Turkey update 04 April 2020
Mehmet Haberal, Baskent University, Ankara
As of 04.04.2020, the number of confirmed cases in Turkey is 20921 with 425 deaths. A total of 484 people have fully recovered following treatment. Most of the victims in Turkey have been elderly.
The first batch of rapid COVID-19 tests arrived last week and 50,000 quick diagnostic kits --which allow comprehensive results in 60 minutes-- came from China on 25.03.2020 and an additional 300,000 kits arrived the day after. All private and foundation hospitals have been designated as pandemic hospitals as of 20.03.2020.
Currently, as Baskent Ankara Hospital, we have assigned one floor for the patients, but it will be reorganized based on the circumstances. Transplant surgeries and all except acute liver failure transplantation, cancer and urgent surgery are postponed in all public and private hospitals in Turkey.
We are closely monitoring our transplant patients in our centers located in different cities of Turkey. Our transplant committee has prepared the following immunosuppressive protocol for COVID-19 transplant recipients:
Antiproliferative immunosuppressant drugs (antimetabolites; mycophenolate mofetil, mycophenolate sodium and azathioprine) should be stopped. Dose reduction or cessation of calcineurin inhibitors (tacrolimus, cyclosporine) has not been clearly defined. Patients who need intubation and have severe pneumonia may benefit from cessation of calcineurin inhibitors. Anti-inflammatory drugs, like tocilizumab may be useful in severe cases. In mild cases, dose reduction of calcineurin inhibitors is preferred. However, calcineurin inhibitors should be stopped if antiviral therapy starts. Steroid therapy should be tapered instead of cessation. Antiviral therapy should be started according to computed tomography scans and continued according to nasopharyngeal swap pcr results.
Fortunately, so far, there are no transplant patients diagnosed with COVID-19 at the Baskent University centers located in various cities. Interestingly, the rate of COVID-19 has been really low among our dialysis patients. We have 21 dialysis centers all over the country, with 2420 hemodialysis patients and 30 peritoneal dialysis patients. Only 3 patients have been diagnosed with COVID-19, which makes a prevalence of about one per thousand. We have commenced a randomized sample study of our 2420 dialysis patients at Baskent University. While negative for SARS-CoV2, 94.7% were hepatitis A antibody positive so we will continue this study of virus prevalence.
According to the authorities in Ministry of Health there are no transplant patients who are COVID-19 positive reported officially to date.
Detailed information on measures taken to prevent the spread of SARS-CoV2 in Turkey can be reached through https://hsgm.saglik.gov.tr/tr/covid19
COVID-19 Committees for TOND (The Turkish Transplantation Society), MESOT (Middle East Society for Organ Transplantation) and TDTD (Turkic World Transplantation Society) have also been formed.
As of today, the number of confirmed cases is 1872 with 44 deaths. Most of the deaths in Turkey to date have been elderly, two were age 50-60, one was 91, and all the others were older than 61. Schools, universities, mosques, shopping malls and hairdressers have been temporarily closed and professional sports have been halted as part of measures to contain the virus. The Ministry of Health also announced that cafes, restaurants, pastry shops, and similar workplaces are closed and will only fulfill online orders and takeaway. There are restrictions on supermarkets, banks and public transport systems are obliged to limit their numbers to a maximum of 50% of their licensed capacity. Turkish citizens who are older than 65 and/or suffer from chronic illnesses are restricted from leaving home or even walking in open areas such as parks and gardens.
The first batch of rapid COVID-19 tests arrived last week. 50,000 quick diagnostic kits allowing comprehensive results in 60 minutes arrived today with an additional 300,000 kits arriving this week. All private and foundation hospitals have been announced as pandemic hospitals as of last Friday. At Baskent Ankara Hospital, we have currently assigned one floor for COVID-19 positive patients. Transplant surgery and general surgeries, except for transplants for acute liver failure, as well as cancer and emergency surgery are postponed in all public and private hospitals in Turkey. Detailed information can be reached through following link provided by the Ministry of Health https://hsgm.saglik.gov.tr/tr/covid19