Iran's president said Tehran has no immediate plans to quarantine cities over the new coronavirus rapidly spreading across the country, even as the Islamic Republic suffers the highest death toll outside of China with 19 killed amid 139 cases confirmed on Wednesday.
President Hassan Rouhani went on to acknowledge that may take "one, two or three weeks" to get control of the virus in Iran, linked to most of the over 210 confirmed cases of the virus now spread across the Mideast. That comes after the top official in charge of Iran's response to the coronavirus tested positive for the illness after a day earlier trying to downplay the disease.
Still, Rouhani sought to portray the virus crisis in terms of Iran's tense relations with the U.S.
"Coronavirus must not be turned into a weapon for our enemies to halt work and production in our country," Rouhani said, according to a transcript posted to the Iranian presidency's website.
Iranian state television reported Wednesday that 19 people have been killed by the new coronavirus amid 139 confirmed cases in the country so far.
The announcement by a state TV anchor came as Health Ministry spokesman Kianoush Jahanpour urged Iranians to avoid "nonessential travel," particularly to the hard-hit provinces of the country such as Gilan and Qom.
The coronavirus has infected more than 80,000 people globally, causing over 2,700 deaths, mainly in China. The World Health Organization has named the illness COVID-19.
Experts remain concerned that Iran may be underreporting cases and deaths, given the rapid spread from Iran across the Persian Gulf. Ahmad Amirabadi Farahani, a hard-line lawmaker in Iran alleged Monday there had been 50 deaths in the Iranian city of Qom alone, which was denied by authorities.
Meanwhile, Wednesday's figures still showed no cases confirmed in the Iranian city of Mashhad, though a number of cases now reported in Kuwait are linked to Mashhad.
In Tehran overnight, workers disinfected mass-transit buses and the capital's underground metro system, removing overhead handles in an effort to limit areas the virus could be picked up from. Traffic again appeared lighter on Tehran's normally gridlocked roads amid a winter rain, as signs warned Iranians not to touch surfaces in crowded areas.
"We must be optimistic, because pessimism causes us to attract this disease," said Afsaneh Azarloo, a Tehran resident. "We should be optimistic and hope that nothing bad will happen to us."
That optimism was not shared by another passer-by, who merely gave his name as Saeed.
"I'm worried. It's the first time I have left home after a week," he said. "My home is now my workplace too."
Rouhani's estimate of as much as three weeks to control the virus comes after officials repeatedly downplaying the virus previously. That's spark more concern among Iranians already angry over nationwide economic protests, the U.S. drone strike that killed a top Iranian general and Iran accidentally shooting down a Ukrainian jetliner and then denying it for days. A recent parliamentary election also saw the country's lowest-ever recorded turnout.
Jahanpour on Tuesday suggested it could take as long as late April to control the virus. And with the Persian New Year, or Nowruz, coming March 20, experts worry about the virus spreading even further across the country if not stopped by then.
"Containment of the COVID-19 virus within Iran will be a challenge because of Iran's poor health infrastructure and traditional unwillingness to communicate freely and openly across all branches of government and between health institutions," the Austin, Texas private intelligence firm Stratfor said.
That worry was echoed by analysts at the Eurasia Group.
"Tehran is likely significantly underestimating the risk posed by an outbreak of coronavirus to its citizens, economy and neighbors," the analysts wrote. "Iran has a relatively robust public health system, although it has been weakened by US sanctions. But a breakdown in national-level decision-making has severely hampered its ability contain the spread of the virus."
Meanwhile Wednesday, Egyptian airport officials said the country's national carrier, EgyptAir, has indefinitely extended the suspension of its flights to and from China, for the safety of its passengers. The officials spoke on condition of anonymity as they weren't authorized to brief journalists.
Mahathir Mohamad said Wednesday that he will form a new nonpartisan government if he is elected to return as Malaysia's prime minister, as the king completed two days of consultations with lawmakers to resolve a political vacuum caused by the abrupt collapse of Mahathir's ruling coalition.
