News from Good Doctors

Lessons From Using Telemedicine During the Pandemic and Opportunities in the New Normal: Good Doctor Shares Their Views at Various Events

December 8, 2021 | Muhammad H.
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The use of digital health technology has proven effective in the COVID-19 self-isolation program. In the webinar “The Trends in Health Insurance Programs: Self-isolation and Telemedicine Services”, dr. Ega Bonar Bastari, Medical Manager of Good Doctor Technology Indonesia said, “At the end of June to early July 2021 there was an extraordinary increase in COVID-19 cases. Meanwhile, as a country, we have limited resources, especially in hospitals, beds, and health workers. Indonesia’s population is concentrated on the island of Java. and the island of Java was in the red zone. As a result, the entire bed occupancy rate was already at its maximum. There was a tremendous panic because we can no longer distinguish which ones need initial help, which patients needed critical help, and which patients could be monitored fromhome. To overcome this incident, the Ministry of Health brought together telemedicine services including Good Doctor, pharmacies (at that time Kimia Farma) and delivery service to unite to support the government in carrying out an independent isolation program. The trial program started on July 6th and July 7th became the starting point. Since then, about 3,000 people have consulted every day to 11 telemedicine services in Indonesia, whereas the number of cases has reached 20,000 per day because these services are only opened in Java and Bali; and had served up to 5,000 cases per day.”

The program flow is simple, but involves many stakeholders. “There is one center that controls the PCR result data. If someone’s PCR result is (+), that person will immediately get a WA stating you are (+) COVID and can do teleconsultation. The goal is to prevent people from going to the hospital because the hospital is very full. Upon successfully starting a consultation via telemedicine, the doctor asked if there were any symptoms that required special treatment so that they had to be hospitalized. From that answer, it will be determined that this patient would not need to go to the hospital, and be self-isolated and will then be treated according to its category. Appropriate medicines were also prescribed and sent to the patient’s home,” said dr. Ega in a joint webinar with Great Eastern Life Indonesia and Indonesian Association of Insurance and Reinsurance Brokers (APARI) who recently received an award from the World Business Outlook as The Best Educational Service Provider of the Year, and The Best Insurance and Reinsurance Brokers Training Company – Indonesia 2021. 

Indeed, self-isolation at home is more comfortable because at that time the hospital was so full that the beds were placed in tents outside the hospital. However, there are strict eligibility conditions to qualify patients for home-isolation. Doctor Ega explained that there are two conditions that must be met, namely clinical requirements and home requirements. If one of them is not met, then self-isolation cannot be done. Clinical requirements include age under 45 years, without comorbidities, no chronic disease suffered, and no symptoms or only mild symptoms. The home requirements include being able to live in separate rooms and have a bathroom in the house. If the two conditions are not met, they must be put in a special treatment place. In Jakarta, for example, Wisma Atlet is the appointed isolation site for patients or families who did not meet the criteria for home isolation for in various scenarios.

“This government program provides clear evidence that telemedicine is successful. Nearly 80% of these self-isolation programs were successfully managed during the 10-14 day period depending on their condition when people (+) COVID are treated at home with doctor’s monitoring via telemedicine. The remaining 20% suffered from worsened condition, so had to make a patient referral because that is what the patient needs. Meanwhile, the success of telemedicine for common illnesses is even greater, namely 93-98%.” The effectiveness and efficiency of telemedicine, including a cashless payment system, has made telemedicine integrated into insurance, such as Good Doctor and Great Eastern Life Indonesia.  To achieve the goal of one doctor for every family in Indonesia and Southeast Asia, Good Doctor (GD) develops a holistic healthcare ecosystem. The ecosystem consists of pharmacies, payors, providers, and patients. “On the Good Doctor and GrabHealth platforms, there is a significant change in user behavior, both in terms of online doctor consultations and the purchase of drugs and health products. This happens not only in the big cities, but throughout the province. Transaction growth only from independent pharmacies at Good Doctor was more than 300% in the last year, namely the period January-October 2020 to January-October 2021. This shows that the interest of the Indonesian people is more directed towards digital channels,” said Danu Wicaksana, Managing Director of Good Doctor Technology Indonesia in the recent Danone Indonesia Pharmacy Growth Academy talk show.

