2. Ensuring sufficient physical infrastructure and workforce capacity
ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability of health workers. The section considers the physical infrastructure available in a country and where there are shortages, it describes any measures being implemented or planned to address them. It also considers the health workforce, including what countries are doing to maintain or enhance capacity, the responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health workers.
2.1 Physical infrastructure
Hospitals, intensive care units and acute beds
On 30 March 2020, Okmeydani Hospital in Istanbul, with currently over 600 beds, including 81 high-tech intensive care unit, was designated to serve coronavirus patients besides its regular services. In addition, Kartal Hospital, in Istanbul, is used as a COVID-19 treatment center. Two other existing facilities in the vicinity of Istanbul, a hospital in Pendik and a section of the hospital in İkitelli were opened on 10 April and repurposed to treat COVID-19 patients.
On 6 April 2020, the President announced that two new hospitals would be established in Istanbul to address the coronavirus pandemic, each one with a capacity of 1000 beds. One of the hospitals will be built in the location of Atatürk Airport (Istanbul’s old airport) on the European side of the city, while the other will be built in Sancaktepe, on the Asian side. These two new hospitals are expected to be built within 45 days.
The overall capacity of adult intensive care units in Turkish (public and private) hospitals has been estimated to be 25,466, which the Ministry of Health judges is likely to cover needs in critical scenarios. However, the number of ICU beds per 10 000 population varies between the regions in the country, ranging from 5.6 per 10 000 population in the Mediterranean region, 4.8 in Istanbul and 3.3 in Northeastern Anatolia. (Health Statistics Yearbook, 2018 at https://dosyasb.saglik.gov.tr/Eklenti/36164,siy2018en2pdf.pdf).
Currently, the intensive care bed occupancy rate around the country in approximately 60% , with the occupancy rate of regular beds at 50.2%.
As a precautionary measure in case of a surge in cases needing criticla care, on 23 March 2020, the Minister of Health mentioned that the production of ventilators would be increased in Turkey. By the day of writing (May 15) there was no documented shortage of ventilators, and nearly all hospitals have enough ventilators to treat COVID-19 patients. The new ventilators produced for this pandemic are being distributed to hospitals in Istanbul, the main center for treatment of COVID-19, and will be distributed to other provinces if needed.
PPE for health workers
On 30 March 2020, the President announced that 24 million surgical masks, over 3 million N95 masks, and over 1 million protective gowns and goggles would be distributed to hospitals and that production of these materials would be increased.
There are no documented shortages of any of the above-mentioned items. However, restrictions have been placed on the export of PPE for the time being. In addition, grant programs have been launched to support the production of COVID-19 tests or PPE projects through regional development agencies.
Masks for the general population
On 5 April 2020, officials announced that Turkey would start distributing free face masks to citizens to stem the spread of COVID-19 in the country. Citizens can apply for free masks through the national postal service e-commerce website (www.ePttAVM.com). All citizens, except those aged under 20 or over 65, who have been curfewed, can apply for five free masks weekly. The government policy regarding curfewed population groups is that they did not need the masks during the period at home.. As of 10 April 2020, 3.5 million masks had been distributed.
Since 6 April 2020, the sale of face masks has been prohibited; instead, face masks are given out for free at supermarkets or distributed to homes by the Turkish postal service (PTT). On 8 April 2020, Turkey began distributing free face masks and hand sanitizers (cologne) to people in higher risk groups, including those aged 65 or over and people suffering from chronic illnesses. In addition, the Turkish Pharmacists’ Association (TFA) announced that as part of an agreement with the Ministry of Health, as of 10 April 2020, pharmacies in Ankara and İstanbul, and later in other provinces, would also start distributing free masks to people aged between 20 and 65.
On 9 April 2020, Minister of Interior reported that 10 million masks were being distributed daily, and the same amount was being produced. The aim is to raise production to 20 million units per day shortly.