ALMATY, Kazakhstan -- Confusion reigns in Central Asia after the World Health Organization concluded a mission to Turkmenistan by recommending the government activate "measures as if COVID-19 were circulating" despite no cases being detected officially to date, while surging infections send neighboring countries back into lockdowns.
The long-delayed WHO mission, sent to assess how prepared Turkmenistan is to cope with COVID-19, arrived in the country on July 6. The leader, Dr. Catherine Smallwood, broadly endorsed the government's line that it is one of the last countries in the world that has not detected coronavirus cases. Yet, speaking in the capital Ashgabat at the end of the 10-day visit, she urged Turkmenistan to behave in public health terms as if the coronavirus were present; to fully investigate cases of acute respiratory infections; and to step up testing for suspected cases of COVID-19.
According to the Turkmen government, it is one of a dozen countries to remain coronavirus-free, along with North Korea and some isolated Pacific island states. Turkmenistan borders the COVID-19 hot spots of Iran, Afghanistan, Uzbekistan and Kazakhstan.
With the pandemic gripping the rest of the region in March, Turkmen President Gurbanguly Berdymukhamedov -- who also goes by the title Arkadag, "the protector" -- suggested that burning harmala, a medicinal herb, would be enough to stop the virus taking hold in Turkmenistan.
As the WHO visit began, the messaging from Ashgabat started to change. People were urged to wear masks on the streets as a precautionary measure against a supposed spike of hazardous dust particles in the air. Restrictions were placed on mass gatherings and on the opening of markets and shops.
While the Turkmen government sticks to its story of zero infections, reports from inside the country tell a different tale. The U.S. Embassy in Turkmenistan said on July 9 that it had "received reports of local citizens with symptoms consistent with COVID-19 undergoing COVID-19 testing and being placed in quarantine."
Saglyk, a website that provides Turkmen-language information on health matters, expressed concerns in June that "unconfirmed reports of patients diagnosed with 'atypical pneumonia' in Ashgabat" were actually cases of COVID-19.
Meanwhile, neighboring Kazakhstan, Uzbekistan and Kyrgyzstan are all battling a surge in COVID-19 cases. Central Asia has also seen a huge rise in pneumonia cases since the pandemic began. Kazakhstan's Ministry of Health reported a 300% year-on-year increase in cases in June, to 32,724 from 7,964. Fatalities were up 129%, to 628 from 274.
On July 9, the Chinese Embassy in Kazakhstan jumped on the pneumonia risk, warning its citizens of the spread of a dangerous, unidentified form of the disease in the country, initially dubbing it "Kazakhstan pneumonia" on its WeChat channel. The wording was later changed to "non-COVID pneumonia," but not before the story had gone viral in the world's media.
Kazakhstan, which borders China and is an ally and major trading partner, labeled the allegations disinformation. "The information published by some Chinese media regarding a new kind of pneumonia in Kazakhstan is incorrect," the authorities said.
The WHO backed this position, saying that the outbreak in Kazakhstan was most likely coronavirus, with the executive director of the WHO's Health Emergencies Program, Michael Ryan, speculating that the cases "just have not been diagnosed correctly."
Since exiting its first lockdown in mid-May, Kazakhstan's health care system has come under increasing pressure as coronavirus cases have increased 12-fold. As of late this week there were more than 65,000 reported cases, with 375 recorded deaths. Hospitals are struggling to cope with this, coupled with the spike in pneumonia cases.
After initially containing the spread of the coronavirus, a mix of ineffective communication and a lack of enforcement of preventive measures have combined to send infection rates soaring in Kazakhstan.
"In the very beginning we didn't see many cases, people didn't believe that this virus exists," Gaukhar Mergenova, a public health expert at Columbia University's Global Health Research Center of Central Asia in Kazakhstan, told a recent Carnegie Endowment webinar. "People didn't follow recommendations about masking, social distance, all these things were not followed," she added.
A poll conducted in June by Gallup International and Russia's Romir research group found that 61% of respondents in Kazakhstan thought the risks of the pandemic to be overstated, the second-highest of the 19 countries surveyed.
But with infections rising by over 1,500 a day, Kazakhstan went back into a partial lockdown for a month on July 5. Markets, cinemas and gyms are shuttered, but bar and restaurant terraces remain open. Transport links between regions are running but mass events such as weddings and birthday parties -- thought to be a key driver of the infection rate surge -- are banned.
There are signs that the authorities in Almaty, Kazakhstan's largest city, are belatedly starting to tackle the messaging problem. Billboards have started appearing on the streets advising people to wear masks, and mobile operators also started sending out SMS texts with the same advice. To enforce the measures, a $200 fine is being imposed.
Turkmenistan is also getting serious about masks. On Wednesday, Arkadag was shown on television wearing a mask in public for the first time while doing some socially distanced fishing and bird-watching on his vacation.