Coronavirus: why Iran can become a global threat

The New York Times

02/25/2020 - 18:30

• Clarín.com
• World

Religious pilgrims, swallow workers, businessmen, soldiers and clerics all come and go across the border of Iran, often entering countries with few border controls, weak and inefficient governments and fragile health systems.

Now, while trying to contain the expansion of the coronavirus, Iran seems to be the second focus after China for the spread of the disease . Cases in Iraq, Afghanistan, Bahrain, Kuwait, Oman, Lebanon and the United Arab Emirates - even in Canada - have all been traced to Iran, causing panic waves from Kabul to Beirut.

The Middle East is for many reasons the perfect place to incubate the pandemic, experts say, because of the constant circulation of Muslim pilgrims and itinerant workers who could carry the virus. Iran's economy has had to deal with sanctions, its people have lost confidence in their government and their leaders are isolated from much of the world, offering little clarity about the extent of the epidemic.

Civil wars or years of uneasiness have shattered the health systems of many of the neighboring countries, such as Syria, Iraq, Afghanistan and Yemen. And most of the region is governed by authoritarian leaders with very bad backgrounds in terms of offering transparency, public responsibility and health systems.

"It's a recipe for a massive viral epidemic," said Peter Piot, director of the London School of Hygiene and Tropical Medicine, and former executive director and founder of the Joint United Nations Program on HIV / AIDS.

Millions of Muslim pilgrims travel every year from across the region to visit Shiite sacred sites in Iran and Iraq. In January alone, 30,000 people returned to Afghanistan from Iran , and every week another hundred continue their pilgrimage to Qom, the place where the epidemic originated, officials from Afghanistan say.

Iraq closed its borders with Iran on Saturday, but millions cross it every year. So many infected people could have entered Iraq with the virus, depending on how long the virus has been present in Iran. And until noon on Monday, in Najaf, flights to and from the Persian country continued to take off and land.

Municipal employees disinfect a subway car in Tehran, Iran, this Tuesday. / EFE

The governors of the Iraqi provinces that border Iran were taking the chances of contagion very seriously, and at least two were inspecting border crossings personally, to ensure that they were being controlled by the police and that the Iranians did not have permission to cross into Iraq.

Qutayba al-Jubouri, the leader of the Committee on Health Affairs of the Iraqi Parliament, called the coronavirus "a plague" and said his committee demanded a much fuller closure of the borders of "land, sea and air" with Iran, "until that the disease is completely controlled ”.

Iran's health minister sent a letter to the governor of Qom on Thursday, and asked Shiite religious leaders to limit the number of pilgrims to the Fatima Masumeh temple, and other religious sites in the city, but still crowds of people on Tuesday they gathered around the temple, touching it and taking part in communal prayers.

Mistrust in the authorities

Iran is for many reasons a case study regarding the risks of the spread of the disease. The country reported its first coronavirus patient less than a week ago in Qom. On Monday, health officials reported that four people had died there on the last day, reaching a total of 12. At least 61 more people had been infected in Iran, officials said, and new cases were reported in Isfaján, Hamedan and others. cities, as well as in Qom.

Now, the news about the virus's expansion, which is beginning to appear slowly, is aggravating Tehran's already acute credibility problems, less than two months after some officials should admit they lied about their knowledge about the accidental demolition of an airplane of Ukrainian passengers by air defense systems. Many Iranians were skeptical on Monday about official accounts about the spread of the virus.

A woman buys cleaning and disinfection products at a pharmacy in Tehran, this Monday. / AFP

A member of Parliament representing Qom said Monday that at least 50 people had died there, including 34 people who were in quarantine, and that the first case had been reported more than two weeks before officials acknowledged any cases.

"Every day 10 more people die in Qom," said legislator Ahmad Amiri Farahani, in a speech in Parliament, demanding a quarantine of the city.

Health Ministry officials vehemently questioned these sayings. "I will give up if the numbers are half or a quarter of the number referred to," said Ahmad Harirchi, counselor of the ministry of health.

To aggravate public anguish, Iranian media reported that Dr. Mohamad Reza Ghadir, direct from the medical university in Qom and chief official in charge of managing the epidemic there, was among the quarantined people.

On Monday, Ghadir told an Iranian state television channel that the Ministry of Health had ordered city officials "not to publish any statistics" related to the epidemic in Qom. The situation there was "very terrible and the disease has spread throughout the city," he said.