This change in behavior was originally caused by the COVID-19 pandemic, which made people worry about going out of their homes. However, because they are comfortable with being online, this behavior can be quite sustainable in the post pandemic era. According to Danu, “In addition to changes in user behavior, there also needs to be a shifting behavior from regulators and principal-principal partners, including Danone which is very innovative. Global companies like Danone are using digital channels like Good Doctor and GrabHealth to better serve customers. They use digital channels to provide education and introduce new products so that customers adapt, now, when they are looking for information about new products or health products, they don’t have to go to newspapers or radio, but to digital channels like our health application. This pandemic has made it safer and more convenient for people to order health products online because it reduces interaction and travel time. This is what makes regulators, in this case the Ministry of Health, and several other institutions provide a kind of tolerance for several digital platforms such as GD to provide digital prescriptions so that Indonesian people who need drugs or health products that require prescriptions can obtain their prescriptions at GD electronically and get the product just by waiting at home. Our driver from Grab Express will drop it off.”  The development of digital technology and the three driving forces above have opened up opportunities for selling health products online. “The government updates the regulations regularly and this is a very good opportunity to add sales channels to digital. Sales of Foods for Special Medical Purposes (FSMP) products require a doctor’s prescription. Getting a doctor’s prescription physically is of course not easy, especially during the pandemic, which we don’t know how long it will last for. By joining a digital platform like GD, we can provide end-to-end genie users. This means that users who come and need the product can consult their needs with our doctor. When our doctor feels that the product is really needed by the customer, our doctor can make an e-prescription which will then be forwarded to the pharmacy, which is within a radius of 5-10 km around the customer. When a pharmacy joins our platform, of course, it will have more opportunities to get sales from users who need these FSMP products.” To date, more than 1,000 independent pharmacies have been registered in the GD ecosystem with delivery coverage in more than 100 cities with an average delivery time of less than one hour. 

The case study entitled “Rapid Scaling of Telemedicine to Address Unmet Healthcare Needs: Good Doctor Technology Indonesia” published by Saw Swee Hock School of Public Health, National University of Singapore in November 2021 demonstrates ​​that when telemedicine is augmented by productivity-enhancing technologies, it can greatly expand access to primary care. GDTI also managed to serve more than 13 million patients in the first 2 years of its operation. Second, by partnering with the most widely used consumer apps, healthcare providers can increase their reach much more quickly than via organic growth, and this is crucial especially for countries that have significant needs and large gaps to address in the journey towards Universal Health Coverage and the attainment of SDG Goal 3. There is tremendous potential to build on the initial successes and extend the platform to support the national primary care health coverage scheme as well as develop further applications for specialist services. Third, in the COVID-19 context, there is also opportunity to leverage upon health technology companies like GDTI to support self-isolation programmes and lessen the load on hospitals. Fourth, through GDTI’s collaboration plans with various stakeholders in Indonesia, GDTI will continue to support the MoH’s effort in improving public access to good quality healthcare through its digital innovation. One thing to be grateful for from the COVID-19 pandemic is the increased acceleration of digital technology in almost all aspects of life, including health. In the health sector, there are 3 main problems, namely access, cost, and quality of service. These three problems can be overcome with digital technology. In the webinar “Optimizing Digital Technology to Help Deliver Services to Older People” in mid-November, dr. Adhiatma Gunawan, Head of Medical at PT Good Doctor Technology Indonesia (GDTI) said, “The implementation of digital technology can be used to solve this problem. Digital technology can help everyone from Sabang to Merauke to gain access. Digital technology also makes it much more cost efficient, of course without compromising the quality of the services provided.”

The webinar was held by the Ministry of National Development Planning/National Development Planning Agency (PPN/Bappenas) in the context of launching and socializing of The Presidential Decree Number 88 Year 2021 concerning the National Strategy of Ageing. Minister of PPN/Head of Bappenas, Dr. (H.C.) H. Suharso Monoarfa said, “This Presidential Regulation is a manifestation of the government’s commitment to the issue of population aging. We hope that Indonesia can encourage the creation of an independent, prosperous, and dignified elderly population through the formulation and implementation of systematic policies and programs for the elderly.” The event also conveyed the development of the SILANI Digital Platform (Elderly Information System) trial which was initiated by Bappenas. “What we want to achieve from SILANI is to provide the elderly with better access to services by using wider technology so that they continue to be active, healthy, and prosperous,” he said. SILANI digitization in the form of website and android-based applications for elderly vulnerability assessments, service referrals, and case management is carried out, among others, to increase the digital literacy of the elderly which is currently still relatively low, at 46.68% in 2020. “Through our ongoing multi-stakeholder engagement initiatives to partner with like-minded leaders within the public and private sectors, we will continuously support public health education initiatives to ensure that the elderly population are not left behind in today’s digital age,” said dr. Adhiatma. 