Breaking his silence two days after his shocking resignation, Mahathir confirmed that his Bersatu party ditched the alliance Monday in a bid to form a new government with the United Malays National Organization, or UMNO, the party of disgraced ex-leader Najib Razak, who is on trial for corruption, and a fundamentalist Islamic party. The move had thwarted a pre-election agreement by Mahathir to hand over power to his named successor, Anwar Ibrahim.
Mahathir said he had quit to show he wasn't power crazy and because he cannot work with the corrupt-tainted UMNO, which he had ousted in 2018 elections. He made no mention of Anwar in his televised speech, but reiterated that the lower house of Parliament should be the one to pick the prime minister.
"If I really still have support, I will return. If not, I will accept whoever's chosen," said Mahathir, the world's oldest leader at 94.
Anwar's camp, as well as UMNO and the Islamic party, have rejected Mahathir's proposed nonpartisan government.
"I am not aiming to be popular," Mahathir said. "I just want to do what is best for the country. ... I believe, rightly or wrongly, politics and political parties must be set aside for now. If allowed, I will form an administration that does not side with any party. Only national interest will be prioritized."
The departure of 37 lawmakers, including 11 from Anwar's party, deprives the governing Alliance of Hope of majority rule and sparked a crisis less than two years after its election victory ousted a corrupt-tainted coalition that had ruled for 61 years. The king dissolved the Cabinet but reappointed Mahathir as interim leader.
Mahathir spoke as the king finished consulting all 222 lawmakers to determine who they support as prime minister or if they want fresh elections. The king's role is largely ceremonial in Malaysia, but he appoints the person with majority support in Parliament as prime minister.
Shortly after Mahathir's speech, Anwar said lawmakers from the three remaining parties in his alliance had nominated him as prime minister during their meeting with the king — marking a U-turn from an earlier stand to support Mahathir as their leader.
Anwar said the change was due to Mahathir rejecting their offer to restore their former government. The alliance also said the new plan would only create a "Mahathir government" that goes against voters' mandate.
Anwar said they will leave it to the king to decide and will accept the outcome. The palace didn't say when the king will reveal his findings.
The alliance's move could potentially cause a new deadlock if no one gets majority support. Anwar's alliance controls 41% of parliamentary seats, short of 20 seats for a simple majority. UMNO and the Islamic party, which jointly controls a quarter of parliamentary seats, have also withdrawn their support for Mahathir and called for fresh elections.
"At the end of the day, the real fight is still between Mahathir and Anwar," said Oh Ei Sun, a senior fellow at the Singapore Institute of International Affairs.
The premiership eluded Anwar two decades ago. Once a high-flying member of the former ruling coalition, he was convicted of homosexual sodomy and corruption after a power struggle with Mahathir, who was prime minister for 22 years until 2003. Anwar was freed from prison in 2004 but was once again convicted for sodomy in 2015, charges that he said were concocted to destroy his political career.
Angered by a massive corruption scandal at a state investment fund, Mahathir made a political comeback, and he and Mahathir forged an alliance that that ousted Prime Minister Najib's coalition, which had been in power since independence from Britain in 1957.
Anwar couldn't participate in the 2018 elections because he was behind bars for a second sodomy conviction. But he was freed and pardoned by the king after the alliance won power. Mahathir initially said he expected to stay as prime minister for two years to clean up the government, but refused to set a firm timeline for passing the baton to Anwar.
Mahathir has been meeting with various political leaders. He met with finance ministry officials Wednesday and his office said he will announce a stimulus plan Thursday to bolster an economy that has been hurt by the new virus running through Asia and much of the world.
Mallinckrodt Pharmaceuticals doled out lavish perks for top U.S. employees who hit or beat sales goals for prescription opioids and other drugs: six-figure bonuses and a chance to snag a coveted "President's Club" award, which could mean vacations to Hawaii, the Caribbean or Mexico.
