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Istanbul Death Toll Hints Turkey Is Hiding a Wider Coronavirus Calamity Istanbul Death Toll Hints Turkey Is Hiding a Wider Coronavirus Calamity
(7 days later)
ISTANBUL — For weeks President Recep Tayyip Erdogan has presented Turkey’s performance in handling the coronavirus as one of the world’s most successful, as he maintained strict control over information about the outbreak.ISTANBUL — For weeks President Recep Tayyip Erdogan has presented Turkey’s performance in handling the coronavirus as one of the world’s most successful, as he maintained strict control over information about the outbreak.
The presidential palace rolled out a carefully orchestrated propaganda campaign, ensuring reports from hospitals, grave sites and mourning relatives remained virtually absent. Doctors who spoke out on social media were reprimanded, and 410 people were detained in March for “provocative and abusive” posts.The presidential palace rolled out a carefully orchestrated propaganda campaign, ensuring reports from hospitals, grave sites and mourning relatives remained virtually absent. Doctors who spoke out on social media were reprimanded, and 410 people were detained in March for “provocative and abusive” posts.
But data compiled by The New York Times from records of deaths in Istanbul indicate that Turkey is grappling with a far bigger calamity from the coronavirus than official figures and statements would suggest. The city recorded about 2,100 more deaths than expected from March 9 to April 12, based on weekly averages from the last two years, far more than officials reported for the whole of Turkey during that time.But data compiled by The New York Times from records of deaths in Istanbul indicate that Turkey is grappling with a far bigger calamity from the coronavirus than official figures and statements would suggest. The city recorded about 2,100 more deaths than expected from March 9 to April 12, based on weekly averages from the last two years, far more than officials reported for the whole of Turkey during that time.
While not all those deaths are necessarily directly attributable to the coronavirus, the numbers indicate a striking jump in fatalities that has coincided with the onset of the outbreak, a preliminary indicator that is being used by researchers to cut through the fog of the pandemic and assess its full toll in real time.While not all those deaths are necessarily directly attributable to the coronavirus, the numbers indicate a striking jump in fatalities that has coincided with the onset of the outbreak, a preliminary indicator that is being used by researchers to cut through the fog of the pandemic and assess its full toll in real time.
Even by the official count, confirmed cases in Turkey rose to more than 90,000 by Monday, lifting Turkey above China to become the seventh-most affected country in the world. Deaths have reached 2,140.Even by the official count, confirmed cases in Turkey rose to more than 90,000 by Monday, lifting Turkey above China to become the seventh-most affected country in the world. Deaths have reached 2,140.
The government maintains that it acted swiftly, stopping flights and border crossings from five of the most affected countries in February, and closing schools, restaurants and bars in mid-March, when the first infection was confirmed.The government maintains that it acted swiftly, stopping flights and border crossings from five of the most affected countries in February, and closing schools, restaurants and bars in mid-March, when the first infection was confirmed.
But by then, the statistics compiled by The Times show, the damage was done.But by then, the statistics compiled by The Times show, the damage was done.
The government announced the country’s first death from Covid-19 on March 17. But the statistics compiled by The Times suggest that even around that time, the number of deaths overall in Istanbul was already considerably higher than historical averages, an indication that the virus had arrived several weeks earlier.The government announced the country’s first death from Covid-19 on March 17. But the statistics compiled by The Times suggest that even around that time, the number of deaths overall in Istanbul was already considerably higher than historical averages, an indication that the virus had arrived several weeks earlier.
Still, Mr. Erdogan assured the nation on March 18, after the second death was announced, that Turkey had “quickly taken all precautions.”Still, Mr. Erdogan assured the nation on March 18, after the second death was announced, that Turkey had “quickly taken all precautions.”
“We, together with our people, rose to this challenge ably and decisively, as we always do in the face of attacks against our country,” he said.“We, together with our people, rose to this challenge ably and decisively, as we always do in the face of attacks against our country,” he said.
Yet the actions taken by Mr. Erdogan since early February have revealed his priorities. He has repeatedly tried to reassure the population, describing how he eats a spoonful of mulberry molasses every morning to boost the blood. And, in an effort to keep at least part of the economy functioning, he has avoided ordering a complete nationwide lockdown.Yet the actions taken by Mr. Erdogan since early February have revealed his priorities. He has repeatedly tried to reassure the population, describing how he eats a spoonful of mulberry molasses every morning to boost the blood. And, in an effort to keep at least part of the economy functioning, he has avoided ordering a complete nationwide lockdown.
An economic collapse would spell disaster for his presidency. His popularity had been sliding amid a faltering economy and high unemployment, even before the pandemic.An economic collapse would spell disaster for his presidency. His popularity had been sliding amid a faltering economy and high unemployment, even before the pandemic.
Instead, Mr. Erdogan has introduced gradual measures to encourage social distancing, restricted domestic travel, and ordered a curfew for those over 65 and under 20 years old.Instead, Mr. Erdogan has introduced gradual measures to encourage social distancing, restricted domestic travel, and ordered a curfew for those over 65 and under 20 years old.
