Detangling the Figures: Why One Hospital Reports 700 Covid-19 Fatalities

Since the day the coronavirus outbreak in Iran was officially announced in February, people’s fears have been exacerbated by their mistrust of officials of the Islamic Republic.

According one survey published by the state-owned IRNA news agency (IRNA), just 27 percent of respondents trusted official figures. Only 25 percent “relatively” trusted them and 48 percent said they did not trust them at all.

In this report, IranWire tries to provide a more accurate picture of coronavirus infections and fatalities in the southwest province of Khuzestan, through a careful examinations of reports coming out of the province. We begin in one hospital in the province and then extend our view from there.

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“All wards of Taleghani Hospital have been allocated to coronavirus patients and all four ICU wards are now full,” a doctor, who works at the hospital and wants to remain anonymous, told IranWire.

“Since March 2, when the first coronavirus patient died in Abadan, until now, in this hospital alone close to 700 coronavirus patients have died. In the past week, in my ICU alone, 14 patients died. These numbers, of course, are separate from those of Oil Industry Hospital. I have no accurate information about that.”

Taleghani Hospital is located in the port city of Abadan. It has 194 beds in total and four ICU wards, and has been designated as the primary hospital to hospitalize and treat coronavirus patients in southwest Khuzestan: those coming from the cities of Abadan, Khorramshahr and Shadegan. It started treating coronavirus patients on February 27 when the first case of Covid-19 was diagnosed in Abadan.

The 607,000 residents of this area are covered by Abadan University of Medical Science. Since March 18, Imam Khomeini Hospital, also known as Oil Industry Hospital, has also been placed at the disposal of the Coronavirus Taskforce and a number of its wards have been allocated to Covid-19 patients.

The 700 fatalities that Taleghani Hospital’s doctor reports took place in an area that only covers three of the 27 counties in Khuzestan and 12 percent of its population.

 

Panic causes more infections

Under new guidelines hospital staff have received, the doctor says, they can only hospitalize patients who are in a critical condition. Senior officials at the Health Ministry and the Khuzestan University of Medical Sciences pressure the hospital to discharge as many patients as possible, as soon as possible.

As a result, patients who suffering from COVID-19  symptoms are forced to go to other clinics and treatment centers, which in turn has led to an increase in coronavirus infections among the medical personnel in Abadan.

“In recent days,” says the doctor, “at least eight patients have been hospitalized at Shahid Beheshti Hospital and because of the high number of people who visit, a high number of its medical personnel have been infected, including almost all the specialists in internal medicine and emergency medicine, the hospital’s president and vice president, and most of the nurses.”

In recent days, says this doctor, more than 90 percent of coronavirus tests conducted on the premises have been positive. “The number of people who come to the hospital is very high,” he says, “just like the early weeks of the epidemic in other parts of Iran. They rush to the hospitals because they are scared of coronavirus but this crowding by itself contributes to the spread of coronavirus. There are no drugs or specific procedures to treat coronavirus when it is not intense. The only thing to do is for the patient to quarantine himself at home.”

Khuzestan University of Medical Sciences and its medical schools are responsible for treating coronavirus in five treatment zones: Ahvaz, Dezful, Abadan, Shushtar and Behbahan. Of these five, Ahvaz and Dezful have the highest number of infections. The doctor says that he is aware that the situation in Ahvaz and Shushtar zones being worse than in Abadan and believes the fatalities in these two areas must be higher.

In an interview with IRNA on May 27, Dr. Mehdieh Tavakoli, Dezful Medical School’s vice president, had claimed that the rate of hospitalization of coronavirus patients in that zone was only seven percent. “Only patients in critical conditions are hospitalized in Dezful and the rest of the infected cases are sent home or to recovery centers to be quarantined,” she said.

On June 5, however, Dr. Tavakoli contradicted her earlier statement. In another interview with IRNA, she said that 4,100 people have come to the emergency rooms in that zone and 1,300 of them, or more than 31 percent, have been hospitalized.

 

The Battle of Percentages

Based on various statements by Iranian health officials, including Dr. Masoud Mardani, an internal medicine specialist and member of the National Coronavirus Taskforce, approximately 15 percent of Covid-19 cases are hospitalized. If this is true, then the admission rate in Dezful hospital is 16 percent higher than the national average: indicating a critical situation in Dezful area.

Despite this, in her interview with IRNA, Dr. Tavakoli claimed that since the outbreak of coronavirus only 108 Covid-19 patients had died in Greater Dezful Hospital. Considering the number of hospitalized coronavirus patients in Dezful and the average fatality rate among hospitalized patients in Iran, we must question the reliability of Dr. Tavakoli’s claim.

In an interview on May 28, Dr. Massoud Mardani of the National Coronavirus Taskforce reported that of the 15 percent of COVID-19 patients who go to hospital in Iran, five percent are hospitalized at ICU wards and of these, number 50 percent die. In other words, 16.6 percent of hospitalized COVID-19 patients lose their lives. If this is correct, then we have to assume that the number of fatalities in Dezful treatment zone is much higher than the official figure – and at least 205 COVID-19 patients have died at the Greater Dezful Hospital.

Even these numbers are much lower than the figure reported by the doctor at Abadan’s Taleghani hospital. He said he believes that, based on his own experience over the past few months and the high number of infections among medical staff at Dezful, official figures about the city of Shush within the Dezful treatment zone, are not correct. “My more than 20-year experience in the healthcare system and my close to four-month presence in the frontline of fighting coronavirus tells me that, unfortunately, the number of infected cases in Shush, both those who have been hospitalized and those who have died, must be much higher than the figures announced,” he says.

