EDITORIAL: Successful Treatment Strategy of Turkey against Covid-19 Outbreak
Hilmi Kodaz11Department of Medical Oncology, Acibadem Eskisehir Hospital, Eskisehir, Turkey,
Turkey’s fight against Covid-19 outbreak seems to be successful. The most important factor of this success is establishing a scientific committee, consisting of academics from Turkey's leading universities, at the earlier time of COVID-19 outbreak by the Ministry of Health.
At early January, firstly the scientific committee have followed the developments about virus outbreak from its outset and then prepared Covid-19 guide according to first data of the outbreak. After taken effective and preventative measures, the first Covid positive patient was reported at March,10. The scientific committee have held 6 hours of meetings each day, chaired by the Ministry of Health an after this meeting, treatment algorithms have been updated and new measures, including regional qarantines, to be taken have been implemented. Turkey increased the test numbers and Covid-19 outbreak is undercontrol now. Currently, a total number of tests reached to 477 716, a total of 69392 positive cases were detected. Mortality rate is about 2.1 % and death number reached 1518, beside 1820 patients are at intensive care unit, as 1052 of them are entubated.
Minester of Health, Dr. Fahrettin Koca, has summarized the followings after Coronavirus Scientific committee meetings. Briefly;
1. Each Covid positive adult patients are initially treated with hydroxychloroquine and azithromycin. To do this, enough medicine had to be provided and by acting early enough drugs were stocked.
2. Favipravir had been started to use in intensive care patients who had severe Covid-19 pneumonia. By virtue of its efficacy on virus clearence, Health ministry approved it as a valuable option for initial phase of pneumonia in hospitalized patients rather than ýntensive care unit. This might be reason of diminished ratio of intensive care unit administration.
3. Turkey has the highest ICU bed capacity per 100,000 people compared to most European countries, China and the US. Beside that well-qualified and trained staffs in ICU is also big chance for ICU management strategy.
4. Health ministery provided tocilizumab treatment option in ICU for patients with severe Covid-19 related cytokine release syndrome. In addition, convalescent plasma from recovered patients are also well-organized and have started to use for patients who had severe disease.
5. It was also observed that additional problems such as coagulopathy (coagulation disorder) occurred in COVID-19 patients and related with mortality as well. Therefore, anticoagulant drugs were added to the treatment algorithm.
In addition to the scientific board's continuously updated treatment algorithms above
as our Editorial thoughts and suggestions;
1. Compared to other country in the world, Turkey has such the most enough numbers of computerized tomography imaging opportunity according to the population. In addition to PCR for the diagnosis of Covid-19, our Computerized Tomography (CT) imaging capacity is very good, so it can be quickly diagnosed and people can be isolated as fast as possible.
2. Doctors in Turkey was doing 60-100 outpatient visits per day in the pre-epidemic period. Since this intensity is a situation that doctors are accustomed to during this crisis, healthcare professionals did not have difficulty.
3. Since the past, Turkey has free health-care system, including drug (free of charge) price. Moreover, the number of elderly (>60 years) patients who receive ACE inhibitors are much
more and there might be possible association between this class of agents and disease severity.
4. New data showing favipravir efficacy on Covid-19 pneumonia by providing shorter viral clearence and significantly improved radiological outcomes are remarkable and this update data are adapted to national Covid-19 guide and Healt ministry have ensured the favipravir treatment for all patients who had Covid-19 pneumonia according to physicians’ choice. Current statistical data show that there is a reduction in patient care rate in intensive care units. Favipravir might be the first-agent for hospitalized covid-19 pneumonia patients. On the other hand, currently there was a trend towards diminished entubated patients’ rate in ýntensive care units. Mortality rate of entubated Covid patients with acute respiratory disstress syndrome are high and physicians are aware of ventilator-induced lung injury. So, there was a reduction of entubated patients’ rate in young patients without comorbidities who can tolerate non-invasive measures.
5. Traditionally, Turkish society consumes a lot of spices, especially hot pepper, and citrus rich in vitamin C in meals. Effects on cytokines of Capsaicin and Possible preliminary antiviral effects of Capsaicin might be assessed on new type coronavirus by furhter designed studies.
6. On the other, the hypothesis of Dr.Muhittin Taþdoðan and his team looks valuable and it might be preferable to get answer against Covid-19 outbreak. Hypothesis 1:Could childhood vaccines be the reason for a milder infection in children? https://www.ejmo.org/10.14744/ejmo.2020.40743/
I would like to thank Dr. Osman Kostek for their support in the preparation of this paper.16.04.2020
Cite This Article
Kodaz H. EDITORIAL: Successful Treatment Strategy of Turkey against Covid-19 Outbreak. EJMO. 2020; 4(2): 177-178
Corresponding Author: Hilmi Kodaz