No confirmed cases of Wuhan Corona virus in Indonesia

spicyayam

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Jan 12, 2009
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I think this is more worrying than not having a confirmed case of the virus - https://www.thejakartapost.com/news...navirus-in-indonesia-what-we-know-so-far.html

It would suggest that hospitals cannot test for the virus here.

This is a report from SMH a few days ago: https://www.smh.com.au/world/asia/t...s-vulnerability-revealed-20200130-p53wc9.html

The Sydney Morning Herald and The Age can reveal that Indonesian medical laboratories lack the testing kits needed to rapidly detect the Wuhan coronavirus, according to one of the country's leading molecular biologists, and the virus may already be present in the country despite government claims of no infections.
 
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Foamcrest

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We are coming up to Bali in two weeks from Sydney and as I have a thing called COPD, or just stuffed lungs, I’m just a tad concerned about the airport’s and plane travel. Ive bought the P2 grade masks for the travel and of course won’t need anything in Penestanan or Lipah. Considering that a million plus Australians visit Bali every year you’d think someone might think we’d better prepare for the inevitable case of the virus. All a slight concern I’d say.
 

spicyayam

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Just viewed an NBC map of the world showing in red those countries with established corona virus cases. Amazingly although surrounded, Indonesia has no red! Is that conceivable?

No, I don't it would be possible. Some planes came in from Wuhan and other parts of China as the CNY started.

Infected people can show no symptoms for up to a week.

Ive bought the P2 grade masks for the travel

A mask only offers some protection, you also really need to cover your eyes and wear gloves.
 

Foamcrest

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It’s just been reported here that 5000 Chinese tourists are stuck in Bali because flights have been cancelled between Indonesia and China. It’s stated in the article that their visas will be extended and hotels are doing their best to accommodate them.
 

spicyayam

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It’s just been reported here that 5000 Chinese tourists are stuck in Bali because flights have been cancelled between Indonesia and China. It’s stated in the article that their visas will be extended and hotels are doing their best to accommodate them.

And still not one confirmed case in Indonesia. Kind of embarrassing.

The government needs to check how many of them are from Hubei province, where the virus originated and where most of the deaths have been.

It is hard to get a reading of the situation, some people say it is overblown in the media and others are saying it is actually worse than what the Chinese government is saying.

I have read in some expat groups in China that school closures/holidays have been extended until March 1st. Up until recently, they were supposed to go back from CNY break next week. This would suggest that the situation is getting worse and the virus is spreading further.
 
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Mark

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Just viewed an NBC map of the world showing in red those countries with established corona virus cases. Amazingly although surrounded, Indonesia has no red! Is that conceivable?
No.
 

mugwump

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Something new to consider. Apparently a scientist that was prominent in investigating the Sars epidemic of some years past has reported that viruses of this nature originate in colder climates and then pass on to tropical climes in a rather innocuous form, or even fade out there.
Unfortunately this was passed on to me from another person and then lost the article before we could obtain the scientist's name or other pertinent info.
That being said, the information bears some reflection. Flu epidemics and their related viral aspects seem to emerge in cold weather and diminish with the onset of sunshine and warmer weather in the Northern Hemisphere. Have viewed a calendar of the infamous Spanish Influenza epidemic of the early 20th. Century that though occurred widely was responsible for 5 million deaths in the US alone, and occurred in Fall and winter months.
This current novel coronavirus arose in China this previous Fall which from the pictures reflect a colder environment (sorry didn't check Central China prior to this post, but have been in Beijing in October when it was beginning to get chilly and just a bit further north of Wuhan).
If the virus was transferred from Wuhan by a traveler to a tropical climate could it then develop as a lesser affliction? It takes some investigation, and worthy of the effort if we dwellers of a tropical climate are not just wishful thinkers or worrying beyond a realistic fear.
 
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tel522

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Interesting ,but how does this match up with singapore currently orange alert ,2nd highest warning .
 

spicyayam

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Interesting points. There were 2 cases of Sars in Indonesia and no deaths. https://en.wikipedia.org/wiki/Severe_acute_respiratory_syndrome

I just saw this posted in a group in China. It seems the testing methodology for the virus is not accurate.


Here is Google translation of the article:

Tan Wei, deputy chairman of the Medical Imaging Professional Committee of Hubei Province, believes that CT results are in good agreement with new coronary pneumonia but negative nucleic acid detection accounts for about 30% -40%.


