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A review of exceeding death by COVID-19 in Iran in 2019
Originally published on May 10, 2020

Few expected it.

We knew it would happen again, but perhaps we hoped, optimistically, that we would not be victims of its reappearance.

Viral epidemics are our historical companions. Viruses, these fantastic inhabitants of the planet Earth, creatures that walk on the border of life definitions, have an undeniable role in the evolution of our environment. Part of the oxygen we breathe daily is due to ocean viruses. If we lined up all these ocean-dwelling viruses along each other’s length, they would occupy a distance of 42 million light-years.

 When we look at the fateful sentences of our existence, which are intertwined in the form of that famous spiral, which transmits our characteristics from generation to generation (DNA), we see how the viruses that infected our ancestors in the distant past leave their traces. In this map, the builders of our lives have left a part of their DNA in our DNA.

 On paper, everyone knew that sooner or later, a new virus would emerge from somewhere on the planet and quickly infect the world. But there is a difference between knowing and accepting an event.

This difference manifested in our encounter with the first wave of the covid-19 pandemic, which resulted from the SARS-CoV-2 virus.

From China, where it seems that the virus was just born from the unusual association of a bat with another creature and was transferred to humans and marked the origin of the current epidemic, to Iran and the United States, in the first wave of their confrontation, they took the path of denial. Those who accepted the reality of the epidemic with an open mind and listened to the scientific community’s advice are witnessing the positive effect of their behaviour these days. Those who started denying also see the result of their wrong thinking.

Arrival date: unknown

We are still determining exactly when the virus entered Iran. But its arrival time is much earlier than what is officially announced. Some unconfirmed or later denied reports have the news that part of the country’s medical and political community knew about the virus entering Iran since early February.

But the official statistics say that the first suspected death caused by Corona in Iran happened in Tehran on the 21st of Bahman. But it was on the 30th of Bahman that with the death of two citizens in the Kamkar-Arabnia Hospital in Qom, the rumour of the first deaths due to Covid-19 gained strength. This news was quickly denied and confirmed shortly after.

In this way, the first official death of the new Coronavirus or SARS-CoV-2 in Iran happened on the last day of Bahman. The coincidence of the last decade of Bahman and the first days of March with the ceremony of the Fajr decade on the one hand and the elections of the Islamic Council, with the days when the news of the development of Covid-19 came in different countries, caused a group of observers to doubt whether the government is worried about the impact of panic. Have you delayed the announcement of the epidemic and its effects on two crucial political and social events?

 There was no answer to this question.

On the other hand, incoming flights from China, the main focus of the crisis at that time, continued, and there were even several flights from Wuhan to Tehran.

A little later, the development of the disease increased to such an extent that it was practically impossible to ignore it.

 Iran became the second hot spot of the epidemic after China. No more soothing words. While inviting everyone to calm down, the health minister’s advisor revealed the symptoms of the acute illness in front of the television cameras. The medical presenter of the news said that this Coronavirus is unimportant; I got infected a few weeks ago and recovered without any problems only a few days later. This time he got infected with the virus and stayed at home.

Little by little, some of the recommended policies of health organizations were put into practice. Some flights were cancelled, some offices and schools were closed, Friday prayers were cancelled, and some religious centers were closed, although none of these actions were without problems. On the one hand, some people considered this virus and its spread to be a global conspiracy against Iran. Later, they thought it was a manufactured product and then tied it with religious and political beliefs.

However, SARS-CoV-2 was looking for new hosts, regardless of all these rumours, through which it could perform its only task in the best way: entering new cells, finding new hosts, and multiplying more.

The world adopted different policies to deal with this epidemic. But perhaps the only common point in all these policies was providing accurate statistics.

Recognizing the problem is the first step in dealing with it.

Without data and information, not only do the primary victims of this disease not know what water they are swimming in, but political, cultural and economic decisions will be followed blindly. Without the accurate publication of statistics, people do not know what the crisis is like in their country, city and neighbourhood. Are existing policies responsive, or should they ask for changes, are the places they plan to travel to—by choice or by choice—safe? And whether the conditions of their places are such that they can open their business or is it necessary for them to continue their closure.

