Turkey’s COVID-19 infection rate is the fastest rising in the world. Here’s why it got so many cases so quickly.

• Turkey, a nation of 80 million, had the fastest growing number of coronavirus cases in the world.
• Less than a month ago, it didn’t have a single case. As of April 10, it had 42,282 confirmed cases with 908 deaths.
• Here’s what happened in between.
• Visit Business Insider’s homepage for more stories.

Turkey’s novel coronavirus cases came late, but once they started, they rose quicker than anywhere else in the world.

Less than a month ago, the nation of 80 million people didn’t have a single reported case. As of April 10, Turkey has 42,282 confirmed cases of COVID-19 – the disease caused by the novel coronavirus – with 908 deaths. Some fear that it could be the next pandemic hotspot.

While it has a relatively low death count, the infections have been increasing by 3,000 every day, according to The Guardian.

Turkey has imposed restrictions like closing schools, universities, and cafes, and stopping prayers, and halting flights to particular countries. But the restrictions have been incremental, and even with cases continuing to rise, a nationwide lockdown has not been imposed.

Here's what it has been like in Turkey.

In Turkey — a nation of 80 million, which has the largest refugee population in the world, as well as a booming tourism industry with about 50 million visitors in 2019 — the coronavirus came late, but when it did arrive, it struck hard.

Source: The Guardian

The country's economic situation made the threat of a pandemic worrying. Turkey already had high unemployment, inflation, and the looming possibility of a recession due to a massive fall in its currency in 2018.

Source: The Guardian

The country also had a weakened healthcare sector. After a failed coup in 2016, Turkey's government blacklisted about 15,000 health care workers, as well as a coronavirus expert named Mustafa Ulasli, who was allegedly linked to the coup.

Source: Foreign Policy

Still, Emrah Altindis, a professor at Boston College who studied the epidemic in Turkey, told The New Yorker that more than two weeks before Turkey's first coronavirus case there was a good sign. On February 24 Turkey's health minister Fahrettin Koca publicly said that Wuhan and Italy did a great job by locking down.

Koca also spoke about how he called the health minister of Iran, and his peer in Iran admitted that they hadn't locked down the city, which was why it spread.

These two statements were important, according to Altindis, because it showed he was aware that locking down streets helped to stop the infection.

Source: The New Yorker

Altindis then told The New Yorker despite Koca's statement, Turkey's President Recep Tayyip Erdogan was the only person who made decisions about a lockdown, and he could not be convinced.

According to the Financial Times, Erdogan is typically criticised by his opponents for being too heavy-handed, but during the coronavirus pandemic he has been "accused of being too laissez-faire."

Sources: The New Yorker, Financial Times

Caghan Kizil, a professor of neuroscience and genetics at the Helmholtz Association of German Research Centres later told Al Jazeera, Turkey's rapid acceleration was because "social mobility wasn't prevented," unlike in Wuhan.

Source: Al Jazeera

Turkey's first coronavirus case was detected on March 11. In less than three weeks, the country would witness one of the steepest rises of cases in the world.

Sources: The New Yorker, The New York Times

On March 11, after the first case was announced, Koca told state media: "If there is an infection in the country, it is very limited. The coronavirus is not stronger than the measures we will take."

Source: The Guardian

The measures Turkey has since taken have been mixed. While it promptly closed its borders to travelers from China and Iran — both countries that had a high number of cases — it also tried to keep its borders otherwise open and tourism going steady.

Source: The New York Times

The second major failure, according to Al Jazeera, was the low number of tests it carried out early on in the outbreak. Turkey focused its testing on people coming into the country from abroad, but by that point, it was too late, and the coronavirus had likely spread.

Sources: Al Jazeera, Bloomberg

Another factor was domestic coverage of the coronavirus. According to a Washington Post op-ed, religious scholars "dominated coverage" and focused on talking about the role of "extramarital relations, adultery, homosexuality, and anal relations" and how that related to the virus spreading.

Source: Washington Post

By March 12, there were 47 confirmed cases in Turkey.

Source: Bloomberg

That same day, public prayers at mosques, of which there are about 80,000 in Turkey, were suspended. But according to the op-ed in the Washington Post, it was already too late, as 16 million people took part in weekly prayers, and were doing so while the coronavirus was in the country.

