Tracking all-cause mortality at the epicentre of Indonesia’s COVID-19 epidemic (TREMOR)

Funder: OUCRU (Wellcome Funding)

Principal InvestigatorI: Iqbal Elyazar

Locations of activity: 8 cities in Indonesia (Jakarta, Tangerang, Bandung, Semarang, Yogyakarta, Surabaya, Mataram, Denpasar)

Indonesians have suffered heavily due to COVID-19. Its causative agent, the SARS-CoV-2 virus, has been confirmed to occur in all 34 provinces. Since the first reported cases in Indonesia on 2 March 2020, nearly 250,000 cases and 9,500 deaths confirmed as COVID-19 have accrued. Both numbers are seriously under-reported as a consequence of severely limited diagnostic capacities.

We know that a heavy backlog of diagnostic services for COVID-19 pushes the turnaround time to 1-2 weeks or more, and many, if not most patients who die, do so before the diagnosis can be confirmed. Those patients are referred for burial as suspected COVID-19 and the subjects of special protocols for burial, e.g., sealed plastic wrapping rather than ritual cleansing and wrapping in fabric as per religious custom.

Given the extremely limited capacity of diagnostics, we aim to develop access to records of burials and cremations, or other measures of all-cause mortality, in these cities in order to begin to analyse the extent of mortal harm caused by COVID-19 as a means of measuring the spread and impact of SARS-CoV-2 transmission. Success in doing so would lead to broader surveys of COVID-19 attributable mortality. The protocol here represents a proposed work as a means to demonstrate the utility and validity of the methods applied.



Determine quantifiable excess mortality and understanding of deaths associated with the onset of COVID-19 epidemics among eight urban centres in Indonesia. Specifically:

  • Assemble weekly data on all-cause mortality by age and gender from all eight cities from January 2015 up to the present day, with weekly reporting until March 2021.
  • Assemble weekly data reporting regarding COVID-19 suspect deaths, along with confirmed COVID-19 cases and confirmed deaths, all by age and gender.
  • For each city, generate a monthly calculation of excess mortality attributable to COVID-19 compared to both suspected and confirmed deaths.
  • Report these findings to the government agencies managing the COVID-19 crisis.

Output to date: 

Elyazar I, Surendra H, Ekawati L et al. Excess mortality during the first ten months of COVID-19 epidemic at Jakarta, Indonesia. [Internet] 2020;Available from: