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The Post-Truth Phase Of Turkey’s Pandemic Response

BLOG - 8 December 2020

It has been a rough awakening for the majority of people. For those who followed experts and knew about the rapid spread of the coronavirus elsewhere, who were deeply suspicious of official numbers, the development of the virus in Turkey was not a surprise. The magnitude was still, however, shocking. On November 25, Turkey’s Health Minister, Fahrettin Koca, announced that Turkey’s daily Covid-19 cases reached 28,351. The announcement immediately shot Turkey up in the rankings, to be 5th in the world and 1st in Europe in the number of daily reported cases. Just a day before, on November 24, that number stood at only 7,381. How could the caseload possibly rise by almost fourfold in just a day without any substantial change in testing practices? The answer to this question was obvious: the authorities had, for quite some time, been engaged in a massive effort of data engineering that finally caught up with them. 

The First Wave

During the first wave of the pandemic, Turkey was able to deploy quite stringent measures, relatively early. It was among the first European countries to stop flights to and from China; closed its borders except for returning residents and citizens; introduced social distancing measures; suspended large events and gatherings; closed schools and nonessential shops; halted many public services; employed targeted lockdowns for specific age groups. Although the priority of the Turkish government has always been to keep the workforce on the production line and these measures did not completely contain the spread of the virus, the daily cases were steadily decreasing after the first peak in Mid-April and throughout the month of May. 

More importantly, during the first wave, as we discussed in an earlier piece, the rapid spread of the infection did not overwhelm the healthcare system as happened in many Western countries. Furthermore, death rates remained lower than in most other countries, mostly as a result of a combination of factors:

  • demographics - having a relatively young population
     
  • the family based welfare system - a family culture that sees nursing homes - the epicenter of the pandemic in the first wave in many Western societies - as a taboo
     
  • the structural features of its health sector - concentration of hospitals in the cities where the cases were initially high, the high number of ICU beds and the devoted and highly experienced medical workforce.

This relative success in the first wave vastly increased the confidence of the Turkish government. As summer approached it was obvious that the lockdown measures hit the Turkish economy hard. In fact, even before the pandemic became a global phenomenon, Turkey had a collapsing economy that was particularly vulnerable to the global financial meltdown of the Covid-19 pandemic. More importantly, the tourism season was approaching and the government, ignoring overwhelming evidence that tourism was one of the hardest hit industries globally, was eager to keep the wheels of the industry turning

Turkey had a collapsing economy that was particularly vulnerable to the global financial meltdown of the Covid-19 pandemic.

With the confidence in its ability to handle the crisis running high, the AKP government unsurprisingly opted to boost the economy in the middle of an ever-deepening economic crisis and announced normalization measures on May 4, 2020. 

Enters Normalization

The government officials labeled the process of gradual lifting of restrictions as the "new normal". In fact, the new normal was not just a gradual lifting of the restrictions but also a gradual shifting of responsibility for the spread of the pandemic, from the state to the citizens. Health Minister Koca defined the new normal as controlled social life and urged individuals to observe social distancing measures, to follow hygiene and to wear masks. Government officials continuously upbraided the citizens for not following these protective measures, shared the images of non-compliers, and accused the society of spreading the virus. 

The new normal is a situation in which citizens would be compelled to act cautiously depending on their own calculation of risk and minimum intervention coming from the state. The state acted not as a nanny but as a guardian. The fines for not wearing a mask were very high, and TV screens were filled with images of police officers punishing non-compliers. A pattern was also established: if restrictive measures were introduced this was due to the irresponsibility of social actors, institutions etc. If there was an easing of restrictions the laurels went to the government.

On May 11, despite criticism from professional health organizations and experts, shopping malls reopened. The remaining restrictions were lifted on June 1 and by the beginning of July 2020, life was almost back to normal. Domestic travel was freed and international limitations significantly loosened; public recreational places were allowed to reopen; kindergartens, day-care centers, driving schools were allowed to provide services. Hotels, motels, and guesthouses started accepting customers. The practice of shorter working hours in workplaces and remote working were terminated. By the end of the month most public activities, such as religious services, gatherings, weddings etc., were back in full force - albeit with some limitations. Mosques were open as the malls were fully functioning. Targeted lockdowns on people over 65 continued in a much looser form. 

Even then, professional organizations, including the Turkish Medical Association, sharply criticized this rapid normalization as coming in too early for Turkey, and warned about a possible second wave in October. The normalization, however, was widely embraced by the public that was psychologically tired of the measures and increasingly more concerned about loss of income as a result of the lockdowns. As the much-needed success was announced, what went out of the window was not only the public measures and caution, but also the initial relative trust in the guidance of expertise and science. 

A pattern was also established: if restrictive measures were introduced this was due to the irresponsibility of social actors, institutions etc.

Despite all expert warnings, the Turkish government did not even shy away from organizing large public gatherings, such as an ostentatious inaugural Friday prayer in Hagia Sophia, recently converted back to a mosque, on July 24. Some 350.000 people from all over Turkey gathered in and around the mosque and that might have enormously contributed to the nation-wide spread of the virus as the participating faithful returned to their provincial towns and villages. Thus, the new normal brought what many experts were afraid of: a steep upward trend in case numbers. By August the death rates were also increasing sharply (see Figure I), suggesting something was going terribly wrong. This upward trend required new measures, but new measures meant the end of the much-cherished success story. These measures also meant new economic costs. So instead, the government kept invoking individual responsibility and opted for another option: data engineering. 

