The true number of coronavirus cases in Iran may be upwards of 18,000, according to a preliminary analysis by Canadian researchers, suggesting an epidemic there nearly 200 times larger than what the country has reported — and a situation with potentially grave global consequences.

A spokesperson for Iran’s health ministry said Tuesday that the country had 95 confirmed cases of COVID-19, as the disease caused by the novel coronavirus is called, and 15 deaths.

The true extent of the outbreak is “not only concerning to people in Iran, but also to Canadians and everyone else on the planet,” said Isaac Bogoch, a co-author of the analysis and an infectious disease specialist at Toronto General Hospital and the University of Toronto.

“We’re so interconnected that this is not just an Iranian problem.”

Experts have expressed concern that the extent of the outbreak in Iran is under-reported, and that uncontrolled transmission in the country could have profound consequences for limiting the global spread of the disease. Iran shares borders with or has close ties to several countries — including Iraq, Afghanistan and Syria — that have little to no capacity to detect or contain infections.

The Canadian scientists, a group of infectious disease specialists and mathematical modellers, crunched numbers over the weekend to estimate the real size of the epidemic in Iran. The results were published Tuesday on medRxiv, a website that posts preliminary research that has not yet been peer-reviewed and published in a journal.

The team based its analysis in part on the number of international cases linked to Iran.

On Thursday, British Columbia reported a confirmed case of COVID-19 in a person who had recently travelled from Iran. At that time, Iran was reporting just five confirmed cases.

“Red flags went up,” said Bogoch.

“If you’re talking about five cases in Iran, what is the probability that one of those five cases in a population of 81 million would get on an airplane? It’s pretty small,” said Ashleigh Tuite, a co-author on the analysis and an adjunct faculty member at the Dalla Lana School of Public Health at U of T.

“When you start seeing imported cases of disease from another location, that usually means there is a fairly substantial amount of disease activity” in the country of origin, said Tuite.

The team drew on flight and tourism data, as well as estimates about the disease itself, to mathematically model how big the outbreak in Iran is likely to be for those cases to appear.

Lebanon and the United Arab Emirates have also reported Iran-linked cases.

Neither Canada nor Lebanon receive large volumes of air travellers from Iran, the researchers noted. Canada ranked 31st for outbound air travel volume from the country during the same period last year.

Some of the 10 cities that receive the most travellers from Iran at this time of year are in countries — Iraq, Syria, and Azerbaijan — that have extremely limited abilities to detect an outbreak. The fact that none had reported a COVID-19 case at the time of the analysis — but that Canada and Lebanon had — would suggest that the disease is likely present in those vulnerable countries.

The researchers estimate that the true burden of disease in Iran is 18,300 cases, but that it could be as low as 3,770 or as high as 53,470. They said uncertainty in the data creates a wide margin of error — but that all of those numbers are much higher than has been officially reported, and any significant outbreak would be difficult for the country to handle.

Loading... Loading... Loading... Loading... Loading... Loading...

Since they crunched the numbers Sunday, Afghanistan, Kuwait, Iraq and Oman have all announced cases of the virus connected to travel from Iran. Bahrain said it had 17 confirmed cases of COVID-19, all in passengers who travelled through cities in United Arab Emirates, Iran’s neighbour across the Persian Gulf.

“There are large populations living in regions with limited public health capacity in the neighbourhood,” said Bogoch. “The concern is they may already have cases that just aren’t going detected, and if they don’t already have cases, they may very soon.”

The situation in Iran threatened to spiral quickly out of control. On Monday, the head of the Iranian government task force on the coronavirus appeared on television to insist the situation in the country was stable, while he repeatedly coughed and wiped his brow. On Tuesday, the official announced he had tested positive for the coronavirus himself.

With files from the Associated Press

Read more about: