Summer in Istanbul is starting to feel normal again — as long as you wear a mask.
People are riding the bus to work, visiting shopping malls and gathering at crowded outdoor cafés. On weekends, families head to city beaches where lifeguards with megaphones occasionally ask revelers to stay 6 feet apart.
Turkey’s reopening follows a national lull in the coronavirus infections. But the country’s largest association of doctors says that based on its own research, the actual number of coronavirus cases in Turkey is much higher than the government admits.
“The decision to reopen was based on economic reasons, not human health. ... The health of a human being is more precious than the economy.”
“The decision to reopen was based on economic reasons, not human health,” said one intensive care physician in Istanbul, who told The World that he wishes to remain anonymous because he did not have permission to speak publicly.
“The health of a human being is more precious than the economy.”
In terms of adequate government response to the coronavirus pandemic, Turkey has seemingly fared well. In February, the country acted quickly to stop flights and close borders as the virus took hold in neighboring Iran. Over the coming months, with just weekendlong lockdowns in major cities, the country’s per capita death rate from COVID-19 remained among the lowest in Europe.
“We have seen [other] states that cannot maintain their supply chain despite their economic strength and cannot maintain public order,” Turkish President Recep Tayyip Erdoğan exclaimed at an opening ceremony for a new research center in the industrial city of Izmit.
“None of the annoying, embarrassing images experienced in many other places were experienced in our country.”
The numbers don’t add up
This summer, Turkey has continued to clock a steady 1,000 to 1,300 new cases per day nationwide, according to numbers released by the country’s Health Ministry. This prompted Germany to partially lift a travel warning for holidaymakers visiting the Turkish coast, but a European Union warning against nonessential travel to Turkey remains in place.
As of yet, there are no special restrictions on US travelers.
But internal reports from chapters of the Turkish Medical Association (Türk Tabipleri Birliği) paint a much different picture.
“There have been more than 1,000 daily diagnoses in [the city of] Ankara, alone. ... We say these contradicting numbers must be explained. But no explanation has been given to us.”
“There have been more than 1,000 daily diagnoses in [the city of] Ankara, alone,” said Dr. Osman Elbek, a member of the association’s medical body. “We say these contradicting numbers must be explained. But no explanation has been given to us.”
Elbek ticks off statistics from memory. The association’s chapters in the southeastern regions of Diyarbakir, Mardin and Batman are reporting an average of 100 cases per day, he said.
The agrarian, apricot-producing province of Malatya is reporting similar numbers. But in official government data, Malatya’s caseload is combined with six more provinces into a region that steadily reports fewer than 100 daily cases.
Elbek also said that while only 1% -2% of patients with the coronavirus in most countries will end up in an intensive care unit, a whopping 10% of Turkish patients need intensive care. He speculates that either the virus in Turkey has somehow mutated to become more deadly, or milder cases of the disease are going unnoticed.
If Turkey’s coronavirus caseload is indeed undercounted, it is unclear by how much.
One likely factor is that the country has decided to report only cases of COVID-19 that are confirmed with a PCR test, which goes against World Health Organization guidelines.
But Turkey’s public health officials have raised questions over the reliability of test results, where patients who present clinical symptoms of the coronavirus may not be identified with a test.
One ICU doctor interviewed said that even patients who initially test positive for COVID-19 and receive treatment may not make it into the official tally. He requested anonymity to protect his security.
“If a patient dies of COVID-19, but their last test result is negative, we don’t write it in the report. Because we know it’s not going to be approved by public health officials, and they won’t be able to be buried. ... We’ve started to self-censor ourselves.”
“If a patient dies of COVID-19, but their last test result is negative, we don’t write it in the report. Because we know it’s not going to be approved by public health officials, and they won’t be able to be buried,” he said. “We’ve started to self-censor ourselves.”
To Germany-based neuroscientist Caghan Kizil, who is not affiliated with the Turkish Medical Association, the consistency of Turkey’s daily case counts is a red flag on its own, explaining how numbers should fluctuate.
“Every day is different in a pandemic. Monday is a workday, on Sunday people are home. The Haghia Sophia was converted to a mosque, people went there, and even after that, nothing changed,” he said.
This suggests one of two things, Kizil said. Either Turkey’s capacity to test and identify the coronavirus is too limited to accurately measure the scale of the outbreak, or the numbers are fabricated.
“If [the government is] hiding it, it means they know the actual numbers, and maybe they’re taking precautions. ... But if the second case is true, that we can’t find these cases, it means it’s out of control.”
“If they’re hiding it, it means they know the actual numbers, and maybe they’re taking precautions,” Kizil said. “But if the second case is true, that we can’t find these cases, it means it’s out of control.”
A new epicenter emerges in Turkey’s southeast
In the southeast, home to many members of Turkey’s Kurdish minority, a strained medical system struggles to handle the outbreak, said Dr. Halis Yerlikaya, an oncology specialist in the city of Diyarbakir, and a member of the medical association’s central governing committee.
Public hospitals in the cities of Mardin, Sanliurfa, Gaziantep and Diyarbakir are operating at full capacity, he said. Patients with minor symptoms must be turned away from hospitals to make room for more serious cases, placing their families at risk when they return home.
“At the beginning of the pandemic … we were able to do the necessary treatment. But right now ... we cannot accept patients to the hospital. Because we have no capacity. ... The same is true for the whole region.”
“At the beginning of the pandemic ... we were able to do the necessary treatment. But right now. ... we cannot accept patients to the hospital. Because we have no capacity,” he said. “The same is true for the whole region.”
In southeastern cities, extended families commonly live together in one home, Yerlikaya said. In the 1980s and '90s, thousands of families were forced from villages and small towns during Turkey’s decadeslong fight against the Kurdistan Workers' Party or PKK. Many settled together in cities and rebuilt their lives, but a generation of inherited wealth was wiped out in the process.
“When the calls to ‘stay home’ were being made, people here were saying "OK, we’ll stay home — but are we going to die of hunger?"" Yerlikaya said.
Turkey’s leaders have acknowledged that case numbers are ticking upward, but deny that any hospitals are full. Instead, doctors and experts who try to raise public warnings about the coronavirus situation being worse than government claims are slapped with lawsuits and charges of “alarming the public.”
“Let’s trust science, follow the rules,” the country’s Health Minister, Dr. Fahrettin Koca, tweeted on Wednesday, as his office released data showing that Turkey has topped 250,000 confirmed cases of the coronavirus. “There is no epidemic that has not [been] ended in history.”