ABSTRACT
BackgroundThis study aims to estimate the prevalence of COVID-19 in the general population of Iran. MethodsThe target population was all Iranian people aged six years and older in the country. A stratified random sampling design was used to select 28,314 subjects from among the individuals registered in the electronic health record systems used in primary health care in Iran. Venous blood was taken from each participant and tested for the IgG antibody against COVID-19. The prevalence of COVID-19 was estimated at provincial and national levels after adjusting for the measurement error of the laboratory test, non-response bias, and sampling design. ResultsOf the 28,314 Iranians selected, 11,256 (39.75%) participated in the study. Of these, 5406 (48.0%) were male, and 6851 (60.9%) lived in urban areas. The mean (standard deviation) participant age was 35.89 (18.61) years. The adjusted prevalence of COVID-19 until August 20, 2020 was estimated as 14.2% (95% uncertainty interval: 13.3%, 15.2%), which was equal to 11,958,346 (95% confidence interval: 11,211,011-12,746,776) individuals. The prevalence of infection was 14.6%, 13.8%, 16.6%, 11.7%, and 19.4% among men, women, urban population, rural population, and individuals [≥]60 years of age, respectively. Ardabil, Golestan, and Khuzestan provinces had the highest prevalence, and Alborz, Hormozgan, and Kerman provinces had the lowest. ConclusionsBased on the study results, a large proportion of the Iranian population had not yet been infected by COVID-19. The observance of hygienic principles and social restrictions should therefore continue until the majority of the population has been vaccinated.
ABSTRACT
BackgroundIran is one of the countries that has been overwhelmed with COVID-19. We aimed to estimate the total number of COVID-19 related infections, deaths, and hospitalizations in Iran under different physical distancing and isolation scenarios. MethodsWe developed a Susceptible-Exposed-Infected-Removed (SEIR) model, parameterized to the COVID-19 pandemic in Iran. We used the model to quantify the magnitude of the outbreak in Iran and assess the effectiveness of isolation and physical distancing under five different scenarios (A: 0% isolation, through E: 40% isolation of all infected cases). We used Monte-Carlo simulation to calculate the 95% uncertainty intervals (UI). FindingsUnder scenario A, we estimated 5,196,000 (UI 1,753,000 - 10,220,000) infections to happen till mid-June with 966,000 (UI 467,800 - 1,702,000) hospitalizations and 111,000 (UI 53,400 - 200,000) deaths. Successful implantation of scenario E would reduce the number of infections by 90% (i.e. 550,000) and change the epidemic peak from 66,000 on June 9th to 9,400 on March 1st. Scenario E also reduces the hospitalizations by 92% (i.e. 74,500), and deaths by 93% (i.e. 7,800). InterpretationWith no approved vaccination or therapy, we found physical distancing and isolation that includes public awareness and case-finding/isolation of 40% of infected people can reduce the burden of COVID-19 in Iran by 90% by mid-June. FundingWe received no funding for this work. Research in contextO_ST_ABSEvidence before this studyC_ST_ABSIran has been heavily impacted by the COVID-19 outbreak, and the virus has now spread to all of its provinces. Iran has been implementing different levels of partial physical distancing and isolation policies in the past few months. We searched PubMed and preprint archives for articles published up to April 15, 2020 that included information about control measures against COVID-19 in Iran using the following terms: ("coronavirus" OR "2019-nCoV" OR "COVID-19") AND "Iran" AND ("intervention" OR "prevention" OR "physical distancing" OR "social distancing"). We found no studies that had quantified the impact of policies in Iran. Added value of this studyGiven the scarcity of evidence on the magnitude of the outbreak and the burden of COVID-19 in Iran, we used multiple sources of data to estimate the number of COVID-19 infections, hospitalizations, and deaths under different physical distancing and isolation scenarios until mid-June. We showed that implementing no control measures could lead to over five million infections in Iran; [~]19% of whom would be hospitalized, and [~]2% would die. However, under our most optimistic scenario, these estimates could be reduced by [~]90%. Implications of all the available evidenceWith no effective vaccination or treatment, advocating and enforcing physical distancing and isolation along with public education on prevention measures could significantly reduce the burden of COVID-19 in Iran. Nonetheless, even under the most optimistic scenario, the burden of COVID-19 would be substantial and well beyond the current capacity of the healthcare system in Iran.