In a hospital in Hangzhou, a patient tested negative for nucleic acid reagents six times and did not test positive until the seventh time.


Several front-line doctors expressed similar views. The most important influencing factor for nucleic acid detection is first of all sample collection.


A couple admitted to a designated hospital in Taizhou who tested negative for nucleic acid, the hospital was afraid to let them go. The wife made trouble every day, shouting "the country has confirmed that we are not sick, and you are still holding me here", and still scolding the nurse in the isolation ward.


This article first appeared in Southern Weekend

Text | Southern Weekend Reporter Tang Yucheng Tan Chang

Special Contributor for Southern Weekend Yan Liyuan Jiang Yanyu

Editor-in-Chief | He Haining

Sister Wu was surprised when she got the nucleic acid test results.

In January 2020, sister Wu and her son Li Zhe (pseudonym) had fever and illness. Before the nucleic acid test, they took a CT scan at Wuhan Ninth Hospital: the son's result was a double lung infection, and Wu's was a bilateral lung infection with ground-glass shadows. Sister Wu also took two photos. She said that she had shown the CT results to some doctors, who all thought that they were highly suspected of neocoronavirus infection and their symptoms were highly consistent.

During the days in the observation room, the mother and son lived in different wards. Every time Li Zhe went to see her mother, she could see her mother talking to different people, thinking that she wanted to have a nucleic acid test. On January 28th and 29th, they finally looked forward to the opportunity of nucleic acid detection and did it twice in a row. On the first day, the doctor took a throat swab to take a sample from Wu's mouth, and the next day, from the nasal cavity.

However, the results were unexpected. Li Zhe ’s nucleic acid test result was “positive”, but sister Wu, who had a more serious illness and had an earlier onset, was “negative”.

This is not a case. In the early days, for suspected patients, getting a kit was "winning the lottery". And now things have changed. Even patients with consistent symptoms and CT suggesting a viral infection in the lungs cannot obtain a "positive" diagnosis.

This is good news, but now it is a new worry for patients.

Some patients may be true negative, but some may turn from negative to positive after several tests. They could not be initially defined as people with new coronavirus infections, which means that they may be shut out of hospitals, their condition may suddenly worsen, and people around them are at risk of infection.

In February of the new year, there are more and more help posts for negative nucleic acid tests on the Internet. Tan Wei, deputy chairman of the Medical Imaging Professional Committee of Hubei Province, told Southern Weekend reporter that based on his clinical experience, he believes that CT results are very good for new coronary pneumonia, but about 30% to 40% of cases with negative nucleic acid tests.

Li Zhe started hospitalization. Sister Wu did not go well. She had not had time to do the third nucleic acid test, and she did not know whether she would become positive afterwards. Her condition was getting worse, and she was worried about hospitalization day and night.

1
Tested positive for the 7th time

"I really hope that my test result will be positive." Sister Wu said that she was out of luck. If it was positive, she might be hospitalized.

According to her description, her condition is getting worse. When she first took the CT, Sister Wu was able to act as usual. And now she relies heavily on oxygen. Her bed in the observation room is less than three meters away from the toilet, but every time she goes to the toilet, she must sit for a long time and wait for her breathing to be stable before she walks slowly. Exhale through the nose and mouth, and she can hardly persist even for such a short time in the toilet.

Another family, Wu Xi's family of seven, has been diagnosed. The grandfather died the night of the diagnosis. Beds were scarce and the grandfather's bed was reserved for the grandmother who was later diagnosed.

Among the people who performed the nucleic acid test in Wu Xi's house, cousin Dou Juan was the only negative patient, but the images of her lungs showed viral inflammation. She became one of Wu Xi's most worried family members. Wu Xi said: "Two negatives cannot be ruled out, and Li Wenliang only tested positive the third time."

Li Wenliang in her mouth was one of the first "rumor making" doctors to spread the epidemic. Li Wenliang checked the nucleic acid 3 times. The first result was unknown, the second time was negative, and the third time was positive. This is the news he announced on Weibo that day, and 23 days have passed since he became ill.

Not just Wuhan. In Taizhou, Zhejiang, the director of the medical department of a designated hospital told the Southern Weekend reporter that during a video conference on February 3, he heard provincial experts say that a patient had been tested 6 times in a hospital in Hangzhou. Nucleic acid reagents were all negative and were not tested positive until the seventh time.

His hospital has similar cases. A couple who came back from Wuhan had a fever and a lung imaging report showed a viral infection, but all three nucleic acid tests were negative.

