key: cord-0968305-3qh2ifg2 authors: ISAPANAH AMLASHI, Fazel; GILANI, Naghme; BESHARAT, Sima title: Does Local or National Quarantine May Save More Lives in Iran during COVID-19 Epidemic? date: 2020-10-03 journal: Iran J Public Health DOI: 10.18502/ijph.v49is1.3683 sha: 0e84adbe30d0bff56a1e9e59fa7b0f814f10ec34 doc_id: 968305 cord_uid: 3qh2ifg2 nan On 12 Mar 2020, after announcing the outbreak of the COVID-19 as a pandemic by WHO (1), discordances raised between different countries and even within the borders to confront the wide spread of the virus. The first COVID-19 cases in Iran were reported on 20 February 2020, that according to the Genomic epidemiology map came from China and Pakistan on January 2020 (2, 3) . From that time the number of cases have grown rapidly and made the country one of the most places of exposure and virus transmission has been spreading fast (4). Three days after the first report of COVID-19 in Qom province, Tehran (the capital) announced its first cases (2, 5). The strategic position of Tehran with 9 million residences, and its important highways connecting to other parts of the country, made a difficult situation for other districts including north of Iran which is a favorite destination for Tehrani citizens in holidays. As the case numbers continued to spread, the government issued the closing order of schools on third of February 2020 as well as universities and other public places. As a result of this action, university students of Tehran which are consist of all parts of the country and might be infected headed back to their homes and this may have a significant role in virus transmission. Meanwhile, lots of Tehrani citi-zens headed to the northern parts and as the traffic control centers showed heavy traffics in superhighways during that time because of the Nowruz holidays. According to Iran Ministry of Health and Medical Education report, most of COVID-19 cases were from Tehran and Northern parts (5) that was warning and obligated the governmental policy makers to re-evaluate the controlling policy, after evaluating the successful experiences of other countries like China. Policy makers of the central government in China decided to lockdown Wuhan and other cities in Hubei Province after the rapid growth in number of infected cases, to restrict the center of an outbreak inside Hubei. This policy resulted in significant decreased infection's growth rate, and increased the doubling time of COVID-19 cases from 2 days to 4 (6,7). First days of COVID-19 were shocking for everyone in Iran, like any other country. There was no preparation in the general population as our health system confronted a heavy insufferable burden of COVID-19 suspected cases. As for our cultural behaviors in Iran consisted of hand shaking, hugging and kissing each other every time we met, so there was a hesitation to apply a national or local quarantine that lead to a very high rate of spreading infection in the first Available at: http://ijph.tums.ac.ir months of the epidemic and many deaths. This was an unpleasant experience that may teach all a lesson and prevent the next upcoming epidemics and disasters with faster national response and restricting the centers of spread in the very first days. Along with the history, national or local quarantine showed a very significant impact in controlling very contagious infectious diseases such as plague or smallpox. Although it seems weird in the era of technology in 21 st century asking mankind to stay home to prevent contagion, but in the cultural context and socio-economic situation of Iran, self-quarantine or local quarantine sounds efficient to some extent, where national quarantine or complete lockdown of cities seems very difficult due to the economic pressure. The consequences of late-onset quarantine showed that there is no time for hesitation at any rate of highly contagious diseases. We hope such a condition never ever happen again and the health directors choose the best policy according to COVID-19 biopolitical legacy. WHO announces COVID-19 outbreak a pandemic. WHO main website Genomic epidemiology of novel coronavirus Coronavirus disease 2019 COVID-19 coronavirus pandemic Coronavirus disease 2019 (COVID-19) outbreak in Iran: Actions and problems The positive impact of lockdown in Wuhan on containing the COVID-19 outbreak in China The authors declare that there is no conflict of interest.