Iranian leaders once predicted the coronavirus epidemic ravaging China would not affect their country. Now Iran has among the most coronavirus deaths outside China, and Iranian medical workers have been told to keep quiet.
Nearly three dozen Iranian government officials and members of parliament are infected, and a senior adviser to the supreme leader has died.
The Health Ministry has proposed sending 300,000 militia members door to door on a desperate mission to sanitise homes. The top prosecutor has warned that anyone hoarding face masks and other public health equipment risks the death penalty.
Iran's leaders confidently predicted just two weeks ago that the coronavirus contagion ravaging China would not be a problem in their country. They even bragged of exporting face masks to their Chinese trading partners.
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Now Iran is battered by coronavirus infections that have killed 77 people, among the most outside of China, officials said Tuesday. But instead of receiving government help, overwhelmed doctors and nurses say they have been warned by security forces to keep quiet. And some officials say Tehran's hierarchy is understating the true extent of the outbreak — probably, experts contend, because it will be viewed as a failure that enemies will exploit.
As the world wrestles with the spread of the coronavirus, the epidemic in Iran is a lesson in what happens when a secretive state with limited resources tries to play down an outbreak and then finds it very difficult to contain.
Authorities seem as worried about controlling information as they are about controlling the virus, according to telephone interviews and text messages with more than a half dozen Iranian medical workers.
Several said security agents stationed in each hospital had forbidden staff members from disclosing any information about shortages, patients or fatalities related to the coronavirus.
A nurse in a city in Iran's northwest sent a private message to her family — later shared with The New York Times — describing a letter from the security service warning that sharing information about infected patients constitutes a "threat to national security" and "public fear mongering." Such offenses "will be swiftly dealt with by a disciplinary committee," the nurse said the letter had warned.
The secrecy and paranoia, doctors and other experts say, reflects what they call a counterproductive focus on Iran's public image and prestige that appears to be damaging public trust and hindering more practical steps at containment.
A prominent pathologist in Tehran said laboratory staff members testing for the coronavirus were told that they had been threatened with interrogation and arrest if they provided information to the news media.
"Disgraceful," the pathologist said in a telephone interview. "By turning this into a national security issue, they are putting more pressure and stress on doctors and medical teams and creating an environment of chaos and fear."
All spoke on condition of anonymity because of the threats.
In northern Iran's Golestan province — where Iran has acknowledged about two dozen infections — the top health official railed in a news conference Sunday about his frustration with Tehran's refusal to acknowledge the extent of the epidemic.
"We were screaming at the health ministry that we have 594 corona patients, but the ministry was telling us since you don't have positive test results we won't give you equipment you need," the official, Dr. Abdulreza Fazel, complained. "They kept saying, 'wait, wait, wait,' and then suddenly they announce you are an epicentre.
"We've known from Day 1 we are an epicentre," Fazel said.
The virus, which first appeared in China in late 2019, has struck Iran at a moment of particular vulnerability for its leadership.
Iran's economy has been hobbled by US sanctions. Its security forces have struggled to repress a wave of public protests. Its military has reeled from the assassination of a revered Iranian military commander by a US drone. Domestic credibility of authorities may have reached a new low with the begrudging admission after a days of denials that their own air defences had mistakenly shot down a Ukrainian passenger jet full of Iranian passengers.
"They are lurching from crisis to crisis and trying to Band-Aid each crisis," said Sanam Vakil, a researcher on Iran at Chatham House, a London-based research institute. "They underestimated the potential effect of the coronavirus."
Iranian health officials initially boasted of their public health prowess. They ridiculed quarantines as "archaic" and portrayed Iran as a global role model. President Hassan Rouhani suggested a week ago that by this past Saturday life would have returned to normal.
Instead, Iran on Tuesday acknowledged as many as 77 deaths from the virus and at least 2,300 cases of infection. But medical experts say the 77 deaths suggested that, based on the expected death rate, about 4,000 people are presumably infected.
Authorities also said Tuesday that they had temporarily freed 54,000 prisoners considered symptom-free, apparently in hopes of minimising contagion in Iran's crowded penitentiaries. But it was unclear from the announcement how many prisoners had actually been tested, given the severe shortages of testing kits in the country.
Because of those shortages, the reality is that no one can guess how far the coronavirus has spread in Iran. One Canadian study projected a week ago that the true total of infections may have been more than 18,000, "and a week ago is eons when we are talking about an epidemic," said Isaac Bogoch, a Toronto doctor who was one of the authors.
The roster of current or former senior official sickened in the contagion includes a vice president, the deputy health minister and 23 members of parliament. On Monday, Iranian state media reported that at least one official had even died from the virus: Mohammad Mirmohammadi, 71, a member of the Expediency Council, which advises Iran's supreme leader.
