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Ongoing outbreak of COVID-19 in Iran: challenges and signs of concern

By Mahan Ghafari, Bardia Hejazi, Arman Karshenas, Stefan Dascalu, Alireza Kadivar, Mohammad Ali Khosravi, Maryam Abbasalipour, Majid Heydari, Sirous Zeinali, Luca Ferretti, Alice Ledda, Aris Katzourakis

Posted 23 Apr 2020
medRxiv DOI: 10.1101/2020.04.18.20070904

Many countries with an early outbreak of SARS-CoV-2 struggled to gauge the size and start date of the epidemic mainly due to limited testing capacities and a large proportion of undetected asymptomatic and mild infections. Iran was among the first countries with a major outbreak outside China. Using all genomic sequences collected from patients with a travel link to Iran, we estimate that the epidemic started on 21/01/2020 (95% HPD: 05/12/2019-14/02/2020) with a doubling time of 3 days (95% HPD: 1.68-16.27). We also show, using air travel data from confirmed exported cases, that from late February to early March the number of active cases across the country were more than a hundred times higher than the reported cases at the time. A detailed province-level analysis of all-cause mortality shows 20,718 (CI 95%: 18,859-22,576) excess deaths during winter and spring 2020 compared to previous years, almost twice the number of reported COVID-19-related deaths at the time. Correcting for under-reporting of prevalence and deaths, we use an SEIR model to reconstruct the outbreak dynamics in Iran. Our model forecasted the second epidemic peak and suggests that by 14/07/2020 a total of 9M (CI 95%: 118K-44M) have recovered from the disease across the country. These findings have profound implications for assessing the stage of the epidemic in Iran and shed light on the dynamics of SARS-CoV-2 transmissions in Iran and central Asia despite significant levels of under-reporting.

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