Devoted Struggle Against COVID-19 From İstanbul Faculty of Medicine

İstanbul University, İstanbul Faculty of Medicine performs significant work in the process of fighting at the front line with its health workers during the COVID-19 pandemic. On the other hand, the treatment of patients continues with great dedication. İstanbul Faculty of Medicine Hospital is one of the most important university hospitals in Turkey and it has been performing a great teamwork with its employees from every field, from doctors to nurses, from patient care givers to logistical support officers.

At İstanbul Faculty of Medicine, innovative projects which benefit both patients and health workers are being developed at the same time and a versatile contribution to the community health is being made. Almost 2,300 patients have been admitted to İstanbul Faculty of Medicine Hospital, which is among the 18 centers designated by the Ministry of Health as a diagnostic center and the Hospital started its preparations before the identification of the first COVID-19 cases in Turkey. Among these patients, 670 patients were hospitalized, about 250 were enrolled in the outpatient follow-up programme. 30 of the admitted patients are still in intensive care unit, and more that 400 patients have been discharged. İstanbul University Vice-Rector and İstanbul Faculty of Medicine Clinical Microbiology and Infectional Diseases Department faculty member Prof. Dr. Mustafa Oral Öncül made explanations about the works carried out by İstanbul Faculty of Medicine.

What kind of infrastructure work was carried out at İstanbul Faculty of Medicine Hospital and for the COVID-19 pandemic? How was the process followed from the beginning and after the pandemic was announced?

Our preparations for the COVID-19 pandemic in our Hospital already began before 11 March 2020, when the first case was seen in our country. The necessary planning was made by the coordinated efforts of İstanbul University Rectorate, İstanbul Faculty of Medicine Dean’s Office and the Hospital Head Doctor’s Office. All kinds of consumables and fixtures that may be necessary for this disease were determined in advance and supplied in accordance with our budget. In our Hospital, the necessary arrangements have been made for the meeting, interrogation, sample taking, examination, triage and hospitalization procedures of the patients since the first admission. In accordance with this plan, the following works have been made:

1. The arrangements were made for the management of patient’s service in three seperate areas: the triage zone, the COVID-19 patients’ area (Monoblock entrance and Algology building entrance) and COVID-19 Patient Services, where patients are firstly met. The triage area where patients are met was formed in a seperate area outside the First Aid Service where normal patients are first admitted. The COVID-19 patient area was also provided by creating beds and sheltered sections for adult patients at the entrance of Monoblock building and child patients at the entrance of Algology service. This arrangement provided patient and staff safety in terms of infection control, as well as making it easier for COVID-19 patients to get services faster and pass to a treatment programme easier. The Hospital’s building, called Monoblock was organized completely as COVID-19 services before the outbreak.

2. The Hospital Faculty members, specialist doctors, nurses and medical staff were scheduled for shift work and shifts in all 3 areas.

3.Every day, with the participation of a faculty member from the Departments of Infectious Diseases and Internal Diseases, detailed visits were carried out to each patient, on each floor of the Hospital. The doctors, nurses and medical staff belonging to all other branches performed duties in charge of the specialist students of these three branches on each floor. The multidisciplinary working environment formed in this way enabled rapid diagnosis, follow-up and treatment of patients.

4. İstanbul Governor’s Office was contacted by us in order to provide extra cleaning and security personnel during the outbreak and 84 personnel were provided.

5. Safiye Ali Student Dormitory was allocated for our health workers facing the risk of COVID-19 and who do not want to go home in order to protect sensitive people in their family from the staff working in the hospital environment. In this dormitory; free accommodation, three times hot meals, continuous tea and coffee service were provided for the Hospital doctors, nurses and other medical staff who asked for this service. In accordance with the additional request and after contacting the İstanbul Governor’s Office, Turkish Road Labour Union Guest House and İlim Yayma Derneği Hacı Muharrem Higher Education Dormitory were also allocated for the use of our health workers. Apart from these dormitories; Zeynep Sultan Hotel in Sultanahmet has been allocated for our medical staff. Medicals, accommodation and laundry services were provided for nearly 120 doctors, nurses and other health workers in all these dormitories and the hotel.

6. During the outbreak, there was no shortage of consumable (supplies) with the support of the Ministry of Health. A harmonious working environment was provided between our units and the team providing logistical support, masks, protective gowns, antiseptic and disinfectant substances. Our Head Doctor’s Office and the team have been successfully planning and coordinating this issue. In addition to our Ministry of Health, protective gowns and masks made in technical high schools connected to Ministry of National Education were also provided for our Institution.

