Balinese in traditional wears and face masks at the Melasti ritual, March 22, 2020. Photo: Facebook

BALI – Previously persuaded it may have a mysterious immunity, Bali appears to be headed for a cruel Covid-19 wake-up call after a single cruise ship worker who refused to self-quarantine reportedly caused widespread infections in a village in the east of the Indonesian tourist island.

Acting on April 30, authorities sealed off Abuan, lying 10 kilometers north of Gianyar, Bali’s second most densely populated district and the spiritual birthplace of Balinese kings, and confined all 2,640 villagers to their homes.

With eight cases already confirmed through swabs, medical staff descending on the picturesque rural settlement subsequently screened out 442 suspect new cases from among the 1,200 villagers they subjected to the less-reliable rapid test.

Now, the swab results from the state-run Sanglah Hospital laboratory are in: what was widely perceived to be a cluster from hell has turned out to be nothing of the kind. According to officials, none of the 442 were positive for the virus.

Despite the apparent all-clear, Bali Governor Wayan Koster says Abuan will remain in a 14-day lockdown as a precaution, along with another two villages in the district of Buleleng in northern Bali, where there have been at least 16 confirmed cases.

Sources with contacts in the local medical community are skeptical about the veracity of the figures, noting an item in the Bali Tribune on May 3 which reported 25 new confirmed cases that were subsequently not reflected in the national caseload figure.

Still, the episode only adds to the debate, highlighted last week in the New York Times, over why Covid-19 seems so capricious, devastating some places and sparing others on its frightening march across the globe.

Bali and most of  eastern Indonesia are a case in point. As of May 4, 8,235 of the 11,587 cases nationwide were on Java, while Bali, the neighboring Nusa Tenggara island chain, Papua and Maluku have had only 906 cases and just 21 deaths.

A mask-clad Balinese woman during the Galungan holiday at Jagatnata temple in Denpasar, Indonesia’s resort island of Bali. Photo: AFP/Sonny Tumbelaka

A lack of testing is always the standard response to the anomaly, but where is the evidence that people are dying of the virus in their droves? It’s simply not there – at least not now anyway.

Bali has 271 confirmed cases and just four deaths, surprisingly low when migrant workers are still returning from abroad and Chinese tourists were arriving on direct flights from Wuhan as late as January 24.

But, as with Abuan, there are fears of a spike in infections as workers return to their villages across the island to wait out the pandemic and the recovery of a US$46.5 billion industry that has given them a secure livelihood for years.

Many are men and women in their 30s and 40s, young and healthy enough to be asymptomatic with no obvious signs of ill-health apart from possibly a sore throat or slight fever.  

Local residents say post-arrival testing appears to have been minimal and that, like the worker in Abuan, few heeded official warnings to voluntarily self-isolate in their homes for the fortnight after they landed.

University of Udayana public health expert Dr Panda Januraga dismisses suggestions that the Balinese have an immunity, but he gives some credence to other factors, including the tropical climate, that may be slowing it down and interrupting the efficiency of transmission. 

Close contact appears to be critical. Observers note that Chinese tourists have always gone around in packs, which may have helped lower the infection rate because the number of local people they engage with is generally low.

A lack of testing aside, little research appears to have been done into a severe outbreak of influenza that swept the island at the end of 2019, raising questions about what the Australian-trained Januraga calls “under-diagnosis.” 

A large number of schools in Bali were impacted, with classrooms half-empty through December and January. All the while, Chinese tourists continued to pour in for the New Year holiday, with thousands left stranded when all flights to and from China were halted on February 5.

Empty beach chairs in Bali as a resort worker sprays Covid-19 disinfectant in the sand. Photo: AFP

One Indonesian woman, known to the writer, fell ill with relentless coughing, a sore throat and slight fever after arriving at an overseas destination from Bali last December. A close relative caught pneumonia and took a month to recover.

At the end of 2019, Bali health officials also reported a major surge in dengue fever, whose flu-like symptoms mimic Covid-19. In fact, the number of dengue fever cases for the year ended up totalling 4,945, five times more than in 2018.

For now, however, attention is focusing on migrant workers. In early April,  governor Koster revealed that 15 cruise ship crew members who tested positive for the virus had recently returned from Italy and the US, the world’s two Covid-19 hotspots.

Up to then, about 6,000 crewmen had come home, including 316 who had arrived in Bali from Genoa on March 30  after being declared healthy by Italian authorities because they had spent 14 days in quarantine aboard their cruise ship Splendida.

In mid-April, as the industry ground to a halt, authorities imposed mandatory isolation on some but clearly not all of the 900 disembarking Indonesian workers from four cruise ships which arrived in Bali over the course of three days.

Alarmingly, Bali’s Covid-19 task force figures show local transmission increasing from 10% to 22% in the space of a fortnight between April 12 to April 26. “This is a warning to us all,” Januraga told the Ubud Now & Then news portal in a recent interview.

A fifth vessel, the 114,000-ton Carnival Splendor, was forced to sail on to Jakarta on the orders of the central government’s Covid-19 National Task Force, despite the fact that 118 of the 327 Indonesian crew members came from Bali.

Frustrated at being diverted to what they called the “red zone” of the pandemic, they posted an open letter on Facebook appealing to President Joko Widodo to be allowed to land on their home island, where few cases were being reported.

After sailing from its home base of Sydney, the Carnival Splendor had initially been turned away from Indonesia’s Batam island, its original destination south of Singapore, before it was refused landing rights in both Bali and neighboring Lombok.

The Carnival Splendor cruise ship in a file photo. Image: Facebook

The Panamanian-registered liner finally docked at Jakarta’s Tanjung Priok port on April 30, only days after positive swab tests were returned on eight Abuan residents, causing health workers to descend on the hamlet for more comprehensive testing.

Yet another cruise ship, the Quantum of the Seas, which pulled into Bali’s offshore quarantine zone on May 4 with 159 Indonesian workers aboard, may also be directed to Jakarta, according to local officials.

According to the Washington Post, as many as 55 of the world’s luxury liners continued their voyages, despite early outbreaks on other ships carrying thousands of tourists to far-flung destinations which helped the virus spread around the globe.

Although last year’s 30 million cruise ship passengers paled in comparison with the 4.5 billion air travellers, health experts say the fact that they eat, swim and dance together over sustained periods makes the big ships ideal incubators for the disease.

In late February, the government air-evacuated 88 Indonesians from the Diamond Princess, anchored off Yokohama, and sent a hospital ship to bring home another 188 other crewmen from the cruise ship Dream World in Hong Kong. All were quarantined on an island in Jakarta Bay.

Overall, 11,500 Indonesian crewmen have returned home. Foreign Minister Retno Masudi revealed on April 29 that another 2,400 workers from 18 cruise ships were stranded around the globe and struggling to find their way back on the few flights available.

More than 68,000 migrant Indonesian workers have also returned from Malaysia, but given the number it is hard to grasp how officials can claim the returnees have all been subjected to strict health protocols, apart from rudimentary temperature checks.