Chinese people started the New Year 2020 with severe pneumonia symptoms which the reason was not clear. In the following of the virus epidemic, the agent was known as new Coronavirus which has a contagious power in rapid person to person transmission. In recent month, after knowing more about the virus, SARS-CoV-2 has been named to the disease cause. The disease caused by this virus is now known worldwide as Covid-19. Contagion power of the virus in asymptomatic phase in infected cases and travelling may be the main reasons for this rapid distribution [13]. Given that Iran is also a major tourist country in the middle east, then it was not exception of this global outbreak, particularly near Nowruz ceremony (Persian New Year Celebration). According to an interesting report which was conducted based on Data-Driven Coding and statistical methods, a total of 14450 ± 6244 individuals will be infected in Iran and spread to 31 provinces. Also the infection, peaks during 3 weeks and the epidemic is expected to end in June 2020[14]. Another prediction computes the basic reproduction number (R0) of CoVID-19 in Iran, by the mean estimation 3.6; which means; 3.6 susceptible individuals would be infected by confirmed positive cases. There is uncertainty about many of the factors that go into estimating R0, such as in estimating the number of cases. Based on these current estimates, projections of the future number of cases of coronavirus are fraught with high levels of uncertainty and will likely be somewhat inaccurate. The most important reason for ambiguities of these predictions is unknown impact of future impacts of current disease control measures, such as travel restrictions, social and self-quarantine efforts will influence the virus’s continued spread especially in holidays of the new year in IRAN.
As the virus moves into new regions and country, it encounters communication with different health settings that affect their vulnerability to disease (i.e different social structures). The current analysis revealed that the majority of patients were male, which was similar to other studies in China. Our estimation for male prevalence was 56.4%while the percentage was less than Chaolin and Chen’s reports (73% and 68%)[15, 16]. Possible explanation may be related to sex hormones and protection of female due to X chromosome. Another likelihood reason may be due to smoking history. According to primary literature, there is an association between male sex and smoking status in CoVID-19[17]. In another hand, it was revealed that cigarette smoking in Chinese male is more than Iranian male[18]. So, this sex predisposition may be related to much higher smoking rate in men in China, than in Iran.
Another point about current results which is seen in the over world was the high prevalence of CoVID-19 in vulnerable people; it means elderly and individuals with underlying disorders are more susceptible to the SARS-CoV-2. Along with other studies; hypertension, diabetes, and cardiovascular diseases are other important risk factors for CoVID-19 and there is a strong association between mortality rate and having co-exiting comorbidities [19–22].
According to that the medical staff represent the front line in the fight against the SARS-CoV-2, their protection is as crucial as ever. Based on this, the notable point in our results was low contamination rate in our medical staff which was 4%, while it was reported 20% in Italy[23].According to the evaluation of various reports in the countries involved in the disease, it was found that their health staff are either contaminated and many of them have positive tests for CoVID-19[24]. Although the results of different studies on personnel contamination are varying together, the important point is that the medical staff are infected during the human-to-human transmission chain, which is a great threat for other persons especially their patients and their families due to its long incubation time. Another hypothesis regarding clinical staff contamination is that they may be infected by contaminated surfaces that constantly contact with. Due to this highly recommended that clinical staff clean their workspaces and personal items such as stethoscopes, mobile phones, dictation devices, nametags, and other items with hospital-provided disinfectants or alcohol-based disinfectants[25]. Another threat for health staff is their physical and mental exhaustion. In addition to infection risk, missing patients and colleagues make their situation more difficult. [23, 26].
Data analysis of recent study showed approximately 3% mortality rate in total of 440 infected patients, while this rate in China and Italia were reported 11% and 7.2% respectively[15, 27].
Our results showed that all of the nine patients who died during the study time, had underlying diseases. It seems old age and co-exiting health disorders increase the mortality rate. Similar results in other studies showed that weaker immune function of these patients justify these occurrences and the low level of immunity, causes secondary infections, which makes the anti-infective treatment more difficult [15, 28].
Information about patients who receive intensive care in this study, showed resemble pattern in the aspect of comorbidity, fatality, and age in comparison with other studies [15, 16]
Up to date, no specific treatment has been found for SARS-CoV-2 except meticulous supportive care. Currently the best approach is prevention and applying infection control strategies as follow: Immunocompromised individuals should avoid to be in the public gathering, everyone should wash their hands frequently during the day, keep the social distance and evade close contact with animals and raw products. Considering that there is no proper treatment and vaccine for CoVID-19 yet, we should believe that follow the sanitary instructions are the best and least costly way to control and prevent CoVID-19 [29–31].
This study has several strength points: To our knowledge it is the first report from Fars province, southern of Iran. Moreover, from 2538 number of suspected patients during the study time, only 440 cases were confirmed that expresses good infection control strategies have performed despite rapid distributing in compare with other countries with better equipment.
Another notable point in the recent study was that, despite hostile sanctions against IRAN and lack of access to many international facilities, we were able to significantly control the spread of the disease and the number of patients in the first few days of exposure. Despite the limited availability of many medical, pharmaceutical, and laboratory facilities but proper management of resources and extensive health culture in Iran could help in preventing the beyond spread of the disease in the country especially in the southern region[32]. This is while other countries such as European territories and the United States shows a similar pattern of infection spread and even worse in somehow. Another case that has led to successful infection control in Iran, especially in the general population was, a lot of personal protective production line have developed in every city in Iran. Charities, private sector groups and independent manufactures cause that our country be in a good position in compare with developed countries which are not in sanctions and access to all facilities. In fact, Iran, like their counterparts globally, can more or less afford to protect themselves. Nevertheless, limitations should not be ignored in this study. Detailed patient’s information especially about clinical characteristics was un available at the time of analysis.