Date: Wed, 1 Apr 2020 12:33:43 +0200 (METDST)

Tehran, April 1, 2020 (AFP) - Flooding in Iran caused by heavy rainfall has left 21 people dead and one missing, an emergency services spokesman said Wednesday, even as the country battles the coronavirus pandemic.   Mojtaba Khaledi told Iran's ISNA news agency that 22 people had also been injured, with most of the casualties in southern or central provinces.   He said 11 people had died in Fars province, three each in Hormozgan and Qom, two in Sistan and Baluchistan province, and one each in Bushehr and Khuzestan.   Khaledi said one person was still missing in Hormozgan on the Gulf coast.

Flooding last week killed 12 people, and Khaledi warned of more heavy rain to come.   Iran is battling one of the world's deadliest coronavirus outbreaks with 3,036 deaths and 47,593 infections.   In March and April last year, heavy rainfall and flooding killed at least 76 people in Iran.   At the time, the International Federation of Red Cross and Red Crescent Societies estimated 10 million people were affected, describing the floods as "the largest disaster to hit Iran in more than 15 years".
Date: Sun 29 Mar 2020 11:46 AM GST
Source: Reuters [abridged, edited]
<https://in.reuters.com/article/health-coronavirus-iran/iran-extends-prison-furloughs-as-coronavirus-death-toll-rises-idINKBN21G0C2>

Iran's coronavirus death toll has risen to 2640, a health ministry official said on Sunday [29 Mar 2020], as the Middle East's worst-hit country grapples with the fast-spreading outbreak. "In the past 24 hours we had 123 deaths and 2901 people have been infected, bringing the total number of infected people to 38 309," Alireza Vahabzadeh, an adviser to the health minister, said in a tweet. "12,391 people infected from the virus have recovered." Health ministry spokesman Kianush Jahanpur told state TV that 3467 of those infected were in "critical condition".  "I am happy to announce that also 12,391 people who had been infected across the country have recovered," Jahanpur said. "The average age of those who have died of the disease is 69."

President Hassan Rouhani urged Iranians to adapt to their new way of life, which was likely to continue for some time. "We must prepare to live with the virus until a treatment is discovered ... The new measures that have been imposed are for everyone's benefit ... Our main priority is the safety and the health of our people," Rouhani said during a televised meeting.

The government has banned inter-city travel after warning of a potential surge in coronavirus cases because many Iranians defied calls to cancel travel plans for the Persian New Year holidays that began on [20 Mar 2020]. The authorities told Iranians to stay at home, while schools, universities, cultural, religious, and sports centres have been temporarily closed.

To stem the spread of the virus in crowded jails, Iran's judiciary on Sunday [29 Mar 2020] extended furloughs for 100,000 prisoners. On [17 Mar 2020], Iran said it had freed about 85,000 people from jail temporarily, including political prisoners. "The 2nd wave of (the) temporary release of prisoners had already started and their (100,000 prisoners) furloughs have been extended until [19 Apr 2020]," judiciary spokesman Gholamhossein Esmaili was reported as saying by state television. Iran said it had 189,500 people in prison, according to a report submitted by the UN special rapporteur on human rights in Iran to the Human Rights Council in January [2020].  [byline: Parisa Hafezi]
===================
[In the 24 hours from 28 to 29 Mar 2020, the number of cases of COVID-19 confirmed in Iran grew from 35 408 to, 38 309, an increase of 2901 newly confirmed cases. The number of deaths has also increased from 2517 to 2640 an increase of 123 deaths in the 24-hour period. In terms of total numbers of confirmed cases, Iran ranks 7th globally behind USA, Italy, China, Spain, Germany and France. In early March 2020, Iran and Italy were on the same trajectory with respect to daily growth in cumulative newly confirmed cases, but starting 8 Mar 2020, Italy's daily reported newly confirmed cases accelerated at an alarming speed. By 14 Mar 2020, Italy was reporting almost twice as many cases as Iran on a daily basis.

