{"id":31835,"date":"2022-05-23T08:00:47","date_gmt":"2022-05-23T05:00:47","guid":{"rendered":"https:\/\/tatd.org.tr\/?p=31835"},"modified":"2022-07-06T17:49:23","modified_gmt":"2022-07-06T14:49:23","slug":"prof-dr-karcioglu-gecmis-iki-yilda-aldigimiz-derslerden-ogrenilenler-ve-oneriler","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/en\/genel\/prof-dr-karcioglu-gecmis-iki-yilda-aldigimiz-derslerden-ogrenilenler-ve-oneriler\/","title":{"rendered":"Prof. Dr. Karc\u0131o\u011flu : Ge\u00e7mi\u015f \u0130ki Y\u0131lda Ald\u0131\u011f\u0131m\u0131z Derslerden \u00d6\u011frenilenler ve \u00d6neriler"},"content":{"rendered":"

Sorry, this entry is only available in Turkish<\/a>.<\/p>

<\/p>\n

Pandemi Bitti mi? <\/strong><\/h3>\n

Ge\u00e7mi\u015f \u0130ki Y\u0131lda Ald\u0131\u011f\u0131m\u0131z Derslerden \u00d6\u011frenilenler ve \u00d6neriler <\/strong><\/h4>\n

\u00a0<\/strong>COVID-19 pandemisinin ba\u015flad\u0131\u011f\u0131n\u0131n resmen ilan edilmesinin \u00fczerinden iki y\u0131ldan fazla zaman ge\u00e7ti. Avrupa\u2019da vaka say\u0131lar\u0131nda art\u0131\u015f g\u00f6r\u00fcl\u00fcrken ve uzak do\u011fuda aylar sonra tekrar karantina \u00f6nlemlerine ra\u011fmen pandemi ili\u015fkili \u00f6l\u00fcmler g\u00f6r\u00fclmeye ba\u015flam\u0131\u015fken \u00fclkemizde korunma ve izolasyon \u00f6nlemleri kald\u0131r\u0131ld\u0131.<\/p>\n

Pandeminin ba\u015f\u0131ndan itibaren gerek acil servislerde gerek pandemi polikliniklerinde gerekse ihtiya\u00e7 halinde pandemi servisleri ve yo\u011fun bak\u0131mlar\u0131nda yo\u011fun bir emek harcayan Acil T\u0131p Uzmanlar\u0131 olarak d\u00fcnyadaki y\u00fckseli\u015ften ve \u00fclkemizde bu durumun olu\u015fturabilece\u011fi etkilerden endi\u015fe duyuyoruz.<\/p>\n

Bu yaz\u0131 pandemide 3. y\u0131la girildi\u011finde gelinen a\u015famay\u0131 tan\u0131mlamak ve yap\u0131lmas\u0131 gerekenlere acil t\u0131p uzmanlar\u0131 g\u00f6z\u00fcnden \u0131\u015f\u0131k tutmak i\u00e7in TATD COVID-19 G\u00f6rev G\u00fcc\u00fc taraf\u0131ndan \u00fcretilmi\u015ftir.<\/p>\n

D\u00fcnyada 20 May\u0131s 2022 itibari ile toplam\u00a0500 milyonu ge\u00e7en olgu <\/strong>ve 6.200.000 civar\u0131nda \u00f6l\u00fcm\u00a0<\/strong>bildirilmi\u015ftir. G\u00fcnde 1 milyondan fazla olgu ve 3000-4000 aras\u0131nda \u00f6l\u00fcm bildirilmektedir.\u00a0<\/sup>D\u00fcnyada 11.5 milyara yakla\u015fan a\u015f\u0131lanma say\u0131lar\u0131na ra\u011fmen salg\u0131n halen etkisini s\u00fcrd\u00fcrmektedir. Salg\u0131n\u0131n ba\u015f\u0131ndan itibaren 20 May\u0131s 2022 tarihindeki Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 verileriyle toplam 98 bin 900 yurtta\u015f\u0131m\u0131z COVID-19 nedeniyle ya\u015fam\u0131n\u0131 kaybetmi\u015ftir. Bu s\u00fcre\u00e7te, salg\u0131nla m\u00fccadelede 200’den fazla hekim meslekta\u015f\u0131m\u0131z olmak \u00fczere 500’\u00fc a\u015fk\u0131n sa\u011fl\u0131k \u00e7al\u0131\u015fan\u0131 kaybedilmi\u015ftir.<\/p>\n

2021 yaz aylar\u0131nda Delta varyant\u0131 etkisi ile \u00f6l\u00fcm oranlar\u0131 y\u00fcksek iken Ocak 2022 pikinin Omicron nedeni ile ger\u00e7ekle\u015fti\u011fi ve \u00f6l\u00fcm h\u0131z\u0131n\u0131n d\u00fc\u015ft\u00fc\u011f\u00fc g\u00f6r\u00fclmektedir. Avrupa\u2019da dalgal\u0131 seyirle birlikte son haftalarda y\u00fckseli\u015fler g\u00f6r\u00fclmektedir (\u015eekil 1)<\/strong>.<\/p>\n

