Policy, Timing, and Impact: An Evidence-Informed Analysis of Iran's Response to the Pre-Vaccine Phase of the COVID-19 Pandemic

Main Article Content

Hamid Bohloli Zeinolabedin Abbasi Nowdeh Hosein Gerivani Amir Ali Bohloli

Abstract

Introduction: This study comprehensively analyses the Iranian government's policy interventions in response to the COVID-19 pandemic during the pre-vaccine period, from the initial outbreak to the establishment of the Operational Centre for National Headquarters to Combat Corona (OCNHCC). This study emphasizes the pivotal role of policy timing and intensity. This demonstrates a discernable relationship between policy interventions and their consequences, as evidenced by the COVID-19 incidence (Outcome) and mortality rates (impact).


Methods: This study employs a mixed-methods approach, combining qualitative content analysis of media policy news and quantitative data on COVID-19 incidence and deaths to evaluate Iran's time management interventions during the pre-vaccine phase of the pandemic. Using a quasi-experimental design, the study assesses the effectiveness of national COVID-19 policies by comparing various intervention periods. The analysis includes an extensive review of 71,237 news reports and a detailed examination of 316 policy actions, (numerical N1 to N209 clickable in Appendix 3), culminating in a comprehensive assessment of policy impacts on public health outcomes and policy efficacy.


Results: The study highlights that Iran's response to COVID-19 was initially insufficient, leading to widespread transmission. However, implementing measures such as social distancing and localized restrictions resulted in notable reductions in infection rates. These gains were often reversed because of premature easing of restrictions or non-compliance. The study emphasizes the importance of evidence-informed approaches in understanding the outcome and impact of health policies.


Conclusion: This research plays a crucial role in augmenting the understanding of the possible correlation between policy interventions and their subsequent consequences, using COVID-19 incidence and mortality rates as key indicators. The deductions derived from this research can augment our comprehension of the robust and frail aspects of the policy reaction, thereby empowering us to develop the guidelines to ameliorate forthcoming strategies to tackle pandemics.

Keywords: COVID-19 Pandemic, Coronavirus, Policy, Outcome, Impact, Health Politics, Iranian government, Timing of Intervention

Article Details

How to Cite
BOHLOLI, Hamid et al. Policy, Timing, and Impact: An Evidence-Informed Analysis of Iran's Response to the Pre-Vaccine Phase of the COVID-19 Pandemic. Medical Research Archives, [S.l.], v. 12, n. 9, sep. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5547>. Date accessed: 03 oct. 2024. doi: https://doi.org/10.18103/mra.v12i9.5547.
Section
Research Articles

