Röportaj: Deniz Renkveren
Faculty Member of Akdeniz University Hospital, Department of Infectious Diseases and Clinical Microbiology, Prof. Ata Nevzat Yalçın: It is of great importance to share knowledge on the efficacy of the existing drugs or the vaccines and drugs that must be developed.
A new one was added to pandemics throughout the world history with the coronavirus pandemic caused by the COVID-19 virus. The corona pandemic that caused the loss of lives in many countries around the world is known as the fourth pandemic since 2000. The corona pandemic that broke out in China 4 months ago has spread to all over the world depending on the speed of transportation of the global world. It has been announced that there is not a single person dying from corona in China since the 6th of April. However, the USA, where approximately 850 thousand people carry the virus according to the latest data, has become the country with the highest number of cases in the world by surpassing the official number of cases in China by ten times. The number of those killed by the virus in China has exceeded 4,600 with the latest updates. However, the number of people who lost their lives due to the corona in Italy, Spain and France, which are the most densely populated countries in Europe in terms of the elderly, has exceeded 20 thousand in each one. According to the latest available data, COVID-19 was detected in 2,628,527 people worldwide while 784,986 cases beat the disease. The number of people who lost their lives due to coronavirus around the world has reached 184,265.
All over the world, the national healthcare systems of countries are giving a tough test against the corona pandemic. Taking necessary lessons from the countries where the virus was previously diagnosed, Turkey acted quickly to take measures against the corona pandemic. Flexible working methods such as remote working or working on rotation were administered for the employees working in public institutions and organizations. The distance education model was introduced for all education levels. A curfew was imposed on citizens over 65 and under 20. “Stay Home” campaign was launched across the country. Both media outlets and social media are used for raising awareness of the Turkish public on the fight against corona. Turkey is quite successful in its fight against corona with a mortality rate of around 2 percent.
Our interview with Faculty Member of Akdeniz University Hospital, Department of Infectious Diseases and Clinical Microbiology, Prof. Ata Nevzat Yalçın is clarifying many issues regarding the COVID-19 virus the world has just got to know and the measures that must be taken against the corona pandemic in the evidence of the latest developments.
First of all, what kind of virus is COVID-19? How does it affect the airways?
COVID-19 was described as a virus associated with the common cold in 1965. It is a member of an RNA virus group. The coronavirus has 4 subgroups including alpha, beta, gamma, and delta. In fact, we previously had 3 alpha coronaviruses that caused the common cold. In addition, we also knew the virus responsible for the SARS outbreak in 2003 and the MERS coronavirus responsible for the MERS outbreak in 2012. The coronavirus, which is responsible for the current pandemic, is also an RNA virus within the beta coronavirus family.
PERSONAL HYGIENE FIRST
Which measures should we take against corona?
What is most important is hygiene while the most significant part is washing hands. When you come home from outside or touch any object, you must wash your hands because the virus can remain on many substances for a long time. For instance, it was found that this virus remained on steel for up to 3 days. It is absolutely necessary to wash hands with soap and water before and after touching vegetables and fruits, before and after using the toilet and after touching pets. When this is not possible for us, we must use a hand antiseptic product if we have one with us. If this is not possible either, it is best to clean our hands with cologne. This is the most important thing. Secondly, it is necessary to avoid going outside and it is also useful to ventilate our environment from time to time. This is also a very important measure. Apart from this, we must definitely avoid hugging each other and shaking hands during this period. We need to maintain a distance of one and a half meters. When we need sneezing, it is also helpful to use our elbow if we do not have any handkerchief with us.
It is very important to drink water frequently. This virus enters into the body through the mouth, nose, and eye. Hydrating our mouth from time to time can enable us to swallow viruses that may colonize our mouth and nose, and eliminate them in the stomach. Drinking fluids significantly contribute to cleansing the body from different harmful substances, especially in terms of kidneys and somehow removing the virus from our mouth.
THE IMMUNE SYSTEM MUST BE STRONG
What impact does a healthy diet have on protection against the virus?
