Medical staff at Tehran Emergency Center have spoken of the dire conditions in which they are expected to treat patients infected with coronavirus as Iran struggles to cope with the outbreak of the virus in Qom and in the capital.
Saeed (not his real name) works for Tehran Emergency Center and spoke of his frustration. “We ran out of specialist goggles on Sunday morning,” he says. “They sent us goggles for welders. The glasses are open at the sides and our clothes leave the lower part of the body unprotected, exposing us to potential contamination.”
When medical staff raised their safety concerns, they were told by hospital officials not to worry and to use the masks provided. When they made further queries about the protection provided, hospital officials responded briefly and inadequately: ”I don’t know, these are the orders from above.”
Saeed talked about a patient he treated who was in his thirties and who had a high fever and difficulty breathing. “From the symptoms, it was quite clear that he was infected with coronavirus. They said he had developed the symptoms after returning from Qom, where he had gone to visit a relative.
“We are deeply concerned for our wellbeing,” says Saeed. “Would the government themselves treat these patients without being equipped with adequate protective clothing? But they want us, the emergency workers, to get these patients to the hospital without special equipment.”
The first coronavirus cases were reported in Qom, and the number of people suspected to have been infected is on the rise. In recent weeks, 19 cases of the virus have been confirmed by the Ministry of Health, with five of them proving to be fatal.
“The health ministry has issued a protocol for treating patients, stating that should the patient show symptoms of coronavirus, medical staff are to be completely covered and wear N95 masks [masks that cover the nose and mouth and which are designed to help protect the wearer from ingesting hazardous substances], protective gear for the eyes, face, and hands,” a Tehran-based internal medicine specialist tells IranWire.
“On the way to the hospital, the patient might vomit, cough or sneeze and the discharge might splash on the lower body parts of emergency workers. So dispatching emergency workers without necessary equipment is incredibly risky.”
Another doctor who asks not to be named confirms Saeed’s claims concerning the lack of necessities. “Tehran Emergency personnel are quite right,” he says. “We are in a specialized hospital but we have a shortage of masks. I am not just talking about N95 masks. The hospital’s dispensary is out of paper surgical masks, the most basic of precautionary clothing.”
Naïve Optimism, Serious Results
This glaring lack of preparation has hit emergency services hard, with dire consequences being felt across the region. According to a doctor at Tehran Emergency Center who asked not to be named, over the last few days hospitals have received instructions on how to treat patients suspected of coronavirus but communication between health officials and medical personnel continues to be unclear and confusing.
“Since the outbreak of coronavirus in China, when other countries were preparing themselves for its possible spread, the health ministry was naively optimistic that the disease would not reach Iran and, as result, it did not draw up adequate measures to protect medical service workers,” the doctor says.
Shortly after the virus began to spread swiftly around the world, the situation became critical and the health ministry held discussions to review the problem. According to the doctor at Tehran’s medical center, Mohammad Mehdi Gooya, the director of the health ministry’s Center for Prevention of Infectious Diseases, clearly has no strategy for dealing with the outbreak of coronavirus and, in the last few days, the only communication released about the virus has been information regarding the number of confirmed cases.
“Dr. Gooya is a specialist in infectious diseases. He has been deputy minister and director of the Center for Prevention of Infectious Diseases for a number of terms. Why is he not prepared for this disease? Unfortunately, we have a shortage of necessities and the disease is spreading unnecessarily,” the doctor says sadly after a pause.
He says that when the infection broke out in China the health ministry should have at least stocked up on masks, goggles, gloves, and clothing. “Unfortunately even this simple precaution was not taken and now we have to deal with the consequences.”
On Sunday, February 23, the health ministry’s spokesman Kianoush Jahanpour told Iranian TV that the death toll had risen to eight and there were now 43 confirmed cases in Iran. This is a jump from Saturday, February 22’s total of 28 confirmed cases and six fatalities. Iran reported its first case of the virus on Wednesday, February 19, announcing that two elderly people had died from the virus in Qom.
“Unfortunately, the necessary test kits are not available in all cities and the test results for many samples are still unknown,” says the doctor who spoke with IranWire.
