COVID-19 and public health

implications? What should we do?

TIDI Talkshow, Sumut, 19 April 2020

Dr Febi Dwirahmadi
School of Medicine, Griffith University
Queensland, Australia
f.Dwirahmadi@Griffith.edu.au

All pictures in this PPT (taken from many sources) are only for
learning and teaching and not for commercial
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 Content
Effectiveness of PSBB to supress COVID-19 cases

Second wave of COVID-19?

Development of Vaccine ? Any progress?

Long-term health implications?

What should we do then?

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Pembatasan Sosial
Berskala Besar

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 Contribution of transmissibility and severity on
population impact of estimated range of COVID-19 to
other respiratory outbreaks

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Courtesy: dr Dicky Budiman PPT
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Courtesy: dr Dicky Budiman PPT
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Non-pharmaceutical countermeasures (NPC) for
the COVID-19 (SARS-CoV-2) outbreak

• The primary objective of NPCs

is to reduce the impact of an
outbreak by reducing the
number of contacts that result
in disease transmission
– Personal Protective
Equipment
– Environmental
Countermeasures
– Social Distancing
Countermeasures
– Travel Related
Countermeasures

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 Combined countermeasures
is needed !!!
• Indonesia sudah punya kombinasi nya, tapi
kebanyakan fokus di Ekonomi
1. Meningkatkan jumlah penerima dan besaran bantuan Program Keluarga
Harapan
2. Kenaikan Penerima Kartu Sembako
3. Menaikkan anggaran Kartu Pra Kerja
4. Penggratisan tarif listrik 450 VA
5. Mencadangkan anggaran kebutuhan pokok
6. Memberi kerunganan pembayaran kredit
7. Besaran deficit anggaran disesuaikan hingga 3% dari PDB
8. Mengatur besaran belanja wajib pemerintah
9. Penyesuaian tariff PPh
10. Pemberlakuan PSBB

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PP No 21 Thn 2020 (PSBB)

Memberikan ruang
dan kesempatan bagi
COVID-19 untuk
menyebar di wilayah
tersebut, sehingga
penerapan PSBB pada
akhirnya tidak lagi
menjadi tindakan
pencegahan awal

#PSBBserentakseluruhNKRI
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Ditambah lagi: Masyarakat butuh waktu
untuk berubah – PSBB bertahap
Dibutuhkan
kerjasama yang
baik antara
PEMERINTAH
dan Masyarakat

(Prochaska & Diclemente)

#PSBBserentakseluruhNKRI 10
Show the logic to the public!
• E.g. from Australia

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Potential second wave?

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Three Waves – 1981 Flu Pandemic

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HIN1 – 2009

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 Winning the game with the virus

Anderson, R. M., Heesterbeek, H., Klinkenberg, D., & Hollingsworth, T. D.

(2020). How will country-based mitigation measures influence the course of the
COVID-19 epidemic?. The Lancet, 395(10228), 931-934.
 SARS-Cov2 and
Climate
• First, the influenza virus is more stable in
cold temperature, and respiratory
droplets, as containers of viruses, remain
airborne longer in dry air
• Second, cold and dry weather can also
weaken the hosts’ immunity and make
them more susceptible
• High temperature and high relative
humidity reduce the viability of SARS
coronavirus

Wang, J., Tang, K., Feng, K., & Lv, W. (2020). High temperature and high humidity
reduce the transmission of covid-19. Available at SSRN 3551767.
SARS-Cov2 in warmer climate
region
• The presence of central air-conditioning, which tends to maintain a
lower ambient room temperature, may play a role in virus spread in
closed spaces irrespective of the outside temperature
• Lack of hygiene, close contact as seen in high density population areas,
poor living conditions with lack of ventilation may be predisposing
factors for viral transmission in warmer areas
• Not to mention, air pollution PM2.5 will also as an environmental
stressor to enhance the risk of COVID-19 infection.

Kroumpouzos, G., Gupta, M., Jafferany, M., Lotti, T., Sadoughifar, R., Sitkowska, Z., & Goldust, M.
(2020). COVID‐19: A Relationship to Climate and Environmental Conditions?. Dermatologic
Therapy.
 Stand down activities
• monitoring for a second wave of the outbreak;
• supporting and maintaining quality care;
• ceasing activities that are no longer needed, and
transitioning activities to normal business or interim
arrangements;
• monitoring for the development of resistance to any
pharmaceutical measures, if any are being used;
• communication activities to support the return from
emergency response to normal business services; and
• evaluating systems and revising plans and procedures.

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 Potential long-term
health effect of COVID-
19?

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 Still uncertain!!

Ma, L., Xie, W., Li, D., Shi, L., Mao, Y., Xiong, Y., ... & Zhang, M. (2020).
Effect of SARS-CoV-2 infection upon male gonadal function: A single
center-based study. medRxiv.

Others? Still being researched, effect to lung? Others?

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Certain: Psychological impacts
of quarantine
• negative psychological effects including post-traumatic stress
symptoms, confusion, and anger.
• Stressors included longer quarantine duration, infection fears,
frustration, boredom, inadequate supplies, inadequate information,
financial loss, and stigma.
• To avoid: Keep it as short as possible, give people as much information
as possible, provide adequate supplies, reduce the boredom and
improve the communication, health-care workers deserve special
attention, altruism is better and compulsion

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The
psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet.
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Vaccine development

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 Vaccine development
• Global health governance
– WHO
• WHO has created a forum
for everyone who is
developing COVID-19
vaccines to come
together and present
their plans and initial
finding.
• 2 – clinical trial
• 42 – preclinical
• 12 to 18 months

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What can we do in the
meantime?

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 Social distancing and home
confinement
Stay Stay home as much as possible (home confinement).

Wear Wear mask for protection – (not all country

Keep Keep 1.5 metres away from others as much as possible.

Avoid Avoid shaking hands, kissing or hugging others.

Work If you can, work from home.

Avoid Avoid gatherings that aren’t essential.

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 For health workers – be more
vigilant

e.g. dr Eka Airlangga, Sp.A

(Photo taken from his FB)

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 • Open communication
Keys to facilitate • Accept different perspectives
• Trust
risk communication • Empowerment

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 Empowering community
Empowerment is the
Information
process of enabling
individuals and
communities to gain
Decision
making Power resources access to information,
networks, resources,
and decision-making.
Networks (Chu, 1996)

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Care Army in Australia

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31
Meyer, 2018

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 THANK YOU
Febi Dwirahmadi, Contact details:
SKM, MSc.PH, PhD Mobile : +61 4521 80078
Facebook: febi.dwirahmadi
School of Medicine
Griffith University,
IG: Febi.dwirahmadi
Queensland, Australia Email: f.dwirahmadi@griffith.edu.au

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