To the Editor—After epidemics of severe acute respiratory syndrome-related coronavirus (SARS) in 2002 and Middle East respiratory syndrome–related coronavirus (MERS) in 2012, the third global challenge from a coronavirus began at the end of 2019, but this time in the form of a pandemic.^{Reference Li, Guan and Wu1} The coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a virus closely related to the SARS virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). According to the World Health Organization (WHO) guideline, patients with COVID-19 have symptoms ranging from mild respiratory illness (respiratory symptoms, fever, cough, shortness of breath, and breathing difficulties) to severe (pneumonia, acute respiratory distress syndrome, kidney failure, and death).^{Reference Li, Guan and Wu1} Based on scientific reports,² this pandemic began in Wuhan City, China, and quickly spread throughout the country. As of March 15, China has confirmed 81,048 cases with 3,204 deaths. Although the COVID-19 incidence has declined sharply since February 13, 2020, in China, the prevalence increased faster in other countries than scientists anticipated. Italy, with 21,157 positive cases and 1,441 deaths (case fatality rate [CFR], 6.81%), and South Korea with 8,162 positive cases and 75 death (CFR, 0.91%), were the countries most affected as of March 15.²

In Iran, the first COVID-19 case was identified on February 19, 2020, in Qom. As of March 16, 2020, 14,991 COVID-19 cases with 853 deaths (CFR, 5.69%) have been reported cumulatively from all 29 provinces of Iran. Among these states, Tehran has shown the highest incidence, with 3,774 positive cases.² Although Iran has achieved more success in controlling and preventing patient deaths than some developed countries, such as Italy (CFR, 6.81%), Iran has faced some difficulties in controlling this epidemic. Thus, achieving success and overcoming COVID-19 in Iran requires that we understand these deficiencies.

Some of the most effective actions in Iran in the early days of the COVID-19 outbreak included the following: (1) encouraging people to stay home, (2) providing free diagnostic and therapeutic services to COVID-19 patients, (3) allocating at least 1 hospital in each province to providing special services to COVID-19 patients, (4) daily disinfecting public transportation like subways, buses, and taxis, (5) canceling sport competitions, cinemas, theaters, weddings, and funerals, and closing all schools and universities, (6) providing distance and online learning infrastructure for students (7) increasing the capacity of the production of masks and disinfectants by >7 times, (8) extensively informing and promoting a culture of healthcare by the Islamic Republic of Iran Broadcasting system and other media, and launching mobile software, websites and telephone answering systems to address concerns and questions about COVID-19, (9) encouraging people to eat homemade healthy foods instead of fast food, (10) mobilizing and recruiting all national government and nongovernmental organizations to fight COVID-19 under the auspices of “The National Headquarters for Coronavirus,” (11) governmental support of small and large businesses to compensate for the loss of revenue and jobs, and finally (12) publication of a COVID-19 surveillance guideline by the Ministry of Health for various organizations (eg, prisons, barracks, etc) to stop and reverse the growing epidemic trend (Table 1).^{2,Reference Patel and Jernigan3}

Table 1. List of All Actions Taken in Iran by Date and Category

Iran has established an acceptable track record in the control of infectious diseases; but it still has very big challenges to reach an ideal level. These challenges include the following^{2,Reference Lohrasbi, Mohammadzadeh and Shirmohammadlou4} : (1) imposition of travel restrictions by the government on religious cities, like Mashhad and Qom, is difficult; (2) approaching ancient Nowruz ceremonies, like Christmas, are traditionally associated with shopping and large gatherings of people; (3) a failure to quarantine the first city with positive cases of COVID-19 (Qom) with subsequent spread of infection to most provinces of Iran was hampered by the Islamic Consultative Assembly election of 2020 and lack of cooperation by the people; (4) lack of attention by the people to government warnings about travel to Gilan, Mazandaran, and Golestan provinces (popular holiday destinations in Iran) after the closure of schools and universities to aid in spreading the infection; (5) lack of money, medical equipment, and laboratory diagnostic kits because of international sanctions; (6) hoarding of medical devices such as gloves, masks, and disinfectants by profiteers; and (7) lack of space for the quarantine of people with suspected infection in the early days of the outbreak.

Finally, the number of cases in Iran places it in the statistical middle of the COVID-19 outbreak countries (Fig. 1). If Iran tries to overcome to all challenges that are described above, it will be able to manage this crisis. We daresay that “where there’s a will, there’s a way,” and we hope that these challenges will be overcome soon.

Fig. 1. COVID-19 prevalence in Iran.