Eruption of COVID-19 like illness in a remote village in Papua (Indonesia)

BackgroundThe COVID-19 pandemic is creating significant challenges for healthcare infrastructure for countries of all development and resource levels. Low-and-middle resource countries face even larger challenges, as their resources are stretched and often insufficient under normal circumstances. A village in the Papuan highlands of Indonesia; small, isolated, accessed only by small plane or trekking has experienced an outbreak typical of COVID-19. Methodology/Principal FindingsThis description was compiled from patient care records by lay healthcare workers in M20 (a pseudonym) during and after an outbreak and from medical doctors responding to online requests for help. We assume that, for reasons given, the outbreak that has been described was COVID-19. The dense social structure of the village resulted in a rapid infection of 90-95% of the population. Physical distancing and isolation measures were used, but probably implemented suboptimal and too late, and their effect on the illness course was unclear. The relatively young population, with a majority of women, probably influenced the impact of the epidemic, resulting in only two deaths so far. Conclusions/SignificanceThis outbreak pattern of suspected SARS-CoV-2 in a village in the highlands of Papua (Indonesia) presents a unique report of the infection of an entire village population over five weeks. The age distribution, common in Papuan highland villages may have reduced case fatality rate (CFR) in this context and that might be the case in similar remote areas since survival to old age is already very limited and CFR among younger people is lower. Author summaryA village in the Papuan highlands of Indonesia; small, isolated, accessed only by small plane or trekking has experienced an outbreak typical of COVID-19. The outbreak affected 90-95% of approximately 200 residents between 20 February 2020 and 31 March 2020. Lay health workers, consisting of trained local volunteers, without healthcare facilities and limited medication options reached out for help online and managed with what they had available. Their experience is relevant to others in similar settings. This report describes the village, outbreak, timeline, symptoms and treatments, and outcomes.