Corona-path of Turkey: When it’ll probably peak, flatten and finally end?

Which path is expected for Turkey’s coronavirus battle — or will it make its own way?

Introduction

With a population of over 80 million people, as an air traffic hub between east & west, dozens of ports for overseas trade and a broad neighborhood with 8 different countries, Turkey was either lucky or cautious against Coronavirus since it met with first confirmed case on 11th of March, relatively late compared to many countries in Europe.

That is a scary test for any kind of management in the World so no one can deny the difficulty of the battle against this contagious disease. Among many big countries which are being criticized by vast majority for inadequate and late measures, Turkey was having good initial steps at the beginning.

Until first confirmed case has been revealed on 11th March, Turkey had already multiple measures taken beginning from 10th of January. Some crucial steps and the complete updated timeline are listed here:

Timeline of the 2020 coronavirus pandemic in Turkey

As may seen there were multiple on-time measures, however, there are also some mismanagement examples throughout the process. Honestly, although I can easily find many faults to criticize until now, I also avoid to be tough on someone since it’s totally once-in-a-lifetime situation and there are not certain codes to be excellent. Empathy matters a lot.

On the other hand, the virus is not that much naive and gets benefit of every minor fault, inadequate and late measures for the sake of its invade. Since it leaks from any tiniest space rapidly, Tomas Pueyo was absolutely right with his thesis in two excellent articles:

1) Coronavirus: Why You Must Act Now on 10th of March

Source

2) Coronavirus: The Hammer and the Dance on 19th of March

by Tomas Pueyo

As a summary of the article, Tomas Pueyo stated;

Strong coronavirus measures today should only last a few weeks, there shouldn’t be a big peak of infections afterwards, and it can all be done for a reasonable cost to society, saving millions of lives along the way. If we don’t take these measures, tens of millions will be infected, many will die, along with anybody else that requires intensive care, because the healthcare system will have collapsed.

It is true, and also confirmed that a strong hammer was (and still is) needed based on two examples: Italy and South Korea

7 key factors which explain the success or failure vs. Covid-19

For sure there are dozens of factors which effect the results of the battle against coronavirus but if I’d be asked to cluster them in 7 items that would be as below:

1. Preparedness and on time, tough and adequate measures
2. The test performance as the first act for containment
3. Inherent advantages
4. Resources and deployment
5. Communication, collaboration, organization and realistic - analytic - reasonable approach
6. Strengths and weaknesses of Healthcare system
7. Common sense of the people

How does Turkey deal with these 7 key factors?

1. Preparedness and on time, tough and adequate measures

Setting up a Coronavirus Scientific Advisory Board on 10th of January and taking all relevant measures by considering the advices of the Board was good first thing.

Nevertheless, I’d criticize the early small numbers of tests, that was obviously a sign of lack in preperation. Most probably, initial tests have been conducted with imported KITs, which might have arrived late. Meaning, until Turkey has produced its own KITs and more imports have arrived, thus it increased the number of tests, the fight against the virus started not that much strongly. A good preperation for such a rapid and inevitable virus requires a strong inventory of test KIT, on time!

Closing the schools and canceling all sports events just after first confirmed case were true and necessary. Detailed social distancing measures followed up later on, which were more or less equivalent to most of the countries.

Closing the borders, canceling the flights from and to risky countries and then canceling domestic flights and bus trips completely were all true decisions as well but for some countries and regions some late decisions have been encountered.

Source

14-day-quarantine was also applied for those who recently visited foreign countries. Yet some critics have been made for lack of tough quarantine practices.

While a curfew is widely expected, Turkey found its way and continues with a ramp-up hybrid solution:

• Curfew for under 20 and over 65
• Curfew for all ages on weekends for biggest 31 provinces
• 7/24 travel ban between those 31 provinces
• No domestic and international flights and no any kind of trips along cities
• Schools closed and all events canceled, any kind of specific activity has been regulated accordingly
• and some other detailed containment measures followed up in the process.

2. The test performance as the first act for containment

The more test conducted, the more patients put under quarantine or isolation so they don’t contribute to the spread of the pandemic.

Countries’ testing abilities depend on their self-sufficiency, healthcare system, fiscal condition, as well as social and political relations.

says Ali Murat Alhas on Anadolu Agency. No need to add anything to this short quote in order to describe how important extensive test is.

Even though Turkey has started with small numbers and has been criticized for it, test figures has increased in recent days and reached up to 40.000 tests on 16 April.

Since Turkey has started to produce its own test KITs, the numbers seem to be improving in the forthcoming days, that on one hand will increase the positive and asymptomatic confirmed cases, and on the other hand it will enable the authorities to isolate and suppress the disease, consequently the containment will have more chance to succeed.

3. Inherent advantages

• Having the experiences from highlighted China, Iran and Italy cases and getting benefit of the measures and treatments
• The proportion of the young age in the population compared to European countries if we consider it is seemingly affecting the young people less.
• The proportion of +65 age in the population: For Turkey, it was 8,48% in 2018 (Italy: 22,75%, Spain: 19,38%, USA: 15,81%)
• Functioning healthcare system compared to many countries with such a big population
• Reasonable diagnostic capacity, hospital beds, ICU beds, doctors and nurses

• Having the experience to face and embrace different kind of crises frequently, Turkey has a huge inherent advantage for being resilient to battle whatever the enemy is.

4. Resources and deployment

Turkey’s production capability and capacity is very well known. Hence, in a very short moment Turkey achieved to produce its own test KITs, personal protection equipments and some other required supplies.

Public and private institutions all urged to support the healthcare system and rapid solutions reached the field on time.