Figure I - Source: Daily Covid-19 data of Turkish Ministry of Health

Normalization Through Data Engineering 

Ever since the beginning of the pandemic, the statistical figures are the (almost only) reliable references to objectively measure the success or failure of a government and as such they became an arena of the political battle. The Turkish government used various methods of data engineering to portray a continuing success story. During the first wave, only the cases whose tests proved positive were reported. Patients who tested negative but were diagnosed as having Covid-19 based on computed tomography images and clinical findings were not included in the overall figures. 

Later on, even though the testing capacity increased as the pandemic spread, an extensive and aggressive testing policy was never put in motion and the testing protocols constantly changed. During the summer months, reports and news were leaking from hospitals about testing protocols having changed, no longer allowing physicians to test the asymptomatic contacts of the Covid-19 patients. It was also almost impossible for an ordinary individual to get tested without significant Covid-19 symptoms. 

However, the most unique and controversial strategy was a change in terminology in reporting figures. By July 29, the daily Covid-19 reporting of the Health Ministry no longer referred to cases, but only to patients. In the beginning, only a few people noticed the change. But as time passed, some irregularities began to emerge. The percentage of deaths, as well as the number of patients in critical condition in overall figures was rising. Later, a document made public by MP Murat Emir, from the main opposition Republican People's Party (CHP), showed that the number of new Covid-19 cases in Turkey was nearly 20 times more than the official figures announced by the Ministry of Health. 

Citizens who were asked to behave responsibly to control the spread of the virus and who were constantly scolded for their irresponsible behavior by government officials were completely left uninformed on the seriousness of the situation by the same government.

As pressure intensified, Health Minister, Fahrettin Koca, revealed on September 30 that the official figures that had been released since July 29 excluded the number of people who had tested positive for the virus but were showing no symptoms. Koca further explained that all figures since that date referred only to "patients" and not to "cases". This meant starting from July 29, the Turkish government completely altered its reporting without informing the Turkish public and adopted a policy of not listing positive test results if the patient was believed to be asymptomatic. Yet, most other countries were reporting asymptomatic positive cases, based on WHO’s guidance, that defines a confirmed case as "a person with laboratory confirmation of Covid-19 infection, irrespective of clinical signs and symptoms".

This change in methodology and terminology, indeed, made it impossible to reliably track the spread of the pandemic in Turkey or to compare it with other countries given that the total number of cases now included a major irregularity. This was also an uncontroversial choice for a government whose main method of control was individual responsibility. Citizens who were asked to behave responsibly to control the spread of the virus and who were constantly scolded for their irresponsible behavior by government officials were, in fact, completely left uninformed on the seriousness of the situation by the same government.

However, what was even more striking and potentially more harmful, was the attitude of the World Health Organization (WHO). Even though Turkey announced officially that it was not listing asymptomatic cases in its case load, the figures announced by the WHO did not refer to this fact. There was not even a note or a warning in the WHO figures. Instead, for many months, in the WHO figures Turkey stood successfully in the daily case rankings after Austria, Hungary and Serbia - countries which are much less populous than Turkey, yet are reporting much higher infection rates. In fact, the WHO praised Turkey's efforts to curb the novel coronavirus, emphasizing that it significantly increased the daily number of tests and their effects by isolating all Covid-19 positive cases, regardless of their symptoms. Recently, the WHO office in Turkey announced that they were not aware that Turkey was only reporting patients, but not cases.

The Lost Battle?

As the second wave of the pandemic hit, many countries introduced new restrictive measures such as night curfews, regional lockdowns, bans on public gatherings. Turkey’s initial measures, however, were mostly cosmetic, except for school closures - a measure which most European countries opted against in the second wave, arguing that it would be detrimental to the young people’s futures. The figures that now listed only patients but not cases, did not bring any serious measures despite the constant warnings of health professionals and the Turkish Medical Association. These warnings were taken as hostile attempts aiming to discredit and condemn the government’s policy to fight the pandemic. The leader of the junior partner in Turkey’s governing block, Mr. Devlet Bahçeli, even charged the Turkish Medical Association for spreading unfounded and panic-inducing accusations, and asked for its closure - an act which possibly further demoralized health workers. 

As the virus was spreading uncontrollably, Turkey was also losing all of its initial advantages. Even though people over 65 were supposed to stay at home, the rapid spread of the virus among the youth put older people at increasing risk. The infection rate among the younger population, also put the health system under strain. The contagion was no longer concentrated in the big cities, but all over the country where families were larger and comprised higher rates of elderly population. These were also the towns, unlike the big cities, with less hospital beds and ICU units per person. Finally, as they dealt with the relentless spread of the pandemic for months on end, health workers were exhausted. As the spread of the virus was getting out of control, on November 25, Health Minister Koca finally decided to announce the "true" number of cases and not just the patients. This was followed by stricter measures, such as night curfews and weekend lockdowns. Still, the measures were more limited when compared to the first wave and even those limited measures were announced very late. Even though schools and restaurants were closed, malls and mosques are still open. As of this writing there is no travel ban, either domestically or internationally. Under these conditions, Turkey climbed to the top rank in the world in terms of the daily number of reported cases.

Turkey’s response to the pandemic has thus become a perfect example of post-truth politics in which the reality is disconnected from factual details, and is twisted to accommodate the needs of politics and to respond to economic expediency. 

As the surprise and panic of the first wave disappeared and as confidence increased, facts and expert opinions were increasingly sidelined and their views were even considered detrimental to national interest. Principles of good governance, such as transparency, accountability, participation, trust, were long gone anyhow. Citizens were called to behave responsibly, but they were intentionally misguided about the seriousness of the situation. 

At the end, however much the government may have tried to wish it away and needed a success story, the post-truth politics that guided Turkey’s pandemic response only succeeded in pulling defeat from the jaws of victory and leading the country to the winter that has come. 

 

Copyright: Adem ALTAN / AFP

 

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