Ongoing outbreak of COVID-19 in Iran: challenges and signs of concern with under-reporting of prevalence and deaths M. Ghafari1* , B. Hejazi2, A. Karshenas3, S. Dascalu1,4, L. Ferretti5, A. Ledda6, M. A. Khosravi7, M. Abbasalipour7, S. Zeinali7,8, A. Katzourakis1* 1 Department of Zoology, Peter Medawar Building for Pathogen Research, University of Oxford, Oxford, UK. 2 Department of Physics, Wesleyan University, Middletown, Connecticut, USA. 3 Department of Engineering, University of Oxford, Oxford, UK. 4 Avian Influenza Virus, The Pirbright Institute, Woking, UK. 5 Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK. 6 Department of Infectious Disease Epidemiology, Imperial College London, UK. 7 Kawsar Human Genetic Research Center, Kawsar Biotech Company, Tehran, Iran. 8 Department of Molecular Medicine, Biotechnology Research Center, Pasteur Institute of Iran, Tehran, Iran. ∗Corresponding author. Email:
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[email protected] (AK) Abstract Iran was among the first group of countries with a major outbreak of COVID- 19 in Asia. With nearly 100 exported cases to various other countries by Feb 28, 2020 it has since been the epicentre of the outbreak in the Middle East. By examining the age- and gender-stratified national data taken from PCR- confirmed cases and deaths related to COVID-19 on Mar 13 (reported by the Iranian ministry of health) and those taken from hospitalised patients in 14 university hospitals across Tehran on Apr 4 (reported by Tehran University of Medical Sciences), we find that the crude case fatality ratio of the two reports in those aged 60 and younger are similar to each other and almost 10 times higher than those reported from China, Italy, Spain and several other European countries (reported from government or ministry of health websites).