Background

Studies of COVID-19-related mortality in Asia, and in particular from low-resource settings, have been limited. Given that several major urban centres of Southeast Asia, like Bangkok, Phnom Penh, Ho Chi Minh City, and Kuala Lumpur, have thus far been spared major COVID-19 epidemics, the explosive epidemic in Jakarta can provide insights directly relevant to similar settings in other LMIC. To this end, we analysed the complete clinical and epidemiological surveillance data from the Jakarta Health Office, reporting on admissions to 55 COVID-19-designated hospitals within the city during the first five months of the epidemic (March through July 2020).

Importance

This retrospective hospital-based study of the complete epidemiological surveillance data of Jakarta during the first five months of the epidemic is one of the largest studies in LMIC and the largest in Southeast Asia to date that analysed the characteristics and outcomes of patients hospitalised with PCR-confirmed COVID-19.

Overall in-hospital mortality was lower than reported in high-income countries, which is likely explained by the younger hospital population, fewer comorbidities and less severe disease. Nonetheless, age-specific mortalities were comparable to high-income countries. Although the large majority (78%) of people who died were 50 years or older, deaths occurred across all age groups.

A concerning finding was the death of 11% (7/61) of children <5 years hospitalised with COVID-19, which contrasts with previous evidence that severe disease and death among children are rare. Differences in patient populations and access to quality health services, among other factors, greatly influence COVID-19 mortality trends in low-resource settings.

This study affirmed the vulnerability of elderly and comorbid COVID-19 patients. Increasing burdens of non-communicable diseases in the urban centres of developing nations will impact morbidity and mortality associated with COVID-19. Further studies are needed to understand the extent and underlying causes of death related to COVID-19 in children <5 years in LMICs.