It's not just patients. Many doctors in the epidemic area confirmed to Southern Weekend reporters that there are now cases where patients have turned negative for nucleic acid tests.

A doctor supporting frontline in Wuhan said that in his hospital, many patients' clinical symptoms and CT images were consistent with the new coronavirus infection, but these people had fewer positive and more negative nucleic acid test results. In a statistical report obtained by Southern Weekend reporters, many negative patients did not undergo a second test.

The doctor explained that the Wuhan Center for Disease Control and Prevention only gave him 50 test indicators per day, and the number was limited, and the hospital was powerless. There were also retested patients, some of whom remained negative, but one also turned positive.

Many negative patients are applying for a second test. This is true of Lin Jun and his mother. Lin Jun's daughter said that nucleic acid testing has to apply to the community, wait in line for approval, "but that's too difficult to wait." They lined up for the hospital and tried to do another nucleic acid test. Lin Jun heard that there were also patients who tested negative on three occasions and only showed positive on the fourth occasion.

2
Aliased throat swab sampling

On February 3, a screenshot of the circle of friends of Zhang Xiaochun, deputy director of the imaging department of Zhongnan Hospital of Wuhan University, was circulated on the Internet. She believes that in the Wuhan epidemic area, CT images should be used as the main basis for the current 2019-nCoV pneumonia screening; at the same time, people with asymptomatic or negative nucleic acid tests but positive CT images should be isolated to prevent family infections.

In an interview with the media, she said that one of the reasons she sent a circle of friends was that some patients with a positive CT diagnosis due to a false negative nucleic acid test result returned to the home after missing the diagnosis, which eventually caused the family to gather the disease.

Why is there a "false negative" test?

According to Southern Weekend reporters, the detection of new coronaviruses includes “sample collection”, “viral nucleic acid extraction”, and “viral nucleic acid detection”. Each step will affect the results.

In the interview, a number of front-line doctors expressed similar views. The most important influencing factor was firstly the sample collection. At present, throat swab sampling in the mouth and nasal cavity is the most common method of sample collection.

Wang Ruizhi, a laboratory doctor supporting the front line in Wuhan, said that the inspection industry often says "garbage in, garbage out". He said that because the new coronavirus is mainly in the lower respiratory tract, and the throat swab is taken from the upper respiratory tract, the specific operation is to wipe the secretions on the two arches, pharynx, and sacral tonsils with swabs to obtain specimens. The New Coronavirus clinical management guidelines point out that the upper and lower respiratory tract specimens should be tested at the same time to improve the detection rate. However, in Wang Ruizhi's observation, the lower respiratory tract specimens are relatively difficult to obtain, so many hospitals have not achieved simultaneous detection.

Another first-line doctor said that throat swab sampling is the easiest to popularize and has good operability. The sputum is not always available, and the extraction of alveolar lavage fluid involves bronchoscopy, which is inconvenient to operate and more likely to be infected by medical staff.

Sampling techniques can also affect detection accuracy. One doctor said inexperienced nurses may not get qualified specimens, which could lead to false negatives. But a more realistic reason lies outside experience. Tan Wei told the Southern Weekend reporter that nucleic acid testing was first performed by the Hubei Provincial Centers for Disease Control and Prevention. Many medical staff faced the patients face-to-face and became infected. Now the test is expanded to more hospitals. On the one hand, there are many unprofessional people. For testing, the sampling site is not deep enough to reach the pharynx. The more important reason is that some people are afraid that they are too close to be infected, and it is more likely to cause the sampling to be incomplete.

Experimental operations are also possible factors. Wang Ruizhi, who is familiar with in vitro diagnostic reagents, said that the new coronavirus detection has more operating steps, so there are more opportunities for experimenters to make mistakes. In addition, there are a large number of specimens tested every day, and the inspectors are in a high-load working state, and the probability of operation errors will increase.

3
Rushing kit

Another patient concern is about kit performance.

Wang Ruizhi said that at the beginning of the epidemic, the capacity of the kits was insufficient, and the drug regulatory department accelerated the approval process of the kits. Many manufacturers accelerated the research and development and rushed to the market. As a result, the performance of many kits was not adequately tested and evaluated. Generally speaking, it takes 2-3 years for such reagents to reach clinical application from development to certification. In addition, the production process of the kit will also affect the quality of each batch of products, which also involves the stability of the detection efficiency of different batches.

