ANKARA: Istanbul recorded about 30 percent more deaths between March 9 and April 12 than in previous years, the New York Times recently reported, prompting concern that while the official death count in Turkey remains low the real toll may be higher. The city is believed to have recorded 2,100 more deaths than in the same period in the past two years. According to the medical professionals who spoke to Arab News, some of these deaths may be attributed to cancer and other ailments but the rest are likely to be a result of the coronavirus disease (COVID-19) outbreak. Turkey neighbors Iran, which has been hard hit by COVID-19 with 5,391 deaths and 85,996 confirmed cases as of Wednesday, and Ankara took the decision to suspend air traffic very late. Furthermore, COVID-19 testing was not widespread until the beginning of April. “Turkey is only considering COVID-19 cases with a positive test result, without including the cases with negative results (but showing all symptoms of the virus),” Dr. Sinan Adiyaman, head of the Turkish Medical Association (TTB), told Arab News. The World Health Organization uses two key codes for identifying COVID-19 cases: The code U07.1 is assigned to a disease diagnosis of COVID-19 confirmed by laboratory testing, and U07.2 is assigned to a clinical or epidemiological diagnosis of COVID-19 where laboratory confirmation is inconclusive or not available. Contrary to WHO guidelines Turkey does not use the second code. The government announced the first death from COVID-19 on March 17. However, the Times suggests deaths may have begun some weeks earlier when people were not following social distancing rules strictly or using personal protective equipment regularly because they were not instructed to do so. Turkey currently ranks among the most affected countries in the world and the biggest COVID-19 hotspot in the Middle East, with death cases approaching to 2,500 and the total number of infections surpassing 95,500. Yet the country did not choose a countrywide lockdown, except for a curfew for those over 65 and under 20 years old, preferring to keep the economy’s wheels turning amid high rates of unemployment and inflation. Adiyaman emphasizes the need for more transparency and the strict classification of the COVID-19 cases to give a clearer picture of the contagion. The Turkish Medical Association submitted dozens of questions to the health minister last week to get some detailed data about COVID-19 cases, such as the number of medical staff who had been infected by the virus and the cities where patients live. “We call on the Turkish health ministry to classify the deaths in this period separately and to use the U07.2 code for the cases that are diagnosed clinically and epidemiologically because of the reliability of Polymerase Chain Reaction (PCR) kits for coronavirus diagnoses is about 50 percent,” Dr. Adiyaman said. Other groups are also voicing their concern about the under-reporting of COVID-19 fatalities. In a report based on the burial rates recorded on the central electronic system over the past five years, the Turkish Thoracic Society has warned that the death rates in Istanbul and the northern city of Trabzon have increased tremendously, without any reason being made public. The death rates increased by 10 percent in Istanbul, and by 25 percent in Trabzon, especially with the week beginning March 2. “Some patients have been buried without being tested. We are calling for verbal autopsies with their relatives about whether they had a high fever or dry cough during their illness. It will reveal the cause of the death,” Adiyaman said. On Tuesday, Turkey evacuated hundreds of its nationals from abroad and placed them in two-week quarantine to prevent the spread of the virus. In the meantime, the government has banned opposition-run municipalities in Turkey from leading fundraising campaigns, as well as local initiatives such as distributing bread to those in need.