Detection and Contact Tracing of COVID-19 in Indonesia through a Red Cross Community Based Surveillance System

PURPOSE: Epidemics and pandemics begin and end in communities. Communities play a critical role in prevention, detection, and response to infectious disease threats when meaningfully engaged. Surveillance and contact tracing are core components of effective public health preparedness and response efforts. But, surveillance systems that rely on case detection via healthcare facilities may fail or be slow to detect and trace many cases. Communities are often the first to identify unusual disease patterns in humans and animals. Community-Based Surveillance (CBS) gives a voice to communities, enables them to communicate unusual health events to authorities, and complements facility-based surveillance systems. METHODS & MATERIALS: Since 2019, Indonesia Red Cross (PMI) has piloted CBS in 8 villages within four provinces. Initiated for passive surveillance, the volunteers trained to report ‘alerts’ of epidemic-prone diseases to health authorities. The concept was then adapted to an active approach focussing on COVID-19 and scaled to 74 villages across eight provinces. Partnering with local authorities, volunteers supported COVID-19 screening, detection, tracing, and local response, all while implementing volunteer safety standards. The reporting system was created and coordinated by a structure within PMI. RESULTS: From August 2020-June 2021, community volunteers made 1,079 alerts: 99% of the alerts were reported to health authorities, with 71.1% followed up within 24 hours. After alert detection, volunteers sensitized family members on preventive measures while individuals awaited follow-up visits for diagnosis and management by health authorities. 64% of alerts were PCR positive for COVID-19, 12% were negative, 14% did not undergo testing, and test results for 10% of the alerts were unavailable. Of 979 contacts traced by volunteers, authorities followed up 99%, confirming 29% positive and 34% negative for COVID-19; the remaining 37% included those recommended to isolate without testing and those for whom test results were unavailable. CONCLUSION: CBS has supported early detection and contact tracing of COVID-19 in Indonesia. The community case definition used to identify potential alerts was sensitive and easily understood by non-health workers. The system proved readily scalable and adaptable, enabling a shift from passive to active surveillance and making it feasible to be implemented anywhere in the community.