Pandeminin ba\u015f\u0131nda %10 iken \u015fu s\u0131ralarda %1.2 civar\u0131nda oldu\u011fu hesaplanan \u00f6l\u00fcm oran\u0131n\u0131n d\u00fc\u015fmesi\u00a0 artan test say\u0131lar\u0131 nedeniyle daha \u00e7ok olgu saptanmas\u0131 ve oransal olarak \u00f6l\u00fcmlerin bunun i\u00e7indeki pay\u0131n\u0131n k\u00fc\u00e7\u00fclmesi ile ili\u015fkilidir. Yine Omicron varyant\u0131n\u0131n daha az \u00f6ld\u00fcr\u00fcc\u00fc olmas\u0131n\u0131n etkisi bulunmakla birlikte as\u0131l ba\u015far\u0131 d\u00fcnya genelinde etkin a\u015f\u0131lanman\u0131n y\u00fcksek d\u00fczeylere ula\u015fmas\u0131na ba\u011flanabilir. Yine sa\u011fl\u0131k profesyonelleri ve halk\u0131n art\u0131k antrenmanl\u0131 ve bilgilerini yenilemi\u015f olmalar\u0131 da etkendir.<\/p>\n

\u00dclkemizde Mart 2022\u2019de test stratejilerindeki de\u011fi\u015fim ile PCR testlerinin semptomatik hastalarla s\u0131n\u0131rlanmas\u0131 ve klinik \u015f\u00fcphelilerin bildirilmiyor olmas\u0131 gibi sorunlar nedeni ile \u2018resmi\u2019 say\u0131lar salg\u0131n\u0131n ger\u00e7ek boyutunu g\u00f6stermemektedir. COVID-19 tan\u0131s\u0131n\u0131n sadece PCR testi \u00fczerinden g\u00f6r\u00fclmesi \u00f6zellikle geli\u015fmekte olan \u00fclkelerde hem olgu hem de \u00f6l\u00fcm say\u0131lar\u0131n\u0131n ger\u00e7ekte oldu\u011fundan daha d\u00fc\u015f\u00fck g\u00f6r\u00fclmesine yol a\u00e7maktad\u0131r.<\/p>\n

Hem d\u00fcnyada hem de \u00fclkemizde salg\u0131n bug\u00fcne kadar birka\u00e7 kez ciddi y\u00fckseli\u015f ya\u015fam\u0131\u015f, 2020 Mart-Nisan ve Ekim-Kas\u0131m aylar\u0131ndaki ilk y\u00fckseli\u015flerde sa\u011fl\u0131k kurulu\u015flar\u0131 ciddi y\u00fck alt\u0131nda kalm\u0131\u015ft\u0131r. Ciddi y\u00fckten kastetti\u011fimiz, COVID-d\u0131\u015f\u0131 hastal\u0131klardan yat\u0131\u015flar\u0131n, hatta ameliyatlar\u0131n ertelenmek zorunda kal\u0131nmas\u0131na varan kesintiler olmas\u0131, sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n kapasitesinin \u00e7ok \u00fczerinde zorlanmas\u0131, pandemi-d\u0131\u015f\u0131 hastal\u0131klarla ilgilenilmesinin zorla\u015fmas\u0131d\u0131r.<\/p>\n

T\u00fcrkiye\u2019de toplam hastaneye ba\u015fvuran hasta say\u0131s\u0131 pandemide %30-35 kadar d\u00fc\u015fm\u00fc\u015ft\u00fcr. D\u00fc\u015fme Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 ve \u00dcniversite hastanelerinde daha belirgindir. Pandemide Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 hastanelerinde yatarak tedavi olan hasta say\u0131s\u0131 %29, \u00f6zel hastanelerde ise %11 azalm\u0131\u015ft\u0131r. Bu veriler de bir\u00e7ok hastan\u0131n tan\u0131s\u0131n\u0131n konulamad\u0131\u011f\u0131, tedavisini alamad\u0131\u011f\u0131n\u0131 veya ertelendi\u011fini g\u00f6stermektedir.<\/p>\n

Kronik komorbid hastal\u0131klar\u0131 olanlar, \u00f6zellikle akci\u011fer ve kalp rezervlerini t\u00fcketen KOAH, kalp yetmezli\u011fi, koroner arter hastal\u0131klar\u0131; ba\u011f\u0131\u015f\u0131kl\u0131k sistemini \u00e7\u00f6kerten \u015feker hastal\u0131\u011f\u0131, kanser, baz\u0131 ila\u00e7lar\u0131n s\u00fcrekli kullan\u0131m\u0131 gibi durumlar hem \u015fiddetli hastal\u0131k, hem de \u00f6l\u00fcm i\u00e7in y\u00fcksek risk ta\u015f\u0131maktad\u0131r. Bunlarla birlikte KOAH tan\u0131s\u0131 olmadan sadece sigara i\u00e7ilmesi de hastal\u0131k kapmak ve \u00f6l\u00fcm riskini birka\u00e7 kat art\u0131rmaktad\u0131r. Ayr\u0131ca obezite (v\u00fccut kitle indeksi y\u00fcksekli\u011fi) de, \u00f6zellikle 35-40\u2019\u0131n \u00fczerinde ise y\u00fcksek riskle birliktedir.<\/p>\n