As a health platform that aims to provide health services in Indonesia for all age groups, GDTI has proven that digital health technology can make it easier for the elderly to get COVID-19 vaccinations. Doctor Adhiatma said, “More than 9,000 elderly people use our digital services to access vaccination services in 18 cities in Indonesia. Elderly must meet a number of criteria to be vaccinated. What happens if there is a crowd of people at the vaccine site? Because the elderly have limitations to go to the vaccine site and wait a long time. Therefore, we pre-screened by moving a number of questions into the app. The questionnaire must first be filled in accordance with the health condition of the elderly. We take this step with the aim of efficiency in the operational framework of vaccine implementation and vaccine scheduling can be done more accurately so that elderly people who come to the vaccination site do not have to wait too long. Of course this provides convenience and is a real example of how telemedicine platforms like Good Doctor can benefit the elderly.” Digital literacy in the elderly group is indeed lower than the millennial generation and even young people today. However, this does not rule out the possibility that GD will continue to provide health services to the elderly. “We provide consultation on behalf of the existing family or consult on behalf. So, even if the elderly are not able to use the digital platform directly, caregivers or family members can help. Our doctor partners will serve wholeheartedly, will provide what is needed; both online consultation services and if the elderly need prescriptions and health products.”  

Good Doctor Urges People with Diabetes to Step up in their Overall Health Management Amid COVID-19

Did you know that people with diabetes are more likely to have serious complications from COVID-19? In general, people with diabetes are more likely to have more severe symptoms and complications when infected with any virus. Research conducted at Fatmawati Central General Hospital, Jakarta, showed that patients with DM were more than 2.5 times more likely to receive intensive care than the population without DM. Mortality/death in DM patients has the possibility of increasing 2.5 times compared to patients without DM. In commemoration of world diabetes day on 14 November, Good Doctor urges members of the public to step up efforts in taking care of their health in aid in lowering their risk of contracting the virus. To drive this message to various age groups across Indonesia, the Good Doctor team has organised several initiatives to share credible health tips and recommendations to increase the mindshare about diabetes.  Speaking at the latest #GoodKnowledgeGoodHealth webinar series in collaboration with LSPR Communication & Business Institute, Dr. Rulli Rosandi, SpPD-KEMD, a specialist in internal medicine at Good Doctor stated, “Diabetes mellitus (DM) is a metabolic disorder characterized by an increase in blood sugar levels due to disturbances in insulin production, and/or impaired insulin function.” Diabetes mellitus has several symptoms, namely (1) frequent urination, especially at night, (2) quickly feeling hungry and thirsty, (3) weight loss while increasing appetite, (4) feeling tired and sleepy quickly, (5) ulcers or abscesses easily develop with long healing, (6) itching, especially in the external genitalia, (7) tingling, (8) decreased sex drive, (9) blurred vision, characterized by frequent changes in the size of glasses, and (10) mother that gives birth to a baby more than 4 kg. “To determine if someone is diabetic, that person must have their blood sugar levels checked, not just based on the symptoms.” 

A person does not immediately become diabetic. Starting from normal to prediabetes then diabetes. According to Dr. Rulli, “A person is said to be diabetic if his fasting blood sugar (GDP) 126 mg/dl, blood sugar after glucose loading (GDPP) 200 mg/dl, and Hba1C 6.5%.”

The 101 of Diabetes 

There are 4 types of diabetes, namely: type 1 diabetes, type 2 diabetes, specific types of diabetes due to other causes, and diabetes in pregnancy. Dr. Rulli who is also a Diabetes Metabolic Endocrine Staff at the Faculty of Medicine, University of Brawijaya-Saiful Anwar Hospital Malang explained, “In type 1 diabetes, pancreatic beta cells (which function to produce insulin) are unable to produce insulin at all, so the medicine is only insulin injection. In type 1 there is absolutely no insulin, while in type 2 there is insulin, but its function is impaired. Type 2 diabetes is characterized by insulin resistance and is found in many populations. Another cause of specific types of diabetes is infection. When COVID is at its peak, there are people who have no history of diabetes, but their blood sugar is high, more than 200 or even more than 300. When the infection is controlled, their blood sugar returns to normal. While diabetes in pregnancy is caused by hormonal balance disorders that cause blood sugar to increase. However, after delivery, blood sugar returns to normal.” 

