Republic of Turkey is one of the most disciplined and successful countries in fighting against Covid-19 pandemic. In the last 15 years, Turkey’s health system has undergone a major restructuring process. Thanks to the modernization of hospitals in Turkey in the last 15 years, the health system has gained structural abilities that can respond to such a pandemic and crises. The new hospital capacities have been built and the City Hospitals, especially built in recent years, have been put into service as the Europe’s largest and most modern hospitals. Only in 2020, 11 new hospitals with a total of 14 thousand beds and equipped with the latest technology will come into service.
At the same time, Turkey has made large investments in health information technology in this process. Turkey has become the country using the health information systems, «big data» and «artificial intelligence» in the decision-making processes in the best way.
Turkey is one of the countries taking the measures related to the pandemic in the earliest time. Upon the declaration of the start of the pandemic originating from China and appearance of this disease in other countries, Turkey has begun to make preparations against the possibility of the appearance of this disease in our country.
We determined the road map against Covid 19 exactly 31 days before the World Health Organization declared the disease as a pandemic and 50 days before the disease was seen in our country (11th March). We prepared our health institutions and citizens against the possibility of pandemic.
An Operation Center was urgently established within the Ministry of Health on January 10, 2020, exactly 31 days before the World Health Organization declared the disease as pandemic.
At the same date, the Scientific Board, consisting of successful scientists working in different branches in our country, was established. Our Scientific Board is the advisory board that makes the scientific opinion about any steps to be taken from the beginning of the Covid 19 process.
The leaves of all healthcare workers were cancelled and the health personnel and equipment plans were made for each region according to the pandemic scenarios created.
The flights to risky foreign countries have been banned, and the airport and border measures have been taken. The social isolation measures have been implemented. Thanks to the implemented measures, the entry of the virus to Turkey has been delayed for 3 months, and all preparations have been completed in this process.
CASE DETECTION AND CONTROL: FILIATION ACTIVITIES
Turkey gives special importance to the filiation activities for the strict monitoring and isolation of people having contact with cases within the community in addition to put communal limitations to keep the disease limited. The filiation has a big role in the success of Turkey so far.
The filiation is a method of tracking from whom the virus is transmitted to the positive test case and who the case has infected. In other words, in every positive case, it is the method of tracing the infection of virus and determining the chain of spread.
For filiation activities, 20.000-person filiation team has been established as composed of primary care physicians as well as dentists for following contacted cases in whole Turkey.
Since the first case on March 11, the virus was traced around the contact of each new patient. With the tracing method, everyone who has been in contact with the person having the disease in the last 4 days has been contacted, and the necessary tests have been made, and positive cases have been quarantined and treated. In this context, 600 thousand filiation studies have been carried out so far.
The contacted people were reached and asked to isolate themselves, and their evaluations and tests were made by visiting their locations. The trainings were provided to them for preventing their infection potentials. In this way, 99% of those who come in contact with positive cases are reached within a period of 20 hours.
With the help of filiation studies, the cases are detected early and the risk of transmitting the disease to others is minimized. Again, the early detection of the patients by means of the filiation provides early start of the treatment process and increases the recovery rate.
TEST CAPACITY AND NUMBERS
In Turkey, a PCR test is applied to those who show symptoms and apply to health institutions, as well as to citizens that are found to show symptoms during controls and, in the framework of filiation activities, to people who have been in close contact with the aforementioned individuals.
Turkey has so far performed more than 1 million 250 thousand tests. Daily test capacity is 50 thousand.
If needed, human resources and infrastructure are available to increase the daily testing capacity.
HEALTH SYSTEM AND EQUIPMENT CAPACITY
Turkey has a strong health care system capacity and infrastructure. The fight against Covid-19 has not created a strain on Turkey’s health system capacity.
Turkey is very well prepared in terms of the intensive care bed and mechanic ventilation number used within the context of fight against Covid 19. The Turkish health system has 39,934 intensive care beds and 17,852 mechanic ventilators. Even though the peak point has been passed in the pandemic; only 6% of the intensive care bed occupancy rate and only 5% of the ventilator occupancy rate have been reached in scope of Covid-19. In other words, Covid-19 has not put a pressure on Turkey’s health system.
DATA FOR TURKEY AS A WHOLE *
Beds * Intensive care beds * Adult ventilators **
Total occupancy rate 32,31 % 64.20 % 37.72%
* Located in Istanbul, Başakşehir City Hospital, with a capacity of 2,682 beds and 446 intensive care beds, will become functional on 15 May 2020. The construction of two hospitals, each with a capacity of a thousand beds immediately convertible into intensive care beds, will be finished at the beginning of June.
** The number of adult ventilators will reach 23,800 at the end of May, with the delivery of 5,000 nationally manufactured ventilators. Furthermore, there are 10,358 additional ventilators, including portable ventilators to be used in cases of emergency. Even in Istanbul where most cases are recorded, the occupancy rate of the intensive care capacity is only 66% and 42% of the ventilators are being used.
OCCUPANY RATE OF HEALTH INFRASTRUCTURE IN CERTAIN CITIES
Occupancy rate of intensive care beds Occupancy rate of ventilators **
Antalya 59.44% 41.34%
Aydın 69.19% 47.88%
Muğla 50.19% 29.36%
Istanbul * 62.61% 43.57%
Izmir 67.87% 36.69%
Nevşehir 44.13% 25.95%
NATIONAL 64.20% 37.23%
* There will be additional beds and intensive care beds capacity in Istanbul in May and June.
** The capacity of ventilators will increase by the end of May in all cities.
In terms of protective equipment such as masks and protective overall suits, which are of critical importance during the pandemic, Turkey is a self-sufficient country.
Turkey is providing medical aid assistance, which includes products such as masks, protective overall suits and ventilators, to various countries around the world.
Thanks to the capacity it has reached, Turkey is also not leaving alone its citizens living abroad. Up until now, citizens living abroad and who have requested to return to Turkey have been repatriated. Furthermore, our citizens who cannot receive treatment abroad and their family members are repatriated by aircraft ambulances.
In this framework, our fully equipped ambulance fleet has the capacity to provide services in Turkey and other parts of the world.
NUMBER OF FULLY EQUIPPED AMBULANCES
Ambulances 5,477
Snow ambulances 479
Helicopter ambulances 17
Aircraft ambulances 3
Naval ambulances 6
METHOD OF TREATMENT
With the data analysis method and health system experience in the context of Covid-19 treatment, Turkey has been able to develop her own algorithm. In this framework, Turkey has stocked the required medicaments before the virus spread into its borders.
Thanks to the treatment algorithms it applies, Turkey is more successful than most other countries in the treatment process, and mortality rates are considerably low.
In the rate of conversion of cases to pneumonia in Turkey, there has been a big drop from 60% to 12%. This situation has also led to a decrease in our need for intensive care.
In addition, the death rate in patients undergoing intensive care has progressively decreased from 58% to 10%.
Turkey’s successes in filiation, patient monitoring and treatment processes are shared with the World Health Organization and other countries and appreciated and are being followed.
Turkey shares its experiences and knowledge acquired during the treatment process with other countries.