For weeks President Recep Tayyip Erdogan has presented Turkey's performance in handling 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.
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 9th to April 12th, 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 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.
Swift action
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 show, the damage was done.
The government announced the country’s first death from Covid-19 on March 17th. But the statistics 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, Erdogan assured the nation on March 18th, 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.
Yet the actions taken by 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. Instead, Erdogan has introduced gradual measures to encourage social distancing, restricted domestic travel, and ordered a curfew for those over 65 and under 20.
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.
Historical averages
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 9th and April 12th were about 30 per cent higher than historical averages, the New York Times has found. The newspaper's findings were supported by Onur Altindag, an assistant economics professor 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 11th to April 12th. The total number of confirmed Covid-19 deaths across Turkey as of April 12th 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 announced numbers of Covid-19 cases in individual cities on only one occasion, on April 1st.
Istanbul, a city of 16 million, accounted for 60 per cent of confirmed cases of Covid-19 on that day, said Dr Fahrettin Koca, the health minister. Officials such as Koca have emphasised that Turkey's healthcare system was vastly expanded over the last two decades under 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.
Insufficient data
Personal protection equipment has been lacking in some places, and testing was ramped up to a sufficient level only in April, he added. And Turkey is counting only 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, Adiyaman 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 association presented 22 questions to the minister last week, requesting data about cases, the demographics of those infected and details on the number of healthcare workers who have become sick. They have yet to receive answers.
Adiyaman said the science board, a group of experts set up by the government to advise its management of the pandemic, did not make its decisions public and the government did not share data with his association.
The health minister announced that 601 health personnel had been infected with the virus by April 1st. But Adiyaman said that nearly 1,500 had 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 PPE will run out and they will not have new ones.”
Curfew announced
“Some are working 12-hour and 24-hour shifts, and this is causing burnout,” he added. Although the government received a 63 per cent 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 10th gave a glimpse of growing public anxiety.
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.
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, 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."