One of the important issues here is to have a balanced diet. It is beneficial to consume all vitamin groups to a certain extent. It is necessary to consider green vegetables containing vitamin A and B groups and the vegetables and fruits containing vitamin C, protecting the body against oxidative stress and protecting cells such as lemon, orange, grapefruit, apple, green pepper and tomato in particular. Vitamin D is another important component. This vitamin is present in eggs, fish, and milk. Similarly, elements such as zinc, selenium, and iron, as well as kefir and ginger, considerably contribute to the strengthening of the immune system. In summary, we should focus on consuming colored vegetables and fruits. Besides, it is important to keep our immune system healthy. In addition to nutrition, it is important to avoid intense physical activity and to have regular sleep.
We know that the drug named chloroquine is used in the treatment of corona. How effective is chloroquine against corona and are there other drugs?
We are using Chloroquine in our cases. We are also using an antiviral agent called Favipiravir supplied from abroad along with Chloroquine. In addition, we are also using some drugs targeting different bacteria. Chloroquine is a drug used for malaria while other agents are drugs used for some other viruses for a long period of time. An analysis of the data from China and other countries makes one think that they are also effective in this malady. There is no certain potent drug for now. It will take 9 to 12 months to develop a potent drug against corona.
How adequate are the measures taken against corona worldwide?
Corona broke out in China. China’s SARS outbreak in 2002 originated from Hong Kong and then, the outbreak spread to some neighboring countries. Guangdong province of China was also affected by the outbreak at the time. China gained experience with these diseases. Therefore, China also played a very effective role here. Namely, Hubei province has a population of about 57 million while Wuhan is a city with a population of 11 million in this province. Upon the outbreak, a population of about 34 million was quickly quarantined, along with Wuhan. As far as I know, this quarantine will continue until the end of April. These quarantine measures considerably prevented the virus from spreading to the other parts of the country. This was very important. We are observing the success of these measures today. As far as I am concerned, there has been no death since the 6th of April, and I think this is a significant consequence. The rising trend has started to fall steadily and there is no death.
TURKEY TOOK MEASURES IN A TIMELY MANNER
What is the place of Turkey in the fight against the corona across the world?
Turkey is actually one of the important countries that have taken measures in a timely manner and are continuing to apply such measures. For instance, personal measures were taken in our country upon the diagnosis of initial cases while a curfew was imposed on the risk group especially including those over the age of 65 and warnings were made to stay home. People over the age of 65 are very important. The countries with the highest mortality rate are somehow the countries with a dense population of people over 65 as well as people suffering from chronic lung disease, cancer, kidney disease, and diabetes. Therefore, the curfew was an important measure taken for these individuals.
Likewise, this curfew was extended to cover the young population under the age of 20. This was another important measure. I believe that the daily meetings organized by the Ministry of Health and the Scientific Committee were instrumental for taking adequate measures and focusing on the issue in a serious manner in Turkey. Making sure that individuals stay home and do not go outside will considerably contribute to the slowdown of the disease’s speed in line with the recommendations of this committee.
There is a very gloomy picture in the USA, Spain, and Italy. We observed that emergency services were not sufficient. In the US, the situation seems to be underwhelming. What was the biggest mistake made by these countries?
Among these countries, Italy is the country with the highest elderly population in Europe. Besides, a considerable number of Chinese workers are employed especially in the industrial zone in the north of Italy. The epidemic that broke out over here affected the elderly population and individuals suffering from multiple diseases. It was likely that they also had delays in introducing quarantine or other measures. Therefore, Italy and, similarly, Spain were affected a little more. The population in the US is higher. The number of old persons is quite high among homeless people in the USA. I think that insufficient quarantine measures resulted in the escalation of the outbreak.
Is it important to wear masks and gloves against corona?
Wearing marks is crucially important. Gloves should not be worn because this gives individuals a false sense of safety. It is important to wash hands when we touch an object or following another activity. Wearing gloves actually causes you to somehow transmit viruses and bacteria from many places you touch to other places. As for the use of masks, the following is important: Firstly, it is useful for infected individuals to wear surgical masks. Secondly, healthcare professionals such as physicians and nurses, who serve patients, should definitely wear surgical masks. Healthcare professionals must wear masks with a higher level of protection such as N95, FFP2, and FFP3 while serving the individuals sampled due to the suspicion of infection and treating the hospitalized patients.