References

1. Pauline Barnett PB. Neoliberalism: What it is, how it affects health and what to do about it. The New Zealand medical journal. 2020;133(1512):76-84. Accessed June 12, 2023. https://www.researchgate.net/publication/340436503_Neoliberalism_What_it_is_how_it_affects_health_and_what_to_do_about_it
2. Vicente Navarro. WHAT WE MEAN BY SOCIAL DETERMINANTS OF HEALTH. International Journal of Health Services. 2009;39(3):423-441. Accessed July 18, 2023. http://www.jstor.org/stable/45131149
3. Hamid Bohloli. Health Sovereignty: A Historical and Political Analysis of Primary Healthcare Development and Idea Transfer in Iran and the Global Context. Globalization and Health. 2023. doi:10.21203/rs.3.rs-2881250/v1
4. Baum F, Freeman T, Sanders D, Labonté R, Lawless A, Javanparast S. Comprehensive primary health care under neo-liberalism in Australia. Soc Sci Med. 2016;168:43-52. doi:10.1016/j.socscimed.2016.09.005
5. UN News. WHO chief declares end to COVID-19 as a global health emergency. Published May 6, 2023. Accessed May 19, 2023. https://news.un.org/en/story/2023/05/1136367
6. Henrietta Fore. Don’t Let Children Be the Hidden Victims of COVID-19 Pandemic. UNISEF. 2020. https://www.unicef.org/press-releases/dont-let-children-be-hidden-victims-covid-19-pandemic
7. Rachelle N Binny, Michael G Baker, Shaun C Hendy, et al. Early intervention is the key to success in COVID-19 control. Royal Society open science. 2021;8(11):210488. doi:10.1098/rsos.210488
8. European Observatory on Health Systems, Policies, Gemma A Williams, Sara M Ulla Díez, Josep Figueras, Suszy Lessof. Translating evidence into policy during the COVID-19 pandemic: bridging science and policy (and politics). Eurohealth. 2020;26(2):29-33. https://apps.who.int/iris/handle/10665/336293
9. Ghotbi N. The COVID-19 Pandemic Response and Its Impact on Post-Corona Health Emergency and Disaster Risk Management in Iran. Sustainability. 2022;14(22):14858. doi:10.3390/su142214858
10. Farahmandnia H, Molavi-Taleghani Y, Pourvakhshoori N, Ziapour A, Abdolahi M. Experiences and Challenges of Nursing Managers’ Preparedness for Timing Response to COVID-19 Pandemic: A Qualitative Study in Iran. Africa Journal of Nursing and Midwifery. 2022;24(3):14 pages. doi:10.25159/2520-5293/12419
11. Anttiroiko A-V. Successful Government Responses to the Pandemic. International Journal of E-Planning Research. 2021;10(2):1-17. doi:10.4018/IJEPR.20210401.oa1
12. Coccia M. Pandemic Prevention: Lessons from COVID-19. Encyclopedia. 2021;1(2):433-444. doi:10.3390/encyclopedia1020036
13. G. A. Williams, S. M. Ulla Diez, J. Figueras, S. Lessof. Translating evidence into policy during the COVID-19 pandemic: bridging science and policy (and politics). (Special Issue: COVID-19 health system response.): 01 Jan 2020-Vol. 26, Iss: 2, pp;26(2).
14. Davide Ferrari, Andrea Seveso, Eleonora Sabetta, et al. Role of time-normalized laboratory findings in predicting COVID-19 outcome. Diagnosis. 2020;7(4):387-394. doi:10.1515/dx-2020-0095
15. Loewenthal G, Abadi S, Avram O, et al. COVID-19 Pandemic-Related Lockdown: Response Time Is More Important Than Its Strictness. 2020.
16. Wells, Emily M. and Cummings, Christopher L. and Klasa, Kasia and Trump, Benjamin D. and Cegan, Jeffrey C. and Linkov, Igor. Real-time Anticipatory Response to COVID-19: A Novel Methodological Approach. In: Linkov, Igor and Keenan, Jesse M. and Trump, Benjamin D., ed. COVID-19: Systemic Risk and Resilience. Springer International Publishing; 2021:35-59.
17. Jie Long, A. Q. M. Khaliq, K. M. Furati. Identification and prediction of time-varying parameters of COVID-19 model: a data-driven deep learning approach. International Journal of Computer Mathematics. 2021;98(8):1617-1632. doi:10.1080/00207160.2021.1929942