Moreover, while fulfilling its own needs in such a big country, Turkey also contributes the global fight against the coronavirus by sending required supplies to +30 countries.

I hope, especially the western countries, understand what it means and they don’t forget Turkey’s humanitarian approach against all odds.

5. Communication, collaboration, organization and realistic — analytic — reasonable approach

In this point there are both positive and negative approaches.

The communication has started with Health Minister’s press conference, who went famous later on with his daily tweets and reached up to 4,8 million followers — as of 18 April.

For sure, his intention was good, nevertheless some people found this daily tweets primitive so that he changed how he informed the people later on.

But that’s only the visible part of the iceberg. The most important thing here is how the Government communicates the pandemic, collaborates with the institutions, puts realistic and analytic targets and steers the folks towards a very well planned crisis management.

In my opinion it was not flawless with some confusion here and there but considering the time pressure and other urging bottlenecks, Turkey is managing the crisis better than my expectations.

However, I’d like to express that the best realistic, responsible and analytic approach has come from Angela Merkel:

6. Strengths and weaknesses of Healthcare system

As mentioned above, the healthcare system is one of Turkey’s inherent advantages which has deep roots in decades. Not only with its increasing capacity of beds and diagnostic devices, but also the top class health workers, and especially world class doctors.

7. Common sense of the people

Like many countries, one part of the society took it quite serious and complied all instructions. On the other hand, there are also some people who defiantly ignore the threat for themselves and unfortunately for others to whom they might spread the virus.

But I’m not of those who blame the folks for not complying the instructions. Everywhere in the world, from developed countries to developing ones, the issue is the same. So clearly, the Governments is responsible for that and it has to regulate the containment procedures according to the prospective response of its people. That is basically a part of being preparedness.

Statistics

First of all, what we here mention as statistics is not ordinary figures but precious human life. So while talking about hundreds of deaths everyday as if it is normal, we have to recognize that each death has a 100% affect on a family and/or community.

It is weird and sad that hearing positive comments on TVs and Social Media when a death toll has a descending trend with for example 657 deaths on that day. Okay, people don’t imply that 657 people’s lives are valueless and I don’t blame them, but as I said, it is a weird tragedy.

Back to statistics

I follow up the Covid-19 data from several domestic and international sources. As a graduate of statistics, I see confusion in the eyes of the people on that field, which is quite normal since people don’t see that much data visualizations everyday.

Here, I’d like to share some basic and key indicators as following:

• The simplest view of confirmed cases and death toll.

• While accumulated figures are increasing, the rate of the increase is declining day by day.

• Case fatality ratio is at 2,30% by far below global averages.
• Both case growth factor and death growth factor are declining.
• Test positive ratio is also declining, while test numbers are increasing.
• Tests per day are increasing but confirmed cases do not follow its trend.
• The increase on recoveries is way more than deaths, which might be a good sign of proper treatment.

Comparative graphics

• Although it is seen that Turkey has a severe outbreak based on confirmed cases, below you’ll see that the death toll path is pursuing the countries which are fighting well against coronavirus.

• The death toll path comparison of 54 countries, where it is clearly seen that Turkey, until now, is pursuing China path.

• On another graph which is adjusted by country population, Turkey has a better position concerning death toll.

Question mark

Until now at the 5th week of the battle against the pandemic, Turkey seems to have a brave fight, which prevents the death toll to increase like many other countries, but my question mark is what will happen if the healthcare system will be overwhelmed?

Considering that all patients are having proper on time treatment the current fatality ratio is far below global averages, even Germany, by 2,30%. On the other hand confirmed cases have reached to 82.000, which eventually will jeopardize the healthcare capacity.

My concern is if a shortage on healthcare capacity might increase the death toll exponentially.

The answer to this concern has come from Health Minister and he revealed that;

“All necessary measures are being taken concerning healthcare capacity”

With the information that two Covid-19 specific hospitals in İstanbul are under construction, I hope and want to believe that the Health Minister will prove it by results.

Back to the headline: When it’ll probably peak, flatten and finally end?

Opinion

It is getting controversial day by day that which containment approach is better concerning both health and economy:

1. Only a quickest total lockdown can prevent the death toll rise and the disruption in economy.
2. The ideal containment policy doesn’t cease all economic activity at once, but instead gradually closes businesses as the number of infections rises.

With all due respect to both ideas, which all come from remarkable academicians of the science society of the world, I’m not sure if the first approach has an assumption on what will happen after the containment measures are lifted?

Contrary, second approach’s assumption is clear:

The rationale: if everyone is kept away from the virus, no one will develop an immunity, so as soon as the containment measures are lifted, the infection rate will again soar.”

It is clear that a hammer is essential for buying some time. But it is also crucial to consider post-1st-wave.

In between these competing ideas, I’m more tend to stand for the second, which is actually Turkey’s hybrid approach.

I hope that will work best for the entire society.

Predictions

The whole world is seeking for the same answer: When it’ll probably peak, flatten and finally end?

I don’t know. I just try to read those comprehensive studies. Only that way I gather some insights, which are:

• For Turkey, I agree with the forecasts which estimate that within mid of May, it will start to flatten and until end of May the trend will be descending.
• But containment policies most probably will be eased only after Ramadan Fest, so a curfew for the entire week (i mean bridge) would be prominent.
• At the beginning of the August it is expected that the trend-lines converge to zero.
• However, a second wave, within November is highly expected. But I believe that this time tackling the virus will be easier than it is today.

I’d like to finish the article with a cliche:

Until a fully effective vaccine arrives the earth, we have to learn to live with the new norm.

Heads up! Stay healthy!