Mandatory Service in Covid-19 Days

Covid-19, which we met in March 2020, affected everything we can think of, especially our health system, in waves. Many terms such as quarantine, pandemic, filiation, number of intubations, pneumonia, closure, curfew have become a part of daily life. I would like to tell about this epidemic, which has very strong economic and social effects besides health, from the perspective of a small town's internal medicine specialist.
I continued in the Zile district of Tokat from the beginning of 2020, with the appointment of a spouse to my compulsory service (State Service Obligation - DHY) task, which I started in the last days of 2019. When the first cases emerged in Wuhan, like all doctors in Turkey, I initially ignored the event. Frankly, I have to admit, I may not have grasped the seriousness of the incident until I saw the alleged lung tomography of Cemil Taşçıoğlu.
After the first case was announced on March 11, 2021, all hospitals quickly implemented their already ready pandemic plans. This was really the wrong time to be a head doctor or an infectious disease specialist. The chief physician had to draw a route in the tiny hospital that would move normal patients and pandemic patients without encountering each other, and an infectious disease specialist was sought every minute for this.
This period was still the classic calm before the storm, frankly, our workload was already reduced. Normally, our patients, who applied to the hospital for every complaint, did not come to the hospital - without really needing it - because they were afraid of the disease. It was also a good move that the drugs with non-prescription reports were met by the pharmacy. At first, things were going well. Peeing continued in this way until May and we closed the last 15 days of May without detecting any patients. The first wave of Covid was successful except for the operational difficulties and the inexperience period. There was never a shortage of intensive care beds, the referral chain was running smoothly. The only problem of the patients was unnecessary hospitalization. The Ministry of Health was not very fond of outpatient follow-up, which was one of the guidelines of that period. This caused us to hospitalize patients who do not normally need hospitalization, but subsequently, the patients were asked to be discharged.
Although there were minor attacks in between, the most difficult period for Covid-19 was November and December. Let me put it this way: Zile is officially a town with a population of 54,368. There were around 50-60 positive cases a day here. Of course, there were also those who had a negative test even though they had Covid-19. We have entered a period where patients want to be hospitalized because of the fear of death. The Ministry of Health was aware of the seriousness of the job, and after 8 years, a pulmonologist was appointed to the district. In addition, improvements were made in the intensive care unit, mechanical ventilator and other respiratory support supplements were made.
Especially in the heaviest days of the epidemic, unfortunately, the intensive care bed was more valuable than gold. Even the district intensive care units, which were normally mostly empty, were full. In the wards, the patients were now sleeping two people each. Unfortunately, due to the nature of the disease, there was no definitive treatment. Everyone's hope was in the vaccine, so much so that some dreamer friends were counting the days as if the vaccine would be given to 80 million people at the same time.
There were two lucky spots. Firstly, contrary to expectations, the flu virus did not cause an epidemic, secondly, the drug named Favipiravir recommended by the Ministry of Health was also beneficial for the flu. Frankly, I didn't even want to think that we were trying to deal with two viruses at the same time. However, both the implementation of the vaccine and the closure decisions showed their effects after a while, and this wave was over.
I must state here that Covid-19 is a disease that is hated among doctors because of the lack of treatment, and being tied in waves of epidemics has made everyone very sad.
There was another aspect of the Covid-19 pandemic that would not be known without living among doctors and nurses, the companion problem. Normally, relatives of patients in our country are unfortunately used as staff. This is especially important for patients who do not need to be admitted to the intensive care unit due to their illness, but who cannot stay in the room alone due to the elderly or need of care. However, in normal times, relatives of the patients do not want to accompany the care patient because it is a very difficult situation. In the case of an infectious disease such as Covid-19, the problem of companions had gone even higher. Nurses and doctors were naturally not able to observe the patient all the time, and closing the doors and windows of pandemic patients made it difficult to follow up. This further reduced the already hard-to-find beds.
Another unseen effect of Covid-19, as I wrote above, was that other patients did not want to apply to the hospital. For this reason, the follow-up and treatment of many patients were delayed, which of course had very harmful effects on both the patient and the system. In the periods between shutdowns There have been spreads of Covid-19 among patients with overcrowding. Unfortunately, we lost a patient that I followed because of this.
To summarize, we had an extremely difficult process, so I would like to thank my colleagues at Zile State Hospital and the very valuable people of Zile, who did not cause us any intolerable difficulties.