18. City Eldeep, Chahir Zaki. COVID-19 Impact and Policy Response: A General Equilibrium Approach for Egypt. Review of Middle East Economics and Finance. 2022;18(3):139-170. doi:10.1515/rmeef-2022-0004
19. Haber NA, Clarke-Deelder E, Salomon JA, Feller A, Stuart EA. Impact Evaluation of Coronavirus Disease 2019 Policy: A Guide to Common Design Issues. Am J Epidemiol. 2021;190(11):2474-2486. doi:10.1093/aje/kwab185
20. Elitzur M, Kaplan S, Ivezić Ž, Zilberman D. The impact of policy timing on the spread of COVID-19. Infect Dis Model. 2021;6:942-954. doi:10.1016/j.idm.2021.07.005
21. David L Heymann, Nahoko Shindo. COVID-19: what is next for public health? The Lancet. 2020;395(10224):542-545. doi:10.1016/S0140-6736(20)30374-3
22. World Health Organization. Report of the WHO-China joint mission on coronavirus disease 2019 (COVID-19). WHO. https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
23. World Health Organization. Global Surveillance for COVID-19 Caused by Human Infection with COVID-19 Virus: Interim Guidance, 20 March 2020. https://apps.who.int/iris/handle/10665/331506.
24. Jonathan Chun-Hei Cheung, Lap Tin Ho, Justin Vincent Cheng, Esther Yin Kwan Cham, Koon Ngai Lam. Staff Safety During Emergency Airway Management for COVID-19 in Hong Kong. The Lancet. Respiratory medicine. 2020;8.
25. Mohammad Meskarpour-Amiri, Lida Shams, Taha Nasiri. Identifying and Categorizing the Dimensions of Iran’s Health System Response to the Covid-19 Pandemic. Journal-Mil-Med. 2020;22(2):108-114. doi:10.30491/JMM.22.2.108
26. KyodoNews. Japan Adopts Basic Policy to Fight Coronavirus Outbreak. KyodoNews World Services Section. 2020.
27. hamid sajadi. Assessing the Strategies of the Iranian Crisis Management System in Response to the Covid-19 Threats. Research Letter of Political Science. 2020;15(4):189-215. doi:10.22034/ipsa.2020.421
28. World Bank. COVID-19 to Plunge Global Economy into Worst Recession Since World War II. World Bank Group Washington, DC. 2020.
29. Parag Verma, Ankur Dumka, Anuj Bhardwaj, Alaknanda Ashok, Mukesh Chandra Kestwal, Praveen Kumar. A Statistical Analysis of Impact of COVID19 on the Global Economy and Stock Index Returns. SN Computer Science. 2021;2(1):27. doi:10.1007/s42979-020-00410-w
30. Hamid Bohloli, Hamid Reza Jamshidi, Ali Ebraze, Fahimeh Rabbani Khah. Combining government, non-pharmaceutical interventions and vaccination in optimal control COVID-19. International Journal of Healthcare Management. 2022:1-9. doi:10.1080/20479700.2022.2071803
31. Vahey GM, McDonald E, Marshall K, et al. Risk factors for hospitalization among persons with COVID-19-Colorado. PLOS ONE. 2021;16(9):e0256917. doi:10.1371/journal.pone.0256917
32. Cuadros DF, Gutierrez JD, Moreno CM, et al. Impact of Healthcare Capacity Disparities on the COVID-19 Vaccination Coverage in the United States: A Cross-Sectional Study. 2022.
33. Koning ER de, Boogers MJ, Beeres SL, Kramer ID, Dannenberg WJ, Schalij MJ. Managing Hospital Capacity: Achievements and Lessons from the COVID-19 Pandemic. Prehosp Disaster Med. 2022;37(5):600-608. doi:10.1017/S1049023X22001169
34. Winkelmann J, Webb E, Williams GA, Hernández-Quevedo C, Maier CB, Panteli D. European countries' responses in ensuring sufficient physical infrastructure and workforce capacity during the first COVID-19 wavethe first COVID-19 wave.: 10.1016/j.healthpol.2021.06.015. Epub 2021 Jul 9. PMID: 34311982; PMCID: PMC9187509. Health Policy. 2022;126(5). doi:10.1016/j.healthpol.2021.06.015
