Professor warns human-to-human contact must be further prevented to break the cycle in Turkey

Özlem Akarsu Çelik / DUVAR

Murat Akova, an Infectious Ilnesses and Clinical Microbiology professor at Hacettepe University, said the coronavirus outbreak, which has killed 131 and infected over 9,217 people so far in Turkey, will further grow. According to him, Turkey needs to organize itself to combat it. 

Although Turkey is too late to use testing as a preventative measure, it is key to identify infected people, Akova noted, adding that isolation was the most important measure to take at this stage of the outbreak.

Akova told Duvar his take on Turkey’s prevention efforts against the Covid-19 pandemic. 

WE DO NOT KNOW THE EXACT NUMBER OF DEATHS FROM COVID-19

Q: Where does Turkey stand in the phases of the outbreak? What’s the most effective precaution to take at this point?

Murat Akova: We don’t know the exact number of people who have died from the coronavirus because we may be overlooking them. It is highly likely that people died from the coronavirus without ever testing positive. Yet statistically, for every person who dies from coronavirus-related complications, there should be 800 patients. So if we simply multiply the official number of casualties by 800, that means we have more patients than the official numbers.

Q: Why is the geographical distribution of patients not revealed?

Murat Akova: We don’t know why the government insists on keeping that information from the public. For instance, the province of Van is under great risk because of the wide spread of the pandemic in Iran. It’s likely that Van has a large number of patients. Many people from across the world come to Turkey. Recently, pilgrims returned from Mecca. Those people all went back to their respective homes in different cities throughout the country. We don’t know if they had the coronavirus or not. 

TOO LATE TO ENFORCE WIDESPREAD TESTING IN TURKEY

Q: You recently said that China was able to overcome the outbreak thanks to enforcing a lockdown and that South Korea is successful in managing the virus because they test widely. What’s your take on Turkey?

Murat Akova: It’s too late to enforce widespread testing in Turkey, even though this is the primary way of preventing the spread. We need to prevent human-to-human contact if we want to break the cycle. Isolation is key. When the pandemic spreads even further, there won’t be enough hospital beds for patients. The number of patients will grow immensely. There won’t be enough hospital beds or resources for all patients. So we need to develop a system. 

Q: There’s a lot of confusion surrounding the tests. How are the tests conducted and are the same tests used in all countries? 

Murat Akova: The basic principle of the Polymerase Chain Reaction (PCR) tests are the same across all countries. They test discharge from the patient’s upper respiratory system. However, the rapid tests in Turkey test a patient’s blood for antibodies. PCR tests are helpful for early diagnosis as the blood test will only yield results some five to seven days into the illness.

Q: Is it true that you start treatment based on a patient’s symptoms and not based on their test results? Since test results can be misleading sometimes. 

Murat Akova: Well first you need to test your tests’ reliability. Having tests that yield false results would be completely detrimental in this situation. So if we have a patient reporting symptoms but their test says negative, we’ll conduct another test within 48 hours. If their symptoms are severe, we just isolate them and start a treatment.

The main criteria for treatment are fever, a cough or shortness of breath, or a lung x-ray. A newly discovered symptom is loss of the sense of smell and taste. Smell and taste are reduced in regular upper respiratory infections, but they say that coronavirus completely eliminates them. 

YOU CAN'T ASSUME A DRUG IS EFFECTIVE BECAUSE IT WORKED ON 20 PATIENTS

Q: There’s so much debate over the medications that are either already used to treat Covid-19 or ones that are rumored to help. What should we believe about all this?

Murat Akova: None of these drugs are proven to be effective in treatment. It’s only been three months since this virus emerged, and that’s not a long enough time to collect sufficient scientific data. China tried many different medications and established their own protocols. However, Chinese medicine differs from western medicine. There’s nothing yet in the literature about drugs. 

A medication with the brand name Plaquenil is widely used to treat Covid-19 in China, Europe and the US. It’s a combination of chloroquine and hydroxychloroquine. It’s usually used to treat malaria and rheumatoid arthritis. 

There is a debate about whether it should be used on its own or combined with other medications. In a 36-person study in France, it was effective on 20 patients to use it in combination with Azithromycin, another medication used to treat upper respiratory infections. The U.S. promoted this as “French doctors found the miracle cure.” That’s not the case. You can’t assume a drug is effective because it worked on 20 patients. So it wasn’t surprising when a couple days later, it was revealed that these drugs can cause heart arrhythmia, especially when combined with other druges. 

These are not drugs to be played around with. You might kill yourself with their side effects while trying to protect yourself from the illness. 

Q: People have different advice on what to stock up on during this time. Is there a medication that you’d say we should definitely have during this outbreak?

Murat Akova: Acetaminophen will lower your fever and prevent mild infections but it can cause liver failure if taken too much. Turkish people are especially fond of antibiotics but that’s wrong. No medication should be used without consulting a pharmacist. What you think is simply a fever could be a symptom of Covid-19. You should consult a pharmacist if you have those symptoms. 

Really, all of the drugs being administered right now are part of a clinical trial. People are lining up to be lab rats. They’ll drink hydrochloric acid if you let them. People died because they drank chemicals. We’re going from one end of the spectrum to the other.

HIGH-RISK INDIVIDUALS NEED TO GET VACCINATED AS SOON AS POSSIBLE

Q: Up until recently, people were arguing over whether vaccines are healthy…

Murat Akova: People who thought vaccines were the Rockefellers’ secret weapon are now are begging scientists for a vaccine. 

It’s especially important for high-risk individuals to get vaccinated right now. A flu shot won’t protect you from Covid-19 but if you’re immune to other illnesses, it’ll be easier to diagnose it. 

It’s also important to get vaccinated for pneumonia since this virus can cause pneumonia. 

Q: Health professionals are in high-risk situations but we don’t know how many of them get tested or carry the virus. The safety of workers should be a priority but shouldn’t there be precautions at health institutions? Perhaps like making suspected Covid-19 patients enter and exit through another door? Do health institutions take these precautions?

Murat Akova: Anyone who comes into contact with a patient should be tested. That’s how you’d figure out who that patient infected, so you can isolate them. Health professionals treat multiple people they can infect, they could infect their colleagues. So it’s critical that professionals wear personal protective equipment.

At Hacettepe, if you report to the emergency room with a fever and cough, you’ll immediately be directed to a coronavirus clinic without being let into the emergency room. Someone will take your temperature, examine you and take an x-ray of your lungs. If the x-ray indicates illness, you’ll be taken into an observation room. They’ll swab your nose. If needed, they’ll do a tomography. If that comes back suspicious, you’ll immediately be admitted and treatment will start. You’ll wait for your test results there. So these patients are never introduced to the general public. That’s called triage and it’s conducted outside the hospital in a trailer. 

WE HAVE INSUFFICENT NUMBER OF TESTS AT HACETTEPE

Q: Is there a standard procedure that health institutions throughout the country follow? Is the fight against the outbreak conducted in the right way?

Murat Akova: The Health Ministry has a document about what to do when a suspected Covid-19 patient comes in. Of course, it’s easier said that done. 

Rumors have spread that physicians don’t have enough personal protective equipment. That’s the first step. The second step is resolving the lack of testing. We have a limited – and insufficient - number of tests at Hacettepe. 

Rapid tests only serve us with patients who’ve been sick for five days, but it’s better than nothing. What matters is how organized hospitals are. How many patients are there in every province? Or how many could there be? The health workers can’t prepare because they don’t know the answers to those questions. Again, the pandemic will spread, and we need to develop a system.