DAILY INTERVIEWS

Associate Professor Çağhan Kızıl: Covid-19 is not an illness of the aged, everybody is in the risk group

Associate Professor Çağhan Kızıl, working on neuroscience and genetics in the Dresden University Medical Faculty, answered our questions on the coronavirus pandemic.

Çağhan Kızıl

Meltem AKYOL
İstanbul

Concerns continue to surge as figures in the Coronavirus (Covid-19) pandemic rise. What does these figures tell us and what are we to expect? Associate Professor Çağhan Kızıl, working on neuroscience and genetics in the Dresden University Medical Faculty, answered our questions on the coronavirus pandemic.

THE RATE OF INCREASE IN TURKEY IS ABOVE ALL OTHER COUNTRIES

Since the emergence of the first case in Turkey, figures have increased manifold, what are we facing, shall we first start with that? And the most asked question, are we becoming Italy?

As with everywhere in the world, cases are on the rise in Turkey. This is a viral illness with a high transmission rate from person to person, so the increase is measured with a doubling index. This is a model based on the number of days it takes for the number of infected to double. To make a projection taking into consideration the number of cases and tests reported in the last three days, the rate of increase in Turkey is unfortunately above all other countries. This could mean a few things. Only those who have symptoms or are highly ill are tested and this may mean that percentages are high because of this. But even if this was the case, it is an indication that the number of infected people in the population are much higher than we think. In the statement he gave yesterday, the Minister for Health implied that there are cases almost everywhere across the country anyway. Taking into consideration that the number of tests is significantly lower compared to Europe, we can talk about a rapid increase. This is concerning. Whether we will become Italy is a question that will be answered by the extent to which our health system is prepared for the high number of cases we can see in the horizon. We come across substantial issues at this point too. We may aver that things are not going well.

WE MAY BE AT LOOKING A CLEARER PICTURE IN THE COMING 2-3 WEEKS

There are statements that the week ahead is critical, are we able to provide a timescale?

COVID-19 symptoms become visible in 1 to 2 weeks unlike the common cold which takes 1 to 2 days. Hence the illness reaches its peak after a delay of couple of weeks. If the time of the declared first case is accurate, the disease has now been on the increase for the last two weeks. We will be able to see a clearer picture in the coming 2-3 weeks.

THE HERD IMMUNITY PRACTISE IS TELLING PEOPLE ‘TO GO TO RUIN’

The issue of herd immunity tried in Britain, Netherlands and Sweden has been much discussed and criticised. What is herd immunity? Is Turkey implementing this policy?

In the herd immunity system, the main purpose is to leave the disease to run its course in as controlled a way as possible. In this way, some people will catch the disease and will lose their lives, but some will also gain immunity. It can be formulated as when the amount of people in society reaches a certain level then a social immunity would have been achieved. One of the main parameters of this system is the health service capacity. This is because the number of people entering and exiting hospitals should be almost equal so as to allow for the sustainability of the system. In our age, the rate of patients to those who recover is 9. In other words, there is no validity of herd immunity under such conditions. The lockdown decision announced in United Kingdom the previous night is evidence to this. In this model, one of the most effective methods of intervention is the regulation of the movement of children and geriatric population in society. If the number of people entering hospitals is lower than those exiting then you are increasing the disease in the society, for instance by keeping schools open. This is what we see when considering Turkey’s policies.

It may be being implemented in Turkey without mention: the complete interruption brought to social interaction, at first the closure of schools, and now the introduction of curfews for those over 65 are indicative of this.

What will this lead to?

For Turkey, the implementation of this model will lead to great peril. There is not enough hospital or infrastructure to do this anyway. The Minister for Health, the previous day, said they will be recruiting 32 thousand new staff but this also takes time. This is sending an invitation to disaster.

12% OF THOSE IN INTENSIVE CARE ARE UNDER 45

What does the figures about those infected and lost their lives tell us? Who are in the risk groups?

Everybody is in the risk group. Three quarters of those infected across the world are under 60. A sixth of patients needing intensive care are under 50. We do see a higher percentage of deaths in those over 70, however, people across all ages are affected. Life risk for those with cancer, cardiovascular diseases, chronic illnesses such as diabetics is higher. But this is not a disease of the “aged”. It is a disease impacting everyone.

