The doctor in the Tehran pharmacy had the sort of immobile, handsome face that only expensive surgery could buy. As patients filed past him, coughing and spluttering, he kept up a stream of reassuring comments while they complained of tiredness, pain and fever.
On that cold morning in early March, the reality of the coronavirus pandemic was just hitting Tehran after an outbreak in the holy city of Qom. While the world’s focus was on the ravages of the virus in China and infections were just starting to take hold in Europe, no one knew
how bad it would get in Iran.
There was no inkling that, according to the latest official figures released last week, more than 150,000 would be infected and more than 8,000 die, making Iran the worst-affected country in the Middle East. Nor that, three months on, just as the infection rate seemed to be coming under control and the country was getting back to normal, a second wave would now hit Iran, triggering thousands of new cases in one day last week.
I was in Tehran in early March as the government and state machinery, after first ignoring the spread of the virus and dismissing calls for a lockdown as a foreign plot, finally grasped the scale of the pandemic and moved to contain it.
Shrines at Qom were shut and universities and shopping centres closed across the country. For the first time since the foundation of the Islamic Republic, Friday prayers were cancelled.
For some it was already too late. The deputy health minister, Iraj Harirchi, had been filmed at a parliamentary session, sweating and coughing, before
being diagnosed with Covid-19. Then came another MP, and then an adviser to the supreme leader, Ayatollah Ali Khamenei.
Tehran was gripped by fear. Even many supporters of the government were unsure
whether to trust official claims about the virus. Tehranis rushed out to buy masks. In a city racked by shortages of imported medical goods because of international sanctions, many returned home empty-handed.
“We’re out of masks, I’m afraid,” the doctor in the pharmacy told one older woman that morning. “Hand sanitiser too,” he added, before she could ask.
“I’m strong, so don’t worry about me,” he grinned as the patients left clutching bags of painkillers or antibiotics. “But the old people, I don’t know. I think they’ll get sick, and I don’t know if we’ll be able to import medical equipment because of the sanctions. The hospitals aren’t ready for the severe cases.”
His concerns were prescient. By mid-April, according to government figures, there were more than 75,000 confirmed cases and 4,777 people had died. A parliamentary report calculated that the death toll could be twice as high. Satellite photos showed that a graveyard outside Qom had been expanded to make room for the dead. Some of my friends in northern Tehran hid at home, terrified to go outside. Signs hung across motorways urging people to avoid shaking hands and stroking animals.
Distrust of official statistics and reporting helped conspiracy theories and fear to breed. Abroad, royalists backing descendants of the Shah and supporters of the MEK, a cult-like opposition group, spread propaganda about the regime, falsely claiming that people were collapsing in droves on the streets of Tehran.
All the while, although the Iranian medical system is robust in many respects, people were dying. Mehdi Variji, 43, a doctor at a Tehran clinic, posted a video from his apartment saying he felt unwell and had a fever that would not go down. He died a few days later — one of the more than 100 health workers who would lose their lives to Covid-19.
There were fears of a mass cover-up of deaths nationally. But two foreign diplomats with deep insight into the regime told me in March that although the official figures did not show the true number of deaths, they did not believe there had been a cover-up on a massive scale.
Who was to be believed when, in early April, an Iranian health official said about half a million people could have been infected and the curve had not been flattened — and the next day the WHO claimed cases in Iran were “flattening off”?
One incontestable fact was that the economy — already ravaged by sanctions, economic mismanagement and a fall in oil prices, Iran’s main source of income — was in tatters. Many ordinary people were desperate to get back to work. In mid-April the government began scaling back the lockdown, allowing some businesses and mosques to reopen.
“The easing of the lockdown was a response to the same kind of economic pressure that we’re seeing in countries around the world,” said Esfandyar Batmanghelidj, founder of the Bourse & Bazaar think tank.
“There is a significant part of Iran’s population that earns a daily wage, and the government’s ability to provide welfare transfers under lockdown was being tested. The wider economy was suffering because you had this really dramatic decrease in consumption. Shops and restaurants were closed, and it was hard to maintain manufacturing activity in the lockdown.”
Several weeks later, and three months after the first cases, a second wave has hit. Last week more than 3,500 new cases were recorded in 24 hours, the most in two months.
“The government was under pressure to allow the economy to start running again,” said Batmanghelidj. “We’re seeing the consequences of that now as people have stopped observing some social-distancing regulations.”
Given that its outbreak had begun early on, Iran’s experience offered a warning to other countries that were starting to reopen, Batmanghelidj said. “What happens in Iran is a bellwether for what is likely to happen in countries that are similar in terms of development,” he said. “It raises concerns over what will happen in countries like Turkey or Russia, which are starting to open up.”
Iran is different, however, in two ways. First, although sanctions exclude medical supplies, they hamper its ability to fight the second wave.
“While the US has blocked the banking system of Iran, practically the government cannot import any medicine or medical equipment,” said Seyed Hossein Mousavian, a former nuclear negotiator who is at Princeton University in America. “Moreover, Iran’s oil export is now close to zero . . . leaving no financial resources.”
Second, the pandemic has shown the stark divisions in Iran’s leadership — with the health ministry backing away from the more outlandish claims by the clerics and the Revolutionary Guards, who blame Iran’s enemies for the virus.
When the head of the guards and the supreme leader insinuated that the virus was a result of biological warfare, the current deputy health minister, Reza Malekzadeh, said that was “highly unlikely”. “We should have certainly been more vigilant,” he said, adding that there had been “some delay in informing the public”.
Now that the second wave has hit, health officials emphasise the dangers of relaxing social distancing. The health minister, Saeed Namaki, has warned that if officials and the public believed that the pandemic was over, the virus would “score a goal in the 90th minute”.
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