WASHINGTON — Iran has the highest reported number of deaths from the coronavirus outside China, raising questions about how the government is handling the public health crisis and whether the often secretive regime has been fully transparent about the extent of the outbreak.
Iran’s health ministry spokesman Kianoosh Jahanpour said on Tuesday that 15 Iranians have died out of a total of 95 positive cases. But Iran’s state news agency later said one person infected with coronavirus had died in the city of Saveh, bringing the death toll to 16.
Apart from China, where the virus was first detected in December, Iran has recorded the most deaths from the coronavirus. There have been 2,663 deaths in China, out of a total number of 77,658 confirmed cases.
But Iran’s reported mortality rate for the illness — about 16 percent — surpasses the rate for other countries by a dramatic margin. At the epicenter of the outbreak in Hubei province in China, the reported mortality rate is estimated at around 2 percent. In South Korea, 11 patients have died from the virus out of 977 cases, for a reported mortality rate of about 1 percent.
Amid a shortage of surgical masks and hand sanitizer in Iranian shops, public health experts say Iran could become the hub of a major outbreak across the Middle East, especially given its porous borders with unstable countries at war or in turmoil.
Iranian officials reported the first case of virus in the religious city of Qom last week and the virus has spread to at least seven other provinces in Iran. Countries in the region, including Iraq, Kuwait, Oman and Afghanistan, reported their first cases this week and said the patients had recently visited Iran.
In an echo of public reaction in China, critics of the Iranian regime in and outside of the country are questioning whether officials in Tehran have given the public a full and accurate picture of the outbreak. But Iranian officials have rejected any suggestion they are playing down the epidemic.
The head of Qom’s Medical Science University, Mohammad Reza Ghadir, said on Iranian state television that the Health Ministry in Tehran had banned releasing figures on the coronavirus outbreak in the city.
When asked how many people had been placed in quarantine, Ghadir said “the health ministry has told us not to announce any new statistics.”
Ghadir also said that “most of the tests have to be done in Tehran and Tehran announces it.” His comments suggested that diagnostic tests were mainly being conducted in the capital Tehran.
Outside medical experts say reporting on the total number of cases of infection in Iran was possibly lagging behind reporting on deaths. That could be because Iranian authorities are missing less severe cases across the country due to how they are testing and diagnosing patients, how information is shared or because of flawed medical equipment.
“This appears to be a reporting issue,” said Dr. Yanzhong Huang, a professor at Seton Hall University and a senior fellow for global health at the Council on Foreign Relations. “Reporting on the cases of infections may have fallen behind the reporting on the deaths.”
It’s unclear if Iran has the ability to find out how many people have been infected, which would require venturing out to towns and villages to conduct tests and not simply relying on who comes to large hospitals with severe symptoms, said Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center.
“That means going to the neighborhood and knocking on doors and really aggressively trying to find cases,” Schaffner told NBC News. “I don’t know if they have that capacity. Many countries do not, and they don’t have that tradition in their public health systems. This would be a very new thing for them to do.”
Another possibility is that the patients affected are from an elderly, more vulnerable part of the population. Schaffner said.
If the virus “was introduced to a population that was older, and as a consequence has a bunch of underlying illnesses, [that] could explain a high fatality rate,” Schaffner said.
A less likely explanation is that Iran’s hospitals had fallen short and patients were not getting the necessary medical care, Schaffner said. But he doubted that was the case, since Iran has a relatively advanced health care system.
Dr. John Torres, NBC News medical correspondent, said there is no evidence of a change in the genetic profile of the virus, so the explanation for the higher mortality rate likely has to do with how the Iranians are tracking cases of infection.
“There are no significant DNA changes in the virus. The virus has not mutated elsewhere,” Torres said.
An Iranian member of parliament, Mamoud Sadeghi, and the country’s deputy health minister, Iraj Harirchi, who lead a task force battling the virus, tested positive for coronavirus, state media said Tuesday. The news came a day after Harirchi appeared at a press conference looking feverish, reaching for tissues to wipe his brow. He wore no face mask as the ministry spokesman standing next to him expressed confidence about the government’s response to the crisis.
“I say this from the bottom of my heart. Take care of yourselves,” Harirchi said in a video he took of himself that was posted after his diagnosis became public. “This is a democratic virus, it does not distinguish between rich and poor, the powerful and not powerful. It may infect a number of people.”
Harirchi earlier had reacted with anger when an Iranian politician alleged the number of deaths was much higher in the city of Qom than the government had acknowledged. Harirchi also had appeared on television coughing during an interview.
The episode raised questions about how Iran is managing the crisis and whether officials are failing to disclose information to the public — and the rest of the world. Iranian officials are already under public scrutiny over the handling of the downing of a Ukrainian airliner in January. It took Iran’s military three days to admit the plane was shot down by an Iranian missile in error, triggering angry street protests.
Secretary of State Mike Pompeo told a news conference on Tuesday that “the United States is deeply concerned by information indicating the Iranian regime may have suppressed vital details about the outbreak in that country.”
“All nations including Iran should tell the truth about the coronavirus and cooperate with international aid organizations,” Pompeo added.
In Washington, top U.S. public health officials warned Tuesday that Americans should prepare for the spread of the coronavirus in communities across the country.
“It’s not so much a question of if this will happen any more, but rather more a question of exactly when this will happen and how many people in this country will have severe illness,” Dr. Nancy Messonnier, the head of Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, told reporters.