As Canadian cases of the new coronavirus linked to Iran grow, so does the scrutiny surrounding how the country has handled the crisis so far.
The outbreak of Covid-19 in Iran has escalated quickly — with at least 388 confirmed cases and 34 deaths. It has the most deaths outside China.
There have been dramatic developments in recent days. The head of the country’s coronavirus task force was seen coughing and sweating during a press conference before testing positive for the virus. Days later, one of Iran’s vice-presidents became infected. As it stands, there are at least seven government officials combating the new coronavirus.
The surge in cases follows unwavering denial from Iran that the virus was even in the country. By dismissing the outbreak, experts believe it likely helped the virus spread even more rapidly.
“The Iranian development is huge.”
“It’s a country geographically very far from China with a large burden of infection,” said Isaac Bogoch, an infectious disease specialist based out of Toronto General Hospital.
“It shows that we’re either at the precipice of a pandemic or we’re in a pandemic. The word we choose to use at this point is irrelevant because it’s time we all prepare for this now.”
Bogoch is among a group of Canadian researchers who looked into Iran’s ballooning outbreak.
They, like many others, believe there are far more cases of the virus in Iran than being officially reported. Many more, in fact.
Their study looked at the volume of travel from Iran to other countries, including Canada, and the number of infected people arriving in other countries. It estimated there are more than 18,000 cases, as opposed to the government reported 139, which was the tally at the time of their first analysis.
“People keep asking me ‘are the most recent numbers based on the reported cases,’ but honestly, who cares? The point is there’s a lot of infection in the country, whether it’s 18,000 or 25,000, it’s identified as a place that has a high burden of infection,” he said.
“That should be enough to help address some of the public health responses to travellers from Iran.”
Of Canada’s 13 confirmed coronavirus cases so far, at least six of them have ties to Iran.
Quebec’s first presumptive case is a patient who had recently returned from Iran. In British Columbia, a woman who recently spent time in Iran was diagnosed with the virus. Later, a man who had close contact with that woman was confirmed infected. In Ontario, a woman who travelled to Iran tested positive for the virus and her husband later contracted it in Toronto. A third Iran-linked case was reported in Ontario on Friday.
“Compared to other countries, Canada has relatively low connectivity with Iran via air travel,” said Ashleigh Tuite, an adjunct lecturer at the University of Toronto’s Dalla Lana School of Public Health and co-author of the study.
“So the fact that we’re seeing cases in Canada linked to Iran suggests that the outbreak in Iran is much larger than has been officially reported. It’s likely been circulating in the country for a while.”
China has been the country under the microscope since the virus first emerged. The outbreak has been linked to a market in the central province of Hubei and the vast majority of deaths from the virus are found there. Nations around the world have reacted by closing borders, cancelling and suspending air travel to China, and screening recent arrivals for symptoms of the illness.
But Iran’s outbreak is proving that China shouldn’t be the only one on under the scope, both Tuite and Bogoch agree.
“People returning from Iran who have compatible symptoms should come to medical care for testing. Does this mean we need to stigmatize Iranian-Canadians? Absolutely not. Does this mean we should change our practices and stop going to delicious Iranian restaurants or businesses? Absolutely not,” said Bogoch, adding that Italy is another example of a country that needs further scrutiny.
“This means we identify people who may be at a greater risk of having this infection so we can prevent further transmission in community settings.”
But, with the virus now in at least 60 countries, Tuite says relying on travel history to identify possible cases is growing futile.
If you travelled internationally at all recently, you should be screened, she said.
“We should be moving away from using travel history to a specific country at this point.”
“History of international travel alone is probably sufficient enough of a flag for assessing Covid-19 risk,” she said.
She said Canada’s move toward “active case finding,” which involves more systematic surveillance particularly in healthcare, is the appropriate next step given the growing number of countries with cases.
“It’s going to be really important,” she said.
–With files from The Associated Press