A map of Iran showing provinces can be seen at
<https://www.mapsofworld.com/iran/iran-political-map.html> and a
HealthMap/ProMED-mail map at <http://healthmap.org/promed/p/128>. - ProMed Mod.MPP]
Date: Fri 27 Mar 2020
Source: AP News [edited]
<https://apnews.com/6e04783f95139b5f87a5febe28d72015>

Standing over the still body of an intubated 5-year-old boy wearing nothing but a plastic diaper, an Iranian healthcare worker in a hazmat suit and mask begged the public for just one thing: Stop drinking industrial alcohol [methanol, the most common industrial alcohol] over fears about the new coronavirus.

The boy, now blind after his parents gave him toxic methanol in the mistaken belief it protects against the virus, is just one of hundreds of victims of an epidemic inside the pandemic now gripping Iran.

Iranian media report nearly 300 people have been killed and more than 1000 sickened so far by ingesting methanol across the Islamic Republic, where drinking alcohol [ethanol] is banned and where those who do rely on bootleggers. An Iranian doctor helping the country's Health Ministry told the Associated Press on Friday [27 Mar 2020] the problem was even greater, giving a death toll of around 480 with 2850 people sickened. [Apparently all from methanol intoxication. - ProMed Mod.TG]

The poisonings come as fake remedies spread across social media in Iran, where people remain deeply suspicious of the government after it downplayed the crisis for days before it overwhelmed the country.

"Other countries have only one problem, which is the new coronavirus pandemic. But we are fighting on 2 fronts here," said Dr. Hossein Hassanian, an adviser to Iran's Health Ministry, who gave the higher figures to the AP. "We have to both cure the people with alcohol [methanol] poisoning and also fight the coronavirus."

For most people, the new coronavirus causes mild or moderate symptoms, such as fever and cough, clearing up in 2-3 weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia, or death.

The pandemic has swept across the world, overwhelming hospitals, crippling economies, and forcing governments to restrict the movements of billions of people. Particularly hard hit has been Iran, home to 80 million people.

As of now, there is no known cure for COVID-19, the illness caused by the virus. Scientists and doctors continue to study the virus and search for effective medicines and a vaccine.

But in messages forwarded and forwarded again, Iranian social media accounts in Farsi falsely suggested a British schoolteacher and others cured themselves of the coronavirus with whiskey and honey, based on a tabloid story from early February [2020]. Mixed with messages about the use of alcohol-based hand sanitizers, some wrongly believed drinking high-proof alcohol would kill the virus in their bodies.

The Islamic Republic has reported over 29 000 confirmed cases [of COVID-19] and more than 2200 deaths from the virus, the highest toll of any country in the Middle East. International experts also fear Iran may be under-reporting its cases, as officials for days played down the virus ahead of a parliamentary election.

That fear of the virus, coupled with poor education and internet rumours, saw dozens sickened by drinking bootleg alcohol containing methanol in Iran's southwestern Khuzestan province and its southern city of Shiraz. Videos aired by Iranian media showed patients with IVs stuck in their arms, lying on beds otherwise needed for the fight against the coronavirus, including the intubated 5-year-old boy. Iranian media also reported cases in the cities of Karaj and Yazd.

In Iran, the government mandates manufacturers of toxic methanol add an artificial color to their products so the public can tell it apart from ethanol, the kind used in cleaning wounds. Ethanol is also the kind of alcohol found in alcoholic beverages, though its production is illegal in Iran.

Some bootleggers in Iran use methanol, adding a splash of bleach to mask the added color before selling it as drinkable. Sometimes it is mixed with consumable alcohol to stretch supply, and other times it comes as methanol, falsely advertised as drinkable. Methanol also can contaminate traditionally fermented alcohol.

Methanol cannot be smelled or tasted in drinks. It causes delayed organ and brain damage. Symptoms include chest pain, nausea, hyperventilation, blindness, and even coma.

Hassanian said his figures included reports from coroner's offices around Iran also counting those who died outside of hospitals from the poisonings.

"Unfortunately, in some provinces, including Khuzestan and Fars, deaths from drinking methanol has exceeded the number of deaths from the new coronavirus," he said.

Dr. Knut Erik Hovda, a clinical toxicologist in Oslo, said to expect more methanol poisoning victims.

