‘Turkish public must implement measures against COVID-19’

Barçın Yinanç - ISTANBUL

The implementation of the measures taken by the government and health institutions and by individuals will determine the speed of the spread of the coronavirus in the country, according to a member of the Turkish Health Ministry’s Coronavirus Science Committee. Warning against careless behavior, Professor Alpay Azap, from Ankara University’s Medicine Faculty, said, “the public must abide by the rules.”

Tell us which stage we are in terms of the coronavirus pandemic.

We have entered a stage in which the virus is in local circulation. We have started to detect COVID-19 cases in citizens without any first- or second-hand contact with [people that were] abroad. The number of cases are on the rise, and this is a situation we have been expecting. One hundred cases is a critical threshold since afterward, there is a very speedy upward trend in cases. That means the virus has started to spread from several different points. We are currently in the period of rapid rise.

Currently, Italy is being taken as a benchmark. When do we expect the cases to peak in Turkey?

Will we be like Italy or France – or neither? We will be like Turkey. Each country has different social, economic and medical dynamics. I don’t think country comparisons are always effective. Currently, we seem to be ahead of Italy [in terms of the speed of the contamination] since we reached 100 cases on the seventh day. But the first case we officially detected might not be the very first case we found. Maybe there were other earlier undetected cases. But obviously, we have the experience derived from what other countries have done and based on that, we will probably see the peak by mid-April … and then a plateau in the following one or two weeks, followed by a period of one or two months where daily cases will drop. By mid-June, we are expecting [the virus] to lose its effectiveness.

The important point in the epidemic curve is how high and how steep it will go up. That will be determined by the measures that are being taken. These are threefold: first, the measures taken by the government, the Health Ministry and local administrations; second, the level of preparedness of the medical institutions; and third, the measures taken by individuals. If one is missing, the whole system will collapse. So far, I believe that the Health Ministry, as well as medical institutions, have displayed a good performance. But once the virus enters circulation, citizens need to adopt the measures and abide by the rules about social distancing. The public needs to implement the decisions that have been taken.

The cases will increase very rapidly from now on. We are going to try to keep the slope of the curve as flat as possible.

In other words, you want to cut the speed of contagion in order to avoid a very high number of cases piling up at the same time.

What is critical here is that if the curve is too steep, the number of patients going to hospital will increase tremendously in a very short period of time. No matter how ready hospitals might be for that, they won’t be able to handle it. If there is a modest amount of rain pouring every day all through the week, there won’t be a problem. But if you have the same amount pouring in 10 minutes, you’ll get a flood that no one can stop. We are working so that the number of cases increases slowly in a way that does not exceed the capacity of the health system so that we can handle it with minimum damage.

Do you have a good estimate of how speedily the cases will increase? After all, it seems Turkey started to test quite late and in limited numbers.

We will predict the speed of the upward trend from now on in a much more accurate way because of the quick tests. Some 250,000 fast test kits will be distributed throughout Turkey by Monday. These are very practical tests; they give you the result in 15 minutes, and it does not require any equipment or experienced personnel to use it.

Are these the ones coming from China? How accurate are they?

They came from China, and their rate of accuracy is high. They will show us how steeply the outbreak curve will go up.

Right now, are we unable to make accurate predictions because there has not been enough testing?

That’s right. But this will also depend on how locals behave. One individual infects five individuals, and those five each infect another five, and then you reach 625 in two weeks’ time. That’s why having many tests and catching the case as soon as possible is important. Because you can then isolate the people who have been in touch with the COVID-19 cases and break the chain of infection. Starting from last week, Turkey tried to increase its diagnostic capacity, and it did increase, but from now on, we will catch the cases in a much speedier fashion. A fast diagnosis does not help the patient so much, but it is critical to stop speedy contagion.

There are question marks in terms of treatment.

There is a lot of discussion about it worldwide, and nearly 80 different treatment methods are under clinical experimentation. There are treatments that seem to be partially effective, like the drug against malaria, HIV and Ebola. We will have clearer results in a few weeks’ time, but we are hopeful about these drugs. We can find these drugs in Turkey, but the more important treatment is the support treatment. Those with viral infections heal themselves. But if that virus has done damage to your body, you have to heal that damage. If the lungs are damaged, for instance, you have to have mechanic ventilation.

What do you think about the timing of the measures?

I think they were taken at the right time, but what matters here is how people react. Some have taken their kids to the dentist because schools have been closed. Others went to their home cities to visit their relatives. That is not the right behavior.

So do you think we should have a compulsory lockdown?

We might end up needing one. That depends on how the public adapts to the situation. If they act as if there is a state of emergency and take their own proper measures, it will not be necessary to take that decision.

What are Turkey’s advantages and disadvantages? Is the health system well-equipped and prepared enough to handle a pandemic?

Turkey has the advantage of having a health system that has strong infrastructure, especially in terms of hospital services, as well as developed technical infrastructure in intensive care units. The human capital in the health sector is good as well in terms of doctors, nurses and technical staff.

Intensive care is a separate specialty in Turkey, so we have a lot of intensive-care physicians.

We have 1,500 physicians with expertise in microbiology and infectious diseases; that’s more than any country in Europe.
Since 2005, each hospital with bed capacity is required to have infection control committees. Each year, they are inspected by the Health Ministry. Since the 2008 influenza epidemic, hospitals have prepared action plans for pandemics. Each year, these action plans are reviewed. And recently, the government declared all qualified hospitals as pandemic hospitals.

Our disadvantage is that we have a very low health literacy. It’s possible to encounter careless behavior. If the public and individuals fail to abide by the rules, then we could face the flood scenario. No matter how well prepared you are, no one can deal with the flood.

Did we choose a model between the Far East and Europe?

We cannot take any country as a model. Each society has different dynamics. We are trying to do the best we can.

Do I understand correctly that self-isolation seems to be the key?

Definitely. And we have to be prepared for at least three to four weeks of social distancing.

*Who is Alpay Azap?

Professor Alpay Azap is a member of the Health Ministry’s Coronavirus Science Committee. He works at the Infectious Diseases and Clinical Microbiology Department of Ankara University’s Medical Faculty, from which he graduated in 1995.

He is the president of the Turkish Association of Clinical Microbiology and Infectious Diseases and a member of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), a Swiss-based non-profit scientific international organization.