7. Among the 18 centers determined by the Ministry of Health as a diagnostic center, İstanbul Faculty of Medicine was included, too. In this way, the samples of patients admitted to our Hospital started to be examined without being sent to another center. Currently, around 300- 400 tests are performed every day in our Hospital. Therefore; this situation together with other centers, had a very positive effect on the diagnosis and treatment process of the disease. Because the early treatment and isolation of patients who received diagnosis were provided, resulting in important advantages for outbreak control.

8. A team formed by İstanbul Faculty of Medicine, Department of Public Health has started the outpatient follow-up and remote access follow-up of treated patients and patients were discharged to their houses. Patient follow-up is still being performed successfully by making daily telehone calls.

9. Additionally, a telephone line and guiding unit was established at the Health Workers Clinic, which was established by our Public Health Department. In this Clinic, COVID-19 suspected health workers can receive fast support and a follow-up programme was created. Besides, a seperate sampling unit and treatment service were established for our health workers diagnosed with COVID-19.

10. An assistant to the Head Doctor was assigned to monitor and programme the donations during the outbreak. Donations directed to İstanbul University Faculty of Medicine Foundation began to be used by buying consumables and fixtures for patients’ needs.

Can you give us information about the doctors and health workers working at İstanbul Faculty of Medicine Hospital? What kind of team are they and how does it operate? How do our health workers protect themselves?

All health workers working in the COVID-19 area at İstanbul Faculty of Medicine are currently performing their duties in a superior sense of responsibility and service. All health workers, came together regardless of the difficult conditions they live in and started to work in a team spirit with other health workers in different disciplines, as never seen before. This unity spirit, which emerged in the direction of a common purpose and in difficult conditions, provided the health workers with the opportunity to become a team. It also increased the cooperation and sharing. On the other hand, emergency and surgical services continue to meet all the needs of our people who have other health problems besides the Epidemic. Emergency Cardiology, Oncological surgery and other departments requiring emergency intervention are successfully being maintained with the superior working discipline and responsibility awareness of the related branch doctors.

Additionally, all needs of the medical staff working in the field were closely monitored and all kinds of support was provided especially by İstanbul University Rectorate, the Dean and the Head Doctor’s Office of İstanbul Faculty of Medicine.

As I have mentioned before, doctors are actively involved in the diagnosis and treatment of COVID-19 patients with the participation of all areas of expertise, by the coordination of, the Departments of Infection Diseases and Clinical Microbiology, Chest Diseases, Internal Diseases and Anesthesiology and Reanimation. Multidisciplinary patient visits, duty sharing, and team spirit brought successful results in the fight against the Epidemic so far.

On the other hand, health workers are very knowledgeable and careful about protecting themselves in the hospital environment. The health workers who come to the hospital firstly go to the dressing section reserved for them in the clean area of the hospital and get all the materials such as bones, masks, protective aprons, overalls and protective glasses from the warehouse. After getting the best protective gear for themselves, they go to the service areas. It is very important that all kinds of equipment and material support is provided, and also extra support is provided to the incoming medical personnel. So far, a total of nine of our staff, including three doctors, three nurses and three other medical staff, have had COVID-19 infection. This is very reasonable value for such an intensely staffed institution.

Can we get information about the Pandemic Service created at İstanbul Faculty of Medicine? How much capacity does the Hospital’s Pandemic Service offer?

The Pandemic Service formed at İstanbul Faculty of Medicine started to serve on all floors in the Monoblock building. In each floor, the responsible specialist doctors and assistants, as well as nurses and caregivers in necessary numbers, continue their work with great dedication. In the following period, the number of patients discharged with the successful treatment began to increase at the Pandemic services, which began operating at full capacity just after the outbreak. This created a great morale and its increased confidence for health workers working in the field. At the same time, the outbreak management has been successfully done without opening new departments for the pandemic service.

How are the cases determined? What kind of process is followed the diagnosis?

COVID-19 suspected cases are first questioned by the Hospital reception team when they first arrive. Patients thought to have COVID due to suspicious contact, symptoms and signs are directed to the triage center. There, anamnesis, physical examination, laboratory and radiological examinations are done and then samples are taken for diagnosis. Patients who are evaluated according to the data obtained are evaluated about their admission to the service or; outpatient follow-up and treatment planning is made. Follow-up of patients admitted to the services are performed by nurses at frequent intervals daily. Patients are closely monitored with blood analyses taken every day, daily treatment responses are evaluated, and intervention procedures are performed with a change of treatment, when necessary. During daily visits, the patients’ status is evaluated in detail by Faculty members in different branches and the tretment programme is reviewed, again. These applications provide positive results for patients’ treatment responses in a short period of time. Treatment responses are determined by checking the improvement in clinical findings and laboratory findings. As a result, the patients are then discharged and their follow-up and control programme is carried out in the home environment.

