Determinants of risk factors for COVID-19 transmission in densely populated areas: Insights from the first wave of the pandemic
More details
Hide details
National Research and Innovation Agency, Jakarta, INDONESIA
Health Development Policy Agency, Ministry of Health, Jakarta, INDONESIA
Faculty of Nursing, Universitas Airlangga, Surabaya, INDONESIA
School of Nursing & Midwifery, La Trobe University, Melbourne, AUSTRALIA
School of Nursing, University Central Florida, Orlando, FL, USA
Online publication date: 2023-08-01
Publication date: 2023-11-01
Electron J Gen Med 2023;20(6):em531
COVID-19 spreads quickly, especially in densely populated countries like Indonesia. Understanding transmission factors can support in reducing transmission rates. The purpose of this study is to analyze the various factors that may contribute to the transmission of COVID-19 in Indonesia, especially in the first wave of pandemic.

This was a cross sectional study design. The sample was selected from the new all record data or the database for recording COVID-19 cases at the health office at the research location by online system. The research was conducted in seven districts and cities across three provinces to obtain an overview of transmission in each regional characteristic. The number of samples was as high as 2,010, with confirmed cases and close contacts in Banda Aceh City, Aceh Besar District, Semarang City, Magelang District, Ternate City, South Halmahera District, and Tidore Islands City. Data analysis was done descriptively and were analyzed using Chi-square and logistic regression with SPSS software.

The multivariate analysis shows that five dominant factors the risk of COVID-19 transmission, there are, age, employment status, activities outside the home, medical history, and vaccination status. Age group of 20-39 years (odds ratio [OR]=1.6-1.7; 95% confidence interval [CI] 1.07-2.71), working of employment status (OR=1.51; 95% CI 1.10-2.07), have a comorbid in medical history (OR=2.39; 95% CI 1.67-3.4), have activities outside home (OR=1.82, 95% CI 1.39-2.39), and have not been vaccinated of COVID-19 (OR=3.03; 95% CI 3.37-3.87) were significantly related with an increased risk of COVID-19 transmission.

productive age, work and activities outside the home, having comorbidities, and not having received COVID-19 vaccination are all risk factors for COVID-19 exposure. Eliminating all of these factors at the same time will undoubtedly be difficult. As a result, cross-sectoral collaboration is needed to control the spread of COVID-19 at the community and individual levels, as well as to support policy interventions to accelerate the elimination of COVID-19 cases.

Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect Dis. 2020;20(5):533-4. https://doi.org/10.1016/S1473-... PMid:32087114.
Liu Q, Lu P, Shen Y, et al. Collateral impact of the coronavirus disease 2019 (COVID-19) pandemic on tuberculosis control in Jiangsu Province, China. Clin Infect Dis. 2021;73(3):542-4. https://doi.org/10.1093/cid/ci... PMid:32857838 PMCid:PMC7499510.
WHO. COVID-19 weekly epidemiological update. World Health Organization; 2022. Available at: https://www.who.int/publicatio... (Accessed: 23 January 2023).
Marks M, Millat-Martinez P, Ouchi D, et al. Transmission of COVID-19 in 282 clusters in Catalonia, Spain: A cohort study. Lancet Infect Dis. 2021;21(5):629-36. https://doi.org/10.1016/S1473-... PMid:33545090.
Idrovo AJ. Long but unreal lockdowns in latin america. Int J Environ Res Public Health. 2020;17(21):1-2. https://doi.org/10.3390/ijerph... PMid:33147711 PMCid:PMC7662823.
Ministry of Health. COVID-19 in Indonesia. Available at: https://infeksiemerging.kemkes... (Accessed: 23 January 2023).
WHO. Indonesia situation. WHO (COVID-19). Available at: https://covid19.who.int/region... (Accessed: 23 January 2023).
Ministry of Health. Profil kesehatan Indonesia 2021 [Indonesia health profile 2021]. Available at: https://www.kemkes.go.id/downl... (Accessed: 23 January 2023).
Ministry of Health. Protokol kesehatan bagi masyarakat di tempat dan fasilitas umum dalam rangka pencegahan COVID-19 [Health protocols for the community in public places and facilities in the context of preventing COVID-19]. Available at: https://covid19.kemkes.go.id/p...# (Accessed: 14 November 2022).
Djalante R, Lassa J, Setiamarga D, et al. Review and analysis of current responses to COVID-19 in Indonesia: Period of January to March 2020. Prog Disaster Sci. 2020;6. https://doi.org/10.1016/j.pdis... PMid:34171011 PMCid:PMC7149002.
