Iran was one of the first countries to experience a COVID-19 epidemic, and began relaxing restrictions in April, but cases have since rebounded. Sharmila Devi reports.
Following a sharp rise in daily new cases of COVID-19 in Iran during the past few weeks, President Hassan Rouhani warned on June 13 that movement restrictions would be reimposed unless health regulations were strictly followed.
Iran was one of the first countries to have a large number of cases, and began restrictions on public gatherings in late February, including Friday prayers in Tehran, the closure of restaurants, bazaars and major religious shrines, and a ban on internal travel.
Since mid-April, Iran has gradually relaxed its restrictions, reopening shops, workshops, and factories outside of Tehran on April 11, and allowing travel between cities in the same province on April 12. Cases dropped, with fewer than 1000 new cases per day by the start of May, but daily cases have since increased, with the Iranian Health Ministry reporting 2410 new cases on June 13. In total, 184 955 cases and 8730 deaths have been recorded, but a report by the Iranian Parliament's research centre in April suggested that the real death toll could be twice as high as the official number, which only counts hospital deaths.
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“If there is no cooperation, we will have to reimpose the restrictions”, said Rouhani, as reported by the state news agency IRNA. He said officials should do more to ensure that people complied with measures on mask wearing and maintaining physical distancing of 1·5 m at prayers, for example.
Officials say the easing of the lockdown, as well as increased testing from about 10 000 a day to 25 000 a day, has contributed to the higher reported infections. The epidemic was initially concentrated in the cities of Tehran and Qom, and the recent flare-up included the southwestern province of Khuzestan, where a localised lockdown was reimposed earlier in June.
“It's difficult to use terminology that's not well defined like a ‘second wave’”, Christoph Hamelmann, WHO representative in Iran, told The Lancet. “I don't think at this moment or in the near future we are close to another national lockdown, but provincial or county-level lockdowns are possible as happened in Khuzestan, which is a good sign.”
He said increased testing had uncovered a greater number of cases in the wider community as opposed to in hospitals, while the death rate remained roughly constant. Any increase in deaths would take several weeks to become apparent, he said. 107 deaths were reported on June 14, the highest number in 2 months.
The country had been hard-hit by the reimposition of unilateral sanctions by the USA in 2018, had a “lot less fiscal space”, and needed to restart the economy. However, its easing of the national lockdown had been gradual, cautious, and based on risk assessments, said Hamelmann.
“Iran was the first country to speak of ‘smart distancing’, with different sectors opening at different times, but there does need to be greater effort around messaging and [COVID-19] literacy, and this is something other countries could learn from”, he said.
The country's strong primary health-care system was helping to create a system of contact tracing, while 70 million people out of a population of 80 million had registered with a government website aimed at tracking the spread of the disease, said Hamelmann. Economic resilience forged during decades of international isolation had also helped Iran to become self-sufficient in personal protective equipment, with local production in the past month removing the need for imports, he said.
He also pointed to serological studies that showed the number of infected people was broadly in line with other countries, notwithstanding known issues of accuracy around serological tests.
Goodarz Danaei, associate professor of cardiovascular health at the Harvard T H Chan School of Public Health, also said the numbers seen in Iran did not diverge greatly from those reported elsewhere. But one of the biggest challenges was compliance with health regulations. “People get tired. Anecdotally, I hear that the lines at airports are back to normal and people aren't 6 feet away from each other. I'm sure people aren't using masks properly and have a false sense of confidence”, he said.