ANKARA/ISTANBUL: Two medics in protective suits jumped out of a car in a deserted street in central Ankara and hurried inside a building - one carrying medical equipment and the other, paperwork. Some 15 minutes later, they sped off to their next appointment, one of nearly 6,000 teams deployed across Turkey to try to stem the coronavirus pandemic by tracking down the contacts of those found to have become infected.

After recording some of the fastest growth in COVID-19 infections in the world, health officials say the outbreak in Turkey has hit a plateau around six weeks after the first case was confirmed. The death toll of 3,336 is lower than 12 other countries. The daily death toll has been on a downward trajectory for more than 10 days, with 78 deaths confirmed in the past 24 hours, according to health ministry data on Saturday.

Health Minister Fahrettin Koca credits the country's contact tracing efforts along with Turks' largely voluntary adherence to lockdown measures, for the trend. In contrast to South Korea, which limited deaths to below 250 with the help of a contact-tracing app, Turkey has taken a more labor-intensive approach. Koca said on Wednesday around 5,800 teams of two or three medics had identified 468,390 people who have been in contact with coronavirus patients. He said around 99 percent of those had been reached and were regularly monitored by health officials.

In the capital Ankara, a coordination center oversees the field visits and follow-up calls by telephone. The two groups cooperate to identify, test and report cases across the city. "Since a household is on average four to five people, with the workplace added in, there have been cases where we tracked 200 people at once," said Ayse Cigdem Simsek, the Ankara Provincial Health Directorate Deputy Chairwoman of Public Health Services. Under the system, the teams are tasked with telling contacts of a COVID-19 sufferers to stay at home for 14 days, even if they do not have symptoms.

Other teams are then instructed to call them daily to ensure compliance and check on their health. If they report symptoms, they get another visit to give a sample for testing in hospital, Kerime Altunay, a public health doctor and coordinator of the remote monitoring team in Ankara, told Reuters. The system grew out of a method Turkey had been using for decades to contain previous outbreaks of measles and flu, Simsek told Reuters.

But while testing was launched on the day the first case was confirmed, March 11, it took a while to roll out. Initially Ankara sent testing kits to the United States when it was short of them at home, but has since ramped up testing. Turkey, with a population of 83 million is now doing 30,000-40,000 tests a day, according to data from the Health Ministry. Schools were closed immediately and other measures, including the closure of non-essential shops and factories and compulsory lockdowns at weekends, were brought in in stages. The lockdown has been stricter than South Korea but less stringent than some European countries like Spain or Italy.

Death toll debate
The head of the Turkish Medics Association (TTB), Sinan Adiyaman, said early in the outbreak that not enough tests were being done. The TTB has also questioned the death toll, as experts have done for other countries, and said it wants the government to include those who died with COVID-19 symptoms even if they have not tested positive. The government says it is following reporting standards set by the World Health Organization (WHO). The TTB was not available for comment.

Irshad Shaikh, acting head of the WHO's Turkey office, told Reuters the recent declining trend in new cases showed Turkey's testing methodology was robust and that the numbers of tests were sufficient. He said contact tracing helped lessen the spread in Turkey by pinpointing the majority of people who came into contact with confirmed cases.

Shaikh said Turkey conducts tests during autopsies on suspected cases who die outside of hospitals, and repeat tests on suspected cases that initially turn up negative, which would make the potential number of errors in reporting deaths very small. Koca said on Wednesday that the coronavirus outbreak was at its peak and would decline, and that contact tracing would continue to ensure it does not reignite.

Mustafa Necmi Ilhan, head of the Public Health Department at Gazi University Medical School, said the initial speed of the outbreak in Turkey, which was similar to the worst affected countries such as Italy, prompted fears, but that contact tracing helped break the chain of infection. Turkey also says its distinctive practice of delaying transfer of patients to intensive care from other wards has helped limit the death toll by easing pressure on intensive care resources, such as medical gear and staff.

Ankara has stressed the early use of high flow oxygen instead of intubation when respiratory difficulties appear, as well as early administration of hydroxychloroquine, an anti-malarial drug, before patients develop more severe symptoms. The government said this had lowered the death rate and shortened recovery times.

Hydroxychloroquine, a decades-old generic medicine, has been touted by US President Donald Trump and others as a "game changer" treatment for the highly contagious respiratory illness, and the US Food and Drug Administration (FDA) authorized its use in COVID-19 on an emergency basis. But there is not yet scientific proof that it works. There are currently no approved medicines or vaccines specifically for COVID-19.

Last week the US FDA cautioned against the use of hydroxychloroquine in COVID-19 patients, saying it could cause abnormal heart rhythms and dangerously rapid heart rate. Ilhan said the drug was administered carefully, in different doses depending on the age and health of the patient. While it may have side effects, none had appeared so far, he said. - Reuters