File photo: Doctors check a traveller in their designated residential area to check on residents who returned from Iran if anyone is infected with the novel coronavirus, at Isa Town Health Center, south of Manama, Bahrain, March 2, 2020 Reuters

A paper by the University of Toronto’s Ashleigh Tuite and others noted that, by February 23, cases of Iranian origin had surfaced in Canada, Lebanon, and the United Arab Emirates

A study has indicated that the number of coronavirus cases in Iran is expected to be much higher than what has been officially reported.

As of March 9, according to Johns Hopkins University’s Coronavirus Resource Center, Iran has reported 6,566 COVID-19 cases, or about one in every 12,000 people in its population.

Reporting its first case on February 19, Iran is now third behind China with 80,695 cases, South Korea with 7,314 cases, and just ahead of Italy with 5,883 cases.

Although the official number of cases is 6,566, a variety of other indicators suggest that far more people in Iran have become infected:

A paper by the University of Toronto’s Ashleigh Tuite and others noted that, by February 23, cases of Iranian origin had surfaced in Canada, Lebanon, and the United Arab Emirates.

Given the volume of air travel between Iran and these countries, Tuite’s team estimated how many native COVID-19 cases must have occurred in Iran to produce one case each in these other countries.

Their estimate for February 23 was 18,300. Since the epidemic reached 100 cumulative cases, the official numbers have doubled roughly every three days.

On March 3, 23 out of 290 members of the Iranian parliament—about 7.9%—had the disease. Unlike ordinary people, these MPs probably had reliable access to diagnosis and the state media insisted they contracted the disease not from one another, but from their home districts.

The rate of infection of parliamentarians would, if applied to Iran’s total population, come up to 6.4 million cases.

On March 4 and 5, two evacuation flights of Chinese citizens were allowed to leave Tehran for China’s Gansu province. Chinese authorities were of course wary of introducing more coronavirus carriers into the country, so they tested passengers and found 11 COVID-19 cases out of 311 passengers.

If Chinese people in Iran got the disease at the same rate as Iranians, this suggests a rate of 3.5 percent, for a total of 5.7 million at the time of the flight.

Tuite, the researcher who studied earlier flights, cautions that this number would undercount total cases, because it represents the number of cases on that plane at that time, or the point of prevalence, and not total cumulative cases—which would be higher, about 8 million.

On March 8, health authorities in Golestan province declared that hospitals there were full. Golestan has about 2.2% of Iran’s population, and assuming it has the same percentage of its hospital beds, the province should have 2,600 hospital beds.

About 15 percent of COVID-19 patients need a hospital stay. This suggests that 13,000 people, or about 0.8 percent of the province’s population, have COVID-19 in Golestan.

If that rate applies countrywide, it yields 610,000 infections, which suggests a cumulative total of about 1 million infections—if those who have already recovered are included.

Finally, because hospitalizations are a lagging indicator, double that number to account for growth in the past week would be 2 million. This is about 250 times the official number and 15 times the total cases acknowledged worldwide.

Edward Kaplan, who studies epidemics at Yale, looked at these numbers and noted that many of Iran’s politicians are old men—the average age of senior advisory council members is 70—who are therefore especially likely to show symptoms of COVID-19, leading to a higher share of sufferers in political circles than in the general population.

David N Fisman, a colleague of Tuite’s at the University of Toronto, notes that the virus reportedly spread after panicked residents of Qom and Tehran fled to smaller cities, thereby sowing COVID-19 all over the country.

Circulating on social media are reports that some provinces, such as Mazandaran, have set up roadblocks to keep more people with the infection from spilling into their territory.

The situation the doctors describe is desperate, with nurses wrapping themselves in tablecloths because they have long since run through their supply of proper gear. They swear that the official numbers are wrong.

But why would Iran lie? On February 21, Iran conducted the latest in a series of elections in which only government-selected candidates could run for office.

To show disapproval, many Iranians refuse to vote, and as participation has dropped, the appearance of electoral legitimacy has dropped as well.

Iran’s government told its people that the United States had hyped COVID-19 to suppress turnout, and Tehran vowed to punish anyone spreading rumors about a serious epidemic.

Around 43% percent of Iranians voted, unaware that the outbreak had already begun.

Quick action could have allowed quarantines to be put in place. Instead, Iran greased its own path toward the most catastrophic outbreak in modern history.