"The virus is spreading, and people are just dying off, and I think they are even less aware of the fact there are other dangers around," Hovda said. "When they keep drinking this [methanol], there's going to be more people poisoned."

Even before the outbreak, methanol poisoning had taken a toll in Iran. One academic study found methanol poisoning sickened 768 people in Iran between September and October 2018 alone, killing 76.

Other Muslim nations banning their citizens from drinking also see such methanol poisoning, although Iran appears to be the only one in the pandemic so far to turn toward it as a fake cure. In Buddhist Cambodia, police said they seized 4200 liters (1100 gallons) of methanol from a man who unwittingly planned to make toxic hand sanitizer because of the virus outbreak.

Muslim drinkers in Iran can be punished with cash fines and 80 lashes. However, minority Christians, Jews, and Zoroastrians can drink alcoholic beverages in private.

While police occasionally announce alcohol busts, the trade in nontoxic alcohol also continues. Locally made Iranian arak from fermented raisins, known as Aragh sagi, sells for USD 10 for a 1.5 l [1.6 qt] bottle. Imported vodka sells for USD 40 a bottle.

"Every year during Nowruz, or the Persian New Year holidays beginning 21 Mar 2020, my customers double," said Rafik, an Iranian-Armenian who makes vodka in the basement of his Tehran home. He spoke on the condition only his 1st name be used for fear of arrest. "This year [2020], because of coronavirus, it jumped up by 4- or 5-fold."

Farhad, a self-described heavy drinker who lives in central Tehran, said alcohol remains easy to find for those looking for it. "Even you can find it offered when you are walking down the street, " he said.

Since 1979, Iran's 40 alcohol factories have seen their production changed to pharmaceutical needs and sanitizers. Others had been left idle, like the abandoned Shams alcohol factory east of Tehran.

But now, in a time when even some mosques in Iran hand out high-proof alcohol as a sanitizer, officials plan to start work again at Shams to produce 22 000 l [23 247 qt] of 99% alcohol a day. [This alcohol is not for internal consumption but can be used in hand sanitizers. - ProMed Mod.TG]  [Byline: Nasser Karimi and Jon Gambrell]
====================
[Methanol toxicity initially lacks severe toxic manifestations. Its pathophysiology represents a classic example of lethal synthesis in which toxic metabolites cause fatality after a characteristic latent period. In other words, these people may not realize they are sick or ill until sometime after consumption.

Methanol is sometimes used as an ethanol substitute for alcohol. Foods such as fresh fruits and vegetables, fruit juices, fermented beverages, and diet soft drinks containing aspartame are the primary sources of methanol in the human body, but [they contain] minute quantities.

Wood alcohol is also known as methanol. It is a commonly used toxic organic solvent causing metabolic acidosis, neurologic issues, and death when ingested. It is a part of many commercial industrial solvents and of adulterated alcoholic beverages or is mistaken as being the same as alcohol for ingestion. Methanol toxicity remains a common problem in many parts of the developing world, especially among members of lower socioeconomic classes.

Neurological complications are recognized more frequently due to advanced technologies and because of early recognition of the toxicity and advances in supportive care. Hemodialysis and better management of acid-base disturbances remain the most important therapeutic improvements.

Serum methanol levels of greater than 20 mg/dL correlate with ocular injury. Funduscopic changes are notable within only a few hours after methanol ingestion. The mechanism by which the methanol causes toxicity to the visual system is not well understood. Formic acid, the toxic metabolite of methanol, is regarded as being responsible for ocular toxicity, and blindness can occur in humans.

The prognosis in methanol poisoning correlates with the amount of methanol consumed and the subsequent degree of metabolic acidosis; more severe acidosis confers a poorer prognosis. Methanol has a relatively low toxicity. The adverse effects are thought to be from the accumulation of formic acid, a metabolite of methanol metabolism. The prognosis is further dependent on the amount of formic acid that has accumulated in the blood, with a direct correlation existing between the formic acid concentration and morbidity and mortality. Little long-term improvement can be expected in patients with neurologic complications.

