Iran Has Far More Coronavirus Cases Than It Is Letting On

By Graeme Wood

March 9, 2020

You are standing before a huge barrel of apples. You can’t see the apples, but you can reach in and pick them out. Most are delicious, but a very small number of them are rotten—just about one in 12,000, your friend assures you. You reach in blindly and miraculously pick out a rotten apple. You reach in again and withdraw a whole heaping bushel of apples, maybe 50 in all. Most are good, but when you look closely you see them: one, two, three, four more rotten apples. One rotten apple is an amazing coincidence. Five means your barrel has lots of rotting apples in it and your friend was lying to you.

As of yesterday, according to Johns Hopkins University’s Coronavirus Resource Center, Iran has reported 6,566 COVID-19 cases, or about one in every 12,000 people in its population. The first case appeared on February 19. Right now Iran is third behind China (80,695) and South Korea (7,314), and just ahead of Italy (5,883). But the official Iranian number is almost certainly an undercount, probably due to the Iranian government’s attempt to hide a desperate situation for which it is partially responsible. When the final history of the coronavirus epidemic of 2020 is written, it may go something like this: The disease started in China, but it became finally and irrevocably uncontained in Iran. Knowing that the Iranian number is much higher than currently disclosed tells the rest of the world that the epidemic is even further along than official statistics indicate.

The first sign of dishonesty came on February 28, when Masoumeh Ebtekar, one of the country’s vice presidents, announced that she had the virus. Ebtekar is one of the most famous politicians in the country, well known even in the West for her role as a particularly sadistic member of the group that held U.S. diplomats hostage in 1979 in Tehran. Of course, being a notorious sociopath confers no immunity against COVID-19. But here is where the rotting apples come in.

If COVID-19 is so rare—fewer than 400 cases had been reported in Iran by the day she announced her diagnosis—what are the chances that one of the afflicted would be a famous politician? Soon we learned of three other senior officials who not only contracted the virus but were killed by it: Mohammad Mirmohammadi, a member of a senior advisory council to Iran's supreme leader, and Hossein Sheikholeslam and Hadi Khosrowshahi, both former high-level diplomats. Mohammad Sadr, another member of the council, announced his infection last week, as did Ebtekar’s fellow cabinet member Reza Rahmani. Recently, the speaker of parliament said 23 of his fellow members of parliament had tested positive. Two of them, Mohammad Ali Ramezani (February 29) and Fatemeh Rehber (March 7), have died.

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That’s a lot of tainted apples, statistically speaking. Why would Iran lie? On February 21, Iran conducted the latest in a series of sham elections in which only government-selected candidates could run for office. To show disapproval, many Iranians refuse to vote, and as participation has dropped, the appearance of electoral legitimacy has dropped as well. Iran’s government told its people that the United States had hyped COVID-19 to suppress turnout, and Tehran vowed to punish anyone spreading rumors about a serious epidemic. Forty-three percent of Iranians voted, unaware that the outbreak had already begun. Quick action could have allowed quarantines to be put in place. Instead Iran greased its own path toward the most catastrophic outbreak in modern history.

Remember that the official number of cases is 6,566. Yet a variety of other indicators suggest that far more people in Iran have become infected:

The average of these estimates is about 2 million, which is about 250 times the official number and 15 times the total cases acknowledged worldwide. According to models, Tuite told me, the point-prevalence of COVID-19 in Canada could rise to 5 to 10 percent of the total population when the epidemic reaches its peak. These numbers, which I have shown to experts, suggest that Iran might be at or near that point.

Does Iran really have 2 million citizens with COVID-19? Perhaps politicians spend more time in public, and are therefore more susceptible to infection; if so, some of the estimates above would overstate the number of cases. Then again, it’s also possible that they were aware of the epidemic earlier and took precautions. In that case, those estimates would understate the number of cases. Edward Kaplan, who studies epidemics at Yale, looked at my numbers and noted that many of Iran’s politicians are old men—the average age of senior advisory council members is 70—who are therefore especially likely to show symptoms of COVID-19, leading to a higher share of sufferers in political circles than in the general population. It’s also possible—perhaps likely—that these numbers over-sample for Tehran and Qom, both cities hammered by the epidemic. COVID-19 is in every Iranian province, but some provinces are earlier in their cycle than others.

Many similar unknowns make these estimates difficult to assess—which is why experts have to attack the problem from multiple angles, with the assumption that errors in one approach do not correlate to errors in the others, and get rounded out in the average. Even if the estimates are off by a lot, they still reveal an outbreak completely out of control, beyond the capacity of Iran or perhaps any country to manage.

The messages coming out of Iran on social media, especially from health-care workers, do little to convince me that my doomsday figures are inaccurate. David N. Fisman, a colleague of Tuite’s at the University of Toronto, notes that the virus reportedly spread after panicked residents of Qom and Tehran fled to smaller cities, thereby sowing COVID-19 all over the country. Circulating on social media are reports that some provinces, such as Mazandaran, have set up roadblocks to keep more people with the infection from spilling into their territory.

The situation the doctors describe is desperate, with nurses wrapping themselves in tablecloths because they have long since run through their supply of proper gear. They swear that the official numbers are wrong. “Just stay overnight in the hospital to find out what I'm talking about,” one wrote. Or if you want to live, go home, and don’t come out until the plague passes. “[Our] society now needs fear more than hope.”

By Graeme Wood

March 9, 2020