But many people continue with their normal lives, saying they are not from risk groups, what should be happening, what does saying I don’t belong to the risk group lead to?

As stated, young people are carriers of this disease. According to scientific research on the subject, many asymptomatic people are the most active group in transmitting this disease. There are findings that 86% of infections in the first pandemic in China were carried by these undefined and asymptomatic people. After a complete curfew was introduced, this figure is reduced to 14%. Almost half of the geriatric population in Turkey is sharing a house with at least one young person in Turkey. Hence the infection has the potential to enter every household. Let’s underline once again, 12% of patients taken into intensive care are under 45 years old. In other words, young people should not say “nothing will happen to us” under any circumstance. They can both catch the disease and transmit it to others.

VIRUS FOUND ALSO IN CHILDREN’S FAECES

What’s the situation of children?

Children are becoming infected too. And are even displaying symptoms. In the age distribution of infections, the proportion of children under 15 years of age is around 5%.  Positively no child death has been reported so far. But children do also experience symptoms such as pneumonia and other symptoms. Virus was even found in children’s faeces. Whether this virus could infect is not known but children are still one of the most effective means of transmission for this disease.

95% OF THE CASES IN SOUTH KOREA, 90% IN GERMANY IDENTIFIED WITH TESTS

As for the matter of tests… TTB, the Medical Association, experts, you.. all are calling for tests. Why are tests so important?

The spread of the virus is enabled especially by undiagnosed individuals and mostly by young people. A paper published in the Science journal had shown that unidentified cases considerably accelerate the rate of spread. As such, the capacity for diagnosis should increase so as to allow individuals spreading the illness to be identified and isolated from social interaction. South Korea and Germany are good examples to this. 95% of cases in South Korea and 90% of cases in Germany are identified with tests. This is what the models shows. For this reason, both these countries protected the geriatric population and despite the increase, are experiencing lower numbers of death. Science is suggesting testing. Italy is in this state because of not being able to identify the sick.

Are there enough tests in Turkey?

No. From the very start, many molecular biologists and myself have said universities and leading people should get involved with this and that we could raise our test capacity to much higher levels. 24 thousand tests have been done in the 13 days that has lapsed since the outbreak of the pandemic. This figure is 167 thousand in Germany, 207 thousand in Italy, 317 in South Korea. These are the facts. According to a statement by the Molecular Biology Association, weekly test capacity may be increased to 50 thousand per week.

COMPLETE CURFEWS, PAID LEAVE FOR ALL, WIDESPREAD TESTING…

A curfew has been declared for those over 65. Is this enough? Considered more broadly, what can you say about Turkey’s approach to coronavirus, indeed the package announced by the President last week was debated and criticised widely?

The restrictions brought to those over 65 are not adequate, because those under 65 are those infected and carry the disease the most. It seems to me that this practice has the purpose of enabling the sustainability of the workforce and protecting the economy. A complete curfew must be declared and paid leave should be granted to all ensuring no loss of rights. One can combat this disease only in this way. This is what is done in Europe. Yesterday, United Kingdom began this practise too, this is also what science says. On the long-term economy will inevitably suffer if the spread of the disease rises.

WE ARE SEEING THE VINDICATION OF CALLS FOR ACCESSIBLE HEALTH FOR ALL…

The world has been locked into the issue of coronavirus for over 2 months.

But despite this, serious crises are experienced in many countries leaving aside the exceptions… Italy, Spain, Britain, Iran… Why did states not take precautions?

Inertia was the greatest mistake here. Travel was restricted much too late, economic motives prevented mobilisation. The policy of wait and see was wrong. Measures were not taken early. The society did not pay much either, to be sure. Nothing will happen to me, it is too far, was the attitude. But it takes the virus only a day to find you.

We witnessed the collapse of the health system…

It is said that the world will not be as it was, this is true. After each major pandemic we witness radical changes. In some articles, there are also those who dub this situation as epidemiologic neoliberalism. This is true too. If you subject the health system to profitable or populist practises, at the end, no capacity, equipment or staff could be adequate to this situation. This will be widely discussed once the pandemic is over. Fairer heath services accessible by all were subjects discussed for a long time, we are now experiencing the truth of this call in a disaster as a world. We witness especially how countries like the US with privatised health services are rendered disadvantaged in containing such a disaster. It is now more than necessary than ever to defend equal health services and access to health services for all.


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