Effectiveness of Large-Scale Social Restrictions ( PSBB ) toward the New Normal Era during COVID-19 Outbreak : a Mini Policy Review *

The government of Indonesia has not used lockdown or quarantine as an option to tackle the spread of Coronavirus, as the impact of lockdown on small communities in the informal sector that lives from daily income will be severe. Alternatively, the government is enforcing Large-Scale Social Restrictions (Pembatasan Sosial Berskala Besar or "PSBB") to respond to the state of emergency in public health. Starting in June 2020, the government has implemented transitional PSBB in some red zone areas, including the capital Jakarta and East Java province, despite the surge in case numbers. This paper aims to investigate the effectiveness of the PSBB policy applied in Indonesia during the COVID-19 outbreak and the readiness to embrace the new normal, between April and June 2020, based on rapid literature analysis in a search on Medline(-Pubmed), government speeches and reports, social and mass media platforms. Implementation of PSBB is a preventive measure to combat Coronavirus’ spread in some Indonesian areas. Indonesia should not be in a “new normal” situation. The transitional PSBB phase serves as an early chapter of a new normal that would apply only to strategic sectors with manageable risks combined with better regulation and compliance by the public.


INTRODUCTION
A novel Coronavirus called Coronavirus 2 (SARS-Cov2) severe acute respiratory syndrome (1) identified as a source of viral pneumonia in Wuhan, China, in December 2019. The World Health Organization (WHO) named it Coronavirus Disease 2019 or "COVID-19", and on March 11, 2020, it was declared a pandemic condition (2). As of June 21, 2020, more than 8,500,000 cases of COVID-19, with 450,000 deaths, reported from over 180 countries worldwide (3).
The first zero cases reported by Indonesia before the WHO declaration on a global pandemic is questionable by many (4). Despite reports of those infections from all the countries around Indonesia at the time, Indonesia did not issue any travel restrictions and traveler quarantines arriving or returning to Indonesia, even from severely hit countries like China. On January 27, 2020, Indonesia issued a travel restriction from the province of Hubei which was then the epicenter of COVID-19 globally, while evacuating 238 Indonesians from Wuhan at the same time. Following the initial and subsequent reports of infections, Indonesia began to recognize the dirt of the situation and since then has released numerous policies and actions to resolve of COVID-19 and the readiness of the government to embrace the new normal. This study can be seen as a "real-time evaluation" because it provides observations and lessons for all stakeholders to strengthen and adapt current policy options from July 2020 until the end of the crisis, mainly at the national level.

METHODS
Studies were included if they presented PSBB policy data or commentaries to reduce COVID-19 spread. Studies can be in any setting. We also included articles that covered the COVID-19 pandemic in Indonesia in general, which included rapid analysis based on media content analysis, including speeches and reports from governments as well as observation of various social media platforms available from April to June 2020. We specifically explored online media content from the www.covid-19.go.id website, mass media, and participant insights from social media sites (e.g., government posts and related stakeholders). We excluded articles on COVID-19's restrictions policy if they covered subjects not relevant to Indonesia. In a search on Medline(-Pubmed) up to June 20, the literature was identified using the following search strategy: ((((((coronavirus) AND ("2020"[Date -Create] : "3000"[Date -Create]))) OR SARS-CoV-2) OR 2019-nCoV) OR COVID).