Pandemiyi bitirecek ana \u00f6nlem olan a\u015f\u0131lanma oranlar\u0131m\u0131z istenilen d\u00fczeyde de\u011fildir. Mart-Nisan 2022\u2019de en az 4 doz a\u015f\u0131l\u0131 n\u00fcfusumuz %9.5\u2019tir (\u015eekil 2)<\/strong>. 2021 ba\u015f\u0131nda 2 doz inaktif a\u015f\u0131 olan insanlar\u0131n 2022\u2019de halen a\u015f\u0131l\u0131 say\u0131lmas\u0131 yanl\u0131\u015ft\u0131r. A\u015f\u0131n\u0131n koruma s\u00fcresi ge\u00e7mi\u015f oldu\u011fundan bu insanlar a\u015f\u0131s\u0131z, korumas\u0131z kabul edilmelidir. T\u00fcberk\u00fcloz ve s\u0131tma gibi endemik bir\u00e7ok hastal\u0131\u011f\u0131n her y\u0131l binlerce hastan\u0131n \u00f6l\u00fcm\u00fcne yol a\u00e7t\u0131\u011f\u0131n\u0131 biliyoruz. A\u015f\u0131lamada iyi bir d\u00fczeyde olmad\u0131\u011f\u0131m\u0131z da hesaba kat\u0131ld\u0131\u011f\u0131nda COVID-19 endemiye d\u00f6n\u00fc\u015ft\u00fc\u011f\u00fcnde en \u00e7ok etkiledi\u011fi co\u011frafyalardan birinin \u00fclkemiz olaca\u011f\u0131 rahat\u00e7a anla\u015f\u0131labilir.<\/p>\n

D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc ve Birle\u015fmi\u015f Milletler kaynaklar\u0131na g\u00f6re Omicron\u2019un BA.2, BA.4 ve BA.5 alt tiplerinin d\u00fcnyada giderek \u2018Endi\u015fe Verici Varyant\u2019 kategorisinde izlendi\u011fi bilinmektedir (1).<\/p>\n

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\u015eekil 1. Avrupa’da Covid nedenli hastane yat\u0131\u015flar\u0131 artmaya devam ediyor.<\/p><\/div>\n

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\u015eekil 2. Toplumumuzda a\u015f\u0131lanma oranlar\u0131.<\/p><\/div>\n

 <\/p>\n

\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Tablo 1.<\/strong>\u00a0T\u00fcrkiye\u2019de COVID-19\u2019dan korunmak amac\u0131yla yap\u0131lmakta olan a\u015f\u0131lar\u0131n koruyuculuk d\u00fczeyleri (1)<\/p>\n

\"\"<\/p>\n

\u00d6l\u00fcm say\u0131lar\u0131 Belediyeler, Mezarl\u0131klar M\u00fcd\u00fcrl\u00fc\u011f\u00fc gibi kaynaklardan al\u0131narak analiz edilip \u00f6nceki y\u0131llara g\u00f6re kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda \u2018fazladan \u00f6l\u00fcmler\u2019 kavram\u0131 ortaya \u00e7\u0131kmaktad\u0131r. TTB Pandemi \u00c7al\u0131\u015fma Grubu \u00fcyesi G\u00fc\u00e7l\u00fc Yaman\u2019\u0131n yapt\u0131\u011f\u0131 projeksiyona g\u00f6re pandemi boyunca \u00f6nemli dalgalanmalar ya\u015fanmakla birlikte t\u00fcm salg\u0131n d\u00f6nemi hesaplanan fazladan \u00f6l\u00fcm say\u0131s\u0131 280 bine ula\u015ft\u0131 (\u015eekil<\/strong> 3). Resmi Covid \u00f6l\u00fcm\u00fcn\u00fcn 98 bin civar\u0131nda oldu\u011fu g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda ger\u00e7ek COV\u0130D \u00f6l\u00fcmlerinin resmi say\u0131dan 2 ile 3 kat fazla oldu\u011fu ortaya \u00e7\u0131kmaktad\u0131r. Bu durum WHO taraf\u0131ndan yap\u0131lan de\u011ferlendirmelerde 2.7 kat olarak bildirilmi\u015ftir. \u00c7\u00fcnk\u00fc fazladan \u00f6l\u00fcmlerin yakla\u015f\u0131k 2\/3\u2019\u00fcn\u00fcn COVID\u2019e ba\u011fl\u0131 oldu\u011fu hesaplanmaktad\u0131r. Bu durum da \u015feffafl\u0131k ve a\u00e7\u0131kl\u0131\u011f\u0131n \u00f6nemini ortaya koymaktad\u0131r.<\/p>\n

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\u015eekil 3. \u00d6l\u00fcmlerin yakla\u015f\u0131k yar\u0131s\u0131n\u0131n kaydedildi\u011fi 24 kentte fazladan \u00f6l\u00fcmler ve T\u00fcrkiye projeksiyonu.<\/p><\/div>\n