The standard policy throughout the world was accurate information dissemination. The number of patients, the number of tests performed, and the number of deaths caused by the disease were and are being published separately not only by country, province, and state but by city and neighbourhood. With the epidemic’s beginning in Iran, the Ministry of Health began to publish statistics by province. But when some experts pointed out that the data is not compatible with the global trend, and for example, the official statistics of infections in Iran in the initial period of the announcement, contrary to the direction of viral development, it does not show an exponential growth of the virus, and the infection graph changes in a linear form. Not only did the Ministry of Health not clarify, but after a while, it announced that it would even stop reporting provincial statistics. Since then, every day, only the statistics of new infections and deaths caused by it have been announced on a national scale.

This decision, along with some semi-authentic news, such as that some forensic doctors were advised to determine the cause of death of people only after obtaining permits from some security institutions, fueled public suspicion.

In response, once again, instead of emphasizing clarification, the Ministry of Health only stated that the data is what we say and nothing else.

In the meantime, people who follow the story of Corona tried to find a sign of accurate statistics by following indirect sources.

Follow the trail of death until you FIND the DEATH

 One way was to follow the death toll.

The authority for announcing these statistics is the Civil Registry Office. Where possible, obtain seasonally disaggregated mortality statistics for different years, albeit in non-identical formats. From 2013 onwards, these data were published in tabulated files on five pages (statistics for four seasons and the whole year) by province.

If we have the exact number of deaths by date and run it on a time scale, we get a trend of changes that can reasonably predict the number we expect for the next year or season.

If there is a significant difference between the predicted number and the announced number, we may find a clue about a particular factor that has played a role in changing this trend.

The lost column of winter 2019

But when the reporters went to the website of the civil registry office to get this data, they realized that the winter section of this year needed to be completed in the file related to 2019. Several follow-ups were left unanswered at first. Finally, the civil registry office replied to one of the journalists following this issue that the reason for the absence of this column is the order of the Supreme National Security Council, the Ministry of Health, and the Corona Headquarters. This issue was not limited to civil registration; even cemeteries like Behesht Zahra avoided providing burial statistics.

No interpretation can be taken from such a claim other than the wrong official data.

After a few days, finally, last week, the civil registry office published the list of the dead for the winter of 2019.

This late release gives rise to doubts about the nature of the data. However, this statistic is the most reliable data we have so far. But will looking at these data help to understand the existing reality? In the following, we have tried to look at these numbers.

Let’s start by reviewing some of the points considered in these calculations.

1. There are two numbers in the data of the civil registry office every year. One is general death statistics, and the other is all death documents. The difference between these two should usually be related to the time of death registration and the time of death or the difference between the place of death and the place of registration. However, my call to ensure this was unsuccessful, so I checked both numbers separately for each point in all subsequent calculations. Whenever the total number is mentioned, the Civil Registry Organization refers to the total number of documents, or Doc refers to the total number of records in the data of the Civil Registry Organization.
2.  All these data are based on the information published by the Civil Registry Organization.

The first step after the publication of the numbers for the winter of 2019 was to compare these numbers directly.

 For this purpose and considering that seasonal factors play a role in changing the death rate, for example, comparing spring with winter due to the change of these parameters (holidays, trips, weather conditions and the like) may cause errors in This review of statistics related to winters has been compared. Also, due to the lack of data before 2013, we have chosen this year as the starting point.

Death in Iran from 1392 to 1398

Before we check the numbers based on the data of each province and separately, we have compared this number for the whole of Iran during the winters of 1392 to 1398.

The graphs below show the changes based on the two parameters of total deaths (blue graph) and death registration (orange diagram).

Black winter 2013

A quick look at the above two representations before the turn of 2019 reveals two remarkable points. One is a tangible increase in the trend of mortality between before and after 2015. The second point is more important.

 In 2013 and specifically in the winter of 2013, we saw a significant and giant leap in the total number of deaths, specifically in the total number of death documents. If this jump was only limited to the data related to the papers, it could be associated with the change of the archive, the way the document was issued, or something like that. But this change is also observed on a smaller scale in the total number of deaths. Although part of this change may be due to administrative issues, this jump is a question mark that should be considered.

