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The WHO's a little sketchy about pinpointing when we shift from one level to the next.

They say Level 3 consists of human infections, with trace human-to-human transmission cases thrown in. We've certainly reached this level, as evidenced by the HCW's getting sick in Vietnam while treating patients, to name one example.

Now, Level 4 is "Evidence of Increased Human-to-Human Transmission". But as I said, this is a little vague. I have heard that a criteria they look at is if the virus goes human-to-human-to-human. Apparently, once it moves from the index case to, say, a doctor, and then from the doctor to the doctor's wife, then it's considered Level 4. But that's just hearsay, and I don't know if it's official policy or not.

The current situation in Turkey is very murky. Level 4 scale transmission may have occurred, but it's difficult to be sure.