Covid19 Pandemisinin sona erdi\u011fi konusunda toplumda var olan iyimser havaya ra\u011fmen Nisan ay\u0131 sonunda Avrupa ve Uzak Do\u011fu da g\u00f6zlenen vaka art\u0131\u015flar\u0131 halen sahip oldu\u011fumuz riskleri g\u00f6stermektedir. \u00dcstelik ge\u00e7mi\u015fte ve bug\u00fcn ya\u015fad\u0131\u011f\u0131m\u0131z gibi gelecekte de pandemiler olabilece\u011fini ak\u0131ldan \u00e7\u0131karmamal\u0131 ve haz\u0131rl\u0131klar buna g\u00f6re yap\u0131lmal\u0131d\u0131r. \u0130\u00e7irisinde bulundu\u011fumuz g\u00fcnlerde, Orta ve Afrika’da g\u00f6r\u00fclen ve endemik bir vir\u00fcs olarak kabul edilen monkeypox yani maymun \u00e7i\u00e7e\u011fi vir\u00fcs\u00fcn\u00fcn Avrupa’n\u0131n ard\u0131ndan ABD’de de etkisini g\u00f6stermesi bu duruma bir \u00f6rnek olarak kabul edilebilir.<\/p>\n

Monkeypox (MPX) veya \u201cMaymun \u00e7i\u00e7e\u011fi hastal\u0131\u011f\u0131\u201d<\/strong> kemirgenlerden insana ge\u00e7en, d\u00fc\u015f\u00fck oranda insanlar aras\u0131nda bula\u015fan viral zoonotik bir hastal\u0131kt\u0131r. \u00d6nce Orta-Bat\u0131 Afrika’n\u0131n tropik ormanlar\u0131nda ortaya \u00e7\u0131km\u0131\u015f, 2022 May\u0131s ay\u0131nda \u0130ngiltere, \u0130spanya, Portekiz ve Amerika’da g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Vir\u00fcs\u00fcn k\u0131sa s\u00fcrede k\u0131talararas\u0131 bu kadar h\u0131zl\u0131 yay\u0131lmas\u0131 sonucu hastal\u0131k D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc taraf\u0131ndan yak\u0131n izleme al\u0131nm\u0131\u015ft\u0131r. Hastal\u0131\u011f\u0131n tam anlam\u0131yla bir pandemiye d\u00f6n\u00fc\u015f\u00fcp d\u00f6n\u00fc\u015fmeyece\u011fi \u015fu an kesin de\u011fildir, ancak pandeminin s\u00f6zc\u00fck anlam\u0131 birka\u00e7 k\u0131tada yay\u0131l\u0131m \u00fczerine kuruldu\u011fundan yak\u0131n zamanda bu kriterleri kar\u015f\u0131layabilecektir.<\/p>\n

Bu nedenlerle tehlikenin ciddiye al\u0131nmas\u0131, acil servisler ve birinci d\u00fczey bak\u0131mda yer alan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131na MPX hakk\u0131nda e\u011fitim verilmesi, riskli gruplar\u0131n belirlenip taranmas\u0131 uygun olacakt\u0131r.<\/p>\n

Pandemi ile ge\u00e7en 2 y\u0131l\u0131n ard\u0131ndan bug\u00fcn ve gelece\u011fe \u0131\u015f\u0131k tutabilmek amac\u0131yla tespit etti\u011fimiz sorunlar ve \u00f6nerilerimizi \u015fu \u015fekilde s\u0131ralayabiliriz.<\/p>\n

Sorunlar\u0131m\u0131z-eksiklerimiz:<\/h4>\n
    \n
  1. \u00dclkemizde salg\u0131n y\u00f6netimi geli\u015fmi\u015f d\u00fcnya \u00fclkelerinden farkl\u0131 olarak meslek kurulu\u015flar\u0131, uzmanl\u0131k dernekleri ve genel olarak bilim toplulu\u011funun d\u0131\u015f\u0131nda \u015fekillenmi\u015ftir.<\/li>\n
  2. \u00dclkemizde a\u015f\u0131lanma resmi olarak bildirildi\u011fi gibi y\u00fcksek de\u011fildir. Etkin a\u015f\u0131lanma, o anda ba\u011f\u0131\u015f\u0131kl\u0131k korumas\u0131 alt\u0131nda olan n\u00fcfusun genele oran\u0131 ile \u00f6l\u00e7\u00fcl\u00fcr. Etkinli\u011finin y\u00fcksek oldu\u011fu bilinen mRNA a\u015f\u0131lar\u0131 ile yak\u0131n zamanda a\u015f\u0131lanm\u0131\u015f, ba\u011f\u0131\u015f\u0131klama korumas\u0131 alt\u0131ndaki n\u00fcfusumuz ancak %20\u2019ler civar\u0131ndad\u0131r. N\u00fcfusun b\u00fcy\u00fck k\u0131sm\u0131n\u0131n 2021 Ocak-Nisan d\u00f6neminde a\u015f\u0131land\u0131\u011f\u0131 bilindi\u011fine g\u00f6re bu grubu a\u015f\u0131l\u0131 olarak kabul etmek bizi yanl\u0131\u015f olarak, gereksiz bir iyimserli\u011fe g\u00f6t\u00fcrecektir. Son aylarda giderek azalan a\u015f\u0131lanma h\u0131z\u0131 ile etkin a\u015f\u0131l\u0131 oran\u0131n\u0131n daha da d\u00fc\u015fece\u011fi a\u00e7\u0131kt\u0131r.<\/li>\n
  3. Salg\u0131na kar\u015f\u0131 a\u015f\u0131lanma ba\u015flad\u0131\u011f\u0131nda tek se\u00e7enek olarak bulunan inaktif CoronaVac a\u015f\u0131s\u0131n\u0131n etkinli\u011finin d\u00fc\u015f\u00fck oldu\u011fu bilinmesine kar\u015f\u0131n sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131 ve di\u011fer riskli gruplar bu a\u015f\u0131 ile a\u015f\u0131lanmak durumunda kal\u0131nm\u0131\u015ft\u0131r. Halbuki t\u00fcm geli\u015fmi\u015f \u00fclkeler mRNA a\u015f\u0131lar\u0131 ile salg\u0131na kar\u015f\u0131 m\u00fccadele etmi\u015f, \u00f6l\u00fcm say\u0131lar\u0131 bu \u015fekilde d\u00fc\u015fm\u00fc\u015ft\u00fcr. CoronaVac gibi inaktif a\u015f\u0131lar de\u011fil geli\u015fmi\u015f ve sorgulanabilir y\u00f6ntemle \u00fcretilen, \u00e7al\u0131\u015fmalarda y\u00fcksek etkinlik g\u00f6steren mRNA a\u015f\u0131lar\u0131 sa\u011fl\u0131k\u00e7\u0131 ve di\u011fer y\u00fcksek riskli gruplarda \u00f6nceliklendirilmelidir (Tablo 1).<\/li>\n
  4. PCR testi salg\u0131n y\u00f6netiminde bu a\u015famadan sonra \u00f6nemini yitirmi\u015ftir. Hastaneye yat\u0131r\u0131lan a\u011f\u0131r olgularda, obezite, kanser, diyabet, kalp veya akci\u011fer hastal\u0131klar\u0131 gibi \u00f6l\u00fcm olas\u0131l\u0131\u011f\u0131 y\u00fcksek olan gruplarda influenza A ve B\u2019den ay\u0131rt etmek, vir\u00fcs\u00fcn \u00fczerine eklenen ve \u00f6l\u00fcmlerden as\u0131l sorumlu oldu\u011fu d\u00fc\u015f\u00fcn\u00fclen bakteriyel enfeksiyonlar\u0131 tan\u0131mak i\u00e7in bu testler \u00f6nemlidir. Toplum taramas\u0131nda PCR kullan\u0131m\u0131 ise \u201ctest yok-vaka yok\u201d durumuna yol a\u00e7abilmekte, salg\u0131n\u0131n oldu\u011fundan daha hafif g\u00f6r\u00fcnmesine yol a\u00e7maktad\u0131r. Nitekim son haftalarda PCR testlerinin semptomatik olgularla s\u0131n\u0131rlanmas\u0131 olgu say\u0131lar\u0131n\u0131 azaltm\u0131\u015ft\u0131r, ancak bu bir yan\u0131lsamadan ibarettir. Toplumda genel tarama testi olarak PCR testi yerine h\u0131zl\u0131 antijen testi kullan\u0131lmal\u0131d\u0131r.<\/li>\n
  5. \u00dclkemizde hangi varyantlar\u0131n hangi oranda oldu\u011fu bilinmemektedir. Sekans analizi sonu\u00e7lar\u0131n\u0131n payla\u015f\u0131lmas\u0131 durumunda bilim toplulu\u011funca \u00f6nlem al\u0131nmas\u0131 m\u00fcmk\u00fcn olacakt\u0131r. Kullan\u0131lan PCR testlerinin bask\u0131n varyant ile ili\u015fkisinin de ortaya konmas\u0131, yanl\u0131\u015f negatiflik\/pozitiflik oranlar\u0131n\u0131n bilinmesi salg\u0131ndaki durumu anlamam\u0131z\u0131 sa\u011flayabilir.<\/li>\n
  6. Asemptomatik, gen\u00e7, ek hastal\u0131klar\u0131 olmayan bireylerde test yerine a\u015f\u0131lanma ve ba\u011f\u0131\u015f\u0131klanman\u0131n yayg\u0131nla\u015ft\u0131r\u0131lmas\u0131 \u00f6n planda olmal\u0131d\u0131r.<\/li>\n
  7. Salg\u0131n stratejisinde en \u00f6nemli sorunlardan biri insanlar\u0131n hasta olmas\u0131n\u0131n beklenmesi, semptomatik olarak ba\u015fvurdu\u011fu sa\u011fl\u0131k kurulu\u015funda \u00f6nlem almaya ba\u015flanmas\u0131d\u0131r. Pandemi hastanelerde de\u011fil, toplumda, evlerde, temasl\u0131 takiplerinde, risk grubu taramalar\u0131nda kar\u015f\u0131lanmal\u0131d\u0131r. \u00d6rne\u011fin grip veya so\u011fuk alg\u0131nl\u0131\u011f\u0131 belirtileri g\u00f6steren her bireye COVID-19 olgusu olarak yakla\u015f\u0131larak testten ba\u011f\u0131ms\u0131z olacak \u015fekilde gerekli izolasyon \u00f6nlemleri al\u0131nmal\u0131d\u0131r.<\/li>\n
  8. Acil servislerden Yo\u011fun Bak\u0131m veya servislere yat\u0131r\u0131lacak hastalarda PCR bak\u0131lm\u0131\u015f olma zorunlulu\u011funun pratik bir anlam\u0131 kalmam\u0131\u015f, acilde ek y\u00fck olu\u015fturan bir b\u00fcrokratik basama\u011fa d\u00f6n\u00fc\u015fm\u00fc\u015ft\u00fcr. Hasta \u00f6zelinde, kons\u00fcltasyonlarla karar verilecek bir konu olarak yakla\u015f\u0131lmas\u0131 daha do\u011fru olacakt\u0131r.<\/li>\n
  9. Koruyucu hekimli\u011fin g\u00fc\u00e7lendirilmesi, temasl\u0131 takibi, riskli gruplar\u0131n taranmas\u0131n\u0131n \u00f6ne \u00e7\u0131kar\u0131lmas\u0131, ger\u00e7ek bir filyasyonun ger\u00e7ekle\u015ftirilmesi anahtar \u00f6nlemlerdir.<\/li>\n
  10. Temasl\u0131 takibi, riskli gruplar\u0131n belirlenmesi gibi pratikler terkedilmi\u015f veya gev\u015fetilmi\u015ftir.<\/li>\n
  11. Bilgi azl\u0131\u011f\u0131 ve kirlili\u011fi, hem a\u015f\u0131 teredd\u00fcd\u00fcn\u00fc art\u0131rmakta, a\u015f\u0131lanmay\u0131 azaltmakta, hem de gereksiz vitamin-katk\u0131 sat\u0131\u015flar\u0131, yanl\u0131\u015f ila\u00e7 kullan\u0131m\u0131, antikor testleri gibi yan yollarla zarar vermektedir.<\/li>\n
  12. Bir\u00e7ok hastanede acil servis b\u00fcnyesinde olu\u015fturulan s\u00fcr\u00fcnt\u00fc alma ve COVID poliklinikleri hastane b\u00fcnyesinde, acilden ba\u011f\u0131ms\u0131z birimlere d\u00f6n\u00fc\u015ft\u00fcr\u00fclmeli ve acil servise ek y\u00fck getirmeyecek \u015fekilde planlanmal\u0131d\u0131r.<\/li>\n
  13. A\u015f\u0131lanma oranlar\u0131 bu derece d\u00fc\u015f\u00fck iken k\u0131s\u0131tlamalar\u0131n tamamen kald\u0131r\u0131lmas\u0131, ba\u011f\u0131\u015f\u0131kl\u0131\u011f\u0131 zay\u0131f ve riskli kabul edilen toplum gruplar\u0131n\u0131n sa\u011fl\u0131\u011f\u0131 i\u00e7in \u00f6nemli bir tehdit olu\u015fturmaktad\u0131r.<\/li>\n<\/ol>\n

