Was social distancing in Indonesia cost-effective?

A study of health responses in Indonesia calculated the cost benefit of social distancing measures versus more relaxed approaches towards managing the pandemic.

Story by Drish Lokee.

COVID-19 is a serious challenge for the health system in Indonesia. The pandemic reached its peak in 2020, recording approximately 82 percent of confirmed cases and 70 percent of total deaths. Considering Indonesia's geographical challenges to reach vulnerable places and the lack of access to public health services, the  government introduced social distancing measures to prevent the spread of the virus.

“Many countries, including Indonesia, are initially hesitant to use social distancing because it may have an impact on economic growth. Working from home, limiting access, and closing schools can all slow an economy and cause other problems, but there have been few studies that calculate the cost benefit of SD in Indonesia,” says Dr Inge Dhamanti, an Adjunct Senior Lecturer in School of Psychology and Public Health at La Trobe University

Dr Dhamanti worked alongside Dr Auliya A. Suwantika, from Universitas Padjadjaran in Bandung who led the project, to examine the cost-effectiveness of social distancing in reducing disease transmission in Indonesia.

Two mitigation scenarios were presented, comparing social distancing when it was implemented for one month only versus continuous application.

By developing a compartmental model, the data on cost effectiveness of social distancingshowed that school closures, workforce and community contact reductionsincreased, showing the total savings in scenarios of SD for one month and continuous SD to be approximately $415 billion and $699 billion, respectively, while the averted deaths were 4.6 million and 8.5 million, respectively in Indonesia.

“According to the findings, continuous social distancing has the greatest impact on lowering the number of out-patient, non-ICU, and ICU hospitalisations and deaths. In addition, when compared to other scenarios, continuous social distancing has the lowest pandemic cost,” says Dr Dhamanti.

The study highlighted that absenteeism at work led to a loss of productivity.

“In hospitalized cases, the person must stay in the hospital for several days, resulting in productivity loss. Individual productivity is also lost as a result of premature death due to illness from the time of death until retirement,” she says.

However, the Dr Dhamanti says that intervention of social distancing measures also resulted in an increase of productivity loss.

“During social distancing, workers must work from home and frequently assume increased household responsibility for childcare due to closure of schools and day care. This could result in a decrease in productivity. Shop or business closures will also have an impact on productivity, particularly if the business relied on face-to-face interaction for trade,” she says.

Dr Suwantika who investigated the qualitative and quantitative data, noticed the comparison to other costs highlighting that the loss of productivity due to disease was expected to be reduced by 92 percent while productivity loss increased by 96 percent.

“Our analysis highlighted that basic reproduction number, infectious period, daily wage, incubation period, daily ICU hospitalization cost, and case fatality rate were the most influential parameters affecting the savings and the number of averted deaths in all mitigation scenarios,”says Dr Suwantika.

The results confirmed that the overall expenses of the pandemic were $777 billion, $362 billion, and $78 billion in the baseline, social distancing for one month and continuous social distancing, respectively.

Dr Dhamanti continues to contribute to public health area as she extends her research to assess the impact of COVID-19 on patient safety in Indonesian hospitals and the quality of hospital reporting during the pandemic.

“Patient safety is a human right and the critical aspect of service quality that must be met,” says Dr Dhamanti. “The government has made numerous efforts to improve patient safety, however there are many challenges in implementing patient safety in Indonesian hospitals.”