RESULTS AND DISSCUSION
Indonesia may not be able to conduct sufficient testing to implement a valid "trace and isolate" strategy. Without mass screening, "blindfolded" move virusstricken nations. Meanwhile, the government had been extremely selective in testing patients with COVID-19 symptoms using the polymerase chain reaction (PCR). Therefore, Indonesia remains on the list of countries with appallingly low test rates, with only 136 tests per 1 million people, according to pandemic data released by Worldometer (3). In contrast, Malaysia and Singapore, two of the closest neighbors, tested 2,988 people and 16,203 per 1 million people, respectively (12). COVID-19, including the appointment of 100 general hospitals as referral hospitals on March 3, 2020. To counter the ever-increasing number of COVID-19 patients, on March 18, 2020, the number of referral hospitals increased to 227. Nevertheless, despite these efforts, the number of fatalities continues to overgrow. Indonesia's health ministry provides live data on the impacts of COVID-19 in Indonesia (5) and President Joko Widodo (Jokowi) announced a state of Emergency Public Health Status on 31 March 2020. The government has not used lockdown or quarantine as a choice to tackle the spread of Coronavirus (6), as the impact of lockdowns on small communities would be serious, especially in the informal sector that lives on daily income such as food stalls, small traders, home industries, public transportation drivers and network motorcycle taxis (7). The government has agreed to introduce Large-Scale Social Restrictions (Pembatasan Sosial Berskala Besar or "PSBB") to respond to the State of Emergency for Public Health. Under Reg 9, PSBB is defined as restricting the activities of individual citizens in an area suspected of infection with a disease and/or contamination to avoid the Coronavirus disease spreading (8,9). PSBB enables regional governments to limit the movement of people and goods to and from their respective locations, given they have obtained permission from the Health Ministry. Local governments must have data on the proliferation of cases, local transmission events, and data on the increase in the number of cases over time accompanied by epidemiological curves, as well as the readiness of the region regarding aspects of the availability of basic living needs for the citizens of the area. The law also defined a "minimal" restriction, including the closure of schools and workplaces, limitations on physical worship, public gatherings, social-cultural activities, modes of transportation, and other explicit defense and security-related activities (8).
Starting in June 2020, the government has implemented transitional PSBB in some red zone areas, including the capital Jakarta and East Java province, despite the surge in the case numbers. On June 17, 2020, Indonesia became the country with the largest number of cases of Coronavirus in Southeast Asia, with 41,431, overtaking Singapore's former hot spot with 41,216 cases (10). East Java noted the most recent 225 cases, followed by 127 in Jakarta, and 115 in Central Java. The death toll also increased to 2,276 after another 45 people died in Covid-19 between June 16 and 17 (11). The effectiveness of PSBB policy in preventing the spread of Coronavirus has always been important and it deserves investigation. Given the implementation of COVID-19 through the majority of countries, on this specific occasion, health officials need convincing proof of the previously implemented policies. In this study, we aim to investigate the effectiveness of the PSBB strategy applied in Indonesia during the outbreak The government has taken various steps at both the central and regional levels through PSBB implementation to prevent the increasingly severe spread of Coronavirus. It becomes a clear and binding legal basis for the implementation of PSBB in Indonesia (8), with some requirements to be completed based on Permenkes No.9 2020 and policy implementation through PP No.21 2020. After about two months of implementation of PSBB in DKI Jakarta, some indicators of COVID-19's spread have fallen by more than 50 percent. However, human movements in the capital region are still a threat. The rate of COVID-19 transmission in West Java has flattened too. PSBB has been able to reduce the risk of infection as the strict policy has resulted in people refraining from going outside and meeting in public. However, East Java health authorities reported that the strategy had yet to flatten the curve and that the number of confirmed COVID-19 cases in Surabaya and its neighboring regencies of Sidoarjo and Gresik had continued to rise (14)(15)(16).
On the other hand, this situation has almost halted facets of daily life, trade, and other economic activities. Also, the government must disburse funds to meet the life needs of the laid-off people, or to construct new medical facilities (17). Finance Minister projected that from the pandemic 1.89 million to 4.89 million Indonesians would become weak, while 3 million to 5.23 million would lose their jobs (18). Suitable protection for vulnerable communities is required. The benefit of the stimulus package can not suffice to cover the household economic impact.
