DUBAI (Reuters) - Iranian authorities ignored warnings by doctors in late December and January of an increasing number of patients with high fevers and lung infections in the historic city of Qom, which turned out to be the epicentre of Iran’s coronavirus outbreak, said two health ministry officials, a former ministry official and three doctors.

A member of the Islamic Revolution Guards Corps (IRGC) troops measures a temperature, following the outbreak of coronavirus disease (COVID-19) at the entrance of Qom, Iran March 24, 2020. WANA (West Asia News Agency) via REUTERS

And, when the authorities did become aware of domestic cases of the flu-like virus in early January, they didn’t announce the news until weeks later, out of concern that releasing detailed information would unsettle the public ahead of parliamentary elections scheduled for February 21, according to a senior official with direct knowledge of the matter.

“The last thing we needed was a pandemic. The mood was already down,” said the senior official.

Added to that was another concern, said the senior official and one of the health ministry officials: The virus had originated in China, and Iran did not want to risk disrupting its vital trade and diplomatic ties with Beijing, one of its most important allies.

On Feb. 19, the Iranian government publicly announced its first two cases of – and deaths from - the new coronavirus, which can lead to breathing difficulties and pneumonia. Iran has now reported more than 47,500 cases of coronavirus and more than 3,000 deaths, making it the worst hit country in the Middle East. More than 900,000 infections have been reported globally, according to a Reuters tally.

The fresh details about the warnings by doctors and why Iran’s establishment didn’t disclose early on the spread of coronavirus come in the wake of allegations by some Iranians, including former officials and medical professionals, that the government has low balled the death toll. This account, based on interviews with officials and doctors in Iran, also underscores how governments of all stripes, democratic and authoritarian, in rich nations and poor ones, have made similar miscalculations.

Iran is far from alone in facing criticism over its early handling of the coronavirus. From China and Japan to Italy, Spain, Britain and the United States, health experts have accused governments of initially downplaying the disease’s seriousness or failing to take swift enough action to curb it. Like the United States, for instance, Iran was hobbled by a shortage of testing kits, which could have helped the country better manage the outbreak, officials have said.

The Iranian government denies concealing facts about the outbreak. President Hassan Rouhani said during a televised speech on March 18 that his government had been “honest and straightforward with the nation.”

In response to questions from Reuters about whether the government was aware of the virus reaching Iran earlier than acknowledged, Alireza Miryousefi, spokesman for Iran’s mission to the United Nations in New York, said: “The emergence of coronavirus and its rapid spread took every country, including the Western countries by surprise. Iran was no exception.”

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“The notion that there was intentional concealing of facts is preposterous,” Miryousefi said. He added that the World Health Organization (WHO) has confirmed that Iran’s measures are “stringent.” WHO officials said in early and mid-March that Iran’s response to coronavirus was coordinated and evolving in the right direction, but that more needed to be done.

Government spokesman Ali Rabeie said on state television in early March that on Jan. 24, President Rouhani was alerted to reports that coronavirus was present in China and some neighbouring countries and that Iran had tourists from those countries. He added that two days later, the president ordered necessary measures to be taken.

“But at that time, we did not know that the virus had entered Iran,” the spokesman said on state television.

“DOCTORS STARTED TO PANIC”

Qom, among Iran’s most important cities, has close links to China and is home to many Chinese. Iran’s health minister has publicly said that the virus is believed to have arrived from China by a merchant from Qom, who died of the virus.

On Dec. 31, China informed the WHO of cases of “pneumonia of unknown cause.” By Jan. 7, Chinese researchers detected a new type of coronavirus, according to Chinese state television.

A nurse at Qom Hospital said that in late December and early January, the hospital had an increase in people with respiratory problems. The hospital authorities declined to comment.

“Dozens of them died in a week,” the nurse said. “Our chief doctor informed senior officials at the health ministry. But we were told to give them medicine and release them,” said the nurse. Reuters couldn’t independently confirm the nurse’s account and the chief doctor was unavailable for comment.

The health ministry official said that by mid-January, senior officials in the ministry had received letters from doctors warning about the problem in Qom, followed by similar warnings from Mashhad and other cities. “But the ministry silenced everyone,” the official said.

A health ministry official in Qom said he was aware of the ministry being alerted to a sharp increase in patients around late January.

A senior pulmonologist in Qom, who works at a hospital designated for the coronavirus, said large numbers of people with lung problems were coming to the hospital almost every day, well ahead of the government’s Feb. 19 announcement. “We did not know what it was. We thought it was influenza. But none of those medicines for influenza worked,” he said.

Deputy Health Minister Reza Malekzadeh told state television in March that he believed the virus had entered Iran a while ago. “But as we had influenza epidemic in the country and as China had not announced any outbreak of the coronavirus ... no one thought about the coronavirus disease,” he said.

TIES WITH CHINA

As the global coronavirus outbreak was emerging, Iranian leaders were caught off guard by the death of Iran’s top military commander Qassem Soleimani, who the United States killed in Iraq on Jan. 3. At the same time, Iranians’ confidence in their leaders had been damaged following a bloody crackdown on protests in November and the belated public acknowledgement of the accidental shooting down in January of a Ukrainian airliner that killed all 176 aboard.

China has offered an economic lifeline to the Islamic Republic since 2018, when President Donald Trump pulled the United States out from Iran’s 2015 nuclear deal with six world powers and re-imposed sanctions on Tehran. China, a party to the nuclear deal, has urged the United States to lift sanctions on Iran amid the outbreak.

The ruling establishment didn’t heed warnings about the coronavirus, said the former health official, because doing so would have meant disrupting travel and business between Iran and China.

Dozens of Chinese companies operate in Iran, including China Railway Engineering Corp., which is building a high-speed rail line through Qom.