How Iran’s coronavirus death toll came to be the highest behind only China

(SCMP) – Iran has been thrust to the forefront of rising global concern about the spread of the novel coronavirus after reporting by far the most deaths of any country apart from China.

Iranian health officials have confirmed 15 deaths from the Covid-19 disease among 61 cases in the country, while a parliamentarian representing the city at the centre of the outbreak in the country has claimed the death toll stands at 50.

Either figure would dwarf death tolls in South Korea, Japan and Italy, until now the most severely-affected countries outside China, where at least 80,000 people have taken ill and more than 2,700 people have lost their lives since the virus was first detected in Wuhan in December.

How did the virus reach the country?

After insisting as recently as last week that the country had no cases of the coronavirus, Iranian authorities on February 19 confirmed the deaths of two elderly people in the city of Qom, about 145km south of the capital Tehran, followed by more fatalities in subsequent days.

On February 25, officials raised the death toll to 15, from 12 the previous day – making the outbreak in Iran the deadliest outside China.

Ahmad Amirabadi Farahani, a lawmaker for the city of Qom, said on the same day there had been in fact 50 deaths, claiming the government was late to announce the outbreak and his city was ill-equipped to deal with the public health emergency. Deputy Health Minister Iraj Harirchi disputed those claims in a press conference on state television, pledging to resign if the death toll was even one-quarter of the higher figure.

Most of the cases have involved people who live in or visited Qom, a centre of learning for Shia Muslims in the country and across the Muslim world, but health ministry official Minou Mohrez on Friday warned it was possible the virus was present in all cities in the country.

“In recent history, Iran has not had the experience of dealing with the outbreaks on the scale of the current Covid-19,” said Asif Shuja, a senior research fellow at the Middle East Institute at the National University of Singapore (NUS). “Notably, the recent Middle East respiratory syndrome (Mers) outbreak had a minimal impact on Iran.”

After officials earlier speculated about possible sources of the outbreak including Chinese workers and pilgrims from Pakistan, Iran’s health minister Saeed Namaki on Sunday said the contagion was believed to be linked to a merchant from Qom who regularly travelled between Iran and China. The Iranian, who died from the virus, had been using indirect flights to get around a ban on direct flights between the countries introduced at the end of January.

Why is the outbreak in Iran causing particular concern?

Although the virus has already been confirmed in 31 countries and territories outside mainland China, the rapid surge in cases in Iran – far away from the epicentre of the outbreak in Wuhan – has fuelled fears the virus is on course to become a global pandemic.

World Health Organisation (WHO) director general Tedros Adhanom Ghebreyesus on Saturday warned the “window of opportunity” to contain the virus globally was narrowing rapidly.

“The cases that we see in the rest of the world, although the numbers are small, but not linked to Wuhan or China, it’s very worrisome,” Adhanom Ghebreyesus said. “These dots are actually very concerning.”

At least two people, a Canadian woman in her 30s and a 45-year-old woman in Lebanon, have tested positive for the virus outside Iran after travelling to the country. The eruption of cases in Iran also comes amid sudden spikes outside China in South Korea and Italy, which have confirmed more than 800 and 150 infections, respectively. South Korea has confirmed 10 deaths due to the virus. Italy has reported seven fatalities and Japan five.

The disproportionately high fatality rate in Iran’s official figures – with about one in five of those infected succumbing to the virus, compared to one in 50 in China – has been taken by some experts as a sign the true number of cases in the country is far higher than currently known.

Assuming a fatality rate of about 2 per cent, the official death toll so far would translate into about 600 cases overall in Iran, about 10 times the current count.