In daily life, we are wearing masks when we have to go outside. It is forbidden to enter into many supermarkets without wearing a mask. How much does this contribute? Is it a good practice?
Actually, wearing masks while entering into indoor environments or healthcare institutions makes a considerable positive contribution in order to keep this social distance in the external environment and as this is a period during which the disease is quite active. This is a good practice because infected individuals may also enter inside. The mask can prevent them from transmitting the disease to healthy individuals and infecting foodstuffs with their secretions.
Considering the incubation period of the corona pandemic as well as the number of cases, can you make any prediction regarding when it will come to an end? The pandemic is said to break out again in autumn. What do you think about this?
The coronavirus has an incubation period of 2 to 14 days on average. In some cases, it may go up to 21 days. The mathematical models developed by public health experts envisage a process of 6 to 8 weeks during which the pandemic will rise to a certain summit, make a peak there and then fall into a decline after remaining at this peak for a while. Of course, it is also stated that the virus will not disappear completely. I think that the disease will prevail for a while in the form of a limited number of cases although there will no pandemic of this magnitude.
Can you say that we can acquire social immunity against this disease over time?
Of course, individuals who are undergoing this disease, the people around them, and a significant part of the community will acquire immunity to this disease.
People over the age of 60 are defined as a risk group. Could you please talk about other risk groups not limited to the age factor?
People with pulmonary diseases such as asthma and bronchiectasis, chronic liver diseases, cirrhosis, chronic renal failure, tumors, diabetes, those using immunosuppressive drugs, and hypertensive individuals were detected as risk groups in the analysis of cases from China. When these groups are infected with the corona, this disease has a more severe course and the crude mortality rate is higher among these groups. It was observed that the speed of recovery was slow in some infected individuals due to certain substances in the cigarette. There are warnings such as “stop smoking and drinking alcohol” throughout this process. Another conclusion from these analyses is that male patients go through a severe course when compared to female patients.
80 PERCENT OF VIRUS CARRIERS DO NOT DEVELOP ANY SYMPTOM
Some experts say that the corona will infect the entire population in one way or another. Some experts argue that this will not be the case. In any case, are we likely to overcome this disease lightly even if we get infected when we strengthen our immunity as a society?
The analysis of cases from China indicates that between 70 and 80 percent of virus carriers underwent this disease without developing any symptom or in an asymptomatic way as we call it. Very few have various respiratory complaints. This is the case in 80 percent of the cases. Around 15 percent of the total cases developing the disease-specific symptoms are considered as the group for whom diagnostic procedures must be performed and treatments must be administered. Some of these cases corresponding to around 4-5 percent of them must be treated while intubated to other respirators under intensive-care conditions. In other words, the vast majority of the population will actually undergo, are undergoing or underwent this disease without even realizing it. It is important that their rate of immunity reaches a certain level because this virus is highly infectious. In other words, 1 person is infecting 3 to 4 persons on average. Considering this situation over time, the number of patients may reach quite a number in a month. Therefore, the mortality rate is now around 2 percent. A serious focus on the necessary measures will contribute to a lower mortality rate or a lighter course of the disease among certain risk groups including the elderly in particular.
Does the Corona cause any permanent damage to the lungs or other organs?
It has been 3.5 to 4 months since the diagnosis of the first case in China. Until now, there is no clear data on getting ill again and post-disease permanent damage in infected persons. Antibodies are thought to be protective. Time will tell the answer to these questions. In some cases, it is thought that there may be a loss of flexibility in the lungs but it is not clear, yet.
TABIP IS STRENGTHENING DOCTORS AROUND THE WORLD AGAINST THE CORONA VIRUS
Do you have any recommendations to your colleagues or general suggestions on solidarity and drug development for healthcare systems across the world?
It is important to share information on various platforms. It is especially very important to share information about the efficacy of existing drugs or the vaccines and drugs that must be developed. Various social platforms have been created to share epidemic data for the early diagnosis of certain risk groups and these are shared with our colleagues. For instance, I think that I have benefited a lot from the TABIP portal led by Yunus Emre Institute. Thank you for your contributions to this matter.