The development of the kit was indeed hasty. The staff of a company designated to produce this test reagent told Southern Weekend reporter that it took less than 20 days for the company to develop a product and obtain certification. At the beginning, the company often worked overtime until the early hours of the morning, but the workers on the production line kept working. They had 40 or 50 workers available for deployment.

"At that time, all companies were racing against time, and everyone would say that they were the first to produce." The staff member said. On January 26, the kits of four domestic companies passed the emergency approval channel of the State Drug Administration at a record-breaking rate to accelerate production to reach disease control centers and hospitals in various places. According to the Southern Weekend reporter's understanding, before that, the drug regulatory department has provided two reviewers to each company, providing 24-hour answers to questions and concerns about all aspects of approval.

Now that the Spring Festival holiday is over, most of the company's staff return to work on the third day of the first year, with a full capacity of 200,000 copies a day. However, daily output is based on daily order demand from hospitals and CDCs.

When Southern Weekend reporter asked about the sensitivity of the kit, the other party responded: "We can only express that our kit is highly sensitive and specific, and the specific data of almost all reagent production companies is difficult to determine." The staff said that the company Up and down have been busy recently, and clinical data has not been collected yet.

The kits produced by different companies will also vary. "Each company develops different detection sites for virus nucleic acids, plus different raw materials for reagents, different production processes, and the performance of each kit is definitely different." Wang Ruizhi told Southern Weekend reporter.

Jiang Rongmeng, a member of the National Advisory Committee for Infectious Diseases, suggested that there is another possibility besides sampling and reagent problems. He believes that the detection of the virus is also related to the time of the patient's onset. Generally speaking, the positive level is not as high as one or two days in the early stage of onset. "It is the case that the reagent is not defective and the sampling is not defective. The time of onset is also affected. The early viral load is low, and the positive may be low." Jiang Rongmeng said that this logic also exists in chest CT diagnosis, and some patients have positive nucleic acid tests. However, lung imaging is not shown, and such patients also need to be observed in isolation.

4
How to treat "negative" patients in Wuhan

On the morning of February 2nd, Wuhan Ninth Hospital notified Wu sister and some other patients with negative diagnosis to be transferred. Sister Wu claimed that she was unable to wait in the lobby because she was extremely dependent on the oxygen supply of the hospital, so she was not able to transfer to the hospital. Then she contacted several hospitals by herself, but failed for a variety of reasons.

At first, there were seventy or eighty patients in the observation room with Sister Wu. According to the exchanges among patients, only a few were positive, and there were only eight or nine. Sister Wu stayed in the observation room on the fourth floor for a few days. Most of the patients were elderly people, most of them had fevers, and many of them had difficulty breathing and were breathing oxygen. Some patients who are close to respiratory failure are still struggling and yelling. People die almost every day.

In contrast, the son who was diagnosed as positive was lucky.

On the night of February 2nd, the hospital gave an ultimatum to Sister Wu and made her have to leave. Sister Wu didn't leave, she didn't even hit the needle.

Also on February 2, Wuhan New Crown Pneumonia Prevention and Control Headquarters requested that the four districts of the city conduct centralized treatment and isolation of "four types of personnel". These four categories are: confirmed patients, suspected patients, patients with fever who cannot be ruled out of infection, and close contacts of confirmed patients. Many hotels in Wuhan have been converted into new coronary pneumonia isolation points. During the isolation period, all areas provided free accommodation, medical observation and treatment.

However, according to many reports from Southern Weekend reporters, the main body for the implementation of centralized isolation is the grassroots community. At present, many isolated hotels have not yet been implemented, and many hotels do not have medical conditions. Many patients whose nucleic acid tests are negative but whose condition is still developing are either not assigned to an isolation point or are unwilling to go to an isolation point themselves.

Lin Jun and his mother have been separated at home, while his wife and daughter, who have no symptoms, live in the living room. Lin Jun's daughter told the Southern Weekend reporter that her family's Hongshan District had not been quietly concentrated and there was no one to tell them to go to the hotel.

Wu Xi also asked the community to coordinate the beds for the aunt. Wu Xi said that she had talked about the situation at home with many people, asked for help everywhere on the Internet, and many people contacted her, but she still did n’t give up any opportunity. "So I face you and say it again "On the evening of February 4, Wu Xi told reporters at Southern Weekend.