    \u00d6nerilerimiz:<\/h4>\n
      \n
    1. A\u015f\u0131s\u0131zlar\u0131n a\u015f\u0131lanmas\u0131, eksik a\u015f\u0131l\u0131lar\u0131n a\u015f\u0131lar\u0131n\u0131n tamamlanmas\u0131, risk grubundakilerin \u00f6zellikle hekim ve di\u011fer sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n a\u015f\u0131l\u0131 olma durumu yak\u0131ndan izlenmeli ve bunun i\u00e7in gerekli yasal mevzuat\u0131n planlanmas\u0131 uygun olacakt\u0131r.<\/li>\n
    2. K\u0131r\u0131lgan ve y\u00fcksek riskli gruplarda da olgu ve \u00f6l\u00fcm art\u0131\u015f\u0131 hastal\u0131\u011f\u0131n yayg\u0131nl\u0131\u011f\u0131yla paralel seyredecektir. Riskli gruplar\u0131n a\u015f\u0131lanmas\u0131 bu nedenle ya\u015famsald\u0131r. Devlet bu konuda ger\u00e7ek bir a\u015f\u0131lanma kampanyas\u0131 yapmal\u0131, bakanl\u0131klar, e\u011fitim kurumlar\u0131, kanaat \u00f6nderleri, kad\u0131n kurulu\u015flar\u0131, muhtarl\u0131k ve kaymakaml\u0131klar aktif kat\u0131l\u0131m g\u00f6stermelidir.<\/li>\n
    3. Yo\u011fun bak\u0131mlardaki ki\u015filerin ve \u00f6len hastalar\u0131n hemen tamam\u0131 eksik a\u015f\u0131l\u0131 veya a\u015f\u0131s\u0131z hastalar, veya inaktif a\u015f\u0131l\u0131, a\u015f\u0131 koruma s\u00fcresinin d\u0131\u015f\u0131na \u00e7\u0131km\u0131\u015f ki\u015filerdir.\u00a0<\/strong>Sonu\u00e7 olarak mRNA veya vekt\u00f6r a\u015f\u0131lar\u0131 bilimsel olarak \u00f6nerilen \u015femaya g\u00f6re uygulanmal\u0131d\u0131r.\u00a0Bu konuyla ba\u011flant\u0131l\u0131 olarak, en k\u0131sa s\u00fcrede Turkovac ile ilgili sorulara yan\u0131t verebilecek g\u00fc\u00e7te bilimsel yay\u0131nlar yap\u0131lmal\u0131d\u0131r.<\/li>\n
    4. Havaland\u0131rma, hijyen, maske, semptomatik ki\u015filere yakla\u015fmama gibi \u00f6nlemlerin h\u0131zla b\u0131rak\u0131lmas\u0131 yerine toplumun bilin\u00e7lendirilmesiyle selektif yakla\u015f\u0131mlar vurgulanmal\u0131d\u0131r. Bula\u015fma riskinin artt\u0131\u011f\u0131 kafe-restoran gibi maske indirilen mekanlara giri\u015fte a\u015f\u0131 kontrol\u00fcn\u00fcn yap\u0131lmas\u0131, bunun i\u00e7in HES kodu uygulamas\u0131ndaki gibi a\u015f\u0131 durumunun sorgulanmas\u0131 do\u011fru olacakt\u0131r.<\/li>\n
    5. \u0130\u015fyerleri ve toplu ta\u015f\u0131mada bula\u015f riskini azaltmak i\u00e7in uzaktan \u00e7al\u0131\u015fabilecek ki\u015filerin evden \u00e7al\u0131\u015fmalar\u0131n\u0131n sa\u011flanmas\u0131 toplumsal hareketlili\u011fin azalt\u0131lmas\u0131na katk\u0131da bulunacakt\u0131r.<\/li>\n
    6. H\u0131zl\u0131 antijen testinin veya FDA onayl\u0131 nefes testi gibi incelemelerin yayg\u0131nla\u015ft\u0131r\u0131lmas\u0131 ve pozitif sonu\u00e7lar\u0131n kayd\u0131n\u0131n yap\u0131labilmesi riskli gruplarda hastalar\u0131n tan\u0131nmas\u0131nda \u015fu anki PCR testine g\u00f6re daha pratik bir \u00e7\u00f6z\u00fcm olacakt\u0131r (3). \u00d6rne\u011fin d\u00fc\u015f\u00fck riskli gruplarda temas riski bile yok iken PCR ile tarama testi yap\u0131lmas\u0131 \u00f6nerilmemektedir.<\/li>\n
    7. \u00d6zellikle riskli gruplar\u0131n \u00f6nceliklendirilerek, temasl\u0131 takibinin yap\u0131lmas\u0131 pandeminin bitirilmesinde evrensel bir \u00f6neridir.<\/li>\n
    8. Baz\u0131 hastanelerde ortaya \u00e7\u0131kan yat\u0131\u015f zorlu\u011fu nedeni ile bundan sonra g\u00f6r\u00fclecek pandemiler i\u00e7in t\u00fcm kliniklerin ortak \u00e7al\u0131\u015ft\u0131\u011f\u0131 pandemi servisleri ve yo\u011fun bak\u0131mlar i\u00e7in hastane afet plan\u0131nda yer ve ili\u015fkili personel (deprem \/ afet planlar\u0131nda oldu\u011fu gibi) saptanmal\u0131d\u0131r.<\/li>\n
    9. Post- COVID hastalar\u0131n komplikasyonlar\u0131 i\u00e7in poliklinikler olu\u015fturulmal\u0131d\u0131r.<\/li>\n
    10. Acil servislerde negatif bas\u0131n\u00e7l\u0131 izolasyon alanlar\u0131 olu\u015fturulmal\u0131d\u0131r.<\/li>\n
    11. Acil servis kalabal\u0131kl\u0131\u011f\u0131n\u0131n pandemi dalgalar\u0131n\u0131n d\u00fc\u015f\u00fc\u015f faz\u0131nda \u00f6n\u00fcne ge\u00e7ecek yat\u0131\u015f planlamalar\u0131 resmile\u015ftirilmelidir.<\/li>\n
    12. Son olarak, planlamada en iyi senaryonun veri kabul edilmesi yerine daha ger\u00e7ek\u00e7i, k\u00f6t\u00fcmser senaryolar\u0131n da hesaba kat\u0131lmas\u0131 gereklidir. Diren\u00e7li ve \u00f6l\u00fcmc\u00fcl varyantlar\u0131n, buna ili\u015fkin senaryolar\u0131n da \u00e7\u0131kabilece\u011fi d\u00fc\u015f\u00fcn\u00fclmelidir.<\/li>\n<\/ol>\n

