JAKARTA, Indonesia — As the deadly new coronavirus spreads rapidly around the world, one of Asia’s most-populous countries says it has no confirmed cases — and some public health experts aren’t really buying it.

Indonesia, which last month suspended direct flights to the Chinese city of Wuhan where the virus originated, still hasn’t reported any confirmed cases. Officials maintain their monitoring meets the standards of the World Health Organization, which has endorsed the country’s approach.

But scientists have expressed doubts given the nearly 50 cases in Singapore, more than a dozen in neighboring Malaysia and infections reported as far afield as Nepal and Finland. Harvard University researchers published a paper this month comparing the number of reported cases in countries with their air travel volume to China.

“We found that Indonesia, as well as possibly Cambodia and certainly Thailand, were reporting fewer cases than you would expect given the number of travelers,” said Marc Lipsitch, an epidemiology professor at Harvard University’s T.H. Chan School of Public Health, who co-authored the study. “We presented that as an indicator that these countries were missing cases that didn’t get detected.”

The conclusion suggests the number of cases worldwide — now at more than 45,000, mostly in Asia — may actually be even larger. That figure is crucial for understanding key aspects of the virus, including the mortality rate, which so far appears much lower than Severe Acute Respiratory Syndrome in 2003.

Lipsitch said the research is not meant to single out any one country, and that even Singapore — with one of the best public health systems in the world and experience with SARS — has failed to detect certain cases.

For Indonesia, the doubts pose a perception problem that could have economic implications. Medical groups and corporate risk companies have advised against traveling to Indonesia and other countries with questionable public health screening until the virus is contained.

Companies should expect supply chain disruptions in countries with few or no cases, and consider canceling meetings and conferences throughout Southeast Asia, said Sofia Nazalya, an Asia analyst at global risk advisory firm Verisk Maplecroft. The company puts Indonesia and Cambodia in the “extreme risk” category based on its ability to respond to a pandemic.

“We expect that existing coronavirus cases in Indonesia are currently going undetected,” Nazalya said. “Close travel links between Indonesia and China as well as other neighboring countries where cases have been reported, and the highly infectious nature of the virus, make the chance of zero-infection remote.”

Indonesia’s health ministry has so far denied any problems with the country’s detection methods. N. Paranietharan, the WHO’s representative in Indonesia, said the country is conducting health screening at 135 entry points, ensuring enough specific test kits for the virus, equipping designated hospitals and training personnel to handle suspected cases.

“Indonesia is doing what is possible to be prepared for and defend against the COVID-19,” Paranietharan said by email, referring to the coronavirus.

In a statement earlier this week, Indonesia’s health ministry said 62 of 64 specimens collected as of 6 p.m. on Monday were negative, while the remaining two were still being tested. Indonesia had just two cases of infection and zero fatalities during the SARS epidemic, according to WHO data.

“As WHO said, we have proper and adequate facilities to detect coronavirus according to WHO standards,” Vensya Sitohang, director of health surveillance and quarantine at the ministry, said Wednesday. “So questions surrounding Indonesia’s ability to detect virus are baseless.”

Still, not everyone is convinced. Central Health Partners, which operates medical clinics in Hong Kong, this week advised patients to carefully consider travel to countries such as Cambodia and Indonesia “with limited disease surveillance capacity.”

Indonesia would struggle to enforce a citywide lockdown or properly track its citizens across a vast archipelago, according to Sakshi Sikka, a senior pharmaceuticals and health care analyst at Fitch Solutions.

“The country’s health care sector is not equipped for such a crisis,” Sikka said.


©2020 Bloomberg News

Visit Bloomberg News at www.bloomberg.com


PHOTOS (for help with images, contact 312-222-4194):

Copyright 2020 Tribune Content Agency.

Load comments

You must be a full digital subscriber to read this article You must be a digital subscriber to view this article.

Your RTD Sports Plus digital subscription does not include access to this section.

Upgrade to full digital and have unlimited access to Richmond.com. If you need assistance, call us at (800) 468-3382.

To start a new subscription or to activate digital access included in your print subscription, click the Sign Up button below. You can choose between Subscriber Plus, and receive unlimited access to Richmond.com, or Sports Plus for access to our exclusive sports coverage.

Already a digital subscriber? Click Log In.

Need help? Click here or call (800) 468-3382.

Learn more about Subscriber Plus or Sports Plus.