key: cord-0946184-oj8v1ad4 authors: DOĞAN, Mehmet; BAYRAKTAR, Muhammet title: COVID-19 with a Public Health Perspective: Measures Taken in Turkey and Public Compliance with the Measures date: 2020-10-03 journal: Iran J Public Health DOI: 10.18502/ijph.v49is1.3671 sha: fa787c45acb79cf7bcac02c081740ba763431125 doc_id: 946184 cord_uid: oj8v1ad4 BACKGROUND: This study aimed to evaluate the COVID-19 as seen worldwide from a public health perspective and evaluate the measures taken across Turkey against the virus and to determine the compliance of people with these measures. METHODS: WHO’s official COVID-19 cases were evaluated up to 27 Mar 2020. Public measures adopted by Turkey in combating the COVID-19 were examined. The compliance of those applying to Family Health Centers (FHC) with these measures was also evaluated. RESULTS: Overall, 178 people who applied to the FHC were included in the study. Of the participants, 65.2% were women, and the average age was 56.47±17.27 (Min:18, Max:92). The most frequently used personal protection (96.1%) against the epidemic was liquid soap. According to the participants, avoiding patients (99.7%) and frequent hand washing (97.2%) were stated to as the most effective measures to protect against COVID-19. One of the first and most influential bodies in the fight against COVID-19 in Turkey is the Scientific Committee consisting of academicians. Turkey has taken measures such as closing land borders, stopping all flights, vacationing schools, closing places of worship, and stopping sports events. CONCLUSION: The COVID-19 has affected societies in many areas such as health, education, sports, and trade. Countries should take appropriate and timely measures to combat COVID-19. The public must comply with the precautions taken to fight COVID-19. Besides, all countries should take general precautions for public health against increasing epidemics. A disease or health problem should meet specific criteria to be considered a public health problem. These criteria can be listed as follows: the problem affects many individuals in society and will continue to affect in the future, but it does not affect everyone equally and should affect some disadvantaged groups more. Thus, it should be a threat in terms of mortality, morbidity, quality of life, and cost. Most importantly, the problem is preventable. Although preventive strategies can be developed concerning the problem, preventive studies on this issue can be said to be insufficient (1, 2) . According to these features, coronavirus has become a worldwide public health problem. tory syndrome. Common symptoms of infection are respiratory symptoms, fever, cough, and dyspnea. In more severe cases, pneumonia, severe acute respiratory infection, kidney failure and death may develop (3) . In China, a CoV that has higher pathogenicity called SARS-CoV (Severe Acute Respiratory Syndrome-CoV) and leads to serious respiratory infection, emerged in 2003. SARS-CoV spread quickly around the world. Eight thousand cases of this virus were reported, and 700 deaths occurred (4) . In 2012, a 60-year-old man died in Saudi Arabia from acute respiratory infection and kidney failure. This virus has been identified as MERS-CoV (Middle East Respiratory Syndrome-CoV) with cell culture and genome sequencing (5) . As of Nov 2014, there were 909 identified MERS-CoV cases, and 331 deaths were reported by WHO (6) . When the dates showed 31 Dec 2019, the first coronavirus case in the world was seen in Wuhan City, Hubei Province of China (7) . The total number of cases was 44 with pneumonia complaints until 3 Jan 2020. Chinese officials reported these cases of unknown pneumonia to WHO (8) . Pneumonia of unknown cause was detected in several independent laboratories (9-11). This detected virus was a new type of coronaviruses such as SARS and MERS. Initially, the virus was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus has been named as coronavirus disease 2019 (COVID-19) (12) . The first COVID-19 case outside China was seen in Thailand on Jan 13. Next, on 15 Jan, Japan, and on 20 Jan 2020, South Korea reported the first cases of COVID-19. On Jan 20, 282 cases were reported in 4 countries, 278 of which were in China. Fifty-one severely patients, 12 critical situations and six deaths occurred in 278 cases in China (all in Wuhan city) (8) . COVID-19 spread to other countries, and the number of cases exceeded 100.000 on 7 Mar 2020 (13). The number of COVID-19 cases was 200,000 on Mar 19 and 300,000 on Mar 23 (14, 15) . The number of cases exceeded half a million on Mar 27, when the study was completed (16). According to WHO, the first case was seen in Turkey on Mar 14 (17). Overall, 3629 cases and 75 deaths have occurred in Turkey by 27 Mar 2020 (16) . The number of cases, mortality and fatality rates according to the most recent WHO report are shown in Table 1 . The present study aimed to emphasize the