Abstract
Iran has been the hardest hit country by the outbreak of SARS-CoV-2 in the Middle East. With a relatively high case fatality ratio and limited testing capacity, the number of confirmed cases reported is suspected to suffer from significant under-reporting. Therefore, understanding the transmission dynamics of COVID-19 and assessing the effectiveness of the interventions that have taken place in Iran while accounting for the uncertain level of underreporting is of critical importance. In this paper, we developed a compartmental transmission model to estimate the time-dependent effective reproduction number since the beginning of the outbreak in Iran. We associate the variations in the effective reproduction number with a timeline of interventions and national events. The estimation method accounts for the underreporting due to low case ascertainment. Our estimates of the effective reproduction number ranged from 0.66 to 1.73 between February and April 2020, with a median of 1.16. We estimate a reduction in the effective reproduction number during this period, from 1.73 (95% CI 1.60 – 1.87) on 1 March 2020 to 0.69 (95% CI 0.68-0.70) on 15 April 2020, due to various non-pharmaceutical interventions. The series of non-pharmaceutical interventions and the public compliance that took place in Iran are found to be effective in slowing down the speed of the spread of COVID-19. However, we argue that if the impact of underreporting is overlooked, the estimated transmission and control dynamics could mislead the public health decisions, policy makers, and general public.
Highlights
The outbreak of SARS-CoV-2 in Iran was first officially announced in February 2020, 2 months after the initial outbreak in Wuhan, China [1]
This study aims to understand the transmission dynamics of COVID-19 in Iran and to assess the effectiveness of the control measures that were put in place over time through estimation of the effective reproduction number R (t), defined as the average number of susceptible persons infected by an infected person during their infectious period at a given time in the course of the epidemic
We describe the dynamics of spread using a variation of the susceptible-exposed-infected-recovered (SEIR) model, distinguishing between fatal and recovered cases combined with an estimate of the percentage of symptomatic cases using delay-adjusted case fatality ratio (CFR) (Supplementary Material)
Summary
The outbreak of SARS-CoV-2 in Iran was first officially announced in February 2020, 2 months after the initial outbreak in Wuhan, China [1]. Iran’s patient zero is believed to have been a merchant from Qom who had traveled to China [2]. Despite the initial signs of a spread in Qom, the government declined to place the city under quarantine to contain the epidemic at an early. The first local non-pharmaceutical interventions, such as school and university closures, were put in place a few days after the official acknowledgment of the first cases in Qom and Tehran [4].
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