Turkey medics: alternative virus care improves survival

As Turkey battles to rein in a spike in COVID-19 infections, medics believe an alternative method of treatment is improving the survival rates of patients admitted with the disease. The Associated Press visited two intensive care units in Istanbul on Saturday that are on the frontline of treating serious cases. Staff say they are seeing better results through "extubation", or external tubation, which involves applying pressurized oxygen to the lungs.

With intubation, a breathing tube is inserted into the windpipe, requiring the patient to be sedated. Extubation, or continuous positive airway pressure, uses a high oxygen flow via a mask to reach the lower lungs, where the disease causes damage that can lead to life-threatening conditions. It does not necessitate sedation.

"Here we give high pressure oxygen through the nose with a high-pressure device called 'high-flow' to patients in need of respiratory support," said Dr. Kadem Arslan, an ICU physician at Dr. Ilhan Varank Training and Research Hospital.

"We are striving to reduce the patients' need for ventilators and intubation by carrying oxygen deep into their lungs with the help of pressure because we are aware that patients that are intubated or hooked to ventilators have a higher mortality rate."

However, the use of pressurized oxygen carries risks. Over the weekend, 11 people were killed in a fire caused by an exploding oxygen cylinder in a private hospital's ICU in the southern Turkish city of Gaziantep. The Dr. Ilhan Varank Training and Research Hospital and the neighbouring Dr. Feriha Oz Emergency Hospital, both in the Cekmekoy district on Istanbul's Asian side, are new infirmaries offering some of the most advanced intensive care treatment in Turkey.

The latter was only opened in May, has more than 1,000 beds and deals exclusively with COVID-19 cases. Among those it treats are pregnant women and babies infected with the disease. While visiting, the AP's journalists saw nurses care for an 11-day-old baby boy who arrived just five days after his birth. When the pandemic first struck, Turkey was credited for quickly bringing infection rates under control. It is now seeing an explosion in COVID-19 cases that is putting a serious strain on its health system.

The 7-day average for daily infections is just under 29,000, while the daily death toll has been breaking record highs in recent weeks, with total fatalities reaching above 18,000. Turkey's Health Ministry insists the ICU occupancy rate across Turkey stands at 74% but Turkey's Medical Association has painted a different picture, saying doctors are scrambling to find beds for seriously sick patients.

President Recep Tayyip Erdogan's government has imposed night time curfews and weekend lockdowns to try and slow the surge as well as announcing a four-day lockdown from New Year's eve. Restaurants can only serve take away meals while some businesses such as hairdressers are allowed to operate limited hours. Children and the elderly have been barred from using public transport.

Batuhan Yagci, a nurse at Dr Feriha Oz Emergency Hospital, stressed that the coronavirus does not just represent a danger to the elderly. "Even those who are 27, 25, 20 years old are having difficulties breathing and breakdown crying in front of our eyes," he said. "They say 'I can't breathe, please don't leave me. Hold my hand.'"

Ismet Yucel, a 52-year-old construction worker, was brought to the hospital, which is named after a prominent retired Turkish physician who died of COVID-19 in April, experiencing shortness of breath. "They brought me here in an ambulance. I couldn't breathe. While I couldn't breathe I couldn't lie face down," he said through an oxygen mask.

"My lungs were infected. I was in a very bad condition, I couldn't breathe. Thank God, I'm fine now."

Dr Cigdem Akalan Kuyumcu, an infectious disease expert working in the ICU, said many patients feared admission to the unit. "We have patients that ask as they are entering the ICU, 'Will I be able to come back?' This affects us profoundly," she said. "It saddens us. Of course, when our patients recover we are overjoyed." Meanwhile, the chief physician for both hospitals described the positive results in avoiding intubation. "Our general observation is that patients that are intubated have a very difficult period and are very hard to resuscitate," Dr. Nurettin Yiyit said. "For this reason, we strive to keep patients extubated in the ICU." The new restrictions on everyday life have also proved successful in reducing the number of patients admitted, according to Yiyit.