Using syndromic measures of mortality to capture the dynamics of COVID-19 in Java, Indonesia, in the context of vaccination rollout

Djaafara B.A., Whittaker C., Watson O.J., Verity R., Brazeau N.F., Widyastuti, Oktavia D., Adrian V., Salama N., Bhatia S., Nouvellet P., Sherrard-Smith E., Churcher T.S., Surendra H., Lina R.N., Ekawati L.L., Lestari K.D., Andrianto A., Thwaites G., Baird J.K., Ghani A.C., Elyazar I.R.F., Walker P.G.T.

MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London St Mary’s Campus, Norfolk Place, London, W2 1PG, United Kingdom; Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia; Jakarta Provincial Department of Health, Jakarta, Indonesia; School of Life Sciences, University of Sussex, Brighton, United Kingdom; Centre for Tropical Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom


Background: As in many countries, quantifying COVID-19 spread in Indonesia remains challenging due to testing limitations. In Java, non-pharmaceutical interventions (NPIs) were implemented throughout 2020. However, as a vaccination campaign launches, cases and deaths are rising across the island. Methods: We used modelling to explore the extent to which data on burials in Jakarta using strict COVID-19 protocols (C19P) provide additional insight into the transmissibility of the disease, epidemic trajectory, and the impact of NPIs. We assess how implementation of NPIs in early 2021 will shape the epidemic during the period of likely vaccine rollout. Results: C19P burial data in Jakarta suggest a death toll approximately 3.3 times higher than reported. Transmission estimates using these data suggest earlier, larger, and more sustained impact of NPIs. Measures to reduce sub-national spread, particularly during Ramadan, substantially mitigated spread to more vulnerable rural areas. Given current trajectory, daily cases and deaths are likely to increase in most regions as the vaccine is rolled out. Transmission may peak in early 2021 in Jakarta if current levels of control are maintained. However, relaxation of control measures is likely to lead to a subsequent resurgence in the absence of an effective vaccination campaign. Conclusions: Syndromic measures of mortality provide a more complete picture of COVID-19 severity upon which to base decision-making. The high potential impact of the vaccine in Java is attributable to reductions in transmission to date and dependent on these being maintained. Increases in control in the relatively short-term will likely yield large, synergistic increases in vaccine impact. © 2021, The Author(s).

COVID-19; Indonesia; Modelling; Non-pharmaceutical interventions; Surveillance; Vaccinations


BMC Medicine

Publisher: BioMed Central Ltd

Volume 19, Issue 1, Art No 146, Page – , Page Count

Journal Link:

doi: 10.1186/s12916-021-02016-2

Issn: 17417015

Type: All Open Access, Gold, Green


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