      Acil servis \u00e7al\u0131\u015fanlar\u0131, acil t\u0131p hekimleri ve uzmanlar\u0131 olarak pandeminin do\u011frudan etkiledi\u011fi bir gruptay\u0131z.\u00a0 Enfeksiyon, g\u00f6\u011f\u00fcs hastal\u0131klar\u0131, i\u00e7 hastal\u0131klar\u0131, yo\u011fun bak\u0131m, mikrobiyoloji gibi yak\u0131ndan vir\u00fcsle \u00e7al\u0131\u015fan bran\u015flar aras\u0131nda en fazla COVID-19 hastas\u0131n\u0131n bak\u0131m\u0131na kat\u0131lan, ent\u00fcbe eden, CPR uygulayan, dolay\u0131s\u0131yla vir\u00fcsle ya\u015fayan hekimler olarak \u2018y\u00fcksek riskli\u2019 grupta say\u0131lmay\u0131 sadece sigorta primleri belirlenirken de\u011fil, belli avantajlar ve ayr\u0131cal\u0131klar g\u00fcndeme geldi\u011finde de hat\u0131rlanmay\u0131 istiyoruz. COVID-19\u2019un meslek hastal\u0131\u011f\u0131 say\u0131lmas\u0131n\u0131n gerekli oldu\u011funu d\u00fc\u015f\u00fcn\u00fcyoruz. COVID-19 nedeniyle belli s\u00fcre \u00e7al\u0131\u015famayan, hastanede tefavi edilen, kayba u\u011frayan ve ya\u015fam\u0131n\u0131 kaybeden meslekta\u015flar\u0131m\u0131z\u0131n ek bir i\u015flem gerektirmeksizin meslek hastal\u0131\u011f\u0131 \u00fczerinden i\u015flem g\u00f6rmesi \u00f6nemlidir. \u00d6nceki b\u00f6l\u00fcmlerde belirtildi\u011fi gibi, devlet taraf\u0131ndan ba\u011f\u0131\u015f\u0131klama kampanyas\u0131na \u00f6nem verilmesi gerekti\u011fi; pandemi y\u00f6netiminde meslek \u00f6rg\u00fctleri, uzmanl\u0131k dernekleri ve akademisyenlerin aktif kat\u0131l\u0131m\u0131n\u0131n sa\u011flanmas\u0131 hastal\u0131\u011f\u0131 minimalize edecek yegane y\u00f6ntemdir.<\/p>\n