To prevent massive unemployment, the government has launched the Employment Card Program applicants for the pre-employment card program, which can also be followed by workers who have been laid off or lost their jobs, as well as micro, small, and medium-sized enterprises (MSMEs) that have closed their businesses due to the impact of COVID19's spread. This preemployment card program was prepared with a total budget of Twenty Trillion rupiah for around 5.6 million participants (19). Coordinating Minister for the Economy stated that the central government had made numerous anticipations before deciding to implement PSBB in an area, considering the impacts it could have had on business actors. Particularly for those sectors not engaged in providing essential public needs, as stipulated on the PSBB guidelines in the Health Minister's Regulation number 9 years 2020. For people who work in the informal sector, the direct impact of PSBB is very much felt. In this case, the government must first disburse the stimulus to those affected by the PSBB policy. And with this lower-middle-class culture, take it off (20)(21)(22).
Indonesia's economy may shrink 3.5 percent this year if, according to a worst-case projection by the World Bank, PSBB imposed by several regional administrations nationwide last four months, as the government rushes to reopen the virus-battered economy (18). This is in line if the availability of stimulus is not given to the public. With the presence of PSBB, office, or company operations that are still capable of functioning at the moment as consumer demand will continue to decreases as what is restricting is not the economy but laws that limit the movement of people and products as long as the PSBB is implemented.
Considering the economic impact, beginning at the end of May, President Jokowi asked for a simulation on easing the existence of PSBB, coordinating with the Covid-19 Handling Acceleration Task Force to run four steps to get the country back to normal. On the other hand, with the advent of new patients and the list of breaches of social restrictions, Indonesia is still struggling to control the virus (23). Movement in and out of Jakarta after April 3, 2020, remains strong. Not a few, who travel hundreds of kilometers from the capital city, reinforce the notion that millions of the capital's residents go home first for fear of a pandemic or losing their jobs (17).
There are four preconditions, timing, priority, and coordination measures to ease PSBB, from central to the regional government. The first is a precondition where relevant experts, including community leaders, scholars, and cultural figures, will be involved in the socialization initiative to ensure the determinative steps toward the next step in the easement of social restriction. Second, the time to lighten up that will involve participation from the community to ensure the general public is ready. The third step will identify the areas that will be prioritized for the easement by calculating the urgency and thorough decision to avoid adverse reaction among the community. The fourth step is central and regional coordination to synchronize the containment effort from top to bottom and ensure that there is no possibility of spreading in much larger Indonesia regions (23).
The government is moving forward to reopen the economy to avoid further weakening by lightening restrictions in areas where infection rates are under control, enabling malls and restaurants to open with tight safety protocols, following a national increase in Coronavirus infections. An economist at the Center of Reform on Economics stated that a relaxation of the PSBB might not necessarily boost an economy low due to the Coronavirus crisis (24).

CONCLUSIONS
At the moment, there are still challenges in the field in testing, tracing, isolating, and treating. Implementation of PSBB is a preventive action to combat Coronavirus spread in some Indonesian areas. However, the government is in a dilemmatic position as Indonesians, who mostly work in the informal sector, are dependent on economic relations among social groups. Such PSBB efforts to reduce Coronavirus' effect would go badly if the central and provincial government is unable to provide its citizens with clarity about the benefits. It also seems that the PSBB strategy is very centralized with the coordination between the ministers, the provincial government, and the control group COVID-19, which is thought to have slow handling. The transitional PSBB era serves as an early chapter of a new normal that will only apply to strategic sectors with manageable risks. This is in line with Jokowi's directive to reopen the economy with caution and steady progress.

RECOMMENDATION
Indonesia should not hurry into a "new normal" provided that the country's pandemic curve has shown no signs of flattening. The government could prepare for the new normal, at least in regions where there is a decline in COVID-19 cases. Also, if the government can do extensive PCR testing, contact tracing, and improve health services should the restrictions be relaxed. Local government should also vow to push more vigorous enforcement and public compliance, such as physical distancing, wearing masks, and washing hands.