In comparison, Iran stopped prayers on February 27, and Kuwait stopped them on March 13.

Sources: Bloomberg, Washington Post

The government also placed about 10,000 people who had returned from a religious pilgrimage to Mecca under quarantine, after tracing a coronavirus patient to that same trip.

Source: Bloomberg

On March 17, the first death was reported. Erdogan had not made a public appearance since the first case and, according to Foreign Policy, his lack of appearances and Koca's prominent role communicating updates with the public could be setting the stage for Koca to take the fall.

Sources: Washington Post, Washington Post, Foreign Policy

Then, on March 18, Erdogan made an appearance. He said Turkey was in a better condition than England or France and it would overcome the coronavirus with "patience" and "prayers," according to The Washington Post. He said if it was managed well enough, for a week or two, Turkey would have a "good picture before us."

Sources: Washington Post, Washington Post

By March 19, the country had 200 cases and two deaths. Shops and universities were closing up, but builders and construction workers continued to work.

Sources: NPR, The New York Times

By March 20, the number of cases reached 670. That same day, Bloomberg reported Turkey could "dramatically increase" as a 15-minute diagnosis kit from China was due, while the government had also more than doubled its labs testing from 16 to 36.

Source: Bloomberg

On March 22, people older than 65 were told not to go outside.

Source: Bloomberg

On March 23, Turkey's main opposition leader, Kemal Kilicdaroglu called for blacklisted health care workers to be reinstated, as well as reopening military hospitals Erdogan closed after the 2016 coup.

Source: Foreign Policy

Hospitals were important. In late March, Koca said when there were 6,000 cases that 63% of intensive-care units were full, meaning hospitals could be at capacity by the time there were 12,000 cases. By April 7, there were 34,019 confirmed cases.

Sources: The New Yorker, Johns Hopkins

To get an idea of the strain, Italy has 2.5 times more medical doctors and nurses per thousand people compared to Turkey, according to The New Yorker. Although Turkey has universal health coverage, which provides reasonable access for patients and is better than most of its neighbors, according to Foreign Policy.

• Sources: The New Yorker, Foreign Policy

Instead of reinstating former health workers, authorities tried to clamp down on information. By March 25, Turkish authorities had arrested at least 400 people for their social media posts about the coronavirus for "attempting to stir unrest," according to Foreign Policy.

Source: Foreign Policy

On March 30, Istanbul Mayor Ekrem Imamoglu, as well as Izmir's mayor, urged Erdogan to put in even stricter policies around movement. Imamoglu told the BBC, the authorities had counted 1.1 million people using public transport on a workday, as well as people in private cars.

Sources: BBC, Financial Times

But that same evening, Erdogan dismissed the mayors' calls for greater restrictions. He told the nation: "Turkey is a country where production must continue and the cogs must keep turning under every circumstance and every condition."

Source: Financial Times

On April 1, following on from what Mayor Imamoglu had said, Koca announced that 60% of the country's cases were in Istanbul.

Source: Al Jazeera

On April 3, Erdogan announced 31 cities would be quarantined, no one could enter or exit Turkey's major cities for 15 days, and people younger than 20 could not leave their homes anywhere in the country. But it wasn't a nationwide lockdown, and cases continued to rise.

Source: Bloomberg

On April 6, Koca said the numbers had risen because testing had increased to more than 20,000 per day. The government also ordered everyone to wear masks when they went out and said it would deliver the masks free to all.

Sources: BBC, The New York Times

Al Jazeera reported on April 3 that Mehmet Ceyhan, chairman of Turkey's Infectious Diseases Association, said if things continued cases would reach 300,000 by April 13. It's not that high yet. As of April 10, Turkey has 42,282 confirmed cases of COVID-19 with 908 deaths.

Sources: Arcgis.com, Al Jazeera

Altindis told The New Yorker there were two theories why Erdogan hadn't done enough. The first was that Turkey's economy could not handle a shutdown. The second theory was exploring herd immunity, although that was never publicly mentioned. He said: "This is a one-man regime right now. He decides."

Sources: The New York Times, The New Yorker,

Regardless of why, precautions have been taken too late, according to former Turkish politician Baris Yarkadas. He told The New York Times Turkey had missed the chance to stop the spreading. "Turkey could have been like South Korea but we are like Italy and the United States," he said.

Source: The New York Times