Letter from Turkey

Abstract

Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in Turkey on 11 March 2020, life has completely changed in Turkey and around the world. Here is a brief summary of what has happened in Turkey during the 14 months of the pandemic to date. There have been 51,294,008 SARS-CoV-2 tests performed and 5,139,485 confirmed cases of coronavirus disease 2019 (COVID-19) (6.2% of the population) since the pandemic began in Turkey (https://covid19.saglik.gov.tr/). Our country has the fifth highest ranking worldwide of COVID-19 cases (https://www.worldometers.info/coronavirus/#countries). Fortunately, the high number of cases is not reflected in the mortality rate; 45,186 deaths due to coronavirus (19th ranking worldwide). This may be because Turkey has a relatively young population with a median age of 31.5 years (https:// www.worldometers.info/world-population/turkey-population). The first restriction decisions came into effect in Turkey as of 12 March, and the scope of these restrictions, which were implemented gradually, was expanded over time. By April 2020, nearly 70 countries were banned from flying into Turkey, while education was suspended and thousands of citizens coming from abroad were quarantined. As the number of cases continued to increase, a curfew was imposed for those over the age of 65 years and under the age of 20 years, and restrictions on air transport increased further. After April 2020, Turkey made some decisions to gradually lift some restrictions. It was announced that at the beginning of May, when the daily number of COVID-19 patients decreased and patients in intensive care units decreased, normalization will occur gradually for 3 months. By June, travel restrictions and curfews ended in Turkey, and restaurants, cafes, cinemas, theatres and wedding halls were put into operation again. A change took place in the daily case table announced by the Ministry of Health in July, and the expression ‘daily number of cases’ was changed to ‘the number of patients’. Thus, the Ministry’s report was not the total number of positive cases per day, but only the patients who showed symptoms. After 25 November 2020, the number of positive cases started to be shared with the public again. Turkey entered 2021 with pandemic restrictions. After the number of cases increased in November 2020, the government introduced a series of new restrictions. Face-to-face education was interrupted, and hosting customers in restaurants and cafes was prohibited again. Curfews were imposed after 9:00 PM on weekdays and for the whole weekend. Furthermore, Turkey detected 15 cases of the English variant of coronavirus on 1 January 2021. At the beginning of March 2021, restrictions were relaxed again. But with the rising infection rate, lockdowns were reimposed during weekends and restrictions were returned. According to the Ministry of Health, there was a record increase in the daily case number in Turkey on 16 April; 63,082 new coronavirus cases were detected. A total lockdown was imposed in Turkey between the evening of 29 April and 17 May. COVID-19 vaccination started on 14 January 2021, after the emergency use of the CoronaVac vaccine was approved by the Ministry of Health. Vaccination started with healthcare workers and individuals over the age of 65 years. Pfizer-BioNTech vaccine was first used in our country on 12 April 2021. To date, people can choose which of the two types of vaccine they wish to have. Up to now, 26,761,632 Turkish citizens have been vaccinated for coronavirus; 15,127,647 (18.3%) have received their first dose and 11,433,634 (13.7%) are fully vaccinated (https://covid19asi. saglik.gov.tr/). During the pandemic, hospitalized patients with COVID-19 were managed in a multidisciplinary manner by pulmonology, infectious diseases, internal medicine and intensive care departments in Turkey. When the number of COVID-19 cases peaked, all hospitals were transformed into pandemic hospitals, and physicians in all specialties cared for these patients. There were periods when the intensive care units were completely full and intubated patients were managed in the general wards. However, with the devoted work of healthcare professionals, this challenging process has been overcome. The filiation method has been used to screen the chain of contacts in COVID-19 in Turkey (Figure 1). People who had close contact with a person with definite or possible COVID-19 infection were tested and followed up by filiation teams of healthcare professionals including dentists and medical school students. From doctors to nurses, all health workers are on the frontline of treating patients with COVID-19. Thus, healthcare workers have a high risk of being exposed and infected with SARS-CoV-2 in Turkey as well as all over the world. The total number of health workers infected with COVID-19 in Turkey has reached 7428 according to the Ministry of Health at the end of April 2020. In September 2020, it was announced that 29,865 healthcare workers had been infected and 52 healthcare workers had died across Turkey (https://tubitak.gov.tr/sites/ default/files/18842/covid_rapor_2021.pdf). There was a reduction in hospitalizations for respiratory diseases other than COVID-19 pneumonia compared to Received: 24 May 2021 Accepted: 16 June 2021