In another interview, Dr. Mehdieh Tavakoli put the proportion of COVID-19 fatalities in the Dezful zone at 3.5 percent while sometime earlier Khuzestan’s Governor Gholamreza Shariati had put the it at 5.4 percent. On June 9, a spokesman for the Ahvaz Jondishapur University of Medical Sciences reported that the total number of coronavirus patients in Khuzestan had reached 21,281, of whom 718 had died. This would translate into a death rate of 3.37 percent in the province.

 

False Infection Rates

Based on international studies, the doctor at Taleghani Hospital says, it is hard to judge whether the official fatality rate announced for Iran is valid or not. “In my opinion, aside from our own personal observations, what makes the official figures questionable is the untrue number of infected cases,” he says.

This view is supported by information from statements made by health officials. “Eighty percent of people must get infected before they become immune. But, according to estimates, between 80 to 85 percent of people are still not immune,” said Dr. Yousef Paridar, president of Dezful University of Medical Sciences at a meeting of the city’s Coronavirus Taskforce. In other words, between 15 to 20 percent of the people have been infected with coronavirus.

This estimate was confirmed by Dr. Minoo Moharez, a member of National Coronavirus Taskforce, on June 6. “Around 20 percent of the Iran’s population has been infected with coronavirus,” she said in an interview. However, health ministry spokesman Kianoush Jahanpour then rejected her claim and insisted that “less than 10 percent of the people have been infected with coronavirus.”

According to these estimates and considering the relatively long and widespread outbreak in Dezful area, we must conclude that of the 735,000 residents of this zone between 10 to 20 percent, or between close to 73,500 to 147,000 people, have been infected, regardless of whether they show any symptoms or not.

This means that in the best-case scenario, that is to say, the one insisted on by Jahanpour, there have been 73,500 infections in Dezful area over the past 110 days of whom 3.5 percent, or 2,572, have died.

 

Learning from Germany and South Korea

“One of the most important factors in deciding the rate of coronavirus fatalities and its ratio to the number of infections is the rate of diagnosis of cases,” says the doctor at Taleghani Hospital. “South Korea and Germany have the best record in widespread testing and quick diagnosis of cases. Of course, because of their immediate quarantines, they not only have a lower rate of infections but, apparently, also a lower rate of fatalities. So aside from important factors elsewhere that contribute to the fatality rate, these two countries offer a more realistic death rate from coronavirus.”

According to Dr. Reza Malekzadeh, Deputy Health Minister for Research and Technology, the average rate in Germany and South Korea is 1.6 percent. If we assume that 73,500 people have been infected with coronavirus in the Dezful area since February, then we can say that least 1,176 people have died from Covid-19 in this part of Khuzestan.

By taking into account the numbers provided by the Taleghani Hospital’s doctor and the much higher number of infections in Dezful area compared to that of Abadan, it can be cautiously surmised that this figure is closer to reality.

In Khuzestan, the contradictions in statements by the province’s health officials in the five treatment zones show clearly that official figures cannot be trusted. On June 8, president of Abadan University of Medical Sciences said that in total, 68 patients whose tested positive were being treated at Taleghani Hospital. But on the same day, a vice president of the same university announced that all 194 beds in that hospital are full.

On April 26, it was announced that 161 beds at this hospital had been allocated to COVID-19 patients but on May 28, during a visit by Deputy Health Minister Ghasem Jan-Babaei, it was announced that the total capacity of the hospital, all194 beds, had been allocated to treat coronavirus cases.

The doctor at Taleghani Hospital says their criterion for admitting patients shows why the figures provided by the president of the university must be invalid. “By relying on ‘positive test results’ they reduce the number of coronavirus patients to one third of what it should be and then intentionally ignore patients hospitalized at the Oil Industry Hospital ,” he says, “whereas we follow the guidelines and identify coronavirus cases based on symptoms and test results that include CT scan of lungs and then decide to hospitalize them or not.”

 

Too Many False Negatives

“One of the best methods to diagnose coronavirus is via a CT scan of lungs, which can be more accurate,” said Iraj Malekzadeh, a deputy health minister, on March 13.

But health officials only count coronavirus test results to downplay the actual number of coronavirus cases. As a result, the figures announced by the health ministry will tell only part of the story. Even Dr. Alireza Zali, director of Tehran’s Coronavirus Taskforce, warned on April 12 that coronavirus tests return too many false negatives and there is no guarantee that these results are reliable.

On June 8, Ali Ehsanpour, a spokesman for Ahvaz Jondishapur University of Medical Sciences, announced that “currently 649 coronavirus patients are hospitalized in Khuzestan”: while on the same day, vice president of Abadan University of Medical Sciences reported that the 194 beds at Taleghani hospital were all occupied and new cases have been sent to Oil Industry Hospital.

On June 5, three days earlier, it was announced that after Ahvaz, Dezful has the highest number of coronavirus cases in Khuzestan. And according to official figures announced on June 8, the total number of patients diagnosed in the other four treatment zones in the province was eight times the number in Abadan. In the past few weeks, this ratio has either remained the same or, at best, has been reduced five-fold.

There can be no doubt that the number of hospitalized coronavirus patients in the 16 cities of the other four treatment zones in Khuzestan, home to 78 percent of the province’s population with infected cases at least five times that of Abadan — with 194 patients in the hospital — must be more than 455. In the same way, we must conclude that number of hospitalized cases in Khuzestan on June 8 must have been closer to 1,600, not 649 as claimed.

These numbers are a good example of why we must doubt official figures about coronavirus in Khuzestan and, consequently, in Iran as a whole. Iranian people do not trust official figures and the medical staff on the frontline of war against coronavirus regard them as lies.

It is so bad that even Deputy Health Minister Alireza Raeesi has confirmed their worthlessness. “The real numbers are undoubtedly higher than official figures,” he has said.