It was unclear how recently the adviser had been in contact with the supreme leader, Ayatollah Ali Khamenei, 80.
Embarrassed anew by the spread of the disease, Iranian authorities have responded with a hodgepodge of contradictory measures mixing elements of a crackdown with attempts to save face.
The nation's top prosecutor has threatened to execute anyone who hoards face masks or other supplies — an acknowledgment of the problem.
The health minister, Saeed Namaki, on Sunday announced a plan to dispatch a force of 300,000 plainclothes Basij militiamen that would go house to house to screen residents and disinfect their homes.
Iranian doctors and politicians immediately criticized the plan, saying that untrained militiamen were more likely to spread the virus than to contain it.
"The borders of mismanagement and ignorance are being rapidly redrawn by the health ministry," Dr. Omid Rezaie, a prominent oncologist in Tehran, wrote on Telegram, the social media channel. "I feel sorry for us because we are sitting in a sinking boat that you are managing."
The streets of Tehran, the capital, are deserted as panicky residents stick to their homes for fear of contagion. But in the holy city of Qom, the site of the first and most significant outbreak in Iran, mosques and shrines are still holding mass worship services for visiting pilgrims despite the Health Ministry's advice.
"Frankly, the unwillingness of the Islamic Republic of Iran to restrict large-scale visits to these shrines is criminal in the case of this illness," said Amir Afkhami, a medical doctor and historian at George Washington University who has studied the Iranian response to previous epidemics.
"The government is putting religious prestige and public image ahead of public safety," he said of the leadership's overall response. "It is unprecedented even in the annals of the Islamic Republic."
Dr. Mohsen Basiri, an Iranian physician now in Houston, said that in a conference call Sunday about emergency supplies his colleagues in Iran had said that security agents forced doctors to fill out false certificates for deaths that appeared to be coronavirus, ascribing them instead to lung or heart failure in order to avoid acknowledging fatalities linked to the epidemic.
"They don't have the means, equipment, money, management or trust of the public to combat an epidemic of this scope," Basiri said.
At least two Iranian lawmakers have publicly raised similar claims that authorities are seeking to hide fatalities from the coronavirus by listing other causes on death certificates.
Gholamali Jaffarzadeh Imanabadi, a lawmaker from Gilan province near the Caspian Sea, told the Iranian news media Monday that more than 20 people in his constituency had died, hospitals had reached full capacity, and the designated center for treatment of the virus was now turning away patients. In some cases, he also claimed, local authorities had recorded an alternate cause of death for the victims.
"Based on the numbers, testimonies and proof that we have received, the number of dead and infected people is far higher than what is announced," he complained, calling the official figures "a joke."
"Our officials are not revealing the whole truth about the situation."
Ahmad Amirabadi Farahani, a lawmaker from Qom, raised similar complaints last week, saying in a Twitter posting that staff at two hospitals were falsifying death certificates to minimize the epidemic.
"The doctors at Kamkar and Foghani hospitals are writing that cause of death is respiratory failure," Farahani wrote, "but they know very well that the deaths are happening in the coronavirus quarantine ward."
A spokesman for the Health Ministry disputed those accusations, suggesting that any discrepancy between local estimates and the official numbers might reflect only a time lag during backup testing to confirm infections. The spokesman, Kianoush Jahanpour, said the ministry double-checks results before adding them to the official tally.
Others complained that sheer shortages of testing kits and other equipment may be contributing to an undercount. "There is no testing kit, disinfectants and preventive equipment available in our country that can match the rapid spread of this disease," Bahram Parsaei, a lawmaker from Shiraz, said in a Twitter posting Sunday. "This is why reality is far more than the official numbers."
Iran has prided itself for decades on the strength of the public health system, said Afkhami, the author of a book about Iran's past response to epidemics. As recently as 2008, he said, Iran had acted effectively to avert a cholera epidemic from neighboring countries, partly by banning the sale of fresh vegetables and street foods in certain areas.
This time, though, Iran's health authorities appeared to have let their guard down, he said.
Reliant on China as its most essential trading partner in the face of the U.S. sanctions, Iran was slow to restrict travel to and from the country after the first reports of the breakout in the central Chinese city of Wuhan in December.
Then Tehran boasted of having sent supplies of domestically produced hospital masks to China, depleting Iranian supplies as other countries were quietly stockpiling their own. Now, Afkhami said, "its shortage of face masks is self-inflicted."
Written by: Farnaz Fassihi
Photographs by: Arash Khamooshi
© 2020 THE NEW YORK TIMES