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07 Haz 2022
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CORONAVIRUS - human-made?

CBNW meets Prof Dr Levent Kenar, Chief of the CBRN Department, University of Health Sciences, Ankara, Turkey

CBNW: Thank you for agreeing to talk to CBNW online. May I begin by asking you to kindly introduce yourself and briefly explain your role in CBRN protection in Turkey?
I am a physician with a doctoral degree in CBRN defence. I have been working for 24 years in the CBRN Department in Ankara, Turkey and I am currently the Head of this Department as Professor of CBRN. I have been tasked with scientific and training in the department, conducting scientific studies and giving lectures about CBRN weapons to government staff.

From working as a PhD student in the doctorate programme on CBRN agents betwen 1997-2002, I led the CBRN Response Team established under the authority of the University in 2003 due to the emerging threat from Iraq. I was tasked in prompt and effective response to incidents and supervised team staff during this period.

In CBRN defence I completed assignments with various international organisations and meetings and represented Turkey in NATO-CBRN-related groups. I was certified as an inspector with UNMOVIC (the United Nations Monitoring, Verification and Inspection Commission) and established the Association of CBRN Defence Policy Development (CBRN-DEPA) – the first and unique NGO in Turkey devoted exclusively to research, consultancy and training in defence against CBRN agents.

CBNW: What did this role entail as regards the emergence of SARS-CoV-2 in Turkey?
I have provided consultancy covering strategic analysis, assessments and recommendations on SARS-CoV-2 and emergency situations. The main aim has been to mitigate the worst effects of the Covid-19 pandemic through coordination to preserve the healthcare system and help protect the population. I have been involved in planning and executing meetings, panels and symposia on Covid in academia and for the media.

CBNW: When did Covid-19 first appear in Turkey?
The first case in Turkey was detected in Istanbul on 10 March 2020. The first death occurred on 17 March 2020 in an 89-year-old male patient. The deceased patient was reported to have contracted the virus from a ‘Chinese contact’ employee.

CBNW: How prepared were the Turkish government and healthcare system for the inexorable spread of Covid-19 into the country?
A Scientific and Advisory Committee under the Ministry of Health was established on 10 January 2020 to give recommendations and bring in Covıd-19 pandemic measures, including a guidebook on the health system, which was managed from a single main centre. In addition, state institutions quickly began to implement decisions taken by the scientific committee, which are constantly updated. The experiences of China and Europe have also provided a guide to success in Turkey’s struggle against the virus.

In January, two months before the WHO’s pandemic declaration, measures regarding coronavirus information and protection measures began to be taken, especially at airports. The University of Health Sciences Medical CBRN Defence set up a panel, Coronavirus and its Global Effects, on 5 February 2020 – to which Turkey’s WHO representative was invited.

CBNW: How did Covid-19 affect workplaces, schools, childcare centres, transportation, and supply chains?
Coronavirus has had serious socio-cultural, socio-economic and psychological effects on our society. The Ministry of Health managed the control of social life and stipulated restrictions in areas such as schools, workplaces, public transportation and airports, restaurants, and shopping centres. Studies were carried out in partnership with the Ministries of Culture and Tourism, Industry and Technology, Commerce, Transport and Infrastructure, and Justice and Interior.

CBNW: Could you briefly outline case numbers – one statistic, for example, in March 2020 compared with the height of infection in the country?
On 11 May 2020, two months after the first case, the Turkish Ministry of Health declared that the number of Covid-19 cases had reached 139,771, with 3,841 deaths. On 27 July 2020, 225,173 patients and 5,596 deaths were reported by the Ministry of Health.

In Turkey as of February 2022 a total of 12,834,534 Covid-19 patients and 90,266 deaths have been reported.

CBNW: Could you briefly outline what kind of health service Turkey has in terms of local doctors and hospitals?
We have centralised pandemic management, free testing (PCR), and supportive care medicine in all hospitals. There is immediate hospitalisation of moderate and severe cases, nationwide contact tracing with local doctors, quarantine practices, and daily tracking of all contacts through healthcare workers. Despite the large number of Covid-19 cases, the system continued to work without overloading and state-supported hospital management was successful.

CBNW: Is there a focus on infectious diseases, and if so, where are these specialist centres?
At the peak of the pandemic, private hospitals were declared as pandemic hospitals and state support was provided. In addition, two new pandemic hospitals to be used only in the fight against Covid-19 were put into service in Istanbul, the city with the country’s largest population.

CBNW: Based on a sample period from the past two years, how did hospitals cope with admissions of Covid-19 cases?
All public and private hospitals in the pandemic are managed by a Ministry of Health Head Office. While clinicians were dealing with Covid-19 cases in hospitals, epidemiological studies began in the community. While it may seem time consuming and costly, field serological testing integrated with well-defined active surveillance studies has enabled robust, data-driven recommendations for quarantine to be furthered or maintained. This reduced the patient burden on hospitals and the health system.