The minimal lethal dose of methanol in adults is believed to be 1 mg/kg of body weight. The exact rates of morbidity and mortality from methanol intoxication are not available.

Rapid, early treatment is necessary for survival, but sequelae such as blindness may be permanent.

Metabolic acidosis in methanol poisoning may necessitate the administration of bicarbonate and assisted ventilation. Bicarbonate potentially may reverse visual deficits. In addition, bicarbonate may help to decrease the amount of active formic acid.

Antidote therapy, often using ethanol or fomepizole, is directed towards delaying methanol metabolism until the methanol is eliminated from the patient's system either naturally or via dialysis. Like methanol, ethanol is metabolized by ADH [alcohol dehydrogenase], but the enzyme's affinity for ethanol is 10-20 times higher than it is for methanol. Fomepizole is also metabolized by ADH; however, its use is limited because of high cost and lack of availability.

Hemodialysis can easily remove methanol and formic acid. Indications for this procedure include (1) greater than 30 mL [1 oz] of methanol ingested, (2) serum methanol level greater than 20 mg/dL, (3) observation of visual complications, and (4) no improvement in acidosis despite repeated sodium bicarbonate infusions.

Intravenous administration of ethanol in a 10% dextrose solution may be helpful. As ethanol prolongs the elimination half-life of methanol, the treatment may take several days, and the patient should be hospitalized. Dialysis may be necessary to prevent kidney failure as well. Hemodialysis remains an effective treatment.

Portions of this comment were extracted from
- <http://emedicine.medscape.com/article/1174890-overview>,
- <http://emedicine.medscape.com/article/1174890-treatment>,
- <https://www.nap.edu/read/4795/chapter/35>, and
- <https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750029.html>. - ProMed Mod.TG]

This tragic development is another example of the broader deleterious impact of a pandemic on other aspects of public health.  Anecdotal reports of other potentially harmful "home remedies" for COVID-19 being hawked on the internet reminds us that education of the general public and responsible messaging are more important now than ever. - ProMed Mod.LXL]

[HealthMap/ProMED-mail map:
Iran: <http://healthmap.org/promed/p/128>]
Date: Sat, 14 Mar 2020 11:58:18 +0100 (MET)

Tehran, March 14, 2020 (AFP) - Iran said on Saturday that the novel coronavirus has claimed 97 more lives, raising the country's total to 611, as the number of confirmed cases jumped again.   Health ministry spokesman Kianoush Jahanpour said that "1,365 fresh cases have been added to the number of confirmed infections in the past 24 hours", bringing the total to 12,729.   Jahanpour told a televised news conference that more than 4,300 of those with confirmed infections had recovered so far.

Tehran province had the highest number of new cases with 347, followed by Isfahan with 155 and the northern region of Alborz with 134.   "Naturally, the number of confirmed cases will increase" even more as Iran steps up its laboratory sampling and tests, he said.   The outbreak in Iran is one of the deadliest outside of China, where the disease originated.
Date: Tue 3 Mar 2020 12:24 AM MYT
Source: The Star, Associated Press (AP) report [edited]
<https://www.thestar.com.my/news/regional/2020/03/04/iran039s-military-on-alert-as-virus-kills-77-sickens-leaders>

Iran put its armed forces on alert on Tuesday [3 Mar 2020] to assist health officials in battling the new coronavirus [SARS-CoV-2] that has killed at least 77 people, an outbreak that has sickened top officials and pushed even its supreme leader into wearing disposable gloves while trying to reassure the nation. Even as government officials sit metres away from each other at meetings now in an effort to stop its spread, the virus is ravaging both its civilian leadership and its Shiite theocracy. A top emergency official and at least 23 members of parliament reportedly contracted the virus and now suffer from the COVID-19 illness it causes. Others have died.

There are now over 2540 cases of the new virus across the Middle East, with 2336 in Iran alone. Of those outside Iran in the region, most link back to the Islamic Republic. Experts worry Iran's percentage of deaths to infections, now around 3.3%, is much higher than other countries, suggesting the number of infections in Iran may be far greater than current figures show.