In the table below, we have tried to arrange these changes based on both parameters of documents and total deaths, according to each province, and then subtract the total number of 1393 (and not just the winter of this year) in each column from its equivalent in 1394. As a rule, due to the increase in the population rate and the expected increase in the number of deaths and the rise of the age pyramid, we hope that the difference between the deaths between 1394 and 1393 will be positive (in other words, the number of deaths in 1394 should be more than 1393). But this is not the case.

For example, for the whole of Iran, the total number of deaths in 2014 was 15,578 more than the following year. Also, the number of death registration documents this year is about 70 thousand more than the next year.

 Has an unexpected event caused this jump in 2013, especially that winter?

Corona VIRUS is the number one suspect

Probably the main suspect is one of the family members of coronaviruses.

The MERS-CoV virus, or the Middle East respiratory syndrome coronavirus, was discovered in 2012 for the first time. This virus belongs to the Corona family, which has plagued us these days, and like its relative, it originated from bats.

 Somewhere, a bat transmitted this virus to a camel, and the virus was transmitted to humans through camels. MERS has been with us ever since, causing local outbreaks now and then. For example, in 2015 in South Korea and in 2019 in Saudi Arabia, this virus had an outbreak, albeit with a smaller scope. In 2014, the World Health Organization announced that it had received reports of an outbreak of MERS in Saudi Arabia. According to this report, Saudi Arabia has reported several cases of infection and death due to this disease. The year 2014 was one of the notable outbreaks of MERS.

The World Health Organization’s report on the reappearance of MERS in Saudi Arabia is related to the second wave of that year. The date of this announcement is 7 Dhul-Hijjah 1435 lunar month. The peak of the obligatory Hajj days is when pilgrims from all over the world visit the holy places of Saudi Arabia. Although the initial report did not mention the outbreak in Mecca and Medina, we are sure this virus had also made its way to these two cities. And, of course, there were already reports of the outbreak in Jeddah, which is the entrance gate for many Umrah and Hajj pilgrims.

There is no need to speculate. We know that the MERS virus opened its foot in Iran a few months ago. According to the Ministry of Health reports, this virus reached Iran through Umrah pilgrims in May and infected at least six people in Kerman province. At the end of May 2013, Hamshahri newspaper reported that 1,600 people were possibly infected in Iran, and five people died.

At that time, the story unfolded in its current form. In a report in June of this year, the Tabnak site criticized the lack of transparency of the Ministry of Health regarding the MERS virus. Despite these concerns, sending pilgrims to Hajj continued.

Most of the news in this period in Iran focuses on Saudi Arabia. Although we are sure of the existence of the virus and its development in Iran, there is less news about the constant follow-up of this disease.

In this way, it seems that Mers massacred people that year with more silence than his new relative. This epidemic was not paid as much attention as SARS-CoV-2 in that period because its spread was not as much as it is today, and mainly due to the lack of serious development in the West, it did not attract serious attention from the source media.

If (and of course, this is very important if) this jump in the numbers in the winter (and in general) of 2013 is due to the deaths caused by the MERS-CoV virus. Even if a percentage of it is attributed to this disease, it should be These numbers sounded a great alarm about the prospects of Covid-19 for us and, more importantly, put the question before the authorities that despite this history and experience, why were we not prepared for this epidemic? And with that experience, why have we again taken the path of lack of transparency in reporting statistics?

Unfortunately, the current accountability structure of the Ministry of Health and related institutions is complicated, especially for those who live outside the borders of Iran. Our colleagues in Iran may be able to provide better access to existing authorities or archives, as well as use the possibility of the law of free access to information, in answering more definitively the question of to what extent the MERS virus was responsible for the jump in the number of deaths in 2013. 

Back to 2019

In the following, based on the available statistics on death (documents and total), the winters of 1392 to 1398 have been compared by province.

The chart below is based on the numbers published by the civil registry office in the form of total deaths.

And this one is a graph based on the total number of deaths.

And, of course, both charts are only for the winters of 1392 to 1398.

