By Iain Marlow and Tassia Sipahutar
(Bloomberg) -- 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 neighbouring 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.”
Read more: Indonesia Forecasts $4 Billion Losses on Traveling Restrictions
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.
Indonesian authorities announced Thursday they were retracing the movement of one Chinese tourist, who tested positive in China days after his return from a visit to Bali.
“We are coordinating with the immigration and the airlines,” Bali Health Agency Head Ketut Suarjaya said. “It is possible that this person did not contract the virus while in Bali because he only stayed in Bali for more or less six days and Bali is still virus-free as of now. He may have contracted it elsewhere,” Suarjaya said by phone.
The tourist traveled from Wuhan to Bali on Jan. 22 and returned on Jan. 28. He tested positive for coronavirus on Feb. 5 after arriving in Huainan city in Anhui province, The Jakarta Post reported, citing an advisory by Anhui provincial government on its Weibo account.
“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 Feb. 10 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 like 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 healthcare analyst at Fitch Solutions.
“The country’s healthcare sector is not equipped for such a crisis,” Sikka said.
© 2020 Bloomberg L.P.