Meanwhile, a gloved Ayatollah Ali Khamenei sought to minimise the virus while praising the doctors and nurses combating the outbreak. He urged the nation to pray. "This disaster, in our opinion, is not such a big disaster, there have been and there are bigger disasters than this," Khamenei said. "Of course I don't want to downplay the issue, but let's not exaggerate it much either. Something has happened, it will exist in the country for a time, which hopefully will be short, and then it will go away."

The death of Expediency Council member Mohammad Mirmohammadi on Monday [2 Mar 2020] makes him the highest-ranking official within Iran's leadership to be killed by the virus. State media referred to him as a confidant of Khamenei. The virus earlier killed Hadi Khosroshahi, Iran's former ambassador to the Vatican, as well as a recently elected member of parliament. Ahmad Tuyserkani, an adviser to Iran's judiciary chief, died on Monday night [2 Mar 2020] from the virus, semi-official media reported. Those sick include vice president Masoumeh Ebtekar, better known as "Sister Mary", the English-speaking spokeswoman for the students who seized the US Embassy in Teheran in 1979 and sparked the 444-day hostage crisis, state media reported. Also sick is Iraj Harirchi, the head of an Iranian government task force on the coronavirus who tried to downplay the virus before falling ill.

On Tuesday [3 Mar 2020], lawmaker Abdolreza Mesri told Iranian state television's Young Journalists Club programme that 23 members of parliament had the coronavirus. He urged all lawmakers to avoid the public. "These people have a close relationship with the people and they carry different viruses from different parts of the country, which may create a new virus, so we recommend the lawmakers to cut off their relationship with the public for now," Mesri said.

Members of Iran's Supreme Council of Economic Coordination, including president Hassan Rouhani, met on Tuesday [3 Mar 2020] and sat metres apart from each other. State media did not comment on the move, nor the fact the meeting appeared attended by fewer officials than normal. Iran's state-run IRNA news agency also reported that Pirhossein Koulivand, head of the country's emergency services, had come down with the new virus. It said he was undergoing treatment.

Khamenei ordered Iran's armed forces to be ready to help health workers, but it wasn't immediately clear what the order entailed. Officials previously said they had plans for 300,000 soldiers and members of the Basij, the all-volunteer force of Iran's Revolutionary Guard, to sanitize public areas, direct traffic and trace contacts that sick people had with others. The Guard also has been spraying down streets in major Iranian cities. "Whatever helps public health and prevents the spread of the disease is good and what helps to spread it is sin," Khamenei said at an annual tree-planting ceremony. He had never worn gloves at the ceremony in recent years.

However, life has slowed in Iran's capital, Tehran, where a perfume seller simply stood at her stand at an upscale mall with no one to offer samples. "People are afraid to touch anything or take anything from us," she said. "Everyone is at a loss."

Meanwhile on Tuesday [3 Mar 2020], the Middle East's largest airline, Emirates, said it had to reduce or ground flights due to the new virus. Because of the slowdown, the government-owned carrier has asked its employees to take paid and even unpaid leave for up to a month at a time. Emirates operates out of Dubai, the world's busiest for international travel. "We have been tested before and Emirates will come out stronger," chief operating officer Adel Al-Redha said.

The world's largest airline trade association, IATA, says Middle East carriers have already lost around USD 100 million in revenue due to a drop in ticket sales because of disruptions caused by the virus.
=======================
[In the past 24 hours, the number of cases of COVID-19 confirmed in Iran has grown from 1501 to 2336, an increase of 835 newly confirmed cases. The number of deaths has also increased from 66 to 77, an increase of 11 new deaths. The number of MPs (members of parliament) in the country who have been infected is curious, 23 out of 290 parliament members (7.9%).

Qom, the apparent epicenter of this outbreak, is located to the south west of Tehran in central Iran. Other media reports have mentioned that Tehran has become a major focus of cases.

A map of Iran showing provinces can be seen at
<https://www.mapsofworld.com/iran/iran-political-map.html> and a HealthMap/ProMED-mail map of Iran is available at
<http://healthmap.org/promed/p/128> - ProMed Mod.MPP]
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