The company placed that same staff in charge of reporting any sales of its painkillers that appeared to be suspicious, including to distributors or pharmacies requesting extreme volumes of its most potent formulas. Asked during a federal court deposition last year whether she believed it was appropriate to put incentive-motivated sales staff in charge of calling out questionable sales, Karen Harper, who oversaw Mallinckrodt's suspicious order monitoring system, said yes.
In fact, as the nation's opioid overdose crisis began to explode, not a single order with the company between August 2008 and October 2010 rose from the level of "peculiar" to "suspicious," the category that would have triggered a report to authorities, according to Harper's deposition.
The court documents reveal a company culture that allowed Mallinckrodt to become one of the giants of the prescription opioid market at a time when overdoses were claiming tens of thousands of American lives. The company, based in Great Britain, announced a tentative $1.6 billion settlement Tuesday with state and local governments in the U.S. If finalized, the deal would end lawsuits nationwide over the company's role in the epidemic.
Purdue Pharma has been the poster child for the U.S. opioid crisis, mostly because of aggressive marketing of its signature painkiller, OxyContin. Lesser known is the role of generic opioid manufacturers like Mallinckrodt that produced the vast majority of painkillers during the height of the overdose epidemic. While they may not have been sending sales representatives to encourage prescribing like Purdue, they were filling more and more orders for the drugs — so many that Mallinckrodt couldn't always produce enough to fill them all.
Nationwide distribution data released in a sprawling federal court case and analyzed by The Associated Press shows that Mallinckrodt's U.S. subsidiary, SpecGX, and another generic drugmaker, Actavis Pharma, produced the vast amount of prescription opioids distributed throughout the country.
From 2006 to 2014, Mallinckrodt's subsidiary shipped more than 2.2 billion high-potency oxycodone pills, nearly one-third of its total in that time period, according to the data analysis. Actavis was even more prolific, shipping more than 2.4 billion pills.
The court records made public last year by the U.S. District Court in Cleveland showed some Mallinckrodt employees were more focused on sales than public safety. At least one joked about the rising use of the drugs with a customer.
In January 2009, Victor Borelli, a Mallinckrodt salesman, exchanged emails with Steve Cochrane, who worked at drug distributor KeySource.
"Keep them coming," Cochrane wrote. "Flying out of here. It's like people are addicted to these things or something. Oh, wait, people are."
Borelli responded: "Just like Doritos. Keep eating, we'll make more." After the comment become public, the company disavowed it, calling it "callous."
Borelli said that as a reward for sales, he got bonuses ranging from $101,000 to $119,000 from 2008 through 2010, and that he twice received the company's President Club award. That scored him vacations to St. Thomas and other tropical getaways.
Borelli and other Mallinckrodt employees answered lawyers' questions under oath ahead of what was expected to be the first federal trial over the toll of opioids. The company ended up settling with the plaintiffs — the Ohio counties of Cuyahoga and Summit. Other major defendants also reached deals.
Another opioid trial is scheduled to begin next month in Central Islip, New York, which has created a renewed push among drugmakers and distributors to settle thousands of opioid-related lawsuits.
Mallinckrodt agreed with lawyers suing on behalf of local governments nationwide to pay its settlement amount over eight years. Most of the money is to go into a fund intended for drug treatment and other programs to aid recovery from an epidemic that has been linked to more than 430,000 deaths in the U.S. since 2000.
The deal is still subject to some negotiations and must be approved by a bankruptcy court. It's the first proposed opioid settlement that has overwhelming support from the key lawyers for the governments suing to try to hold the drug industry accountable for the crisis. Teva, which now owns Actavis, is negotiating a separate settlement.
In a deposition last year, Douglas Boothe, who was CEO of Actavis in the U.S. and the Americas from 2008 through 2012, was asked about the company's responsibilities for flagging large and suspicious orders of prescription painkillers.
