Reuters said the failure to use the country’s testing capacity was due to government mismanagement that had led to shortages of staff and reagents, chemicals needed for the tests.

Adisasmito did not respond to questions about the government’s management of testing. Last week, explaining the shortfall in testing, Yurianto said labs did not have enough time to check all specimens, with some labs working limited days and hours.

Minimal contact tracing 

Widespread PCR testing and quick results are essential for tracing the contacts of those infected by the coronavirus. According to national guidelines released by Indonesia‘s health ministry on July 13, contact tracing is “the main key in breaking the COVID-19 transmission chain”.

Reuters spoke to 12 health workers across Indonesia who described the country’s contact tracing effort as bungled and ineffective.

Passengers queue to board a commuter train during the morning rush hour on the outskirts of Jakarta on July 27. Doctors say the country is still battling an endless first wave of the coronavirus [Fakhri Hermansyah/Antara Foto via Reuters]

Rahmat Januar Nor, a health official in the city of Banjarmasin in Indonesian Borneo, said information about new coronavirus cases often came into his office in varying states of disorder, with incomplete names, inactive phone numbers or outdated addresses for patients and their contacts, problems seen by healthcare workers across the country.

“We asked the village leaders for help,” Nor told Reuters. “But in the end, we didn’t find them (the contacts) most of the time.”

When they did reach contacts, many refused to be tested, fearful they would lose their jobs or be ostracised in the community, Nor and other health officials said.

Unpublished data from the government COVID-19 task force, reviewed by Reuters, shows only 53.7 percent of people identified as confirmed or suspected carriers of the disease were subjected to contact tracing by June 6.

Adisasmito did not provide more recent contract tracing data but acknowledged it “remains low” and said the government aimed to track 30 people per positive case. That is still low compared with other Asian countries. South Korea said in May it traced and tested almost 8,000 people after a man with the virus visited a nightclub.

According to five people familiar with the matter, the WHO advised Indonesian authorities that contact tracing should involve at least 20 people tracked per confirmed and suspected case. But Indonesia is only averaging about two traced contacts per case, according to provincial officials and data reviewed by Reuters.

In Jakarta, where the epidemic first took hold in the country, the data shows fewer than two contacts traced, on average, for each confirmed and suspected case in July.

In East Java, another hotspot, tracing rates are 2.8 contacts per each confirmed and suspected patient, according to researchers from Airlangga University.

A WHO spokesperson said Indonesia began following its contact tracing recommendations in mid-July.

‘Always on the first wave’ 

Indonesia‘s decision to reject full lockdowns was driven by economic and security concerns, said government advisers.

Instead, it has urged Indonesians to wear masks, wash their hands and practise social distancing while working, travelling and socialising.

Firefighters Indonesia coronavirus

Firefighters wearing protective suits spray disinfectant at the National Monument area to prevent the spread of the coronavirus disease (COVID-19) in Jakarta in June [Wahyu Putro/Antara Foto via Reuters]

“The argument was that we could not [afford it],” Soewarta Kosen, a health economist who consulted the government on its coronavirus response, told Reuters. “We were afraid that there would be social unrest.”

Widodo’s emphasis on the economy is popular, polling shows. The Indonesian economy only shrank 5.3 percent in the second quarter of 2020, much less than many other regional economies. But epidemiologists said they fear the decision will cost Indonesia more in the long term, especially as its health system is poorly equipped to cope if positive cases continue to surge.

Dr Bambang Pujo, an avid runner and anaesthetist at the main COVID-19 referral hospital in Indonesia‘s second-largest city of Surabaya, said mortality rates in his ward are between 50 percent and 80 percent and there are not enough beds.

“Ten hours inside a hazmat suit is like running a marathon twice,” he said, describing the long hours he spends in protective gear inside the intensive care unit. “Imagine how we feel. It is like playing God. We hope that we don’t make mistakes and, if we do, we are forgiven.”

Indonesia has only 2.5 intensive care beds per 100,000 people, according to the country’s national disaster agency, which leads the COVID-19 task force. That compares with 6.9 per 100,000 people in India, according to an April report from Princeton University. Adisasmito said the healthcare system is being continuously improved.