importance of epidemics, which are common in recent years, especially COVID-19, and affect the world in terms of public health. Moreover, with the increase in the number of cases all over the world, studies to prevent the spread of this epidemic have gained in importance. In the present study, the general measures were taken against COVID-19 in Turkey and the public compliance with these measures are evaluated. A descriptive and cross-sectional study was conducted during 23-27 Mar 2020 at a Family Health Center (FHC) in Turkey. The sample size was not selected in this study (examination, drug printing, etc.). It was conducted in adults (over 18 yr old) who agreed to participate in the study between these dates. The data were collected by the questionnaire method. A questionnaire consisting of socio-demographic characteristics and precautions for COVID-19 was applied. The participants were informed by the researcher about the purpose, the quality of the research, and the confidentiality of the data obtained. Verbal consent was obtained from the participants. Then the implementation of the questionnaires was conducted. The statistical data of the COVID-19 outbreak assembled by WHO until Mar 27, 2020, were Turkey was used evaluated for COVID-19 official applications. Research data were evaluated with the SPSS 15.0 (Chicago, IL, USA) program; percentage and frequency distributions, arithmetic mean and standard deviation were calculated in the statistical analysis. Of the participants, 65.2% were women and, 34.8% men, 51.1% being in the 36-65 age group, and 35.4% in the age group 65 and above. The average age was 56.47 ± 17.27, the minimum age 18 and the maximum age 92. 76.4% of the participants were married, and 56.2% housemakers. While 12.4% of the participants were illiterate, 20.2% were high school and above graduates. The countries with the most cases were China (81116), Italy (27980), and Spain (56188). The countries with the most deaths were Italy (8165), Spain (4089), and China (3298). The countries with the highest fatality rates were Italy (8%,94), Spain (7%,27) and Iran (7%,59). The numbers of cases, mortality and fatality rates according to the most recent WHO report are shown in Table 1 . Table 4 . Discussion COVID-19, which is a highly contagious infection, is spread mainly through droplets and direct contact. Although the average incubation period is 5.5 d, it is known to extend up to 14 d (19) . Disease symptoms usually appear within the first 11-12 d. The most common symptom in symptomatic cases is fever, fatigue, muscle pain, sore throat and dry cough, less often nausea-vomiting and diarrhea (20) . The main reason for hospitalizations is pneumonia (91.0%), acute respiratory distress syndrome (ARDS) in 3.4% cases and shock in 1.1% cases (21) . The total number of cases in SARS is 8000 and the number of cases in MERS is 909 (3). The number of COVID-19 cases that we examined until 27 Mar 2020 has already exceeded 500 thousand (16). The speed of COVID-19 propagation is quite remarkable. While the first 100.000 cases were reached in 67 d, every subsequent 100.000 cases were reached in 9, 7 and 2 d, respectively. Overall, 500.000 cases were reached in less than 48 h. Of course, by the time you read this, the situation will have changed dramatically, such is the speed of the rapidly changing picture of this outbreak. The rapid increase in the number of cases can cause anxiety in the public. We asked the participants in our study, "Do you think COVID-19 caused panic in the community?ˮ 79.8% of the participants said that COVID-19 caused panic in the community. Although it has reached high numbers in terms of case numbers, COVID-19 fatality rate is lower than SARS and MERS. The fatality rate of 11% in the SARS and MERS outbreak was between 35%-50% (3). The fatality rate of COVID-19 was found to be 4.58%, depending on the country (Table 1) . Although the fatality rate is lower than SARS and MERS, the number of deaths is high due to the high number of cases. The fatality rates are low can create a panic atmosphere in the communities and adversely affect the process. Psychosocial support could be provided for the whole society. If psychosocial support is not available to the whole community, psychosocial support can be provided to groups at risk, such as individuals over the age of 65 and those with chronic disease, to reduce their anxiety. There are two critical concepts in preventing the spread of epidemic diseases. These are isolation and quarantine. Isolation is the separation of cases known to have an infectious disease from healthy individuals during the transmission of this disease. Quarantine is the separation of individuals suspected of receiving an infectious disease from both patients and intact during the longest incubation period. The purpose of quarantine is to determine whether the disease will occur in the person. At the end of the quarantine