Ministry of Health Indonesia. Peraturan Menteri Kesehatan Republik Indonesia nomor 84 tahun 2020 tentang pelaksanaan vaksinasi dalam rangka penanggulangan pandemi [Regulation of the Minister of Health of the Republic of Indonesia number 84 of 2020 concerning implementation of vaccinations in the context of pandemic management]. Menteri Kesehat Republik Indones. 2020;2019(2):1689-99. Available at: https://peraturan.bpk.go.id/Ho....
Ministry of Health Indonesia. Cakupan vaksinasi COVID-19 capai 280 juta dosis di akhir tahun 2021 [COVID-19 vaccination coverage reaches 280 million doses by the end of 2021]. Available at: https://sehatnegeriku.kemkes.g... (Accessed: 23 January 2023).
Satgas COVID-19. Cakupan vaksinasi lengkap nasional capai 62% total populasi Indonesia [National complete vaccination coverage reaches 62% of Indonesia’s total population]. Available at: https://covid19.go.id/id/artik... (Accessed: 14 November 2022).
Kwok KO, Lai F, Wei WI, Wong SYS, Tang JWT. Herd immunity–estimating the level required to halt the COVID-19 epidemics in affected countries. J Infect. 2020;80(6):e32-3. https://doi.org/10.1016/j.jinf... PMid:32209383 PMCid:PMC7151357.
Prowse TAA, Purcell T, Baía-da-Silva DC, et al. Inferred resolution through herd immmunity of first COVID-19 wave in Manaus, Brazilian Amazon. medRxiv. https://doi.org/10.1101/2020.0....
Ledford H. The next variant: Three key questions about what’s after Omicron. Nature. 2022;603(7900):212-3. https://doi.org/10.1038/d41586... PMid:35228738.
Al-Yamani MJ, Rabbani SI, Basheeruddin Asdaq SM, et al. Epidemiological determinants for the spread of COVID-19 in Riyadh Province of Saudi Arabia. Saudi J Biol Sci. 2022;29(3):1306-12. https://doi.org/10.1016/j.sjbs... PMid:34955667 PMCid:PMC8686443.
Kepmenkes RI. Decree of the Minister of Health of the Republic of Indonesia number HK.01.07/Menkes/5671/2021 concerning clinical management of corona virus disease 2019 (COVID-19) in health service facilities. Available at: https://www.iccc.or.id/wp-cont... (Accessed: 23 January 2023).
California Department of Public Health. COVID-19 age, race and ethnicity data. Available at: https://www.cdph.ca.gov/Progra...# (Accessed: 14 November 2022).
Ministry of Health New Zealand. COVID-19: Case demographics. Available at: https://www.health.govt.nz/cov... (Accessed: 14 November 2022).
Yu X, Duan J, Jiang Y, Zhang H. Distinctive trajectories of the COVID-19 epidemic by age and gender: A retrospective modeling of the epidemic in South Korea. Int J Infect Dis. 2020;98:200-5. https://doi.org/10.1016/j.ijid... PMid:32623081 PMCid:PMC7330572.
Karyono DR, Wicaksana AL. Current prevalence, characteristics, and comorbidities of patients with COVID-19 in Indonesia. J Community Empower Heal. 2020;3(2):77. https://doi.org/10.22146/jcoem....
Bajaj V, Gadi N, Spihlman AP, Wu SC, Choi CH, Moulton VR. Aging, immunity, and COVID-19: How age influences the host immune response to coronavirus infections? Front Physiol. 2021;2021:11. https://doi.org/10.3389/fphys.... PMid:33510644 PMCid:PMC7835928.
Bazant MZ, Bush JWM. A guideline to limit indoor airborne transmission of COVID-19. Proc Natl Acad Sci. 2021;118(17):e2018995118. https://doi.org/10.1073/pnas.2... PMid:33858987 PMCid:PMC8092463.
Spilchuk V, Arrandale VH, Armstrong J. Potential risk factors associated with COVID-19 in health care workers. Occup Med (Chic Ill). 2022;72(1):35-42. https://doi.org/10.1093/occmed... PMid:34729600 PMCid:PMC8689909.
Yogo N, Greenwood KL, Thompson L, et al. Point prevalence survey to evaluate the seropositivity for coronavirus disease 2019 (COVID-19) among high-risk healthcare workers. Infect Control Hosp Epidemiol. 2021;42(10):1260-5. https://doi.org/10.1017/ice.20... PMid:33317655 PMCid:PMC7783086.
Lotfi M, Hamblin MR, Rezaei N. COVID-19: Transmission, prevention, and potential therapeutic opportunities. Clin Chim Acta. 2020;508:254-66. https://doi.org/10.1016/j.cca.... PMid:32474009 PMCid:PMC7256510.
Stacy Hartmann M, Zachary Rubin M, Heidi Sato P, et al. Coronavirus 2019 (COVID-19) infections among healthcare workers, Los Angeles County, February-May 2020. Clin Infect Dis. 2020;c(3):1-10. https://doi.org/10.1093/cid/ci... PMid:32803237 PMCid:PMC7454348.