“We must know that our infrastructure is not ready for a pandemic like this,” said Pujo. “Other countries have heard of second waves. We’re always on the first wave.”



Source – www.aljazeera.com

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Britain’s unequal troop commemorations due to ‘pervasive racism’ | Racism News

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Inquiry by Commonwealth War Graves Commission finds Black and Asian troops who fought for Empire were not properly memorialised.

As many as 350,000 Black and Asian service personnel who died fighting for the British Empire might not have been commemorated in the same way as their white comrades because of “pervasive racism”, a report has concluded.

The inquiry commissioned by the Commonwealth War Graves Commission (CWGC), in its report released on Thursday, says that between 45,000 and 54,000 individuals of predominantly Asian, Middle Eastern and African origin who died during World War I were commemorated “unequally”.

“A further 116,000 casualties [predominantly, but not exclusively, East African and Egyptian personnel] but potentially as many as 350,000, were not commemorated by name or possibly not commemorated at all,” the report said.

The CWGC works to commemorate those from Commonwealth forces who were killed in the two world wars and to ensure all those killed are remembered in the same way, with their name engraved either on a headstone over an identified grave or on a memorial to the missing.

It issued an apology in the wake of the inquiry’s findings.

“The events of a century ago were wrong then and are wrong now,” said Claire Horton, head of the CWGC. “We recognise the wrongs of the past and are deeply sorry and will be acting immediately to correct them.”

‘Watershed moment’

The CWGC commissioned the report in December 2019 after Unremembered, an investigative television documentary presented by opposition Labour Party MP and shadow justice secretary David Lammy.

The Unremembered investigation found that Africans killed in World War I had not been treated equally and revealed an example of a British governor saying: “The average native of the Gold Coast would not understand or appreciate a headstone.”

It also uncovered how African soldiers’ graves were abandoned in Tanzania, while European officers’ resting places continued to be maintained.

According to Thursday’s report, another officer, who later worked for the CWGC’s predecessor – the Imperial War Graves Commission, had said: “Most of the natives who died are of a semi-savage nature”, and concluded that erecting headstones would be a waste of public money.

The inquiry said decisions that led to the failure to commemorate the dead properly – or even at all – was the result of a lack of information, errors inherited from other organisations, and the opinions of colonial administrators.

“Underpinning all these decisions, however, were the entrenched prejudices, preconceptions and pervasive racism of contemporary imperial attitudes,” the report concluded.

The United Kingdom’s Secretary of Defence Ben Wallace was expected to address Parliament about the findings later on Thursday.

Lammy hailed the report as a “watershed moment”.

“No apology can ever make up for the indignity suffered by the Unremembered,” he tweeted.

“However, this apology does offer the opportunity for us as a nation to work through this ugly part of our history – and properly pay our respects to every soldier who has sacrificed their life for us … The arc of history is long but it bends towards the truth.”





Source – www.aljazeera.com

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OPINION: Leave Katikkiro Alone Until the Person Who Appointed Him Thinks Otherwise

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By Dr Roy Mayega

One of the ‘Prima Facie’ principles of Medical Ethics is ‘Autonomy’. Autonomy includes confidentiality and privacy. Confidentiality means non-disclosure unless permitted by the patient.

Privacy means “having control over the extent, timing and circumstances of sharing oneself with others.” You cannot for instance, as a practitioner, order the patient to immediately dress down in the public area and to bend over so that you stick your fingers up their rectum when everyone is watching.

You need to give them ample time to organize themselves; to do the necessary ‘local’ preparations before they feel comfortable to be undressed; and to get a sufficiently private space.

One of the biggest dilemmas faced by a person who has received a diagnosis of a chronic disease is when, how much, and to whom to disclose. It’s not a simple pedestrian matter: It’s a real hassle – the publics always stigmatize everyone with a chronic disease however moderate it is.

The time it takes for people to process their medical situation and to decide to expose themselves varies widely between individuals and is based on the type of disease, their personality, sensitivities, the medical information they have, their values, their prognosis, and the desire to protect others close to them. Some people want to ‘wait and see’.

Being ‘Prima Facie’, ethical principles are inherently binding, unless they clash with another ethical principle in which case there is an ethical dilemma to be re-solved. There is no ethical dilemma here! Ethics is not freaking morals – leave your self-righteousness to yourself. Ethics is not freaking gut feelings; and neither is ethics about culture. Beliefs and morals die, ethics doesn’t.

I have seen many social media idlers blaming the Katikkiro for ‘not taking the pedestal several months ago to describe what was wrong with the Kabaka.

The Katikkiro cannot unilaterally issue a communique without the freaking permission of his boss! And none of the idlers has any evidence to show that his boss told him to announce and he categorically refused – don’t be publicly silly.

Secondly, people have no right to deny a diagnosis of ‘Allergies’ on the basis of pedestrian medicine. Patients are not examined in videos and diagnoses are not validated by rumors. Doctors are much more sophisticated than that.

Let his physicians be the ones to dissent, or let the Kabaka’s wife declare that what was said was wrong.

Severe allergic reactions and autoimmune diseases can be severe enough to cause anything, independently in their own right, without having to collaborate with social media witchery.

It’s so funny how social media has suddenly caused an upshot in ‘male rumor-mongers’ and ‘cyber-sorcerers’.

Leave the Katikkiro alone, until the person who appointed him thinks otherwise. The person who appointed him has never been devoid of grey-matter.

Good thing is that all of you will one day grow older and experience your own chronic diseases – then we will see if you can willingly stick out your private ‘parts’ in public whenever the publics demand so. Some of you cannot even tolerate a routine prostate exam and you are here asking others to undress?

Read: Questions Abound About Kabaka Mutebi’s Health

The post OPINION: Leave Katikkiro Alone Until the Person Who Appointed Him Thinks Otherwise first appeared on ChimpReports.



Source – chimpreports.com

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India Islamic scholar Maulana Wahiduddin Khan dies of COVID-19 | India News

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Ninety-six-year-old Khan, who authored more than 200 books including a two-volume commentary on the Holy Quran, died on Tuesday.

Indian Islamic scholar and peace activist Maulana Wahiduddin Khan has died in the capital New Delhi after contracting novel coronavirus, his family members announced on Tuesday.

Ninety-six-year-old Khan was recently admitted to a hospital in New Delhi after testing positive for COVID-19.

“The great Islamic scholar Maulana Wahiduddin Khan breathed his last, late this evening. Doctors failed to revive his sinking heart. Pray for his maghfirat [penitence] and high station in Paradise. Amin,” Zafarul Islam, Khan’s eldest son, tweeted on Tuesday.

The author of more than 200 books, Khan has been honoured with several awards. This year, he was awarded the Padma Vibhushan, India’s second-highest civilian honour.

Born in Azamgarh, India, in 1925, Khan has been internationally recognised for his contributions to world peace.

In 2009, Georgetown University in Washington, DC’s list of 500 Most Influential Muslims of 2009 named him “Islam’s spiritual ambassador to the world”.

In 2001, he established the Centre for Peace and Spirituality to promote and reinforce a culture of peace. Khan went on a 15-day Shanti Yatra (peace march) through the western Maharashtra state in the wake of the demolition of the 16th-century Babri Mosque by Hindu hardliners in the state of Uttar Pradesh in 1992.

He also wrote a two-volume commentary on the Holy Quran.

Indian Prime Minister Narendra Modi said he was “saddened” by the news of Khan’s loss.

“He will be remembered for his insightful knowledge on matters of theology and spirituality. He was also passionate about community service and social empowerment. Condolences to his family and countless well-wishers. RIP,” Modi wrote on Twitter.

Indian President Ram Nath Kovind said he was “deeply grieved” by the demise of Khan, saying: “Maulana Wahiduddin made significant contributions to peace, harmony and reforms in the society. My deepest condolences to his family and well-wishers.”





Source – www.aljazeera.com

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