Excess deaths associated with the Iranian COVID-19 epidemic: A province-level analysis

Abstract

There has been no province-level data on the number of coronavirus disease 2019 (COVID-19)related deaths in Iran since the start of the pandemic. This study was performed to estimate the number of COVID-19 deaths and population-level exposure per province using seasonal all-cause mortality data. Methods: Time-series data were collected from the National Organization for Civil Registration on the seasonal all-cause mortality from spring 2015 to summer 2020 (from March 21, 2015 to September 21, 2020), in accordance with the Solar Hijri (SH) calendar, to estimate the expected number of seasonal deaths for each province using a piecewise linear regression model. A population-weighted infection fatality ratio was then applied to estimate the level of exposure per province during this period. Results: From the start of winter to the end of summer (from December 22, 2019 to September 21, 2020), there were a total of 58 900 (95% confidence interval 46 900-69 500) excess deaths across all 31 provinces, with 27% (95% confidence interval 20-34%) estimated nationwide exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In particular, Qom and Golestan were among the hardest-hit provinces, with nearly 57% exposure, while another 27 provinces showed significant levels of excess mortality in at least one season with >20% population-level exposure to the virus. Unexpectedly high levels of excess mortality were also detected during fall 2019 (from September 23 to December 21, 2019) across 18 provinces, unrelated and prior to the start of the COVID-19 pandemic. Conclusions: This study quantified the pattern of spread of COVID-19 across the country and identified areas with the largest epidemic growth requiring the most immediate interventions.

A framework for reconstructing SARS-CoV-2 transmission dynamics using excess mortality data

“…However, this dropped to 2.1 at the later stages suggesting that the testing capacity of the country to record infections and deaths gradually improved over time, but not to the extent to fully capture the majority of COVID-19-related deaths. This is also in agreement with statements from the Iranian health officials suggesting that Iran’s COVID-19-related deaths could be twice the official numbers and also previous studies showing elevated levels of under-reporting of COVID-19 fatalities in Iran, particularly in the early stages of the pandemic 14 , 15 . We also find that the cumulative nationwide excess deaths by 2021-10-22 is 259,641 (95% CI: 230,493–288,790) which is nearly twice the 125,000 reported COVID-19 deaths at the time.…”

“…Assuming that lack of testing is the primary reason behind the discrepancy between excess mortality and official COVID-19 deaths 1 , 15 , 24 , 25 , we attribute the mean excess mortality during the pandemic period to COVID-19. This enables us to reconstruct the SARS-CoV-2 transmission dynamics across the country and infer the population fatality rate (PFR), IFR, and attack rate per province (see Methods section).…”

Tracking excess mortality across countries during the COVID-19 pandemic with the World Mortality Dataset

“…Excess mortality has already been used to estimate the COVID-19 impact in different countries, both in academic literature (e.g. Kontis et al, 2020 ; Alicandro et al, 2020 ; Ghafari et al, 2021 ; Woolf et al, 2020a ; Woolf et al, 2020b ; Weinberger et al, 2020 ; Blangiardo et al, 2020 ; Kobak, 2021a ; Modi et al, 2021 ; Bradshaw et al, 2021 ; Islam et al, 2021 , among many others) and by major media outlets. It has also been used to compare COVID-19 impact to the impact of major influenza pandemics ( Faust et al, 2020 ; Petersen et al, 2020 ).…”

Depression, Death Anxiety, and the Related Factors in Nurses Caring for COVID-19 Patients at Kosar Hospital, Semnan, Iran

“…Consequently, on January 31, 2020, World Health Organization (WHO) declared the virus to be a public health emergency of international concern (2). Within a short period, on February 21, 2020, some cases of COVID-19 were reported in Iran and later became one of the countries with the highest prevalence of the virus (3), so that some provinces such as Qom and Golestan reached > 50% exposure to COVID-19 (4).…”