Covid-19 came late to Turkey – on 11 March – but soon singed every corner of the country. Within a month all 81 provinces had been affected.
It was the one of the fastest growing outbreaks in the world – worse than China or the UK. There were fears that the death toll would soar turning Turkey into another Italy, which was then the hardest hit country.
Three months on that hasn’t happened, even without a total lockdown.
The official death toll is 4,397. Some doctors here dispute that, claiming the real figure could be twice as high because Turkey only includes those who test positive. Either way, in the horrific annals of the Covid-19 era, it’s a relatively low number for a population of 83 million.
An unusual lockdown
Experts warn it is hard to reach conclusions and compare statistics while countries are still burying their dead. But Turkey has “clearly averted a much bigger disaster”, according to Dr Jeremy Rossman, Lecturer in Virology at the University of Kent.
“Turkey fits in the category of several countries that responded fairly quickly with testing, tracing, isolation and movement restrictions,” he told the BBC. “It’s a fairly small club of countries that have been quite effective in reducing the viral spread.”
As the virus multiplied, the authorities subtracted key pieces from the jigsaw of daily life – no trips to the coffee shop, no shopping in crowded markets, no communal prayers at the mosque.
The over-65s and under-20s were locked down completely, weekend curfews were imposed, and major cities were sealed off.
Istanbul was the centre of the epidemic. The city lost its rhythm, like a heart that keeps missing a beat.
How Turkey tracks the virus
Now restrictions are gradually easing, but Dr Melek Nur Aslan remains on alert. She’s director of public health for the district of Fatih, a heavily populated area in the heart of old Istanbul. Dr Aslan, who is articulate, and energetic, leads a contract-tracing operation. Across Turkey there are 6,000 teams.
“We feel we are in a war,” she tells me. “People forget to go home. We say ‘OK eight hours is completed’ but they don’t even care about going home because they know this is a duty they have to complete, before it spreads to anyone else.”
Dr Aslan says they began tracking the virus on day one – 11 March – thanks to decades of experience tracking measles. “Those plans were ready,” she says. “We just got them off the shelf and started using them.”
We join two young doctors in the narrow streets of Fatih, equipped with an app, and clad in Hazmat suits. They head for an apartment block where two flatmates in their twenties have been in quarantine. Their friend is Covid-19 positive.
The women are framed in the doorway of their apartment, both in face masks, and one wearing a headscarf. They are tested on the spot for Covid-19 and will get the results within 24 hours. It’s just a day since they started showing mild symptoms. Nazli Demiralp, 29, is grateful for the prompt response.
“We follow foreign news,” she says, “and when we first heard about the virus we were really scared. But Turkey has rallied faster than we thought – much faster than Europe and the United States. “
Turkey embraces hydroxychloroquine
The country has public health lessons to offer, according to acting head of the World Health Organization (WHO) in Turkey, Dr Irshad Shaikh.
“Initially we were worried,” he told the BBC. “They were having 3,500 positive cases per day. But what has worked is testing. And they did not have to wait five or six days for results.” He also credits the quarantine, isolation and contract tracing measures but says it’s too soon to judge Turkey’s treatment protocol for patients.
Controversially that includes the anti-malarial drug, hydroxychloroquine, as standard. It’s much touted by President Donald Trump – but has been roundly rejected by the latest international research.
The WHO has temporarily suspended it from their trial of possible treatments for the virus. That followed research published in the Lancet which suggested hydroxychloroquine can cause cardiac problems in Covid-19 patients, and could do more harm than good.
We were given access to a hospital where it has been part of the standard treatment for thousands of patients. The Dr Sehit Ilhan Varank hospital, a two-year old-state hospital, is also state of the art. It’s a bright, spacious battlefront against the virus.
Chief doctor Nurettin Yiyit – whose art work is on the hospital walls – says it’s key to use hydroxychloroquine early. “Other countries are using this drug too late,” he says, “especially the United States. We only use it at the beginning. We have no hesitation about this drug. We believe it’s effective because we get the results.”
On a tour of the hospital, adding and subtracting protective layers as we go, he explains that Turkey’s approach is to “get ahead of the virus”, by treating early and treating aggressively. They use hydroxychloroquine and other drugs, along with blood plasma and oxygen in high concentrations.
Dr Yiyit is proud of his hospital’s mortality rate of under 1%, and of the empty beds in the intensive care unit. They try to keep patients out of here, and off ventilators.
We meet 40-year old Hakim Sukuk who has left the ICU and is homeward bound, brimming with gratitude.
“Everyone took care of me so well,” he said, sitting up in bed. “It was like being in my mother’s arms.”
Not over yet
The government’s handling of the pandemic has not been given a clean bill of health by the Turkish Medical Association. It says there were many mistakes in Ankara’s “inadequate” response to the pandemic, including leaving borders open for too long.
However, Turkey is getting some credit from the WHO. “This is a young outbreak,” said Dr Shaikh. “But we would expect more people to be severely sick. Something is going right.”
Turkey has advantages in the fight against Covid-19, including a young population and a high number of ICU beds. Despite this, new cases continue to be recorded, currently at the rate of about 1,000 a day.
While the country is being seen as a success story, there’s still plenty of caution because the story isn’t over yet.