Yet the infections have spread, ballooning in Istanbul and Izmir, big cities with international business and tourism connections, as well as in central cities where 6,000 pilgrims returning from Saudi Arabia did not always follow self-isolation rules.Yet the infections have spread, ballooning in Istanbul and Izmir, big cities with international business and tourism connections, as well as in central cities where 6,000 pilgrims returning from Saudi Arabia did not always follow self-isolation rules.
The government has said the high case count is because of its widespread testing — there have been more than 600,000 tests. And it has also pointed out that the rate of infection is dropping.The government has said the high case count is because of its widespread testing — there have been more than 600,000 tests. And it has also pointed out that the rate of infection is dropping.
Still, deaths in Istanbul during the five-week period between March 9 and April 12 were about 30 percent higher than historical averages, The Times has found.Still, deaths in Istanbul during the five-week period between March 9 and April 12 were about 30 percent higher than historical averages, The Times has found.
In the first two weeks of April, the most recent figures available, deaths in Istanbul were about 50 percent higher than average. Increases of that magnitude are worrisome and seem clearly related to the outbreak, said Stephane Helleringer, a demographer at Johns Hopkins University.In the first two weeks of April, the most recent figures available, deaths in Istanbul were about 50 percent higher than average. Increases of that magnitude are worrisome and seem clearly related to the outbreak, said Stephane Helleringer, a demographer at Johns Hopkins University.
Any death statistics in the midst of a pandemic are tricky to pin down and must be considered preliminary. Many European countries are engaged in trying to improve their death statistics, which they now acknowledge are incomplete.Any death statistics in the midst of a pandemic are tricky to pin down and must be considered preliminary. Many European countries are engaged in trying to improve their death statistics, which they now acknowledge are incomplete.
The Istanbul totals may include both deaths directly linked to the coronavirus as well as those from other causes, like cancer or heart disease, that may have become more common as hospitals reached capacity and people avoided seeking medical care.The Istanbul totals may include both deaths directly linked to the coronavirus as well as those from other causes, like cancer or heart disease, that may have become more common as hospitals reached capacity and people avoided seeking medical care.
The Times’s findings were supported by Onur Altindag, an Assistant Professor of Economics at Bentley University, who has published data from 10 cities in Turkey comparing them with statistics from the previous four years.The Times’s findings were supported by Onur Altindag, an Assistant Professor of Economics at Bentley University, who has published data from 10 cities in Turkey comparing them with statistics from the previous four years.
He found a similar number of excess deaths in Istanbul from March 11 to April 12. The total number of confirmed Covid-19 deaths across Turkey as of April 12 was 1,006, less than half the excess deaths in Istanbul alone, he said.He found a similar number of excess deaths in Istanbul from March 11 to April 12. The total number of confirmed Covid-19 deaths across Turkey as of April 12 was 1,006, less than half the excess deaths in Istanbul alone, he said.
Turkey’s Health Ministry has released only limited data on the spread of the virus and only announced numbers of Covid-19 cases in individual cities on one occasion, on April 1.Turkey’s Health Ministry has released only limited data on the spread of the virus and only announced numbers of Covid-19 cases in individual cities on one occasion, on April 1.
Istanbul, a city of 16 million, accounted for 60 percent of confirmed cases of Covid-19 on that day, said Dr. Fahrettin Koca, the Health Minister.Istanbul, a city of 16 million, accounted for 60 percent of confirmed cases of Covid-19 on that day, said Dr. Fahrettin Koca, the Health Minister.
Several others cities, including Ankara and Izmir, have been declared growing hot spots. On April 10, Turkey began enforcing lockdowns on weekends in 31 metropolitan areas.Several others cities, including Ankara and Izmir, have been declared growing hot spots. On April 10, Turkey began enforcing lockdowns on weekends in 31 metropolitan areas.
Mr. Altindag also found early signs of excess deaths in the town of Sakarya, one of the cities included in the lockdown order.Mr. Altindag also found early signs of excess deaths in the town of Sakarya, one of the cities included in the lockdown order.
Updated June 24, 2020 Updated June 30, 2020
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Officials like Dr. Koca have emphasized that Turkey’s health care system was vastly expanded over the last two decades under Mr. Erdogan, that patients are recovering from the virus and that Turkey will reach its peak in about a week.Officials like Dr. Koca have emphasized that Turkey’s health care system was vastly expanded over the last two decades under Mr. Erdogan, that patients are recovering from the virus and that Turkey will reach its peak in about a week.
But medical professionals warn that Turkey may not have a grip of the spread of the virus. “In February they did nothing although it was known the disease was there,” Dr. Sinan Adiyaman, head of the Turkish Medical Association, said in a telephone interview.But medical professionals warn that Turkey may not have a grip of the spread of the virus. “In February they did nothing although it was known the disease was there,” Dr. Sinan Adiyaman, head of the Turkish Medical Association, said in a telephone interview.
Personal protection equipment has been lacking in some places, and testing was only ramped up to a sufficient level in April, he added.Personal protection equipment has been lacking in some places, and testing was only ramped up to a sufficient level in April, he added.