35. Rhee C. Deconstructing improvements and hospital variation in COVID-19 mortality rates during the early pandemic wave: the effects of wave evolution and advances in testing, treatment, and hospital care quality. BMJ Qual Saf. 2022;31(3):168-171. doi:10.1136/bmjqs-2021-013809
36. Arenas M, Piqué B, Torres-Royo L, et al. Treatment of COVID-19 pneumonia with low-dose radiotherapy plus standard of care versus standard of care alone in frail patients : The SEOR-GICOR IPACOVID comparative cohort trial. Strahlenther Onkol. 2023;199(9):847-856. doi:10.1007/s00066-023-02067-9
37. Gabriela Drummond Marques da Silva , Anelise Andrade de Souza, Mônica Silva Monteiro de Castro, Wanessa Debôrtoli de Miranda, Leticia Lemos Jardim, Rômulo Paes de Sousa. Influence of socioeconomic inequality on the distribution of COVID-19 hospitalizations and deaths in Brazilian municipalities, 2020: an ecological study. Epidemiology and Health Services. 2023;32(1). doi:10.1590/S2237-96222023000100021
38. Kotov EA, Goncharov RR, Kulchitsky YV, Molodtsova VA, Nikitin BV. Spatial Modelling of Key Regional- Level Factors of Covid-19 Mortality In Russia. GES. 2022;15(2):71-83. doi:10.24057/2071-9388-2021-076
39. Schippers MC, Ioannidis JPA, Joffe AR. Aggressive measures, rising inequalities, and mass formation during the COVID-19 crisis: An overview and proposed way forward. Front Public Health. 2022;10:950965. doi:10.3389/fpubh.2022.950965
40. Kaim A, Saban M. Dynamic Trends in Sociodemographic Disparities and COVID-19 Morbidity and Mortality-A Nationwide Study during Two Years of a Pandemic. Healthcare (Basel). 2023;11(7). doi:10.3390/healthcare11070933
41. Saeed, Nemati., Elnaz, Saeedi., Sepideh, Abdi., Ali, Qandian., Esmaeil, Kalhor., Samin, Moradi., Narges, Joshang., Anita, Eftekharzadeh., Masoud, Hatamzadeh, Khanghahi., Pedram, Fattahi., Mojtaba, Vand, Rajabpour., Hamid, Reza, Najari. (Decomposition of socioeconomic inequality in COVID-19 mortality in Iran: A retrospective cohort study. Health & Social Care in The Community. 2021. doi:10.1111/HSC.13627
42. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(12):343-346. doi:10.15585/mmwr.mm6912e2
43. Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-95. doi:10.1016/j.ijid.2020.03.017
44. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 - United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(13):382-386. doi:10.15585/mmwr.mm6913e2
45. Polverino F, Stern DA, Ruocco G, et al. Comorbidities, Cardiovascular Therapies, and COVID-19 Mortality: A Nationwide, Italian Observational Study (ItaliCO). Front Cardiovasc Med. 2020;7:585866. doi:10.3389/fcvm.2020.585866
46. Alali AS, Alshehri AO, Assiri A, et al. Demographics, comorbidities, and outcomes among young and middle-aged COVID-19 patients in Saudi Arabia. Saudi Pharm J. 2021;29(8):833-842. doi:10.1016/j.jsps.2021.06.005
47. Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584(7821):430-436. doi:10.1038/s41586-020-2521-4
48. ISNA News Agency. ISNA News Agency. Published August 18, 2021. Accessed May 25, 2023. https://www.isna.ir.
49. Chen R, Liang W, Jiang M, et al. Risk Factors of Fatal Outcome in Hospitalized Subjects With Coronavirus Disease 2019 From a Nationwide Analysis in China. Chest. 2020;158(1):97-105. doi:10.1016/j.chest.2020.04.010
50. Little P. Non-steroidal anti-inflammatory drugs and covid-19. BMJ. 2020;368:m1185. doi:10.1136/bmj.m1185
51. Wang L, Foer D, Bates DW, Boyce JA, Zhou L. Risk factors for hospitalization, intensive care, and mortality among patients with asthma and COVID-19. J Allergy Clin Immunol. 2020;146(4):808-812. doi:10.1016/j.jaci.2020.07.018