 As you can see, the orange graph for the winter of 2014 shows a significant increase in some provinces. But now, let’s draw our attention to the purple line or column representing the winter of 2019.

As you can see, the delayed statistics of winter 2019 show jumps in the provinces of Isfahan, Tehran, Qom, Golestan, Gilan and Mazandaran. In other cases, the changes in death in the winter of 2019 compared to the previous winter are insignificant. For this reason, this note focuses on these six provinces.

Forecast vs official numbers

In the following, you can see the calculations and tables made for these six provinces and the whole of Iran. In each section, you can see the graph resulting from the prediction of the trend or trend of death in the winter of 2019 based on the data from 2012 to 2017. For each province and the whole of Iran, we created a model based on data from the winter of 1392 to 1397, which can predict the next point of this trend with 95% confidence. In other words, we removed the announced data of 2019 from our data list and tried to estimate the range in which this number should be placed.

The critical point is that, especially in the general statistics of Iran and Golestan province, due to the extraordinary jump in the winter of 2013, the accuracy of the model and its error range has increased.

In each case, while presenting the forecast chart for the winter of 2019 (for both total columns and death certificates), we considered the predicted upper and lowered limits and then calculated the difference between the number announced by the Civil Registry Organization and the upper limit of the prediction. You can see these tables and calculations below.

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Iran

documents

            Winter trend forecast (95% confidence) for 2019

The lower limit is 90602.12 – the upper limit is 106652.70 – the announced number is 105788 – the difference with the upper limit of the prediction is negative 864.7

Total

            Winter trend forecast (95% confidence) for 2019

Lower border 97033.92 – Upper border 106157.52 – Official number 105447 – Distance from the upper limit of estimation: negative 710.52   

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The provinces

Esfahan

documents

            Winter trend forecast (95% confidence) for 2019

Upper bank 7060.8 – Lower bank 6006.51 – Official number 6729 – Estimated distance from the upper bank: -331.8

total

            Winter trend forecast (95% confidence) for 2019

Upper bank 6942.34 – Lower bank 5976.83 – Official number 6681

Estimated distance from the upper bank: -261.34

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Tehran

documents

            Winter trend forecast (95% confidence) for 2019

Upper bank 16542.08        – Lower bank 14946.16 – Official number 16773

Estimated distance from the upper bank : +230.92

total

            Winter trend forecast (95% confidence) for 2019

Upper bank 16495.49 – Lower bank 14944.59 – Official number 16676

Estimated distance from the upper bank: +180.51

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Qom

documents

            Winter trend forecast (95% confidence) for 2019

Upper bank 1669.35 – Lower bank 1562.28 – Official number 2305

Estimated distance from the upper bank: +635.65

total

            Winter trend forecast (95% confidence) for 2019

Upper bank 1667.75 – Lower bank 1561.29 – Official number 2301

Estimated distance from the upper bank: +633.25

---

Golestan

documents

            Winter trend forecast (95% confidence) for 2019

Upper bank 2347.37 – Lower bank 889.26 – Official number 2947

Estimated distance from the upper bank: +599.63

Due to the high jump in 2013 in Golestan province, the forecast period for 2019 has also been widened

total

            Winter trend forecast (95% confidence) for 2019

Upper bank 2357.76 – Lower bank 1789.25 – official number 2941

Estimated distance from the upper bank: +583.24

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Guilan

documents

            Winter trend forecast (95% confidence) for 2019

Upper bank 4766.17 – Lower bank 4289.23 – Official number 5937

Estimated distance from the upper bank: +1137.83

total

            Winter 2013 trend forecast (95% confidence) for 2019

Upper bank 4765.32 – Lower bank 4287.34 – Official number 5936

Estimated distance from the upper bank: +1170.68

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Mazandaran

documents

            Winter trend forecast (95% confidence) for 2019

Upper bank 4689.86 – Lower bank 4118.95 – Official number 5274  

Estimated distance from the upper bank: +584.14

total

            Winter trend forecast (95% confidence) for 2019

Upper bank 4686.75 – Lower bank 4109.22 – Official number 5261

Estimated distance from the upper bank:          +574.25

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As you can see, regarding the statistics of Iran and Isfahan province, the number announced for the deceased in the winter of 2013 (both in total and in the documents) is within our estimation range.

