Authorities in Iran 'hiding' COVID-19 deaths by listing other causes on death reports

According to official numbers announced by Iran’s government – 9,000 confirmed COVID-19 cases as of March 11, with 354 deaths – Iran is the third-hardest-hit country in the world, after China and Italy. But regional officials are reporting higher rates in their own areas, and publicly questioning the statistics being announced by the Health Ministry. Medical staff in Iran told the FRANCE 24 Observers that hospital administrators have instructed doctors treating patients who die from the coronavirus to list other causes – such as pneumonia and pulmonary embolism – on official death reports.

The first signs of an epidemic in Iran, like in China, emerged on social networks. Doctors in the holy city of Qom in mid-February noted an uptick in patients with severe pulmonary problems. As early as February 2, Iranians were posting videos of medical workers in protective suits escorting patients, asking whether the coronavirus had arrived in Iran.

Iranian officials initially denied the virus had reached Iran. Some hardliner activists denounced "rumours" about the coronavirus, saying they were part of a plot by opposition groups to discourage people from voting in the February 21 parliamentary election.

The first official statement about COVID-19 reaching Iran came on February 19, when the Health Ministry announced two cases in Qom. The ministry said later the same day that both patients had died.

This video circulating on Twitter and Telegram shows at least 56 body bags awaiting burial at a facility at the main cemetery in Qom. The man filming the video says: “I’m here at the Qom graveyard. Today is March 2. All of these people died of the coronavirus. Their bodies are waiting to be ritually washed before burial. There are lots of them." At 0:47 in the video, he says: "The bodies in this room have been here for five or six days, but they still haven’t been buried. The situation is horrible." The deputy prosecutor general of Qom said March 5 that the man who filmed the video was later arrested.

As the official toll mounted, local officials started to question the central government’s count. An MP from Rasht, capital of northwestern Gilan province, said February 28 that the number of coronavirus victims buried at three of the city’s cemeteries was "much higher than what is being reported". The MP, Gholam Ali Jafarzadeh Iman Abadi, added: "The statistics presented so far are not true. Cemeteries do not lie."

Farhad Zahed, vice president of the Rasht city council, March 10 appealed to the central government: "Why are you hiding the reality? To avoid panic? No. We have to tell people what’s really going on, so they take it seriously."

This photo, posted on Twitter and Telegram accounts on February 10, shows medical workers at the main cemetery in Rasht, Gilan province, preparing bodies of COVID-19 victims for burial. Officials in the city have accused Iran’s government of underreporting the real number of COVID-19 deaths in the country.

Aliakbar Motezaei, governor of Kashan county in Iran’s central Isfahan Province, told a local television channel March 9 that the city of Kashan (population 400,000) and one suburb had had a total of 1,056 COVID-19 cases and 88 deaths since the outbreak began. Official reports record only 601 cases and two deaths in the entire Isfahan province (population five million).

News that at least 23 members of Iran’s 290-seat parliament, 8 per cent of the total, have contracted the virus has raised questions about why the officially reported rate in the general population is much lower.

 

'Hospitals hide COVID-19 deaths by lying in their reports'

Melody (not her real name) is an emergency room doctor at a hospital in a city 200km east of Tehran. The official COVID-19 death toll in Melody’s city was four as of March 10. Melody told the FRANCE 24 Observers that there had been at least eight deaths at her hospital alone. Like other medical personnel interviewed for this article, she asked for anonymity. Medical staff in Iran have been told not to talk to the media about the COVID-19 outbreak.

 

We’ve had fatal coronavirus cases in our city for three weeks, since mid-February. But it was only on March 2 that the government announced the first death in our city. In the last two weeks, at least eight people have died at our hospital alone because of the coronavirus.

Hospitals hide COVID-19 deaths by lying in their death reports. Our managers tell us to list coronavirus deaths as “pneumonia”, “tuberculosis” or even “heart attack” in our reports.

The two main hospitals in our city are full of suspected or confirmed COVID-19 cases. There are COVID-19 patients in every hospital of the city. However if you look at the official reports, you would think our city is doing fine.

'Doctors can’t write COVID-19 even if they are sure... it is the cause of death'

A senior official at the Medical Council of the Islamic Republic of Iran explains the process of issuing a death report in hospitals in Iran for coronavirus:

 

For every patient death in Iran, the doctor in charge of the patient files a written report. The Health Ministry has asked hospitals to mention COVID-19 in the death report only if there was a positive result from a COVID-19 screening test. But there’s a shortage of COVID-19 tests in Iranian hospitals. If a hospital doesn’t have any COVID-19 tests and has only done CT scans, the doctor cannot mention the coronavirus in the death report.

Doctors don’t technically lie in the reports, but the reports are not complete. For example they’ll list ARDS (acute respiratory distress syndrome), pulmonary embolism (PE) or simply inflammation in the lungs as the cause of death. But what caused ARDS or PE in the patient? COVID-19. But doctors can’t write COVID-19 even if they are sure from the symptoms that the coronavirus was the cause of death.

The hospitals send the death reports to the Health Ministry, which is the only organisation that has access to the nationwide numbers. That’s why the official number of COVID-19 cases is much lower than the real number.

This document posted on Twitter March 5 purports to show a death report for Hamed Jalali, a conservative activist from Qom who died February 28. The report lists ARDS (acute respiratory distress syndrome) as the cause of death, but his friends say Jalali died of COVID-19.

Iranian officials have said their doctors currently depend on COVID-19 tests supplied by China, Russia, the World Health Organization and UNICEF, but Iranian-made tests will be available by March 20. MP Iman Abadi from Rasht told journalists that no coronavirus tests were available for doctors in the city.

 

'The hospital didn’t have any coronavirus testing kits'

Varesh (not her real name) lost two family members in a city in Gilan province. She says doctors told her they died of the coronavirus.

 

​​When two members of my family fell sick, we went to hospital. After four days, the doctors told us they were coronavirus-positive. The hospital didn’t have any coronavirus testing kits, though. So the doctors based their diagnosis on CT scans.

When my family members died, we weren’t allowed to participate in their funerals, because of safety concerns. The bodies were handed over to the Revolutionary Guard Corps and public health representatives. All we know is that they dug a ditch three metres deep. They put in some cement blocks to separate the bodies, but that doesn’t change the fact that they’re in a mass grave.

This photograph circulating on Telegram in Iran since February 28, 2020 shows a grave in Langeroud county in Gilan province that was dug for coronavirus victims. Our Observer Varesh, also in Gilan province, says two of her family members who died of the virus were buried in similar graves.

'We’ve buried more than 10 coronavirus victims'

The director of public health in one county in Gilan Province told the FRANCE 24 Observers there had been at least 10 COVID-19 deaths in his county of 80,000 people.

 

There are strict rules for the burial of bodies with infectious diseases. We’re supposed to have special protective equipment, but we don’t. So instead our staff bury the bodies wearing ordinary surgical masks and latex gloves.

Each burial is a headache for our teams because locals do not want bodies being buried in their village or town graveyard, or near their homes. They make a lot of trouble for each burial.

For days we have asked the authorities to order people to stay in their homes. We asked them to order the closure of all non-essential shops, but they don’t care. All they are doing is broadcasting stupid advice on local TV channels: showing people how to make masks out of tissue, for instance, which is totally useless.

According to official figures from the central government, 21 Iranian doctors and nurses have died of the virus so far, 11 of them in Gilan province.

Article by Ershad Alijani.