52. Colaneri M, Novelli V, Cutti S, et al. The experience of the health care workers of a severely hit SARS-CoV-2 referral Hospital in Italy: incidence, clinical course and modifiable risk factors for COVID-19 infection. J Public Health (Oxf). 2021;43(1):26-34. doi:10.1093/pubmed/fdaa195
53. Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020;369:m1966. doi:10.1136/bmj.m1966
54. van Gerwen M, Alsen M, Little C, et al. Risk factors and outcomes of COVID-19 in New York City; a retrospective cohort study. J Med Virol. 2021;93(2):907-915. doi:10.1002/jmv.26337
55. Holshue ML, DeBolt C, Lindquist S, et al. First Case of 2019 Novel Coronavirus in the United States. N Engl J Med. 2020;382(10):929-936. doi:10.1056/NEJMoa2001191
56. Ebinger JE, Achamallah N, Ji H, et al. Pre-existing traits associated with Covid-19 illness severity. PLOS ONE. 2020;15(7):e0236240. doi:10.1371/journal.pone.0236240
57. Suleyman G, Fadel RA, Malette KM, et al. Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit. JAMA Netw Open. 2020;3(6):e2012270. doi:10.1001/jamanetworkopen.2020.12270
58. Alamri F, Alsofayan Y, AlRuthia Y, et al. Predictors of Hospitalization Among Older Adults with COVID-19 in Saudi Arabia: A Cross-Sectional Study of a Nationally Representative Sample. Risk Manag Healthc Policy. 2021;14:875-886. doi:10.2147/RMHP.S294786
59. Bergman J, Ballin M, Nordström A, Nordström P. Risk factors for COVID-19 diagnosis, hospitalization, and subsequent all-cause mortality in Sweden: a nationwide study. Eur J Epidemiol. 2021;36(3):287-298. doi:10.1007/s10654-021-00732-w
60. Price-Haywood EG, Burton J, Fort D, Seoane L. Hospitalization and Mortality among Black Patients and White Patients with Covid-19. N Engl J Med. 2020;382(26):2534-2543. doi:10.1056/NEJMsa2011686
61. Patel AP, Paranjpe MD, Kathiresan NP, Rivas MA, Khera AV. Race, socioeconomic deprivation, and hospitalization for COVID-19 in English participants of a national biobank. Int J Equity Health. 2020;19(1):114. doi:10.1186/s12939-020-01227-y
62. Yancy CW. COVID-19 and African Americans. JAMA. 2020;323(19):1891-1892. doi:10.1001/jama.2020.6548
63. Hillyar CR, Nibber A, Jones CE, Jones MG. Fatality Rate and Survival Time of Laboratory-Confirmed COVID-19 for Patients in England During the First Wave of SARS-CoV-2 Infection: A Modelling Study. Cureus. 2021;13(8):e16899. doi:10.7759/cureus.16899
64. Olowe OA, Adeagbo O, Olaitan PB, et al. Time-to-survival from COVID-19 disease and its associated factors in Osun State, Nigeria. Infect Disord Drug Targets. 2023. doi:10.2174/1871526523666230613122108
65. Mimkes J, Janssen R. Positive Rates Predict Death Rates of Covid-19 Locally and Worldwide 13 Days Ahead. 2020.
66. Mollazehi M, Mollazehi M, Abdel-Salam A-SG. Modeling Survival Time to Recovery from COVID-19: A Case Study on Singapore. 2020.
67. YAVUZ M, SEZEROL MA. The vaccination characteristics and mortal causes analysis of COVID-19 deaths at a district level. Journal of Medicine and Palliative Care. 2023;4(2):145-150. doi:10.47582/jompac.1255788
68. DeNucci G, Wilkinson T, Sverdloff C, et al. Inhaled nebulised unfractionated heparin (UFH) for the treatment of hospitalised patients with COVID-19: A randomised controlled pilot study. Pulm Pharmacol Ther. 2023;80:102212. doi:10.1016/j.pupt.2023.102212
69. Boka A, Tadesse A, W/Yohannes G, Hussein K. Survival status and predictors of mortality among COVID-19 patients admitted to intensive care units at COVID-19 centers in Addis Ababa, Ethiopia: a retrospective study. Ann Med Surg (Lond). 2023;85(6):2368-2378. doi:10.1097/MS9.0000000000000803
70. Shams F, Abbas A, Khan W, Khan US, Nawaz R. A death, infection, and recovery (DIR) model to forecast the COVID-19 spread. Comput Methods Programs Biomed Update. 2022;2:100047. doi:10.1016/j.cmpbup.2021.100047
