Turkey 'has enough experience to face coronavirus challange'

Barçın Yinanç - ISTANBUL

Turkey may see the first case of coronavirus at any moment but has enough experience to overcome the challenge, according to Professor Önder Ergönül, the chair of the Infectious Diseases and Clinical Microbiology at Koç University’s School of Medicine.

The country’s diagnostic capacity should be strengthened, said Ergönül, adding that Turkey has a diagnostic facility in Ankara, but should have more centers in other big cities.

Tell us what we’re facing and how it differs from previous outbreaks?

The virus was discovered on Jan. 7; since then, we have had more than 82,000 cases, the majority of which are in China. The death toll is around 3,000. The fatality rate is 2 percent.

So this is a virus that spreads easily; it travels very fast compared to the SARS coronavirus [SARS-Cov] and MERS [Middle Eastern Respiratory Syndrome]. It is the fastest-spreading within the coronavirus family, but not within the influenza family. Influenza viruses spread much faster; during the 2009-10 pandemic of H1N1, there were millions of cases; currently there are far fewer cases.

And also, the difference is that the fatality rate is much lower compared to 2003 [SARS-CoV] and among the coronavirus family. The current [coronavirus], which we call Covid-19, is a very close relative of SARS-CoV. The current fatality rate is 2 percent, whereas in 2003, it was 10 percent and in the Mers coronavirus in 2012, it was 35 percent, although the number of all cases was only 2,500.
Here, we have a high rate of dissemination but a lower fatality rate, and we will remember this outbreak in this terms.

Do you think the high rate of dissemination is behind the global panic?

Yes; there is an overreaction. But we can understand why people are concerned because they do not fully understand [the situation], and also they are always concerned when there is uncertainty. Actually, there is a higher rate of mortality with influenza. For example, in the United States in 2020, there have been
almost 15,000 deaths because of influenza but only one fatality from Covid-19.

Also, when real experts are busy working behind the scenes, some other people who are easily accessible get an audience. We suggest people around the world listen to health authorities [instead].

Were you expecting a new outbreak this year?

We don’t expect to have outbreaks at a specific time, but we are also not surprised because we’ve already had similar cases in the past, so this can happen. And due to past cases, we are experienced at the European level; we have many experts on outbreaks including in Turkey.

Do you think countries have acted in time and appropriately? After all, there has been some criticism about China’s initial approach.

I think, overall, it was fine. In the previous SARS case, China was criticized for not being transparent. Currently, health authorities and institutions appreciate the timely and transparent approach of the Chinese Health Ministry. They shared what they had with the scientific community very soon.

Would you say the same for Iran?

Up to now, if I have to evaluate all the countries, Iran is the grayest and most opaque. We don’t know much about what’s going on in Iran. There is some discrepancy in the fatality rate and the total number of cases. The total number of cases appears to be lower when compared to the diagnosed cases.

This might due to their diagnostic capacity – they might not be able to diagnose milder cases.

Iran, Russia and Greece – nearly all of Turkey’s neighbors – have diagnosed cases; how come we’ve had none so far?

First of all let me start by saying that in Turkey we have a diagnostic facility in Ankara. This might bring a limitation. We need to have more centers in other big cities such as Istanbul. In terms of human power, we have enough experience to overcome such a risk.
The ad hoc committee set up at the Health Ministry consists of very experienced, reliable colleagues. And they also read and observe what’s going on in the world, and they determine what to do for each stage.

They have already published what needs to be done when and where a case is diagnosed, having done this a month ago. But, the diagnostic capacity should be increased or should be strengthened.

But is there any explanation as to why Covid-19 has not yet been in Turkey while so many other countries have had cases?

This is a problem of timing. We may have the first case in any moment, and we may have hundreds of cases. This is normal, under such circumstances.

What is the dimension of the risk for Turkey then?

Turkey has, of course, deep international connections. It banned, in a timely manner, flights to and from China and banned flights from Iran. And authorities are very careful in terms of flight connections and the like. Despite these measures, we may have cases – this is an ongoing outbreak. But people do not need to panic.

How well-prepared is Turkey to handle this outbreak?

First of all, Turkey has the capacity to make diagnoses because some countries do not even have this capacity. We are also experienced in managing cases, which means, if you have a case, all the physicians are already trained and already know how to transfer the case to the responsible hospitals or how to take care of these patients in their hospitals.

Every hospital has made its own preparations and has been sharing information. I am assuming all hospitals are ready in Turkey.

Is there any particular aspect in Turkey that might make it more vulnerable, increasing the risks?

International air transport poses the major risk here.

Some have suggested that places with many refugees or poorer neighborhoods could be more vulnerable.

Refugees or, let’s say, vulnerable populations are integrated into the health system; they have easy access to hospitals.

But could poor neighborhoods be more open to risks because of hygiene standards?

We always try to educate people regarding hand hygiene – not just against outbreaks but as a lifestyle and a measure for sustainable healthy wellbeing.

What is Turkey’s past experience?

In 2009-2010, we had Crimean-Congo Hemorrhagic Fever, an endemic influenza, but Turkey contained it very well.
I was also very active at these times, and many colleagues of mine also have this experience. This is a fresh reminder for us in terms of what to expect and what to do.

What are we to expect next?

Warm days will come with spring. Respiratory viruses always decline in spring. Covid-19 will also decline through April.

What do you suggest that people do, especially in terms of traveling as well?

They can travel. There is a ban to China, but I think flights to China will start in less than a month.

The situation is serious; but people should continue on with their lives and listen to the advises of health authorities.

WHO IS ÖNDER ERGÖNÜL?

*Professor Önder Ergönül is the chair of the Infectious Diseases and Clinical Microbiology (IDCM) at Koç University’s School of Medicine. Ergönül is a member of the executive committee of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), as well as the Science Academy of Turkey, a non-governmental organization established in 2011.

*A 1989 graduate of Ankara’s Hacettepe University School of Medicine, Ergönül earned a Master of Public Health degree from Harvard University’s School of Public Health in 2003. He is the editor of books such as “Emerging Infectious Diseases: Clinical Case Studies” (2014, Elsever), which the British Medical Association named as its book of the year, and “Crimean-Congo Hemorrhagic Fever” (2007, Springer).

*He served as the president of the Turkish Society of Clinical Microbiology and Infectious Diseases from 2013 to 2017.