"I don't think we had responsibility for, accountability for preventing diversion," he said. "We had responsibility and accountability for making certain that the orders that we received were valid from licensed pharmacies and were within our suspicious order monitoring thresholds. ... Once it goes outside of our chain of custody, we have no capability or responsibility or accountability."
One of the main destinations for both companies' opioids was Florida, where so-called pill mills drew people from Appalachia and beyond. One deposition from a Mallinckrodt sales representative says that 47 percent of the company's high-potency opioids made in 2010 ended up in Florida.
Steve Becker, a former Mallinckrodt salesman who worked for the company from 2000 to 2014, said he wasn't aware of a system for monitoring suspicious orders. When asked if employees had incentives to report such orders, he said no.
But there were incentives to sell more, Becker said in a 2018 deposition. Employees said they frequently had back orders for pain pills.
"We're doing our due diligence in selling our product to the various accounts, and we're doing what we're supposed to be doing, according to the DEA," Becker said. "When (distributors) then sell their product, it's their due diligence to know where that product is going."
Mexico's drug war has long played out in dusty northern border cities or the poppy fields of its southern mountains, but now the killings have moved to the conservative industrial heartland state of Guanajuato, creating a strange duality: shiny new auto plants and booming foreign investment even as the state becomes Mexico's most violent.
Gleaming four-lane highways pass sprawling automotive plants and people carry yoga mats and sip chai at outdoor cafes in upscale suburbs. Several new luxury subdivisions spring up every year in the state's colonial city of San Miguel de Allende, which is popular with foreigners.
But Guanajuato's visible wealth contrasts with its grim headlines: Seven men lined up in a junkyard and shot. Gunmen open fire in a roadside eatery, leaving nine customers dead in a lake of blood. Seven people are gunned down at a street-side taco stand.
That was just one week in late January when the government said Guanajuato, which has around 5% of Mexico's population, suffered 20% of its homicides. In 2019, the state had a homicide rate of about 61 per 100,000 inhabitants, making it Mexico's most violent.
It is not the auto plant executives or foreigners who are getting killed, as local officials like to point out. The violence arises from a bloody war between the home-grown Santa Rosa de Lima gang and the powerful Jalisco New Generation Cartel, which is waging a major offensive to move into Guanajuato. The state is attractive to drug cartels for the same reason it is to auto manufacturers — road and rail networks that lead straight to the U.S. border.
The head of the state's security commission, Sofia Huett, defines Guanajuato's odd dynamic this way: "Sometimes people confuse the violence with a lack of public safety in Guanajuato, and in fact they are two different things."
What Huett apparently means is that what officials define as decent, law-abiding people aren't being killed. Criminals are killing criminals is a refrain repeatedly heard, along with the belief that most of the criminals are from outside the deeply Roman Catholic state — a reference to the invading gang from Jalisco and violence spilling over from Michoacan.
"The murders in Guanajuato are not killings carried out during robberies," Huett said. For example, she notes that muggings in the state are among the lowest in the nation. "The majority of crimes, the ones that most affect inhabitants, are well below the national average."
Most investors — and even local officials — seem prepared ignore the wave of homicides as just gang members killing gang members.
"There are victims who are caught in the crossfire, and they are the ones I really feel sorry for," said Ricardo Ortiz, mayor of the city of Irapuato. "But we can't be expected to protect people who are doing bad things."
Moises Guerrero, mayor of Apaseo El Grande, where a new, $1 billion Toyota pickup assembly plant opened this month, also minimizes the spillover of the gang war onto citizens and investors. Referring to targeted killings by cartel gunmen, Guerrero said: "They don't make mistakes. They go after the person they are after."
Huett says that "between 80 and 85% of the homicides in Guanajuato are related to criminal activities." She also points the finger at people from out of state. "If we look at 10 people who have been arrested, often of those 10 only one or two of the suspects come from Guanajuato."