Pamidimukkala A, Kermanshachi S. Impact of COVID-19 on field and office workforce in construction industry. Proj Leadersh Soc. 2021;2:100018. https://doi.org/10.1016/j.plas... PMCid:PMC8435809.
Cita Sari U, Budiyanti RT. Workplace requirements in new normal era due to COVID-19 pandemic: Design criteria and health environment perspectives. J Public Heal Trop Coast Reg. 2020;3(2):8-14. https://doi.org/10.14710/jphtc....
Hou H (Cynthia), Remøy H, Jylhä T, Vande Putte H. A study on office workplace modification during the COVID-19 pandemic in the Netherlands. J Corp Real Estate. 2021;23(3):186-202. https://doi.org/10.1108/JCRE-1....
Idrovo AJ. Long but unreal lockdowns in Latin America. Comment on Chen, Y.T.; Yen, Y.F.; Yu, S.H.; Su, E.C. An examination on the transmission of COVID-19 and the effect of response strategies: A comparative analysis. Int J Environ Res Public Health. 2020;17(21):E5687. https://doi.org/10.3390/ijerph... PMid:33147711 PMCid:PMC7662823.
Moghadas SM, Fitzpatrick MC, Sah P, et al. The implications of silent transmission for the control of COVID-19 outbreaks. Proc Natl Acad Sci USA. 2020;117(30):17513-5. https://doi.org/10.1073/pnas.2... PMid:32632012 PMCid:PMC7395516.
Bajgain KT, Badal S, Bajgain BB, Santana MJ. Prevalence of comorbidities among individuals with COVID-19: A rapid review of current literature. Am J Infect Control. 2021;49(2):238-46. https://doi.org/10.1016/j.ajic... PMid:32659414 PMCid:PMC7351042.
Widjaja JT, Kwee L, Giantara AK, Subagiyo HA, Edwin C, Putri RL. Karakteristik pasien COVID-19 rawat inap di RS Immanuel Bandung, Indonesia [Characteristics of inpatient COVID-19 patients at Immanuel Hospital Bandung, Indonesia]. J Med Heal Karakteristik Pasien COVID-19 Rawat. 2021;3(2):164-75. https://doi.org/10.28932/jmh.v....
Alshukry A, Bu Abbas M, Ali Y, et al. Clinical characteristics and outcomes of COVID-19 patients with diabetes mellitus in Kuwait. Heliyon. 2021;7(4):e06706. https://doi.org/10.1016/j.heli... PMid:33842709 PMCid:PMC8020058.
Martínez-Pizarro S. Renin-angiotensin system inhibitors in patients with COVID-19. Rev Cuba Cardiol y Cir Cardiovasc. 2020;26(2):1-2. Available at: https://www.medigraphic.com/pd....
Rahayu LA, Admiyanti JC, Khalda YI, Adha FR, Agistany NFF. Hipertensi, diabetes melitus dan obesitas sebagai faktor komorbiditas utama terhadap mortalitas pasien COVID-19: Sebuah studi literatur tijauan pustaka [Hypertension, diabetes mellitus and obesity as the main comorbid factors in the mortality of COVID-19 patients: A literature review study]. J Ilm Mhs Kedokt Indones. 2021;9:90-7. https://doi.org/10.53366/jimki....
Gunawan A, Prahasanti K, Utama MR, Airlangga MP. Pengaruh komorbid hipertensi terhadapseveritas pasien coronavirus disease 2019 [Effect of comorbid hypertension on the severity of coronavirus disease 2019 patients]. J Implementa HUSADA. 2020;1(2):136-51. https://doi.org/10.30596/jih.v....
Ebinger JE, Driver M, Joung S, et al. Hypertension and excess risk for severe COVID-19 illness despite booster vaccination. Hypertension. 2022;79(10):E132-4. https://doi.org/10.1161/HYPERT... PMid:35862106 PMCid:PMC9444256.
Philipus Senewe F, Endah Pracoyo N, Marina R, Letelay AM, Sulistiyowati N, Upaya Kesehatan Masyarakat P. Influence of community diseases/comorbid and individual characteristics with the event of COVID-19 in Bogor City 2020. J Ekol Kesehat. 2021;20(2):69-79. https://doi.org/10.22435/jek.v....
Peng M, He J, Xue Y, Yang X, Liu S, Gong Z. Role of hypertension on the severity of COVID-19: A review. J Cardiovasc Pharmacol. 2021;78(5):e648-55. https://doi.org/10.1097/FJC.00... PMid:34321401 PMCid:PMC8562915.
