Iran, a country of eighty-three million people, has now become one of the global epicenters of the coronavirus—with the highest mortality rate in the world.
Based on official numbers, the mortality rate in Iran has fluctuated daily, between eight and eighteen per cent, compared to three per cent in China and less everywhere else. Iran is also unique, because a disproportionate number of confirmed cases are senior government officials.
On Thursday, the Vice-President, Masoumeh Ebtekar—who gained fame in 1979 as Sister Mary, the spokeswoman for the students who seized the U.S. Embassy and took fifty-two Americans hostage—announced that she, too, had contracted the coronavirus.
The day before, she had attended a meeting with President Hassan Rouhani and his cabinet. Two members of parliament, including the chairman of the Committee on National Security and Foreign Policy, have also been infected, as has the mayor of a district in Tehran and a senior cleric who had served as Iran’s Ambassador to the Vatican.
One of the lawmakers, Mahmoud Sadeghi, tweeted on Tuesday, “I send this message in a situation where I have little hope of surviving in this world.” The former Vatican Ambassador, who was eighty-one, died on Thursday. So did Elham Sheikhi, a member of the women’s national soccer team, who was twenty-two.
Iran’s official counts—three hundred and eighty-eight confirmed cases and thirty-four deaths, as of Friday—may be grossly underreported. In an early analysis published on Monday, six Canadian epidemiologists calculated that Iran probably had more than eighteen thousand cases of coronavirus.
Their mathematical model was based on Iran’s official death toll, the disease’s infection and mortality rates worldwide, inflections in other countries traced to Iran, flight data, and travel patterns.
“Given the low volumes of air travel to countries with identified cases of COVID-19 with origin in Iran (such as Canada), it is likely that Iran is currently experiencing a COVID-19 epidemic of significant size,” they concluded. Because of the wide margin of error, the number of cases could range from as low as thirty-seven hundred to as high as fifty-three thousand.
In the end, the Canadian epidemiologists settled on eighteen thousand three hundred, with a ninety-five-per-cent confidence rate. All of their estimates are many, many times higher than the figures that Iran has reported. Their model was published on medRxiv, which posts preliminary research that has not yet been peer-reviewed.
Kamiar Alaei, a widely recognized Iranian global health-policy expert who co-founded an innovative H.I.V. clinic in Tehran, also emphasized the tricky and still evolving mathematics of coronavirus contagion.
“The mortality rate elsewhere is around one to two per cent, and three per cent in China,” Alaei, who is now a co-president of the Institute for International Health and Education, in Albany.
“Iran has announced thirty-four deaths, although some unofficial reports claim it is at least a hundred and thirty-four and even two hundred. So if the death rate is only one per cent, then the total number of cases would be between thirty-four hundred and ten thousand or even twenty thousand.”
The outbreak appears to have started in Qom, the conservative city of Shiite seminaries run by leading ayatollahs, about two hours from Tehran.
It is also home to the Fatima Masumeh shrine—famed for its giant gold dome and intricate blue tilework—which draws pilgrims from all over the world.
The first mention of the disease by the government was a report of two deaths in the city on February 19th. Initial reports indicate that the carrier of the virus may have been a merchant who travelled between Qom and Wuhan, in China, where COVID-19 is believed to have originated.
The outbreak is estimated to have begun between three and six weeks ago, which would mean that the two Iranians who died could have been sick and infecting others for weeks.
Within eight days of the first reported death in Iran, COVID-19 had spread to twenty-four of the country’s thirty-one provinces. The number of cases has roughly doubled daily since Tuesday.
Instead of closing down public sites, a measure that public-health experts have taken in other countries, the head of the shrine in Qom called on pilgrims to keep coming.
“We consider this holy shrine to be a place of healing. That means people should come here to heal from spiritual and physical diseases,”
Mohammad Saeedi, who is also the representative of Iran’s Supreme Leader in Qom, said in a video. Cases traced back to Iran have been reported in Azerbaijan, Afghanistan, Bahrain, Canada, Georgia, Iraq, Kuwait, Lebanon, Oman, Pakistan, and the United Arab Emirates. Many of these cases have been linked specifically to visits to Qom.