Diabetic patients in Indonesia continue to increase as seen from the National Basic Health Research (Riskesdas) data. “In 2007 the percentage was 5.7%, increasing to 6.9% (2013) and then increasing again to 10.9% (2018). If Indonesia’s population is 250 million, it means that there are around 25 million Indonesians who have diabetes. In addition, the proportion of young people in Southeast Asia is higher than in other regions. In Southeast Asia, it is dominated by middle age (40-59 years) followed by young people (20-39 years). In contrast to Europe, which is dominated by the elderly population (60-79 years). Clinical features in DM patients under the age of 40 years in Asia show that type 2 occurs frequently and often begins with obesity and 80% has a family history. The problem with diabetes is its complications, such as stroke, cardiovascular disease, diabetic neuropathy, kidney disorders, and eye disorders. Type 2 diabetes at a young age causes more aggressive complications, complications in microvascular and macrovascular occur more quickly, life expectancy is reduced, mortality is more pronounced than the general population, mortality is more pronounced than type 1, and macrovascular complications are more pronounced compared to type 1.”

Good Doctor’s Internist, dr. Rulli Rosandi, Sp.PD-KEMD

Dr. Rulli said, diabetic wounds most often occur on the feet. Diabetes most often affects the long type of nerve fibers in the legs. Diabetic foot skin is often dry due to autonomic nervous system disorders that secrete sweat. Because the sweat does not come out, the skin becomes cracked so that if it is not treated with a moisturizer, it can become an entry point for germs. Then, germs multiply so that diabetic sores begin. Treatment depends on the type of wound. So, if there is a wound, it must be treated so that it does not increase. Reporting from gooddoctor.co.id, a 2018 publication from the American Diabetes Association noted how diabetes is responsible for 50% of amputations in the United States. So what can people with diabetes do to take better care of their health especially during the pandemic? 

Regulating Diet and Physical Activity

The journey of type 2 diabetes: normal > prediabetes > type 2 diabetes > complications > disability and death. Like diabetes, which has a journey, prevention also has stages. Dr. Rulli said, “For prediabetes, primary prevention is done. People whose blood sugar is elevated, is no longer normal, but not yet diabetic, there is a possibility that it can return to normal. However, if you have DM type 2, then the arrow is to the right, it is very difficult to turn back. Therefore, do a healthy lifestyle by starting to exercise, lose weight if you are overweight, and eat more vegetables and fruits.”

The relationship between obesity and diabetes has actually been discussed since 100 years ago in The Journal of the American Medical Association January 8, 1921. The article stated that obesity is a predisposition to diabetes. So, keep the weight in order not to increase. Dr. Rulli explains, “Weight gain is an entry point for diabetes. If you have diabetes, you have friends, namely hypertension, cholesterol, and diabetes. The four elements are the metabolic syndrome with obesity being the boss. If there is a person with diabetes, there must be cholesterol, if there is cholesterol, they must have high blood pressure. It all starts with obesity or weight gain.” Dr. Rulli continued, large studies have shown that diabetes prevention with lifestyle modification, namely maintaining food intake and exercising 150 minutes per week or 30 minutes per day has proven effective. The drugs given for prediabetes are also inferior to the monitored lifestyle, especially physical activity. “Regular physical activity will improve insulin resistance. Improved insulin resistance, decreased obesity. Decreased obesity, decreased hypertension, decreased cholesterol, decreased risk of thrombosis, and decreased systemic inflammation. This means that by doing regular physical activity there are many positive benefits that we get.”

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Heredity is a risk factor for diabetes, but it is not a single gene. In contrast to hemophilia, which is inherited from the X to the X chromosome. The hereditary pattern in diabetes is polygenic. So, many genes are involved, but we can’t yet identify which one is the most dominant. “Even if there is hereditary factor, we will determine whether the heredity will manifest. That is, genetically it is inherited, but if we maintain a good diet and exercise regularly, the genetics will not be unlocked, remain locked, not manifest into diabetes. That is what is called epigenetics,” said Dr. Rulli. A good diet means a balanced proportion of carbohydrates, fats, and proteins so that weight is controlled. Talking about eating patterns reminds me of instant noodles which are one of the favorite foods of Indonesians. Data from the World Instant Noodles Association (WINA) dated May 11, 2021, shows that Indonesia is in second place in the list of countries that consume the most instant noodles in the world. The number will reach 12,640 million portions in 2020. Reporting from gooddoctor.co.id, instant noodles contain high carbohydrates and can cause a rapid rise in blood sugar. Instant noodles are also high in sodium. Sodium can raise blood pressure. If a diabetic wants to eat instant noodles, then choose noodles that are made from whole grains because in general the flour that is the basis for instant noodles has a high starch index. Also, don’t overcook the noodles as it will affect the glycemic index and eat only 1/3 cup. 

