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Cognitive impairment, and post acute sequelae among people with the history of COVID-19 in Indonesia

Background

COVID-19 infection has unique symptoms, and it can continue for long-term symptoms. These symptoms can interfere with the life of people with the previous history of COVID-19. The INSPIRASI Project in collaboration with the Ministry of Health will measure the long-term impact of the exposure to COVID-19.

COVID-19 has a wide range of clinical manifestations such as neurological, psychiatric, psychological, and psychosocial disorders.1 One study showed a high incidence of cognitive disorders following COVID-19 infection with cognitive complaints such as dementia, mild cognitive impairment (MCI), or subjective cognitive decline (SCD).2 Previous study demonstrated a relatively high frequency of cognitive impairment among hospitalized patients found several months after patients contracted COVID-19, including impairment of executive functioning, processing speed, category fluency, memory encoding, and recall memory.3 Another study conducted by Alemanno et al., 2021 revealed that 80% of COVID-19 survivors in the subacute phase had cognitive impairment. The examination of cognitive function was done in the outpatients setting by using Mini-Mental State Evaluation (MMSE), Montreal Cognitive Assessment (MoCA), Hamilton Rating Scale for Depression, and Functional Independence Measure (FIM). 1,2

Cognitive impairment may also occur even in mildly symptomatic subjects six months after the disease onset of covid. Tavares et al, 2022, found cognitive impairment among 23% of COVID 19 patient happen in 29% at severe phase, 30% at moderate phase dan 3% at mild phase.1 The cause of the cognitive impairment associated with COVID-19 is the ischemic changes, as cerebrovascular changes indicate a risk of cognitive impairment and dementia also endothelial damage in COVID-19 which make clearance of brain metabolites may be impaired, including beta-amyloid peptides implicated in Alzheimer's disease.4 Cognitive impairment can have some cognitive symptoms and brain fog condition such as memory problems, attention deficit, difficulty concentrating, difficulty in decision-making, slower reaction times, and language disorders.5

One year cohort study in China found that approximately 3.3% of COVID-19 survivors had dementia and 9.1% had MCI at 12 months after discharge and in particular, the incidences of dementia and MCI were 15.00% and 26.15% in individuals with severe cases, respectively associated with long-term cognitive impairment.6 In June 2020, a letter reported that a third of their discharged COVID-19 patients showed a dysexecutive syndrome consisting of inattention, disorientation, or poorly organized movements in response to command.7 Among global population, health workers are one of group population that easily exposed to COVID 19 infection. Study by Carazo et al., showed that cognitive impairment post-COVID 19 infection become a frequent sequela of ambulatory in working age adults.8 Twelve months after discharge, there is 12,45% incidence of cognitive impairment in COVID-19 survivors.6 Cognitive screening among post COVID 19 infection in population are relatively forgotten, yet the prevalence of Post COVID-19 impairments among the population is still poorly studied. This activity aimed to identify the prevalence of Post COVID 19 Cognitive impairment, and post acute sequelae among the population in Indonesia.

Methods

Study design

The study will be conducted with cross-sectional study design. We will perform observational studies among people who have a history of COVID-19 in Indonesia. Participants of this study will be randomly selected people who tested positive of COVID-19 with reverse transcription‐polymerase chain reaction (RT‐PCR) on nasopharyngeal swab performed between January 1st - September 30th 2022 in the five large tertiary hospitals from Sumatera (Sumatera Utara - RSUP Adam Malik), Java (Jawa Tengah - RSUP Karyadi ; Yogyakarta - RSUP dr. Sardjito), Bali (Bali - RSUP Sanglah) and Sulawesi Regions (Sulawesi Selatan - RSUP Wahidin Sudiro Husodo).

 

Diseminasi Riset Kolaborasi dan Kemitraan dalam Menghadapi Tantangan Kesehatan Masyarakat Pasca Pandemi	link
Kebijakan Menghadapi Dampak Jangka Panjang COVID-19 : Evaluasi Studi Long COVID di 5 Provinsi	link

 

 

 

No.	Kegiatan	Dokumen
1	Penyusunan kurikulum SKDR	link
2	Pelatihan SKDR di Provinsi Yogyakarta	link
3	Pelatihan SKDR di Provinsi Sulawesi Selatan	link
4	Pelatihan SKDR Provinsi Sulawesi Tengah	link
5	Finalisasi Kurikulum dan Bahan Ajar MOOC SKDR	link
6	Audiensi implementasi MOOC SKDR di dinkes provinsi DIY (6 Juni 2024)	link
7	Koordinasi implementasi MOOC SKDR di dinkes provinsi Maluku Utara	link
8	Penyusunan Kurikulum SKDR (catatan dan masukan) MP 1 Konsep Umum SKDR MP 2 Algoritma Penyakit SKDR MP 2 Definisi Operasional Penyakit SKDR MP 3 Konsep Surveilans Berbasis Indicator MP 4 Konsep Event Based Surveillance MP 5 Peran Pemangku Jabatan

 

 

 

 

 

 

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Background

Since March 2020, the number of COVID-19 cases in Indonesia has been growing exponentially. As of 28 June 2021, there have been 2,135,998 confirmed cases of COVID-19 in Indonesia, including 57,561 deaths. The cases are distributed unevenly in 34 provinces in Indonesia, with DKI Jakarta, West Java, Central Java, East Java, East Kalimantan, Riau, South Sulawesi, DI Yogyakarta, Banten, and West Sumatera being the top 10 provinces with the highest number of confirmed cases.
The true burden of COVID-19 in Indonesia remains unclear. Between 6-12 July 2021, the national number of COVID-19 molecular tests ranged from 123,317 – 145,294 tests per day, with a daily positivity rate ranging from 22.8 – 32%. Our country witnessed a record-breaking 56,757 new daily cases on July 15, 2021. The high positivity rate in Indonesia suggests that many infections remain undetected. Even though there is an increase in collective testing capacity among Indonesian laboratories throughout the pandemic, the use of molecular detection of SARS-CoV-2 in Indonesia is more targeted at moderately or severely ill patients, for contact tracing purposes, or one of the travel requirements. The PCR test is also costly to perform and there is a trend to move towards antigen rapid diagnostic tests (Ag RDT) for screening and rapid detection of SARS-CoV-2. Therefore, the number of cases based on molecular assays may not be representative of the actual burden of SARS-CoV-2 infection.