       <\/p>\n

      TATD COVID-19 G\u00f6rev G\u00fcc\u00fc ad\u0131na<\/p>\n

      Prof. Dr. \u00d6zg\u00fcr Karc\u0131o\u011flu<\/p>\n

      okarcioglu@gmail.com<\/a><\/p>\n

      Kaynaklar<\/h5>\n
        \n
      1. COVID-19: Omicron BA.4 and BA.5 variants, not more severe or transmissible, so far https:\/\/news.un.org\/en\/story\/2022\/04\/1116182<\/li>\n
      2. WHO. 2022, Contact tracing and quarantine in the context of the Omicron SARS-CoV-2 variant: interim guidance, Eri\u015fim tarihi: 29 Mart 2022. https:\/\/www.who.int\/publications\/i\/item\/WHO-2019-nCoV-Contact-tracing-and-quarantine-Omicron-variant-2022.1<\/strong><\/a><\/li>\n
      3. Coronavirus (COVID-19) Update: FDA Authorizes First COVID-19 Diagnostic Test Using Breath Samples<\/li>\n
      4. https:\/\/www.fda.gov\/news-events\/press-announcements\/coronavirus-covid-19-update-fda-authorizes-first-covid-19-diagnostic-test-using-breath-samples<\/a><\/li>\n<\/ol>\n

        <\/p>","protected":false},"excerpt":{"rendered":"

        Sorry, this entry is only available in Turkish. Pandemi Bitti mi? Ge\u00e7mi\u015f \u0130ki Y\u0131lda Ald\u0131\u011f\u0131m\u0131z Derslerden \u00d6\u011frenilenler ve \u00d6neriler \u00a0COVID-19 pandemisinin ba\u015flad\u0131\u011f\u0131n\u0131n resmen ilan edilmesinin \u00fczerinden iki y\u0131ldan fazla zaman…<\/p>\n","protected":false},"author":883,"featured_media":31840,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_angie_page":false,"_lmt_disableupdate":"","_lmt_disable":"","_tatd_show_on_main_site":"","page_builder":"","footnotes":""},"categories":[1,10011,10014],"tags":[10245,10199,10145],"class_list":["post-31835","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-haber-ve-duyuru","category-akademik-blog-yazisi","tag-asi","tag-covid-19","tag-pandemi"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/en\/wp-json\/wp\/v2\/posts\/31835","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/en\/wp-json\/wp\/v2\/users\/883"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/en\/wp-json\/wp\/v2\/comments?post=31835"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/en\/wp-json\/wp\/v2\/posts\/31835\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/en\/wp-json\/wp\/v2\/media\/31840"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/en\/wp-json\/wp\/v2\/media?parent=31835"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/en\/wp-json\/wp\/v2\/categories?post=31835"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/en\/wp-json\/wp\/v2\/tags?post=31835"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}