Massage Therapy and Medicine

Basically, more research is needed on the benefits of massage for people with type 2 diabetes. However, several studies on gooddoctor.co.id show that massage therapy can help people with diabetes in:

1. Lowering blood glucose levels

2. Helps manage peripheral artery disease

3. Manage symptoms of diabetic neuropathy

4. Improve the symptoms of neuropathy To treat diabetes also requires medication. However, because the types of diabetes vary, the treatment also varies. “So, we cannot generalize diabetes with one or two kinds of drugs. Types of people with diabetes have their own uniqueness. Drugs that are suitable for A are not necessarily suitable for B or C. The choice of diabetes therapy should be based on the doctor’s consideration,” said Dr. Rulli. There are two forms of diabetes drugs, namely oral drugs and injections. For injection in the form of insulin or GLP-1 RA. Dr. Rulli said, “GLP-1 injected once a week can control blood sugar. Only condition, requires insulin in the body in good condition. The administration of GLP-1 for type 1 DM is still questionable, while for type 2 with a good condition of the pancreas, it is permissible to give it. GLP-1 can also lose weight.” 

Is Your Immunity Strong Enough to Weather the Rainy Season Amid COVID-19? 

In Indonesia, while we are seeing a steady decrease in COVID-19 infection rates across the country, citizens should not lower their guard especially as we enter into the annual monsoon rainy season. With the changes in the weather, many are much more prone to falling ill, thereby increasing their risk of contracting the COVID-19 disease, because of their weakened immune system.  Currently, Indonesia has entered the rainy season. The Meteorology, Climatology and Geophysics Agency estimates that the peak of the rainy season will occur in January and February 2022. While the rainy season does provide a much welcomed cooler climate, it is important to stay healthy over the next few months. According to various health articles on gooddoctor.co.id, health experts warn that, the increased amount of water particles in the air puts us at twice the risk of picking up various air-borne infections. This is because the high water content in the air allows various harmful microorganisms to multiply faster than in warmer, drier climates.

One of the most common diseases in the rainy season is related to the respiratory system. Based on the illnesses users on the Good Doctor (GD) platform were consulting doctors about during the timeframe during the end of October to the second week of November 2021, dr. Adhiatma Gunawan, Head of Medical PT Good Doctor Technology Indonesia cited figures tracked internally by their in-house medical team specifically about a increasing diagnosis trend which shows that acute respiratory tract infections (URTI) cases dominated the category of teleconsultations his team handled and cautions that this worrying trend will only continue to rise if health precautions are not taken to increase one’s immunity during the monsoon period. The Diagnosis Trend shows an increase in URTI of 1-2% every week and is predicted to increase to 10% in the following weeks. Dr. Gunawan added that the majority of the teleconsultation on Good Doctor’s digital health mobile application came not only from Jabodetabek, but also from other cities, such as Bandung, Surabaya, Semarang, Yogyakarta, Palembang, Medan, Denpasar, and Ujung Pandang.

Trends in Diagnosis of URTI (Upper Respiratory Tract Infection) dominates the consultation and still shows an upward trend

URTI is an acute infection that attacks the upper respiratory tract and can be transmitted to other people. The affected body parts can be the nose, sinuses, pharynx, and larynx. Symptoms that may be felt include a runny nose, sneezing, coughing, and nasal congestion. According to healthline.com, “The risk of URTI will increase in people whose immune systems are weak.” Children and the elderly belong to a group with a low immune system. The immune system in children is not yet fully formed, while in the elderly, in line with age, the immune system will decline. Reporting from gooddoctor.co.id, the virus that causes this disease can survive in the air and inanimate objects. This condition causes the spread of URTI disease to replicate easily.