A population-based seroprevalence survey is useful in measuring the extent of SARS-CoV-2 infection as it can identify individuals who were infected but might not have received PCR testing due to mild or asymptomatic disease. Seroprevalence surveys are also useful in measuring overall population immunity, whether achieved naturally or via vaccination. This is the reason that through INSPIRASI (Improving Quality of Disease Preparedness, Surveillance & Response in Indonesia), we would like to conduct a COVID-19 serosurvey study in several provinces in Indonesia. Multiple serosurvey studies are being conducted in the country. This project, which targets populations in four provinces in Indonesia, would contribute to discovering the burden of COVID-19 in Indonesia. The serosurvey will be conducted in Banten, West Java, East Java, and Sulawesi Selatan, which are provinces with very high numbers of COVID-19 cases and have never been assessed with a population-based COVID-19 serosurvey.

Each province in Indonesia has a different laboratory testing capacity. A report by WHO on July 7, 2021, mentioned that there are only 5 provinces in Indonesia that meet the WHO standard of testing 1 person per 1,000 population size. Those provinces were DKI Jakarta, DI Yogyakarta, West Sumatra, West Papua, and Riau. By assessing seroprevalence in our targeted locations, we can provide an estimated number of laboratory-diagnosed infections to the total number of infections in each province. This way, we can also predict the extent of population-level antibody response to SARS-CoV2 in each province.

Data on demographic factors, including existing comorbidities and disease history would also be collected and would give us information on individual risk factors associated with seropositivity. Knowledge, attitudes, and practices on COVID-19 prevention measures, associated risks, and vaccine acceptance will also be evaluated. As of 12 March 2021, a total of 3,696,059 people has received the first dose of the COVID-19 vaccine in Indonesia. That number still falls far behind the targeted number of vaccinated people in Indonesia, which is 181,554,465 people (about 2% of the target). Among the 2%, only 1,295,615 people have also received the second dose of the Sinovac® COVID-19 vaccine. As the vaccination program is still ongoing, vaccine acceptance amongst the general population will be valuable information to collect.

This project would also strengthen technical and analytical capabilities of Indonesian government laboratories to perform immune response characterization by using multiplex, microsphere-based immunoassays through the provision of laboratory equipment and a series of training. This will be beneficial not only for COVID-19 diagnostics but also to diagnose and study many other diseases in the future.

Objectives

1. Primary Objective
   This project is intended to assess the prevalence of SARS-CoV-2 infection among targeted populations in Banten, West Java, East Java, and Sulawesi Selatan
2. Secondary Objectives
   
   1. To identify individual risk factors, especially comorbidities, that are associated with SARS-CoV-2 infection in the studied populations
   2. To estimate the ratio of laboratory diagnosed infections to the total number of infections in each province.
   3. To estimate the extent of population-level antibody response to SARS-CoV2 in each province.
   4. To increase laboratory diagnosis capacity in Indonesia (specifically BBTKLPP Yogyakarta) to perform serodiagnosis of COVID-19 using multiplex microsphere-based immunoassay.
   5. To measure the knowledge, attitudes, and practices (KAP) in the target population regarding knowledge regarding COVID-19 associated risks, preventive measures, and vaccine acceptance.[GG(1]

Study Locations

This serosurvey project targets populations in several provinces of Indonesia; Banten, West Java, East Java, and South Sulawesi (Figure 1). The province selection was done in consultation with the Ministry of Health of the Republic of Indonesia[ABH2] . No COVID-19 serosurveys have been done in the selected provinces. Those provinces are also among the top 10 provinces with the highest number of COVID-19 cases in Indonesia. Following a Laboratory analysis will be conducted at Balai Besar Teknik Kesehatan Lingkungan dan Pengendalian Penyakit (BBTKLPP) Yogyakarta, BTKLPP Makassar and the Integrated Research Laboratory, Faculty of Medicine, Public Health, and Nursing Universitas Gadjah Mada.
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[GG(1]Level 2- Suggest that the purpose of this objective be listed clarify if this data is for documenting historical reasons for vaccination/non-vaccination, or data to direct demand creation activities.
[ABH2]L3 - Please note that the survey will only be representative of these provinces.

 

 

 

No.	Kegiatan	Dokumen
1	Agende kegiatan: Pelatihan online: 22, 24 dan 25 maret 2022 Pelatihan tatap muka: 27 s/d 30 maret 2022 Pendampingan jarak jauh: april - Mei 2022 Table top exercises: Juli - Agustus 2022	link
2	Persiapan Functional Exercise (FX) PHE di Kabupaten Maros, Kota Makassar & Provinsi Sulawesi Selatan	link
3	Video Functional Exercise	link
4	Audiensi Pelaksanaan TTX di dinkes provinsi DIY (6 Juni 2024)	link
5	Koordinasi awal persiapan TTX (12 Juli 2024) Notulensi Materi