71. Sun Y-J, Feng Y-J, Chen J, Li B, Luo Z-C, Wang P-X. Clinical Features of Fatalities in Patients With COVID-19. Disaster Med Public Health Prep. 2021;15(2):e9-e11. doi:10.1017/dmp.2020.235
72. Hosseini MM, Majidpour F, Ahmadinia H, Mortazavi SM, Mosavifard SM, Rezaeian M. Characteristics and Subgroup Analysis of Risk Factors Associated with in-Hospital Mortality Among COVID-19 Patients: A Retrospective Cohort Study. 2022.
73. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3
74. Verity R, Okell LC, Dorigatti I, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669-677. doi:10.1016/S1473-3099(20)30243-7
75. Pooya Parvizi, Milad Jalilian, Hana Parvizi, Sara Amiri, Hamidreza Mohammad Doust. The COVID-19 Pandemic: Data Analysis, Impacts and Future Considerations. Iran-J-Med-Microbiol. 2021;15(1):1-17. doi:10.30699/ijmm.15.1.1
76. Ali Akbar Haq Dost, Ehsan Mustafavi, Nilofer Pikri, Senate Faulty, Hamid Sharifi. Trend of the COVID-19 Pandemic in IRAN. ijhp. 2020;4(1):14-19. http://ijhp.ir/article-1-183-en.html
77. Jefferson T, Dooley L, Ferroni E, et al. Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev. 2023;1(1):CD006207. doi:10.1002/14651858.CD006207.pub6
78. Burch Jane HJ. What are the effects of multimodal campaigns to improve hand hygiene of healthcare workers? Cochrane Clinical Answers. 2020. doi:10.1002/cca.2686
79. Note from the editors: World Health Organization declares novel coronavirus (2019-nCoV) sixth public health emergency of international concern. Euro Surveill. 2020;25(5). doi:10.2807/1560-7917.ES.2020.25.5.200131e
80. Verity R, Okell LC, Dorigatti I, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis. 2020;20(6):669-677. doi:10.1016/S1473-3099(20)30243-7
81. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3
82. Cohen K, Leshem A. Suppressing the impact of the COVID-19 pandemic using controlled testing and isolation. Scientific Reports. 2021;11(1):6279. doi:10.1038/s41598-021-85458-1
83. Razia Malmir, Ali Maher, Rahela Taghiani, Mohammad Saleh Safari. COVID-19 Crisis Management: Reengineering the Health Care System in Iran. jmciri. 2020;38(1):11-18. http://jmciri.ir/article-1-2978-en.html
84. National Institute of Health Research Around Iran. Can a CT Scan of the Lungs of Patients with Suspected Coronary Artery Disease Be Used as a Reliable Diagnostic Test? National Institute of Health Research Around Iran. 2021. https://nih.tums.ac.ir/Item/790
85. Deputy for Government Affairs. Collection of Approvals of the National Corona Headquarters; 2020. http://imed.ir/userfiles/files/23/159946590065333800.pdf.
86. Mohammad Ismail Jasbi A, Ansari. Jomeh prayers and its role in governing society. Journal of Applied Sociology. 1997:71-88.
87. Mohammad Mehdi Masoudi. Ghadr night. Health Science. 2005;10(2-1 (36-35)):199-210. https://www.sid.ir/fa/journal/ViewPaper.aspx?id=54440
88. Mohammad Rajabi, Reza Dost Dar. Goals and characteristics of "Quds Day" in Imam Khomeini’s political thought. Islamic Insight and Education. 1400;18(57 #r001611):9-29. https://www.sid.ir/fa/journal/ViewPaper.aspx?id=570548
89. Mahmud Khalegh verdi. Jihad with the soul is the highest example of "Qurban. Zaer. 2017;24(255):64-65.
90. Hamid Bohloli. National Headquarters for Combating Coronavirus. Shargh. Published 2020:1. Accessed October 6, 2023. https://www.sharghdaily.com/fa/tiny/news-810336.
91. Fattahi Z, Mohseni M, Beheshtian M, et al. Disease Waves of SARS-CoV-2 in Iran Closely Mirror Global Pandemic Trends. Arch Iran Med. 2022;25(8):508-522. doi:10.34172/aim.2022.83
92. World Health Organization, EVIDENCE POLICY IMPACT: WHO Guide for Evidence-Informed Decision-Making; 2021.