That kind of statement has caused untold grief for crime victims like Alondra Mora, whose husband, Miguel Flores Lopez, disappeared Jan. 10 after he was dragged from his taxi by armed men. Mora chokes up as she shows a photo of him in the humble house they rented on the outskirts of Irapuato. The house is so tiny that visitors' knees touch when they sit in armchairs in the living room.
Mora and her husband came to Guanajuato from their native gang-plagued state of Michoacan in mid-2019, looking to build her shoe-retail business in what they viewed as a more prosperous state.
"They have to stop discriminating," Mora said of Guanajuato state officials. "If people with money are kidnapped, how long is it before they are released? One day? But for those who don't have money, it costs them their lives, because they don't even look for them."
Mora experienced first-hand Guanajuato's willingness to ignore the killings of poor migrants from other states.
"When I went to file the missing person report, the guy who took my statement was making fun of us for being from Michoacan, saying: 'Why did you have to come here?'" she recalled.
Prosecutors even asked her to investigate the case for herself, she said. The couple's bank debit card had been used after her husband's disappearance, and she had to ask the bank where the withdrawal was made. Prosecutors never checked phone records, apparently eager to write it off as a gang killing.
"As far as they're concerned, everybody who disappears was involved in something bad," Mora said.
Maria Guadalupe Gallardo López is one of approximately 80 activists looking for missing relatives in the Guanajuato as part of the group "A Tu Encuentro," roughly "Looking for You."
Armed men took her husband, Juan Carlos Medina Serrano, from their house Dec. 3. A few days later, authorities found 19 rotting bodies buried in a backyard in a nearby town, but it took two months for them to notify Gallardo Lopez that her husband had been among the bodies. He was identified by genetic testing.
With the dismembered body returned to the family in a sealed box, the family quickly held a poverty-stricken wake for him, with a few candles next to a cross of quick-lime sprinkled on the bare floor of their dwelling. On a table, a candle burned before a figure of St. Judas Tadeo, Mexico's patron saint of lost or desperate causes popular in the underworld.
Gallardo López can't, or won't, explain what her husband did for a living. "He sold things ... on the street," she said vaguely. But she also said that if police and prosecutors keep writing off deaths like her husband's, it won't be good for anybody.
"They have to do their job. If they don't take action, if they don't do their job, they are going to keep finding people like this," she said. "I don't want anybody to have go through what I did."
While families like hers suffer, many in Guanajuato live lives largely untouched by the violence.
Jorge Barroso, the young marketing director at Tenis Court athletic shoes, whose factory is in Guanajuato's shoe-making capital of Leon, says he lives without fear, going out to restaurants or clubs as he wishes.
"The truth is, I don't even perceive it," Barroso said. "When I read about this stuff in the newspapers, it's like they're talking about another state."
Gov. Diego Sinhue says "Guanajuato is not Sinaloa," the Mexican state that became famous as the cradle of the drug cartel of the same name.
But like Sinaloa, Guanajuato has a home-grown gang, the Santa Rosa de Lima cartel. The gang, named after a small farming hamlet, got its start robbing freight trains and then turned to stealing gasoline and diesel from an oil refinery in the city of Salamanca.
When the government cracked down on fuel theft, the Santa Rosa gang turned to extorting protection payments from local businesses, going industry by industry. First they shook down tortilla shops, then auto dealerships and real estate agents. Now they are apparently focusing on bars and nightclubs.
Part of Guanajuato's odd reality stems from its success at cracking down on crimes that hurt businesses together with its inability to stop the drug gang war.
Theft from railroad cars — which only a few years ago started to affect shipments of tires and auto parts — fell dramatically after soldiers and police were posted on the rail lines, and huge billboards were put up along the tracks saying : "Crackdown on railway theft: prison terms of up to 17 years. This means you. Jail without bail."
In other parts of Mexico, protesters, pressure groups or cartel gunmen regularly block roads and train tracks, but that doesn't happen in Guanajuato. While the state isn't very strenuous in investigating homicides, protesters are hit with the toughest possible charges, including terrorism.