Can we get information about the total number of cases in İstanbul Faculty of Medicine Hospital and the status of these cases?

So far, about 2,300 patients have applied to our Hospital, 670 of them have been admitted to the Hospital and about 250 of them have been enrolled in the outpatient follow-up programme. More that 400 of the admitted patients have been discharged so far. 30 of our hospitalized patients are still in the intensive care unit. As a result of successful treatment in the last week, our intubated patients are now freed from device support and discharged to services and homes. Our mortality rates are below the Turkish average. Successful treatments are carried out in the intensive care unit as well as in the services. So far, three patients over the age of 90 who have been admitted and treated in the services, have been discharged.

İstanbul Faculty of Medicine is also developing productions and projects that will benefit both patients and health workers during the pandemic process. What would you say about these studies?

In our Hospital, projects involving innovation in diagnosis, treatment and product desing are being developed. This will be a useful model for both patients and health workers during the pandemic. By means of convalesence serums of the patients who recovered from the disease and by means of Immunoglobulin G’S in plasma content prepared by Professor of Hematology and Science Board member, Prof. Dr. Sevgi Besisik and her team; the treatment support has begun to be offered to patients. On the other hand, the successful use of drugs such as Tosuzulimab and Anakinra preventing clinical deterioration in the treatment of patients, was carried out. A clinical trial project application was made for Anakinra in accordance with the experiences obtained by TUSEB. In this period, academicians working on different medicines, biological materials, diagnostic kits and protective medical materials to be used in the treatment of COVID-19 patients, started to submit their projects to project calls from TUSEB, TÜBİTAK, ISTKA and BAP. Apart from these, a robot was made by TETLab Office of İstanbul Faculty of Medicine to carry drugs and food to COVID-19 patients. TETLab also carries out material design study for health workers such as protective goggles trench. As a part of the fight against COVID, our Hospital contributes to our economy by providing the use of protective gowns and masks produced in technical schools connected to the Ministry of Education.

Apart from these, the production of hand antiseptics and surface disinfectants needed by our Hospital and İstanbul University was started by the Dean of the Faculty of Pharmacy. The effecient use of self resources has provided a huge support in areas where it is needed.

How is the eduation of the students in İstanbul Faculty of Medicine Hospital, which is a University Hospital, given in this period? Do students practice in the pandemic service?

In the first days of the epidemic, the education of İstanbul Faculty of Medicine students was interrupted within the framework of the decision taken by the Presidency of the Council of Higher Education and the Council of Ministers. And then, the necessary infrastructure studies were completed quickly, and the regular education of the students started within the framework of a determined programme. Now, distance and online education models are carried out without any loss of rights, within the framework of a programme. As a result of the infrastructure provided with the leadership and support of the Dean of İstanbul University Open and Distance Education Faculty (AUZEF), the distance education process has been implemented in İstanbul University Faculty of Medicine on time and in the most successful way. On the other hand, İstanbul Medical Faculty students have not been given any duties related with the pandemics.

During the pandemic, a successful team effort carried out so far in our organization is remarkable. In this work; first of all, our İstanbul University Rector Dear Prof. Dr. Mahmut Ak, the staff working at the Rectorate, and the Dean of the Faculty of Medicine, the Head Doctor’s Office of the Faculty of Medicine and doctors, nurses, patient caregivers, logical support staff working with great dedication in their fields have great labour and support. As of today, the number of patients discharged in our Hospital is more that the number of new patients. At the same time, thanks to the successful treatment process, our patients can be discharged from intensive care unit with their health restored.

The health workers who have achieved this great success by working in dedication and at big risk, and who have managed to struggle against the epidemic successfully and also İstanbul University Rectorate and İstanbul Faculty of Medicine Management who have supported the workers and their studies in the best way; are undoubtedly the most important beneficiaries in this success. On the other hand, we need to appreciate and draw attention to particularly USA Clinical Microbiology and Infectious Diseases, Chest Diseases, the USA Department of Anesthesiology and Reanimation and Emergency Internal Medicine Faculty members. Because they have spent all their time with the heavy duty such as, the treatment of the ill people, planning, coordinating, guiding treatment, making shift planning supplying materials. Because they are the real heroes who have been at the forefront of this challenge, day and night. We also need to mention them and thank all our health workers for their dedication; from the highest to the lowest level, seperately.