Public Health 182 (2020) 187

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Public Health
journal homepage: www.elsevier.com/locate/puhe

Letter to the Editor

Coronavirus disease 2019 in Iran: the need for more attention to

primary health care

While the global effort to prevent coronavirus disease 2019

(COVID-19) spread continues, some experts have suggested that
the disease may be in its first stages.1 After initial reports of the dis-
ease from China, recent reports of this contagious disease have also
been reported elsewhere in the world, including in the World
Health Organization (WHO) Eastern Mediterranean region such
as Iran.2 The Eastern Mediterranean is an area that has many public
health problems.3
On February 20, the Iranian Ministry of Health reported the first
cases of the disease. In fact, in Iran, the initial report, in addition to
reporting two cases, also reported deaths. 4 Given that the incidence
of these cases was unrelated to any direct source outside of Iran,
and on the other hand, given the geographical location of the prov-
inces where the Iranian Ministry of Health reported cases (central
areas of the country), the probability of the epidemic situation of
the disease could be considered.
In fact, it could be argued in the epidemiology of the current sit-
uation that despite the low number of the reported primary deaths,
their importance in the secondary or tertiary transmission position
could be very worrying. This was a prediction that came with the
rapid spread of the disease throughout Iran in a short span.
Accord- ing to WHO statistics, at the end of March 9 and in less
than three weeks after the first new case report in Iran, the total
number of confirmed cases of COVID-19 in Iran was more than
6500 and the total deaths from COVID-19 was 194.5
In these situations, in addition to providing high-quality
medical services to patients, there is a serious need for basic care,
including education for the general public in various areas of
prevention and related health care. In addition to considerations
regarding the abil- ity to manage the conditions ahead, given the
wide scope of the issue across the country, the primary care system
is important in identifying and correctly referring cases.
The primary healthcare system in Iran has had a good standing
over the past few years. The structure has, implemented many
WHO and other public health programs, including the polio eradi-
cation program.6 Over the past few years, the capacity of primary
health care in Iran has been maintained at an acceptable level
owing to the use of appropriate and efficient methods, and the
WHO has reported significant progress in this area, even as a
model for some countries.7
But the important issue has been the shortage of resources in
the health sector over the last few years, and especially in the
last two years, owing to the numerous economic bottlenecks in
Iran.
This, mostly, includes other issues related to the supply of needed
medicines and the possibility of developing specialized hospital
settings, including intensive care units that are necessary in these
critical conditions.8
The use of high-capacity primary health care along with
increased awareness of preventive methods is an effective step in
the effort to control COVID-19 in Iran especially after the recent
widespread epidemic situation. Increasing international coopera-
tion and reducing economic constraints can be an effective step to-
ward improving the current situation.
References
1. The L. COVID-19: fighting panic with information. Lancet (London, England)
2020;395(10224):537.
2. World Health Organization. Update on COVID-19 in the eastern mediterranean
re- gion. Feb 16, 2020. Available from: http://www.emro.who.int/media/news/
update-on-covid-19-in-the-eastern-mediterranean-region.html.
3. Brennan R, Hajjeh R, Al-Mandhari A. Responding to health emergencies in the
Eastern Mediterranean region in times of conflict. Lancet (London, England)
2020. https://doi.org/10.1016/S0140-6736(20)30069-6.
4. World Health Organization. Situational report-31. 20 February, 2020. Available
from: https://www.who.int/docs/default-source/coronaviruse/situation-
¼
reports/ 20200220-sitrep-31-covid-19.pdf?sfvrsn dfd11d24_2.
5. World Health Organization. Situational report. 9 March, 2020. Available from:
https://www.who.int/docs/default-source/coronaviruse/situation-reports/
¼
20200309-sitrep-49-covid-19.pdf?sfvrsn 70dabe61_4.
6. World Health Organization. Programms. 2013. Available from:
http://www.emro. who.int/polio/certification/iran-certification.html.
7. World Health Organization. IRIS home. 2018. Available from: https://apps.who.
int/iris/handle/10665/326243.
8. The Word Bank. Overview. 2018. Available from:
https://www.worldbank.org/en/ country/iran/overview.
R. Badrfamy
Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
A. Zandifar*
Social Determinants of Health Research Center (SDH), Alborz
University of Medical Sciences, Karaj, Iran
*
Corresponding author. 45 meter Golshahr, Alborz, Iran. Tel.:
þ 0098 2634643774.
E-mail address: zandifaratefe@gmail.com (A. Zandifar).
10 March 2020

y
Address: Roozbeh Hospital, South Kargar Street, Tehran, Iran. Tel.: þ0098
2155419151.

https://doi.org/10.1016/j.puhe.2020.03.010
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