With the Latest Discovery of the New COVID-19 Variant, It Is Important to Maintain a Healthy Immune System Despite Being Vaccinated, and Stay Vigilant

Despite Indonesia seeing a promising trend of decreasing COVID-19 infection rates, the COVID-19 pandemic has not shown any signs of ending because on November 24, 2021, for the first time, the latest variant of the Corona virus, Omicron with the scientific name B.1.1.529, was discovered in South Africa. Two days after that, WHO immediately announced that it is considered as a variant of concern (VOC) group. To prevent a recurrence of the Delta variant outbreak, WHO advises all countries to increase vigilance. Researchers are still conducting in-depth studies of Omicron. For the time being, it is known that the variant has several mutations that impact the behavior of the virus. This can affect the risk of spread and the severity of the disease. However, the same as the previous variant, implementing health protocols and carrying out vaccinations are still effective in reducing the risk of contracting, preventing the severity and death of being infected with Omicron.

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In the GoodTalkSeries collaboration between Good Doctor (GD) and Redoxon earlier this November, dr. RA. Adaninggar, SpPD stated, “The vaccine for COVID-19 is a killed virus. Vaccination aims to introduce this virus into a person’s body before we are exposed to the actual virus. When exposed to a virus, the body will respond by forming antibodies and memory cells. Antibodies are a weapon against viruses and will last a long time, while memory cells serve to protect us if we are infected again in the future.”

Good Doctor’s Internist, dr. RA. Adaninggar, Sp.PD

The GD’s internal medicine specialist, who is called dr. Ning said, “Vaccination actually mimics natural infection, only vaccines are made safe because the composition in the vaccine is a dead virus so it can trigger antibodies and memory cells without putting a person at risk of serious illness and death. Vaccines only trigger, which form antibodies and memory cells are each of our bodies. How big the antibodies, the quality of the antibodies, the quality of the memory cells that are formed against this virus depend on each individual’s immune system. For example, the vaccine is injected into the elderly or into those who have a chronic disease or comorbid disease, it can reduce its efficacy. This means that the formation of antibodies and memory cells is not as good as in healthy people. So, it all depends on our immune system. We also seem to be very healthy, we are young, we don’t have any comorbid diseases. If we don’t live a healthy lifestyle, our immune system is not healthy. Even though we are vaccinated, not necessarily the quality of immune formation will be good because it all depends on the quality of our immune system.” In other words, vaccinations carried out on someone with a good immune system will form immunity optimally.

Tips for Dealing with the rainy Season Like Now

Doctor Ning said, do a healthy lifestyle that includes physical and mental health by:

Ensure the nutrition we consume is good. Nutrients can be obtained from daily food. If we cannot meet the required daily needs, we can add supplements. For example, the complete Redoxon in one tablet; so it’s not complicated to have to take two or three tablets.

Sports. Don’t have a sedentary life. Do physical activity regularly to maintain fitness. Reporting from gooddoctor.co.id, there are 5 types of sports that you can try at home during the rainy season, namely:

  1. Physical stretching
  2. Aerobic exercise
  3. Yoga
  4. Weightlifting
  5. Calisthenics exercises

Get enough sleep. Sleep is closely related to the immune system and stress. People who are sleep deprived are irritable, easily anxious, and easily stressed. 

Must be able to manage stress well. There is any problem, we must be able to manage it well. For example, with me-time. Me-time is very important. There must be a balance between work and personal life. 

Health protocols must still be carried out because we are still in a pandemic condition.

In addition to regular exercise, the Ministry of Health of the Republic of Indonesia provides tips to stay healthy during the rainy season, including:

  • Prepare dry clothes, shoes and socks
  • Consumption of non-caffeinated hot drinks
  • Eat more fruit
  • Always have an umbrella
  • Do not pollute the environment with cigarettes • Protect the house from mosquito attacks
Good Doctor’s Pediatrician, dr. Michael Andhika K. M. Biomed, SpA

Especially for younger children, such as elementary school students who have not been vaccinated, dr. Ning said that parents are obliged to take care of them with nutrition, consult a doctor so that if there is a disease it can be treated until it is good so that the immune system is good. The GD’s pediatrician, dr. Michael Andhika K. M. Biomed, SpA in GD’s Instagram stated, there are two things that must be considered regarding nutrition, namely macro intake and micro intake. Macro intake comes from carbohydrates, proteins, and fats, while micro intakes are vitamins and minerals. 

“In fulfilling nutrition for children, the most important thing is the number of calories, which is 100 calories per kg (child weight) per day. Don’t just focus on protein consumption, make sure other nutrients are also met, including calories. So to be balanced, in addition to meeting the intake of macronutrients, also pay attention to the intake of micronutrients for children.”  

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