How Iran Has Approached the Pandemic:
According to a recent census in 2020, the estimated population of Iran
was 83 992 949 . (2) The Iranian Ministry of Health and Medical
Education (MoHME), conducted almost 1,557,872 polymerase chain reaction
(PCR) tests. 19.2 PCR tests per 1000 people have been performed since
the beginning of the pandemic in Iran. The relative comparisons of the
cumulative number of tests performed per 1000 people in the region is
demonstrated in figure1. By June 29, 2020, more than 10 000
PCR-confirmed deaths had been recorded among patients with COVID-19;
accordingly, 2593 and 122 people per 1,000,000 people were infected and
subsequently died from COVID-19, respectively. The highest number of
newly diagnosed patients was recorded on March 30, 2020 (3186 patients),
and a declining slope was observed consequently.
By in large, many infected patients remained undiagnosed up until the
date of the first official report, which dated February 19, 2020., This
was due to lack of awareness of the viral virulence, proper diagnostic
measures, and insufficient warnings. Indeed, some physicians and
specialists around the country have been on record as stating that they
encountered a series of patients with presentations of pneumonia and
computed tomography (CT) scan findings similar to those in patients with
COVID-19 which were stated prior to official reports. Retrospective
evaluations of the CT scans or body fluids from those patients, if
available, would have helped to clarify the real figures. Nonetheless,
this diagnostic negligence prior to the declaration of the World Health
Organization (WHO) concerning “global pandemic warnings” is similar
scenario across the world.
The abovementioned data should be interpreted in light of the following
points:
- After the first surge of the pandemic, the government not only banned
public and religious events but also closed schools, universities,
shopping centers, bazaars, and holy shrines. Serendipitously, the
2-week Iranian New year’s (Nowruz) holidays, which start on the first
day of spring, fell within the period of the restrictions of social
activities, allowing policymakers more time to contain the spread of
the virus and to avail the impact of this pandemic.
- The shortage of laboratory diagnostics in the early period of the
outbreak delayed the testing of COVID-19 extensively, compelling
physicians to deal with patients with suspected infection by relying
merely on physical examinations or chest CT scans, which were
accessible across the nation. As is illustrated in Figure 1, Saudi
Arabia and Turkey performed 45.7 and 39.5 tests per 1000 people,
respectively, in comparison to 19.2 tests per 1000 people in Iran.
Hence, the actual number of patients with COVID-19 may have been
underestimated in Iran.
- As is the case of other countries, it appears that a majority of
infected individuals are either asymptomatic or mildly symptomatic and
have not been referred to hospitals and labs by frontline physicians.
Therefore, the daily figures of diagnosed patients must have been
underestimated and fatality rate may have been overestimated,
consequently.
- The negative economic impact caused by the spread of COVID-19 in Iran
coincides with the highest ever politically motivated economic
sanctions against the country by the United States government. (3) The
Iranian health sector, albeit among the most resilient in the region,
has been affected because of the sanctions.
- On the basis of recent statistics, inpatient healthcare services in
Iran are now provided by more than 900 hospitals nationwide, almost
85% of which are public hospitals under insurance coverage. (4) This
number approximately equals 117 000 hospital beds, producing a density
of 1.62 beds per 1000 people among the Iranian population. Hence,
COVID 19 cases are being dealt on priority.
The Impact:
In the early stage of the pandemic, the MoHME announced that all public
and private hospitals should cancel elective procedures and elective
admissions from February 29, 2020. In conjunction with the decree for
the postponement of elective procedures, each faculty and hospital were
tasked to set up scientific and executive multidisciplinary committees.
Additionally, all hospitals and clinics, except single-specialty
tertiary centers, were to admit patients with COVID-19 including those
requiring admission to general units or intensive care units (ICU).
Thanks to a nationwide network that was implemented decades earlier and
was comprised of a referral system starting at primary care centers in
the periphery going through secondary-level hospitals in the provincial
capitals and tertiary hospitals in major cities, the healthcare system
was able to resorb the increasing emergence of COVID-19 cases and
provide primary response to the current crisis.
With the exponential rise in the number of patients affected,
internists, hematologists, nephrologists, general surgeons, and thoracic
surgeons joined the multidisciplinary framework. Cardiac surgeons were
also involved in the implementation of extracorporeal membrane
oxygenation (ECMO). These initial actions, accompanied by the
restrictions laid down by the government, led to a steady-state curve of
newly diagnosed patients in March 2020.
Domestic pharmaceutical and medical device companies accelerated the
manufacturing of personal protective equipment (PPE), drugs, diagnostic
kits, and essential supplies to overcome major shortages as a
consequence of the international sanctions against Iran in the past
years.
Currently, all hospitals providing care to patients with COVID-19 are
equipped with PPE for healthcare personnel.