A minimum set of conditions must be satisfied before the Turkish economy can be reopened. Before the Turkish economy can re-open entirely, there must be 14 days of downward trajectory of documented cases and a requirement to provide hospital care without any compromising standards of care. These are the requirements for a re-opening, as suggested by Dr. Thomas Ingleby, the director of the Center for Health Security at Johns Hopkins University.
The threat of resurgence rests primarily with the asymptomatic COVID-positive spreaders, so mass testing is needed to find and track those cases. The government can rely on its vast network of local health officials to test people. The good news is that Turkey is on its 13th day of downward trajectory in new cases, close to meeting the goal of 14 days of downward trajectory of documented new cases.
According to Dr. Inglesby, there needs to be close to zero new cases, with a threshold of 20 new cases per 1 million population before a society should consider re-opening. Turkey’s new cases is on a declining trend though as of May 3, there are now 23 new cases per 1 million population, nearly reaching the 20 new cases per 1 million population mark. So this is very good news!
Paul Romer, winner of the 2018 Nobel Prize for Economics, is another authority among the experts researching the level of testing needed to limit the spread of the virus and allow most people to go back to work and resume daily activities.
According to Dr. Romer, an economy can survive with 10 percent of the population in insolation, but it cannot survive when 50 percent of the population is in isolation.
Therefore, isolation must be targeted based on test results, which would reduce the total number of people in isolation, so then the economy could have 10 percent of the population in isolation.
The alternatives to extensive testing are continuing shelter-in-place rules or simply relaxing the stay-at-home orders and hoping for the best, which would be deadly for tens of thousands of people. Especially so for the elderly, the poor and those with underlying medical conditions that put them at higher risk of infection.
Ramping up testing capacity is key to re-opening the Turkish economy.
There must be mass testing capability to identify both those who still have an active infection and those who have evidence of prior infection. There needs to be an unrestricted availability to perform both types of tests, ideally through local health care centers and state hospitals.
In terms of daily COVID-19 tests performed per thousand people from March 10 to May 3, Turkey trails behind Italy, New Zealand, Luxembourg, Israel, Denmark, Belgium, Australia, Bahrain, Canada, Iceland, Russia, Qatar, Portugal, while it is conducting more tests than that of Croatia, Hungary, South Africa, Taiwan, and Ukraine, as shown below in the graphs from Our World in Data.
In comparison to Taiwan, Turkey has performed more tests on a per thousand people basis, but Turkey has more deaths 3,397 than Taiwan does, with only 6 deaths. Without any mass testing, Taiwan was able to bring the spread of the virus under control through using technology, contact tracing, and masks, and began easing some of the restrictions relate to its COVID-19 coronavirus prevention efforts.
If a mass testing capability in Turkey is achieved, then people who have recovered from the virus can return to work, those with immunity, under the age 65, and without any complicating medical conditions. The first group of people who should return to work are those with asymptomatic and previously symptomatic patients who are now virus-free. The second group of people includes those who test negative for the current infection, a test that would need to be repeated at regular intervals, to identify those individuals who may have tested false negative in the past. Both categories would have to be verified by the health authorities.
With enough tests to examine the broad population at large, it would be easier to find people who have been infected but have not shown symptoms. This would mean that the severity of illness is lower than currently believed since “herd immunity” has been achieved to the point that there is so much of a population that is immune to the disease because they have had it and that it can’t easily be transmitted to others. This will help to inform the authorities how soon any resumption of business can occur.
In short, the date for re-opening the economy depends on the constraints of health care capacity and testing capacity but does not depend on the condition of the economy. In fact, there is a growing consensus among the well-known economists that an economy will be even worse if it is restarted prematurely, which in turn means that there should be no specific national date for any reopening of the economy, since that would mean not testing enough people, including not identifying people who are both asymptomatic and symptomatic patients.
Ph.D., Lecturer of Economics, Baruch College, City University of New York.