Iran’s deputy health minister, Iraj Harirchi, was pale and drenched in sweat during a press conference on Monday, as he told reporters that the Islamic Republic had “almost stabilized” the country’s outbreak of coronavirus. He mopped his brow so often that an aide scurried to the lectern with a box of tissues. Harirchi dismissed as hype an Iranian lawmaker’s claim that fifty people had already died from COVID-19. “I will resign if the numbers are even half or a quarter of this,” he said, adding that Iran had only sixty-one confirmed cases, with twelve deaths. Iran opposed quarantines, he said, because they belonged to an era before the First World War—“to the plague, cholera, stuff like that.” The next day, Harirchi confirmed in a video—from quarantine—that he had contracted coronavirus.

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 deputy health minister, Iraj Harirchi, wipes sweat from his brow during a press conference, on Monday. He later confirmed that he has contracted coronavirus.Photograph by Mehdi Bolourian / Fars News / AFP / Getty

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, told me. “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 massive gold dome and intricate blue tilework—which draws pilgrims from all over the world. (For its historic beauty, I visit the shrine complex whenever I go to Qom.) 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, told me. 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.



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