The Coronavirus has crossed the geographical borders of various countries without any restrictions and has caused almost 199 countries in the world to confront the challenges of the disease, death of their citizens, economic pressure, and other issues [20]. Totally, 337459 confirmed cases were recorded from February 19 to March 22, 2020 in the world [21]. Iran was ranked sixth after countries of China, Italy, Spain, United States, Germany with 6.4 % (21638 people) of the confirmed cases, 11.5 % (1685 people) of deaths, and 8% (7840 people)of the recovered cases (Fig. 6) [21]. As shown in Fig. 5, from February 19 to March 6 (16 days), two days after the first incubation period of the disease (14 days), the highest number of new cases was recorded on March 6 with 1234 confirmed cases, and nine days later, 1365 new cases were recorded again on March 14. Despite the declining trend in the number of new cases, a huge number of 1237 new cases were recorded again on March 20. Considering the increasing trend on March 22, it seems that the number of new cases and CF will increase in the coming days [22]. Investigating the Iran's provinces with respect to the Coronavirus epidemic showed that Qom province with two confirmed cases was the first province in disease spreading on February 19, and after that, its adjacent provinces such as Tehran, Markazi, and Isfahan were infected. Results of our study showed a negative significant relationship between the CF of the confirmed cases in different provinces with distance from Qom so that, epidemic was more in the provinces with smaller distance from Qom. In other words, 22% (0.472) of variation in the number of confirmed cases was related to the distance from epidemic center.
Tehran province with 13 million population (17.5% of Iran population) was the first in ranking based on both number of the confirmed cases per day and cumulative number of confirmed cases while, it was not in the category of provinces with high infection after adjusting the cumulative number of the confirmed cases with respect to population of each province. It seems that ACF gives a more realistic description of disease status in each province. According to this adjustment, contrary to the image created by the daily frequency and CF where Tehran, Isfahan, and Markazi provinces were not in a good position, the results of ACF showed that Semnan, Qom, Yazd, Markazi, and Qazvin provinces were in critical condition and needed special attention. As depicted in Fig. 1. , it seems that some provinces have passed the incubation period, but others have to wait. For example, in Tehran province, the number of new cases reached its peak on March 3, after which, a declining and then increasing trend were reported in the number of the patients.
Although, the daily cumulative trend in the number of patients had an upward trend in most provinces, in general, the process of registering new daily cases of the Coronavirus from February 19 to March 22, 2020, in the provinces of Iran can be divided into three categories of downward, upward, and irregular so that Tehran, Qom, Mazandaran, Golestan, Khorasan Razavi, Khuzestan, and Chaharmahal and Bakhtiari provinces showed a downward trend, Fars, Yazd, Zanjan, Hamedan, Sistan -Baluchistan, and West Azarbaijan showed an upward trend, and other provinces showed an irregular trend.
KMCA was used in the present study to identify the existing similarities in the process of virus infection in the provinces. All the provinces were clustered once based on the CF and again based on ACF. The results of KMCA based on CF of the confirmed cases pointed out that among six provinces with the highest frequency of infected cases, Tehran, Isfahan, and Mazandaran provinces had an independent trend so that, they had specific cluster, but Qom, Gilan, and Alborz had similar trend and common cluster. The results of KMCA based on the ACF of the confirmed cases also showed a similar dual trend in the six provinces with the highest frequency. In other words, some provinces such as Qom and Semnan, Markazi and Yazd, Mazandaran and Qazvin had a similar pattern of infection. Clustering provinces with the aforementioned pattern can contribute enormously to implementing similar emergency measures and developing joint control programs for the above-mentioned provinces.
Our results also showed that population, population density, HDI were the three influential factors on the CF of the confirmed cases so that, 20% (0.452), 22% (0.472), and 33% (0.582) of CF variation was related to each of them, respectively. Due to high contamination of the virus, the more populated the province and the denser the population, the easier and faster it is to spread the virus. But the relationship between the HDI, as an indicator of education, life expectancy, and per capita income, and spread of the virus was unexpected.