Another patient, Mr. Li, had a severe lung infection, but both nucleic acid tests were negative. His community wanted to arrange him in the hotel, but they refused, because Mr. Li still needs treatment, he has to be in the designated hospital for a group of seven or eight hours every day for injections, and the community only brings them together for treatment The problem cannot be solved.

Tan Wei, who was treated on the front line, described a sad reality. Some patients were negative for the first and second nucleic acid tests, but CT showed a viral infection, and after a period of time, CT examination was used to find that the condition had worsened. Check the nucleic acid again, and by the time the diagnosis is positive, the patient has become more ill and cannot be saved. Tan Wei pointed out the reason behind-currently patients with a shortage of related drugs, patients who are not seriously ill, did not take such drugs; undiagnosed patients have reached the isolation point, and some isolation points do not have related drugs.

On February 4th, Southern Weekend reporter called several members of the Wuhan Community Grid to ask what should be done for patients whose lung images show a viral infection but a negative nucleic acid test? Some community grid members said that they did not know how to deal with this situation; some people responded that there were no designated hospitals in Wuhan to accept patients with this situation.

Compared with the SARS treatment of the year, according to the "Infectious Atypical Pneumonia (SARS) Diagnosis and Treatment Program (2004 Edition)", for the SARS epidemiological basis, corresponding clinical manifestations and changes in lung X-ray images, and can diagnose other diseases Can make a clinical diagnosis of SARS. On the basis of clinical diagnosis, if a pathogen is detected, a definitive diagnosis can be made. In this diagnosis and treatment plan, clinical diagnosis and confirmed diagnosis are classified as one level, and the other two levels are medically isolated observers and suspected cases. This classification is more relaxed than today's new coronavirus-infected pneumonia.
 

SamD

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You can't seriously expect people to read all that and take it in? I work in healthcare, I am not a clinician but all I can say is that flu kills many more people every year than these viral outbreaks. I am not panicking and I am not wearing a surgical mask.
 
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Juggler

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What colors do the masks come in....if I'm going to wear one i want to be co ordinated
fashionista
 

JohnnyCool

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I was in a Sanur bar/restaurant last week and a waitress gave me a menu.
I spotted Corona Extra on it and asked her what was 'extra' about it (as in did it come with a virus)?
I don't think she got my 'joke'.

It's difficult (for me) to fully come to grips with COV-19 and all of its potential ramifications.
The Chinese government hasn't exactly been transparent enough, IMHO, and there are reports that it knew and suspected
much more much earlier.

The following link to New Scientist is useful, if anyone's still interested:

 

mugwump

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Just read in Bali Update today that hotel reservations are down by 51,000. rooms apparently by virtue of tourist fears of the coronavirus. The report further explains that to date there has still been no evidence of positive results from testing.
This information can hardly help but make a person hope that the loss of tourist funds is in no way influencing the surveillance of potential outbreaks.
 

mugwump

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Regret to keep banging away at the same topic, but don't think the coronavirus is just going to go away no matter how some play ostrich with head in sand.
As mentioned the tropics can't be equated to cold climates where people huddle together in small quarters and avoid the world outside. Still other factors prevail.
One thing I haven't read anything about is what happens to the crew members aboard the cruise ships who have been exposed daily in their work capacities? Where are they going to be treated, isolated and quaranteened and then what? Many cruise ship personnel hail from Indonesia and they do get furloughs. Indonesia isn't just a place where tourists visit and possibly introduce a virus. The way this thing is spreading (all Chinese provinces now are infested) how possibly can Indonesia remain immune?
Those nations reflecting outbreaks are making attempts to face up to the problem and doing something about it. The longer nothing happens the more we can't help but ponder how can Indonesia be so unique?
 

hafri

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Sep 25, 2009
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After reading about the corona virus, it dies after 30 degrees of heat. Maybe that's why Asia is virtually corona-free?
 

Foamcrest

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We came up yesterday and at Sydney airport I saw only one checkin lady wearing a mask and only Asian passengers were wearing masks. I don’t wish to underestimate the seriousness of the situation but 5000 Australians die of the common garden flu EVERY year which is staggering when compared to the deaths worldwide of this Corona virus. The real is worry is that even then people shy away from getting a flu vaccine shot despite it being free in a lot of cases.
Stay Calm and Carry On.
 

JohnnyCool

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After reading about the corona virus, it dies after 30 degrees of heat. Maybe that's why Asia is virtually corona-free?
Yeah, perhaps.
But what about countries like Cambodia, Thailand, the Philippines? Not exactly renowned for cold temperatures.
 
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