CBNW: When did your vaccination roll-out begin, and can you describe how it developed in terms of age groups and provinces?
Under the Ministry of Health Covid-19 Vaccine National Implementation Strategy, the first vaccination with Sinovac was administered on 13 January 2021. On 12 April 2021, the Pfizer-BioNTech vaccine was introduced.
Stage 1: Priority groups for vaccination included employees of health institutions, where all health personnel were vaccinated. Second priority was senior citizens over 65 and those with an underlying condition.
Stage 2: Third priority vaccination included Ministry Of National Defence, Education, Food, etc. sectors to enable them to continue their services. People between the ages of 50-65 were vaccinated after these sectors.
Stage 3: Those with chronic diseases aged below 50 and other groups were vaccinated.

CBNW: Which vaccine was distributed, and how long did approval by the relevant authorities take?
All vaccines brought to our country were analysed by the Turkish Medicines and Medical Devices Agency for two weeks, after which an Emergency Use Approval was given for the vaccine. We obtained first usage approval for the Sinovac company and vaccination began on 13 January 2021.

On 24 March 2021, the Pfizer-BioNTech vaccine was imported. After approval, distribution began on 12 April 2021. Finally, the Sputnik V vaccine was approved on 30 April 2021 with the first shipment on 14 June 2021.

Turkovac, an inactivated vaccine, was approved by the Turkish Medicines and Medical Devices Agency one month after the Emergency Use Approval application on 25 November 2021. This vaccine was developed in Turkey for domestic use.

CBNW: What was vaccination take-up like? How far did the population accept it and was there a substantial anti-vax contingent?
From its inception in January 2021, vaccination continues apace. By mid-Februray 2022 a total of 57,564,527 people have received a first dose – 92.74% of the population over 18 years. A second dose was administered to 52,623,391 people – 84.78% of over-18s – by mid-February. Third and fourth-dose vaccinations are ongoing.

There is some non-scientific opposition to vaccination but also a huge interest among the public in vaccination. Information on vaccination rates is constantly updated by the Ministry of Health. Vaccination rates are consistent with Covid-19 case numbers.

CBNW: What kind of restrictions – such as lockdowns, mask-wearing – were put in place, and how did the public receive them?
Closure of schools and workplaces, stay-at-home, wearing masks and social distancing and following hygiene rules have reduced cases. The citizenry did not resist decisions taken by the state through the scientific committee and most people complied with them.

Evaluating the effectiveness of public measures by research into transmission probabilities, contact rates, and asymptomatic cases has meant decisions announced by the scientific committee helped to convince most people to comply with the measures.

CBNW: When approximately did the Delta and Omicron as prime variants arrive in the country and how did they affect case numbers?
Although there is no clear information about when the Delta variant first started, after the decrease in case numbers in May 2021 the Ministry of Health announced that 90% of the Covid cases seen in Turkey at the end of June and especially in July were caused by Delta.

On 25 December 2021, the Ministry declared that 10% of Covid cases were caused by Omicron and associated with the increasing number of Covid cases in January 2022.

While Delta variant cases were 24,372 on a seven-day average in August 2021, Omicron cases totalled 69,477 weekly in January 2022. Therefore, the spread rate of the Omicron variant is the highest.

CBNW: Do you have any statistics for Long Covid cases in the country?
Numerous reports describe long-term effects on respiratory, cardiovascular, gastrointestinal, neurological, psychiatric, and dermatological systems. In one study in Turkey 39% had at least one co-morbidity, and 47.5% had persistent symptoms.

Fatigue/easy fatigability, myalgia, and loss of weight were the most frequent persistent symptoms (overall 29.3%) followed by respiratory symptoms (25.4%). A total of 235 participants had admitted outpatient clinics and 17 of them were rehospitalised.

CBNW: Was there military support and if so, can you explain how it worked to support the Turkish health service?
Recommendations and decisions of the scientific committee established by the Ministry of Health were carried out by the relevant state institutions without the need for military support.

CBNW: Did Turkey receive help from other countries to deal with the pandemic?
Turkey provided logistical support for health supplies to many countries at the beginning of the pandemic. In the later stages it continued support by sending vaccines to African countries. The help Turkey received from other countries concerned vaccination and the experiences of China and Europe in the fight against pandemics also guided progress.

CBNW: How as Covid-19 affected the Turkish economy and tourism?
Turkey has a critical role in trade. While economic recession were seen in some sectors due to the pandemic, progress was made in others. Tourism, education, construction, car manufacturing, and aviation were adversely affected while medical supplies, agriculture, electronics, food processing, retail and personal care have benefited.

Tourism, a sector with high growth targets for 2020 in Turkey, has been one of the worst affected due to social distancing, quarantining and curfews. Dismissals have begun. The pandemic has also dramatically affected the service sector. Some sectors will adapt to the new situation and the Turkish economy and tourism are developing new strategies to help reduce the pandemic’s impact.

CBNW: How are the case number statistics looking as of mid-February 2022?
On 20 February 2022 the number of cases was 70,355, with 265 fatalities. To compare, between 29 January–4 February 2022, 708,159 cases were recorded with 1,141 deaths; 4% of the patients suffered pneumonia and the ventilator occupancy rate was 29.7%.

Healthcare workers in Turkey wear PPE that includes coverings for the head and neck as well as full-body protective garments when managing COVID-19 patients.
©Dr Levent Kenar