Pakistani soldiers patrol the border between Pakistan and Iran, closed to prevent the spread of the coronavirus. / AFP

The Iranians, distrusting the authorities, disregarded the official demands of staying away from hospitals to prevent the spread of the disease, and instead of doing so they crowded into emergency rooms to get tested. Imam Khomeini Hospital in Tehran established an emergency protocol in a tent outside the premises, to deal with the crowds.

The cost of hospital masks was rising tremendously throughout the region, including Iran, Iraq, Lebanon and Afghanistan, where many sold them 30 times more expensive than normal cost.

Little preparation

Experts fear that few countries in the Middle East are ready to respond effectively to the threat posed by the virus.

"How prepared are these countries?" Wondered Dr. Montaser Bilbisi, a doctor specializing in infectious diseases, trained in the United States, and working in Amman, Jordan. "With total honesty, I have not seen the same degree of preparation that I have seen in China or elsewhere, even some personal protective equipment is needed," he said.

In Jordan, for example, he said he had not yet seen a suit that fully protected against hazardous materials. "So health workers are at a very high risk of infection."

In Afghanistan, officials said the first confirmed case of the virus was a 35-year-old man from the western province of Herat, who had recently traveled to Qom.

Health officials declared a state of emergency in Herat. On Sunday, the government had already suspended all air and land travel to and from Iran.

But borders are hard to close. Thousands of people cross each week on religious pilgrimages, or to trade, or for work, or to study , more or less 30,000 in January alone, according to the International Migration Organization, an intergovernmental agency.

"In the last two weeks more than a thousand people have visited or traveled to Qom from Herat, which means they have been close to the virus," said Afghan health minister Ferozuddin Feroz on Monday at a press conference in Kabul .

While officials tried to reaffirm people that they were ordering more hospital masks, residents panicked about what other precautions they could take.

The son of a professor at Herat University, who returned three days ago from Iran, called a New York Times journalist on Monday asking what the procedure for quarantine was.

"My father does not show any symptoms of coronavirus, but he and our family are worried," said the son, Mohamed Iman. “He has locked himself in a room where he only reads books. He has asked us to leave some food and water at the door, but to stay away. ”

Saudi Arabia was the epicenter of a similar epidemic seven years ago, known as the Middle East Respiratory Syndrome, or MERS, that was transmitted from camels to humans.

But after seven years , Saudi Arabia, one of the richest countries in the world, has struggled to adapt to current hygiene procedures to limit the spread of the virus within hospitals. An MERS epidemic last spring came to infect 61 people, killing eight.

"Many hospitals in Saudi Arabia have improved, but some could improve even more to help with prevention," said Dr. David L. Heymann, former president of the Health Protection Agency of Great Britain.

In Iraq, the country that shares the largest border with Iran, only one case has been detected for now: that of a 22-year-old boy, an Iranian religious student in Najaf, named Suhail Mohamed Ali.

Taking the first real steps to combat the spread of the virus, the education department in Najaf postponed the spring exams on Monday and the sacred temple Imam Ali was closed.

The Department of Health of the central government recommended avoiding crowded places, as well as kissing or shaking hands.

Emergency Plan in Lebanon

In Lebanon, a 41-year-old woman who had traveled to Qom on a religious pilgrimage landed in Beirut on Thursday night and was discovered Friday that she had the virus. It was not until Monday, however, that the government issued an emergency plan, suggesting that the trip to the affected areas should be restricted and that arriving passengers should be isolated at the airport if they showed any type of symptom.

A woman with a chin in front of the Rafic Hariri University Hospital, in Beirut, Lebanon, this Tuesday./BLOOMBERG

But there were no orders of definitive restrictions; Not all passengers who arrived in Beirut in recent days have been checked; and two other planes coming from Qom obtained permission to land in Beirut on Monday. The passengers on the plane carrying the infected Lebanese woman were instructed to make their own quarantine at home.

The country's health minister, Hamad Hasan, told the Lebanese on Monday to remain calm. But Rabih Shaer, founder of a nonprofit organization in Lebanon that fights corruption, said the government's lazy response was "irresponsible and criminal."

"The Lebanese population no longer trusts that the ruling class can deal with these problems," he said. “And now, until today, they have not yet taken the appropriate measures. There is no transparency, there is no responsibility. ”

David D. Kirkpatrick, Farnaz Fassihi and Mijib Mashal