period, the process is terminated if the person is determined not to be infected. Persons identified as infected are isolated (22) . One of the ways to prevent the spread of COVID-19 is quarantine. Turkey has taken measures restricting travel practices in the fight against COVID-19. It has closed all domestic and international flights. It has introduced domestic travel permits. Besides, Turkey repatriated its citizens, especially citizens returning from Umrah were quarantined for 14 d in hotels and dormitories. Cancel or postpone your travels abroad and spend the first 14 d at home on your return from abroad ( Table 2 ). All schools (including universities) have been closed across Turkey. All sports competitions are postponed indefinitely. Mosques and mosques are closed to worship. It has forbidden it to go out onto the streets in people over 65 yr old and with chronic diseases such as diabetes and hypertension. Video shows have been prepared to prevent people from going out on the street with the slogan of "#stay at home" with mass media such as social media, TV, and radio. Dissemination needs to fulfill the practices that people should do individually. In our study, 91.6% of the participants stated that they kept away from contact with people, 90.4% of them kept their distance from the other, 99.7% of them kept away from those who showed symptoms of the disease (Table 3) . Quarantine applications are critical in combating the COVID-19 outbreak. Countries need to get the necessary practices quickly, and the public must comply with these practices. Besides, it is also vital that the citizens meet the essential needs of the citizens of the countries when they are asked not to go out to prevent the spread of the epidemic. In short, all health protection practices can be called hygiene (23) . In cases where there is not enough hygiene, it poses a risk for water-borne diseases such as diarrhea, dysentery, typhoid and hepatitis A. The development of hygiene education and hand washing by WHO enables diarrhea cases to be reduced by up to 45.0% (24). Hand washing is among the essential protection methods not only for oral-fecal transmitted diseases but also for respiratory diseases (25) . According to the meta-analysis results of eight intervention studies evaluating the relationship between hand washing and respiratory tract infections, hand washing reduced the frequency of respiratory tract infections between 6% and 44% in all studies (26) . In the global action plan for the prevention and control of WHO's pneumonia, goals have been identified under the main topics of protection, prevention and treatment. One of the listed items under the title of protection aimed at helping children live in a healthy environment is hand washing (27) . One of the 14 rules Turkey's Ministry of Health has stated in the fight against COVID-19 is hand washing. In the rule, "It is necessary to wash your hands frequently with soap for at least 20 secˮ. In our study, all of the participants stated that the Ministry of Health knew the subject of hand washing (Table 2) . 97.2% of the participants stated that they frequently fight with COVID-19 by washing hands frequently. Liquid soap is used as a personal protective material in 96.1% of the participants (Table 3) . Moreover, there was a significant change in the hand washing habit of the participants. While the rate of those who stated that they washed their hands at every opportunity before the COVID-19 outbreak was 38.2%, this rate was 98.9% after the outbreak. While the rate of those who say they wash their hands when they come from outside was 67.4% before the COVID-19 outbreak, this rate increased to 100% after the COVID-19 outbreak (Table 4) . Hand washing will be useful in preventing COVID-19 spreading due to the relatively low cost of soap and its easy availability. The relatively cheaper and easy availability of water and soap will also facilitate hand washing. Hand washing habit change, which occurs positively in individuals, is effective in preventing COVID-19 spread. Many municipal water bill debts during the outbreak in Turkey have been postponed. It is not known how much more COVID-19, which caused hundreds of thousands of cases and thousands of deaths, will affect the public and cause death. This overload affects the health systems of the countries negatively. It not only causes harmful effects on health. It has become a significant public health problem with its effects on many areas such as education, trade, sports and tourism. Besides, it has made it difficult for people to access basic needs such as water, food and cleaning products. In order to combat COVID-19, we should focus on research into vaccines and drugs, for instance, as well as studies to prevent further spread. The public also needs to comply with these measures and pursue individual measures. 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