During the disease epidemic in Iran, the government first considered emergency measures for the center of the disease epidemic, the Qom province, and after that by observing new cases in Tehran, Gilan, and Mazandaran provinces, which are the adjacent provinces to Qom province, the emergency measures for these three provinces were considered as well [23]. Sending medical teams, suspending transportation and banning the entry and exit (lock down), and closing the schools and universities were some of the emergency measures needed at this level. Gradually, the scope of the virus epidemic was expanded and the virus spread to neighboring provinces. Finally, on March 5, 2020, all the 31 provinces of Iran became involved in the epidemic. Following this epidemic, the Iranian government established some specialized epidemiology committees for reporting and combating the Coronavirus at the national and provincial levels. The Provincial Committees on Combating the Coronavirus were formed under the auspices of the Ministry of Health's forces and on the advice of the professors from universities of medical sciences and trained personnel of the healthcare centers. The president provided the Ministry of Health with the necessary powers to fight the disease, and the national military forces cooperated fully with the Ministry of Health. Later, all the gatherings of people including religious sites were banned. A new Scientific and Technical Committee was established to guide the epidemiological studies, determine the type of interventions, prepare the necessary guidelines in accordance with the recommendations of World Health Organization (WHO) for people from all different walks of life [24], with various occupations, and also inform the public by mass media and social networks. The valuable experiences of other countries including China were also used. Subsequently, an online screening system was launched and the community was asked to record the required information) www.salamat.gov.ir). The case detection program was also activated through 5,000 healthcare centers and 17,000 health homes in urban and rural areas. Mobile health centers were set up to initially identify the infected people across the provinces in order to reduce the number of patients referring to the main hospitals dedicated to the Coronavirus disease. Equipping and preparing more hospitals, disinfecting the urban public places, closing all the centers except those providing the peoples' basic necessities, recruiting new staff in the medical staff of the Ministry of Health and calling on the retired workers to return to work, encouraging the local manufacturers to produce the masks, goggles, disinfectant liquids and gels, and medical staff uniforms, agreeing with Iran's neighbors to further control the borders, calling for cooperation with international organizations to provide laboratory kits and medical equipment, encouraging the people to be quarantined at home, establishing an extended-care facility for the 14-day rest of the recovered patients after discharge and before going home and being around the family members, and formation of a psychology task force to reduce the stress of the patients and ordinary people were among the other measures taken by the government in this regard. Despite strong international sanctions against Iran, all the activities were encouraged and approved by the WHO’s expeditionary team during a visit to monitor the Iran's control activities in the fight against the Coronavirus. At the time of writing this Paper, the Iranian New Year (Nowruz) began and since this time is an opportunity for the families and friends to visit each other according to the Iranian tradition, the government banned all the trips and visits and asked the people for using digital facilities instead of direct exposure to each other [25]. Also, in addition to activating the highest level of measures to combat the Coronavirus, a plan called Social Distancing was implemented for minimizing the contacts between ordinary people, the entry and exit of non-indigenous people were prevented in all the Iranian cities and villages, and heavy fines were imposed on the passengers. The government also extended the New Year holidays and all the government departments were asked to continue working with only 30% of their employees in addition to observing the healthcare instructions. The Iranian army and military forces have pledged to build a 2,000-bed hospital for the patients infected by the Coronavirus on March 25. The government also suspended loan repayments and tax payments and promised to give cheap supportive loans to support the economy. Various epidemiological studies have been conducted on the Coronavirus using several different samples obtained from 41, 99 and 138 patients and the characteristics of individuals such as age, sex, family history of heart disease, blood pressure, and diabetes were investigated [26,2,27]. The present study was carried out to investigate the incidence of COVID-19 in different provinces of Iran and there was no possibility to have access to the individuals’ characteristics.
The reports on modeling and prediction of the Coronavirus status in the country conducted by the Iranian Ministry of Health have stated that if isolation levels were 25% on March 10, the number of cumulative deaths would be 13450 in the whole country by May 20; if isolation levels raised to 32 %, the number of deaths would be 8630; and if isolation levels reached by 40%, the number of deaths would be 6030 [28]. Extensive research studies are underway worldwide to discover the treatment for the Coronavirus disease. Some studies have considered the isolation as one of the most effective ways to preserve the patients' lives and found that the discovery of a specific drug takes several years Similar to what John Snow did for cholera in the 18th century in London, further research is needed to be done to discover the origin and complete treatment of the disease [29]. Focusing on finding the right response to the crisis should not lead to neglect providing routine care to the people in the community so that, finally, the number of patients who have died due to lack of access to health care will exceed the number of deaths due to the Coronavirus. The incidence of the COVID-19, as the biggest crisis since World War II, gives rise to promote the environmental health, reduce the air pollution, decrease the road accident fatalities, and increase the national solidarity among different walks of life despite the problems created for the healthcare system and global economic system.