And Turkey is only counting cases of Covid-19 that have been confirmed with a positive test result. It is not including in its totals cases that have been clinically diagnosed as Covid-19 but have not been tested positive, Dr. Adiyaman said.And Turkey is only counting cases of Covid-19 that have been confirmed with a positive test result. It is not including in its totals cases that have been clinically diagnosed as Covid-19 but have not been tested positive, Dr. Adiyaman said.
“The data we have is not sufficient to say if they are controlling the pandemic,” he said.“The data we have is not sufficient to say if they are controlling the pandemic,” he said.
The Turkish Medical Association, an independent professional association with about 120,000 members, has called for more transparency, which would help doctors better understand the disease.The Turkish Medical Association, an independent professional association with about 120,000 members, has called for more transparency, which would help doctors better understand the disease.
The association presented 22 questions to the minister last week, requesting data about cases, the demographics of those infected and details on the number of health care workers who have become sick. They have yet to receive answers.The association presented 22 questions to the minister last week, requesting data about cases, the demographics of those infected and details on the number of health care workers who have become sick. They have yet to receive answers.
Dr. Adiyaman said that the science board, a group of experts set up by the government to advise its management of the pandemic, does not make its decisions public and the government does not share data with his association.Dr. Adiyaman said that the science board, a group of experts set up by the government to advise its management of the pandemic, does not make its decisions public and the government does not share data with his association.
The health minister announced that 601 health personnel had been infected with the virus by April 1. But Dr. Adiyaman said that nearly 1,500 have been infected, including 1,000 in Istanbul. Seventeen health professionals have died from the virus in Istanbul, according to reports released by several trade unions.The health minister announced that 601 health personnel had been infected with the virus by April 1. But Dr. Adiyaman said that nearly 1,500 have been infected, including 1,000 in Istanbul. Seventeen health professionals have died from the virus in Istanbul, according to reports released by several trade unions.
“From the beginning there has been a problem with personal protective equipment,” he said. “Some are worried that their P.P.E. will run out and they will not have new ones.”“From the beginning there has been a problem with personal protective equipment,” he said. “Some are worried that their P.P.E. will run out and they will not have new ones.”
“Some are working 12-hour and 24-hour shifts, and this is causing burnout,” he added.“Some are working 12-hour and 24-hour shifts, and this is causing burnout,” he added.
Although the government showed a 63 percent approval rating in a recent poll for its performance tackling the coronavirus pandemic, the rush of panic buying that occurred around the country when a curfew was abruptly announced in several major cities on April 10 gave a glimpse of growing public anxiety.Although the government showed a 63 percent approval rating in a recent poll for its performance tackling the coronavirus pandemic, the rush of panic buying that occurred around the country when a curfew was abruptly announced in several major cities on April 10 gave a glimpse of growing public anxiety.
Mr. Erdogan’s government is already short of cash and has depleted reserves shoring up the Turkish lira over the last year. With businesses closing and one of Turkey’s main income earners, tourism, halted, the government has several times had to announce additional assistance for workers and businesses.Mr. Erdogan’s government is already short of cash and has depleted reserves shoring up the Turkish lira over the last year. With businesses closing and one of Turkey’s main income earners, tourism, halted, the government has several times had to announce additional assistance for workers and businesses.
The virus has already revealed the gathering strength of Mr. Erdogan’s opponents. Increasingly confident and active opposition politicians, including the mayors of Istanbul and Ankara — Ekrem Imamoglu and Mansur Yavas — have marked Mr. Erdogan’s every step, and have often been ahead of him in offering assistance to their constituents.The virus has already revealed the gathering strength of Mr. Erdogan’s opponents. Increasingly confident and active opposition politicians, including the mayors of Istanbul and Ankara — Ekrem Imamoglu and Mansur Yavas — have marked Mr. Erdogan’s every step, and have often been ahead of him in offering assistance to their constituents.
The opposition mayors have forced Mr. Erdogan to provide free face masks for the entire population — an added cost when the government had at first planned to have private companies sell masks to people. The government has also offered free health care for all, including for those who have not made social security contributions.The opposition mayors have forced Mr. Erdogan to provide free face masks for the entire population — an added cost when the government had at first planned to have private companies sell masks to people. The government has also offered free health care for all, including for those who have not made social security contributions.
Well aware of the government’s economic straits, the opposition has not eased the pressure during the pandemic. If anything, it has increased its efforts to see that the people of Turkey do not lose out.Well aware of the government’s economic straits, the opposition has not eased the pressure during the pandemic. If anything, it has increased its efforts to see that the people of Turkey do not lose out.
“The government is devastated,” Kemal Kilicdaroglu, the leader of the opposition Republican People’s Party, said in an interview on a national television channel Haberturk TV. “They do not know what to do. There is no money. This is the truth.”“The government is devastated,” Kemal Kilicdaroglu, the leader of the opposition Republican People’s Party, said in an interview on a national television channel Haberturk TV. “They do not know what to do. There is no money. This is the truth.”
Allison McCann contributed reporting from London.Allison McCann contributed reporting from London.