"Here, there are no road blockades by protest groups or criminals, and in the end that is attractive for business," said Huett, the security commissioner.
Last year, 79 police officers were killed in the state. To stem the onslaught, the federal government has made Guanajuato a priority, constructing some of the first National Guard barracks here.
Worst hit has been the town of Apaseo El Alto, where Mayor Maria del Carmen Ortiz took office after her husband — the leading candidate to fill the office — was shot to death in 2018. Between late 2019 and early 2020, her police chief, a town councilman and a police officer were shot to death.
"2018, 2019 were terrible years," she concedes.
Scientists can't tell yet how deadly the new virus that's spreading around the globe really is — and deepening the mystery, the fatality rate differs even within China.
As infections of the virus that causes COVID-19 surge in other countries, even a low fatality rate can add up to lots of victims, and understanding why one place fares better than another becomes critical to unravel.
"You could have bad outcomes with this initially until you really get the hang of how to manage" it, Dr. Bruce Aylward, the World Health Organization envoy who led a team of scientists just back from China, warned Tuesday.
WHAT DO WE KNOW ABOUT THE DEATH RATE?
In the central China city of Wuhan, where the new coronavirus first exploded, 2% to 4% of patients have died, according to WHO. But in the rest of hard-hit China, the death rate was strikingly lower, 0.7%.
There's nothing different about the virus from one place to another. Instead, the never-before-seen strain of coronavirus struck Wuhan fast — before anyone knew what the illness was — and overwhelmed health facilities. As is usual at the beginning of an outbreak, the first patients were severely ill before they sought care, Aylward said.
By the time people were getting sick in other parts of China, authorities were better able to spot milder cases — meaning there were more known infections for each death counted.
And while there are no specific treatments for COVID-19, earlier supportive care may help, too. China went from about 15 days between onset of symptoms and hospitalization early in the outbreak, to about three days more recently.
Still, Aylward expressed frustration at people saying: "'Oh, the mortality rate's not so bad because there's way more mild cases.' Sorry, the same number of people that were dying, still die."
WHAT ABOUT DEATHS OUTSIDE OF CHINA?
Until the past week, most people diagnosed outside of China had become infected while traveling there.
People who travel generally are healthier and thus may be better able to recover, noted Johns Hopkins University outbreak specialist Lauren Sauer. And countries began screening returning travelers, spotting infections far earlier in places where the medical system wasn't already strained.
That's now changing, with clusters of cases in Japan, Italy and Iran, and the death toll outside of China growing.
Aylward cautioned that authorities should be careful of "artificially high" death rates early on: Some of those countries likely are seeing the sickest patients at first and missing milder cases, just like Wuhan did.
HOW DOES COVID-19 COMPARE TO OTHER DISEASES?
A cousin of this new virus caused the far deadlier severe acute respiratory syndrome outbreak in 2003, and about 10% of SARS patients died.
Flu is a different virus family, and some strains are deadlier than others. On average, the death rate from seasonal flu is about 0.1%, said Dr. Anthony Fauci of the U.S. National Institutes of Health.
That's far lower than what has been calculated so far for COVID-19. But millions of people get the flu every year around the world, leading to an annual death toll in the hundreds of thousands.
WHO'S MOST AT RISK FROM COVID-19?
Older people, especially those with chronic illnesses such as heart or lung diseases, are more at risk.
Among younger people, deaths are rarer, Aylward said. But some young deaths have made headlines, such as the 34-year-old doctor in China who was reprimanded by communist authorities for sounding an early alarm about the virus only to later succumb to it.
In China, 80% of patients are mildly ill when the virus is detected, compared with 13% who already are severely ill. While the sickest to start with are at highest risk of death, Aylward said, a fraction of the mildly ill do go on to die — for unknown reasons.
On average, however, WHO says people with mild cases recover in about two weeks, while those who are sicker can take anywhere from three to six weeks.