A Quickly Developing Epidemic Left Untreated
Many Telegram channels have been reporting that some members of the medical profession have been infected by coronavirus, including Dr. Rosita Abolghasemi, a kidney specialist, and her husband Ali Asghar Babajani, an ear, throat, and nose specialist, both of whom are now in quarantine at Tajrish Martyrs Hospital in northern Tehran.
A specialist in the northern province of Gilan reports that another doctor and his wife have been infected with coronavirus: “Dr. Behrouz Hassanzadeh and his wife have been infected and are now in Razi Hospital in Roodbar.”
On February 20, Dr. Hassanzadeh tended to a 52-year-old patient who had walked to the hospital by himself but “quickly developed breathing problems and his heart and lung functioning deteriorated quickly.”
Another coronavirus fatality in Gilan was a prominent doctor, Dr. Reza Koochekinia, the president of the health network in the city of Astaneh. His body was buried in his family’s plot in the city of Lahijan in a public ceremony.
“He was in quarantine at Pars Hospital in Rasht when he died,” an individual who attended the burial ceremony tells IranWire. “The test results for coronavirus had not yet arrived when he died but, regardless of this lack of testing, they delivered the body to his family.”
Public burial ceremonies for victims of viral infectious diseases such as coronavirus are not allowed, and the burial must take place under specific conditions.
“Such patients must be buried without a burial shroud and without ablution [washing of the body as required in Islamic tradition]. The body should be wrapped in special, airtight protection, and be covered with lime,” a specialist doctor tells IranWire.
He points out that in 2017, when several people died in Gilan as a result of the Crimean–Congo hemorrhagic fever, they were all buried by people wearing specialist uniforms. But, this time, it is not known how the victims of coronavirus have been buried.
A Community left Outraged
“The people of Lahijan are incredibly distressed because they believe that by releasing the body of Dr. Koochekinia, who happened to be a much loved, influential member of the community, a disservice has been done to them,” a resident of Lahijan tells IranWire. “Dr. Koochekinia’s family insists that he died of influenza, not from coronavirus, but Pars Hospital’s medical personnel say that tests performed on Dr. Koochekinia came back as positive and the news has spread in the city.
“If the deceased test positive for the coronavirus then the family and others who had been in contact with him must be quarantined for two weeks and take the necessary precautions”, a specialist in internal medicine tells IranWire. “For death by influenza, too, the family must be quarantined, but for the flu virus, the dormant period is five days and a five-day quarantine is sufficient.”
But the Lahijan resident tells IranWire proper procedures are not being followed. “It does not matter what Dr. Koochekinia died of — it was a lethal disease and his family should not have held a public burial ceremony.”
On Saturday, February 22, Hossein Nooraninejad, a reformist political activist, tweeted that his cousin had died of coronavirus in Qom. “Today my cousin was buried in a painful way,” he tweeted. “I do not want to dwell on it and torture the reader but the management of this crisis, from the control of the disease to treatment and even to burial, has been a disaster.”
The family was expected to go to the morgue and collect his body, They carried him to the graveside and when they found out that the body had not been shrouded, his brother was forced to shroud him by himself. The staff of the morgue and of the hospital did not want to have anything to do with the bodies, and it is the responsibility of trained personnel to handle victims of coronavirus with special equipment and wearing proper attire. They did not help the family, nor did they do anything to prevent the spread of the infection.
“For the last two days we have sent messages to various health ministry officials to tell them about these problems and ask them to come up with solutions, but they have not answered,” Nooraninejad wrote in another tweet.
According to a specialist, since coronavirus also exists on the surface of the body, the deceased person’s home and belongings must be disinfected as well. “When we have difficulty in properly disinfecting the hospitals, how can we expect the health ministry to disinfect the homes and the personal belongings of these victims?”
In the last few days, Saeed has taken a number of people with suspected coronavirus to Imam Khomeini Hospital by ambulance. “After delivering the patient to the hospital, they supposedly disinfect the ambulance with bleach and water, but is this the proper method of disinfection?”
The government’s lack of preparation to deal with the coronavirus epidemic has left Saeed and his colleagues in the emergency services feeling frustrated and in fear for their lives.
“Forget about us,” he adds, “If we are infected, the people around us become infected as well.”