Politics may have played a role in the government’s handling of the health crisis, Alaei, the health-policy expert said. The outbreak coincided with two major milestones—the anniversary of Iran’s revolution, on February 11th, and the parliamentary election, on February 21st.
“The government didn’t want to acknowledge that they had a coronavirus outbreak because they feared it would impact participation in these two events,” he said.
“So for weeks there was a huge silence.” Less than forty-three per cent of Iranian voters turned out for the election, the lowest rate of participation since the 1979 revolution. Both voters and poll workers were photographed wearing masks.
“It was the political decision that led to this outbreak in Iran,” Alaei said.
“It’s very unfortunate, as Iran has a very well-established infrastructure for the health system and well-educated doctors.” Alaei was imprisoned in 2008 for “communicating with the enemy,” running espionage rings, and trying to “launch a velvet revolution” against the government in Tehran.
He spent thirty months in the notorious Evin Prison. He moved to the United States after his release.
The coronavirus is also becoming a new flashpoint between Iran and the United States. After the election, the Supreme Leader, Ayatollah Ali Khamenei, accused Iran’s enemies of exaggerating the threat of coronavirus to scare voters away from the polls.
“This negative propaganda about the virus began a couple of months ago and grew larger ahead of the election,” he said. “Their media did not miss the tiniest opportunity for dissuading Iranian voters and resorting to the excuse of disease and the virus.” On Wednesday, the U.S. Secretary of State, Mike Pompeo, countered that Iran was lying about “vital details” of the spread of the virus.
The timing of the epidemic is particularly dire for Iran’s economy. As part of President Trump’s “maximum-pressure campaign,” the U.S. reimposed economic sanctions on Iran—and any foreign company or country that does business with it—in November, 2018. Iran’s economy contracted more than nine per cent last year.
Since the coronavirus outbreak began, ten days ago, eleven countries, including major trading partners such as Afghanistan, Iraq, and Turkey, have closed their borders to the Islamic Republic, according to Adnan Mazarei, an economist at the Peterson Institute for International Economics, in Washington. “The entire Middle East region could soon be affected by Iran’s role as an epicenter of this contagion,” he wrote on Thursday. “The Middle East region will certainly be hit by a new round of downward pressure on oil prices on account of a decline in demand for oil by China and elsewhere,” he added. And China has accounted for a quarter of all Iranian trade.
Internal commerce is also likely to take a hit on the eve of Nowruz, the Persian New Year, in three weeks. Nowruz is the country’s biggest holiday, and the ritual is to buy new clothes and toys—and to travel to the Caspian coast or other vacation spots to take a break from Iran’s mounting crises. The more that Nowruz celebrations are curtailed, the greater the danger for protests about the epidemic, global isolation, and unanticipated economic setbacks. Two waves of protests have challenged the regime since November.
Iran took steps this week to check the contagion’s spread. In Tehran’s subways, cars were disinfected and snack shops were shut. In more than a dozen provinces, public venues—college campuses, schools, and cultural centers—were closed.
Events drawing large audiences, including soccer games and movie screenings, were postponed. Friday prayers were cancelled in the twenty-four provinces where the virus has appeared.
Schools across Iran will be closed for three days, as of Saturday. The Health Ministry has urged people not to shake hands and to avoid crowded places.
Social media was filled with parodies—a video of young men on the street shaking their shoes with one another, to avoid shaking hands, and a barber cutting the hair of a customer, who was wearing a mask, with a razor attached to an extender pole.
Yet the regime has been fighting the image of a nation crippled by an epidemic as much as it has been fighting the coronavirus itself. Speaking at a national headquarters established to deal with the virus, Rouhani said, “In schools, high schools, universities, and workplaces, everybody should pay attention to health recommendations. But we must all continue our work and activities, because it is one of the enemies’ plots to spread fear in our country and close down the country.”
The ailing deputy health minister was more candid. “I’m saying this deep from my heart . . . take care of yourselves,” Harirchi said in a video that he posted from quarantine.
“This is a democratic virus, and it doesn’t distinguish between poor and rich, statesman and an ordinary citizen. It may infect a number of people.” In the Islamic Republic, that number may be frighteningly large.