Of course, it is necessary to remind you again that due to the big jump in the winter of 2013, the total estimation range for Iran was more open and less accurate. In both cases, the deceased is higher than the predicted mid-range, but it is still within the acceptable range.

 However, the situation is different for some provinces that we know have been hit harder by Covid-19 and were more damaged in the first wave. In all 55 provinces of Tehran, Qom, Golestan, Mazandaran and Gilan, the announced number of deceased is higher than the upper bank of the forecast based on previous years. This is normal, and we expect that it happened due to the spread of Corona, but the problem appeared a little later.

The table below shows the higher level of the number announced by the civil registration organization and the upper limit of the prediction. It doesn’t hurt to reiterate that this number represents an increase over the highest forecast for this winter.

It should be kept in mind that at least by reviewing the news of the day, there does not seem to be an additional factor such as an increase in road trips (which we have probably faced with a decrease and as a result of the accidents caused by it), sea flooding, floods, earthquakes, air pollution or the amount of violence that leads to To the death of a role in these provinces in the winter of the year to have a role in increasing the number of deaths. The only significant factor we witnessed specifically in these provinces is the spread of Corona Virus.

These numbers are compatible with expressing the dangers that occurred, especially at the beginning of winter and with the Bahman and Esfand holidays, and the warnings that were given about travelling to the northern regions, and on the other hand, considering that Qom is the center of entry of the virus into Iran.

But the worrying part of this picture is where we compare these numbers with the official statistics and the announced timeline.

As mentioned earlier, according to the official data of the Ministry of Health, the first death due to Corona occurred on the 30th of Bahman (a suspected case was reported before that on the 21st of Bahman). Thus, all the deaths caused by Corona in the winter of 2019are related to only one month of March. (based on the claim of the Ministry of Health).

Looking through the statistics that were announced before April 2019 about the prevalence and death rate caused by Corona in the country, we find that the Ministry of Health of Iran has officially announced that in the whole winter of 2019 (until March 20, 2020) all the deaths caused by There have been 1433 people from Corona in the entire country.

This is only half the additional number we obtained for only five provinces. In other words, a combination of Covid-19 and an unknown factor has caused the number of deaths in the winter of 2019 in these five provinces to increase by about 3 thousand cases compared to the most pessimistic forecast based on the previous trend. According to official statistics, almost half of this is related to Corona – but in the whole country.

Of course, it is logically possible that other reasons have played a role in the increase in death in these provinces and raising it higher than the predicted amount, but we do not know such a factor yet.

In other words, we are faced with two options: a) that the death statistics due to covid-19 have been wrongly announced for some reason (intentionally or unintentionally), or b) another cause of death in the same provinces with a strong wave of exposure to covid-19. Since then, he has started killing our fellow citizens. In the absence of any indication of option B, perhaps option A is the most logical choice.

This comparison shows that, in a very optimistic state, the official statistics of deaths caused by Corona are very low due to various reasons (including perhaps due to the lack of tests, the recording of the cause of death due to one of the side factors, or in the most suspicious case, the manipulation of statistics) It’s more than what happens in the real world.

Questions to ask

This comparison alone cannot justify the definitive cause of the increase in death in 2013, nor can it necessarily confirm the difference in death due to Corona between the official and unofficial statistics in the winter of 2019. But in both cases, it emphasizes the need for clear statistics and data. Clear statistics and data help officials and the public make rational decisions with proper risk assessment, increasing trust.

Finally, we must remember that in today’s world, the time to hide data is getting shorter and sooner or later, statistics and data will be revealed.

What can be announced today and cause trust; if published tomorrow, it will further fuel mistrust.

This note should end by repeating two main questions.

In 2013 and especially in the winter of 2013, what factor caused the increase in the number of deaths in Iran? If the reason is MERS, why didn’t we learn enough from it?

What is the reason for the higher-than-expected deaths in the winter of 2019 among the five provinces, and if this increase is due to Covid-19, why are these numbers not consistent with the official statistics?