Rios P, Radhakrishnan A, Williams C, et al. Preventing the transmission of COVID-19 and other coronaviruses in older adults aged 60 years and above living in long-term care: A rapid review. Syst Rev. 2020;9(1):1-9. https://doi.org/10.1186/s13643... PMid:32977848 PMCid:PMC7517751.
Arini SY, Haqi DN. Relationship between gender, smoking habits, and pregnancy status and the risk of COVID-19 transmission in the workplace for workers in Surabaya. Malaysian J Med Heal Sci. 2022;18(SUPP12):135-41. https://doi.org/10.47836//mjmh....
Almansour A, Alamoudi N, AlUrifan S, et al. Effect of smoking on coronavirus disease susceptibility: A case-control study. Tob Induc Dis. 2023;21(January):1-7. https://doi.org/10.18332/tid/1... PMid:36741538 PMCid:PMC9875716.
Patanavanich R, Glantz SA. Smoking is associated with worse outcomes of COVID-19 particularly among younger adults: A systematic review and meta-analysis. BMC Public Health. 2021;21(1):1-9. https://doi.org/10.1186/S12889... PMid:34399729 PMCid:PMC8366155.
Johnson AG, Amin AB, Ali AR, et al. COVID-19 incidence and death rates among unvaccinated and fully vaccinated adults with and without booster doses during periods of delta and omicron variant emergence. MMWR Morb Mortal Wkly Rep. 2022;71(4):132-8. https://doi.org/10.15585/mmwr.... PMid:35085223 PMCid:PMC9351531.
Moghadas SM, Vilches TN, Zhang K, et al. The impact of vaccination on COVID-19 outbreaks in the United States. medRxiv. 2021. https://doi.org/10.1101/2020.1....
Kuodi P, Gorelik Y, Zayyad H, et al. Association between vaccination status and reported incidence of post-acute COVID-19 symptoms in Israel: A cross-sectional study of patients tested between March 2020 and November 2021. medRxiv. 2022. https://doi.org/10.1101/2022.0....
Cavanaugh A, Spicer K, Thoroughman D, Glick C, Winter K. Reduced risk of reinfection with SARS-CoV-2 after COVID-19 vaccination. Morb Mortal Wkly Rep. 2021;70(32):1081-3. https://doi.org/10.15585/mmwr.... PMid:34383732 PMCid:PMC8360277.
Rahman S, Rahman MM, Miah M, et al. COVID-19 reinfections among naturally infected and vaccinated individuals. Sci Rep. 2022;12(1):1-10. https://doi.org/10.1038/s41598... PMid:35082344 PMCid:PMC8792012.
Lewis N, Chambers LC, Chu HT, et al. Effectiveness associated with vaccination after COVID-19 recovery in preventing reinfection. JAMA Netw Open. 2022;5(7):E2223917. https://doi.org/10.1001/jamane... PMid:35895058 PMCid:PMC9331088.
European Center for Disease Prevention and Control. Methods for the detection and characterisation of SARS-CoV-2 variants–first update. What is new in this update: Key messages. WHO Reg Off Eur. 2021;(December):13. Available at: https://apps.who.int/iris/bits....
Rodrigues CMC, Plotkin SA. Impact of vaccines; health, economic and social perspectives. Front Microbiol. 2020;11. https://doi.org/10.3389/fmicb.... PMid:32760367 PMCid:PMC7371956.
Katul GG, Mrad A, Bonetti S, Manoli G, Parolari AJ. Global convergence of COVID-19 basic reproduction number and estimation from early-time SIR dynamics. PLoS One. 2020;15(9 September):1-22. https://doi.org/10.1371/journa... PMid:32970786 PMCid:PMC7514051.
Idris H, Zaleha S. Misperception of vaccine acceptance to the COVID-19 vaccine in Indonesia: A systematic review. Kesmas. 2021;17(1):30-8. https://doi.org/10.21109/KESMA....
Ministry of Communications and Informatics Indonesia. Isu hoax COVID-19 rilis 3 November 2021 [The COVID-19 hoax issue was released on November 3, 2021]. Available at: https://eppid.kominfo.go.id/in... (Accessed: 23 January 2023).
Ministry of National Development Planning. Studi pembelajaran penanganan COVID-19 Indonesia [Learning study of handling COVID-19 Indonesia]. Available at: https://covid19.go.id/storage/... (Accessed: 23 January 2023).
Ministry of Health. COVID-19 vaccine acceptance survey in Indonesia. Minist Heal NITAG, UNICEF, WHO. 2020;1(1):1-8. Available at: https://covid19.go.id/storage/....
Ministry of Health Indonesia. Pemerintah tergetkan 70% cakupan vaksinasi COVID-19 [The government is targeting 70% coverage of COVID-19 vaccinations]. Available at: https://sehatnegeriku.kemkes.g... (Accessed: 14 November 2022).
Journals System - logo
Scroll to top