Quantifying the dynamics of COVID-19 burden and impact of interventions in Java, Indonesia

Abstract

Measuring COVID-19 spread remains challenging in many countries due to testing limitations. In Java, reported cases and deaths increased throughout 2020 despite intensive control measures, particularly within Jakarta and during Ramadan. However, underlying trends are likely obscured by variations in case ascertainment. COVID-19 protocol funerals in Jakarta provide alternative data indicating a substantially higher burden than observed within confirmed deaths. Transmission estimates using this metric follow mobility trends, suggesting earlier and more sustained intervention impact than observed in routine data. Modelling suggests interventions have lessened spread to rural, older communities with weaker healthcare systems, though predict healthcare capacity will soon be exceeded in much of Java without further control. Our results highlight the important role syndrome-based measures of mortality can play in understanding COVID-19 transmission and burden.

Excess mortality during the first ten months of COVID-19 epidemic at Jakarta, Indonesia

“…Poor capacities of laboratory diagnosis and of death surveillance impose uncertainty in both the characterization and management of this ongoing health crisis in Jakarta. As reported by others, some evidence suggests that non-therapeutic interventions implemented by the civil authorities, and broad acceptance and compliance to those, averted far higher numbers of deaths in the city (4). The public burials data described here may provide a useful measure of mortality impacts and of the success of interventions against the epidemic.…”

“…Tracing revealed contact with a Japanese national who had tested positive for the virus in Malaysia after visiting Jakarta in early February ( 2 ). Even earlier transmission of SARS-CoV-2 is suspected on the basis of direct travel links to the pandemic epicenter of Wuhan, China ( 3 ) and findings from mathematical modeling ( 4 ). Once introduced the virus quickly spread to all 34 provinces of Indonesia ( 5 ).…”

Under-reporting of deaths limits our understanding of true burden of covid-19

“…In one study from Jakarta, Indonesia, officially reported covid-19 deaths accounted for about 25% of recorded funerals of people who had had confirmed or probable covid-19 19. Other analyses showed there were 61% more burials in Jakarta from January-October 2020 compared with the same period in 2015-19 32…”

“…Modelling studies in Jakarta found that the effect of city-wide physical control measures is most clearly visible in data on excess funerals rather than official cases or deaths. 19 Accurate mortality data also help track the pandemic's maturity and assess the relative contributions of physical control measures and population level immunity in declining transmission. This in turn helps inform the most appropriate level of interventions and enables more accurate weighing of the benefits of maintaining social distancing against the societal costs of continued closure of schools or workplaces.…”

“…Underascertainment of covid-19 mortality obscures our understanding of the pandemic’s progression, the effectiveness of interventions, and the optimal allocation of resources. Modelling studies in Jakarta found that the effect of city-wide physical control measures is most clearly visible in data on excess funerals rather than official cases or deaths 19…”