[Thalassemia Reports 2020; 10:9157] [page 21] COVID-19 and Thalassaemia in Iran Mahmoud Hadipour Dehshal, 1 Sachiko Hosoya, 2 Fatemeh Hashemi Bahremani, 1 Mehdi Tabrizi Namini, 3 Androulla Eleftheriou 4 1 Charity foundation for special diseases, Tehran, Iran; 2 School of Nursing at Narita, Public Health Nursing, International University of Health and Welfare, Chiba, Japan; 3 Iranian Blood Transfusion Organization, Tehran, Iran; 4 Thalassaemia International Federation, Nicosia, Cyprus Abstract Coronavirus disease 2019 (COVID-19) has had and continues to have a significant medical, public health, social and economic impact on every society around the world. Some groups of chronic patients including thalassaemia and other haemoglobin disor- ders were considered from the beginning of the pandemic, as vulnerable and high risk ones with regards to a more severe clinical outcome of the infection with severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). This is because patients with thalassaemia can present with many and multiple co-morbidities including dia- betes, heart, liver, endocrine and other con- ditions mainly secondary to iron overload and consequent to ineffective or suboptimal medical care and/or adherence to chelation treatment in particular. Transfusion depen- dent patients with β-thalassaemia have been greatly affected across the world, including in Iran, a country geographically situated in the so called thalassaemia belt. Iran with about 20,000 patients with β-thalassaemia and quite successful disease specific pre- vention and management national pro- grammes faced challenges similar to others. Blood shortages for example consequent to COVID-19 precaution measures taken in every country to contain the virus and the difficulties in accessing drugs including lifesaving ones (iron chelation medication) constitute major challenges. In Iran howev- er, and despite the multiple difficulties as described above, SARS-CoV-2 had a rather small impact regarding infection rates as compared to the rest of the countries, albeit a higher mortality rate reaching 26.5% amongst COVID-19 diagnosed patients. More comprehensive data however from a bigger number of patients with thalassaemia across the world infected with SARS-CoV- 2 is necessary to draw any reliable conclu- sions as to the level of vulnerability to SARS-CoV-2 and importantly the clinical impact of this virus in these patients. Introduction The coronavirus disease 2019 (COVID- 19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected millions across the world, with an ever increasing infectivity and mortality rate, currently translated to 5,657,529 confirmed cases of COVID-19 and 56,254 deaths as per the WHO’s official report (last update 29 May 20). 1 The SARS-CoV-2 causes a highly variable disease spectrum in the upper res- piratory tract that ranges from nasopharyn- geal symptoms to full blown pneumonia 2,3 while currently the virus has been demon- strated to have multi-organ impact. Despite an apparent disassociation between this viral infection and inherited haemoglobin disorders, there are particular challenges and risks to patients affected by thalas- saemia and sickle-cell disease, due to the specificities of their pathophysiology and lifelong treatment needs. 4 Thalassaemia and sickle cell disease (SCD) are the most common monogenic disorders in human with about 7% of the global population carrying an abnormal haemoglobin gene. 5 These disorders are characterised by multi-systemic involve- ment and need for intensive lifelong therapy and multidisciplinary care. 6,7 If left ineffec- tively controlled and managed, they lead to a number of severe complications and a very poor quality of life of patients. They are associated with high rates of morbidity and mortality and significant medical, pub- lic health, social and economic repercus- sions. As a consequence, if left untreated or sub-optimally treated, they contribute sig- nificantly to the national/regional and glob- al disease burden. 8 On the other hand, and consequent to the dramatic progress achieved in the last 2- 3 decades in the area of the control of these disorders, one may today safely state that they can be effectively prevented and well managed when primary and secondary pre- vention and management programmes are developed and included in the context of diseases’ specific national strategies. Survival rates, age distribution and reduction of morbidity and mortality rates constitute important indicators of the suc- cess and effectiveness of such programmes. These are seen and adopted particularly in the Western world and in some very few countries beyond, including the Islamic Republic of Iran, where however less than 10% of the global patient population is born and live. In these countries, patients with haemoglobin disorders, particularly those born after the 1980s, have been growing normally, have achieved a very satisfactory quality of life and almost full social integra- tion. 5 In these settings, patients are now fac- ing a new spectrum of co-morbidities relat- ed to ageing. 9 The challenges however are multiple and magnified for patients living in the developing world due but not confined, to different priorities in the area of public health, including communicable diseases, different priorities on non-communicable diseases but also to poor resources and weak health infrastructures. These, in con- junction with the absence of universal-cov- erage health care systems result in the pro- vision of suboptimal medical and other care to patients particularly those with chronic disorders including patients with haemoglobin disorders. Under such condi- tions, the risk of these patients developing serious multiple medical complications, including cardiac, hepatic, endocrine dis- ease and other, is very high. Inevitably, one may anticipate that these patients are at sig- nificantly higher risk for a more severe infection with the SARS-CoV-2. 10 In this widely heterogeneous state of affairs across the globe which reflects the widely different quality in the standards of medical and other care provided to patients with haemoglobin disorders within and across countries, within and across the dif- ferent regions of the word, the COVID-19 pandemic made in the early 2020 its unex- pected grand entry. Thalassemia Reports 2020; volume 10:9157 Correspondence: Androulla Eleftheriou, Virologist, Executive Director, Thalassaemia International Federation, 31 Ifigenias Street, 2007 Strovolos, Nicosia, Cyprus. Tel.: +35722319129. E-mail: thalassaemia@cytanet.com.cy Key words: Thalassaemia; sickle cell disease; COVID-19; SARS-CoV-2; coronavirus; pan- demic. Received for publication: 3 June 2020. Accepted for publication: 4 June 2020. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). © Copyright: the Author(s), 2020 Licensee PAGEPress, Italy Thalassemia Reports 2020; 10:9157 doi:10.4081/thal.2020.9157 Non-commercial use only