Initially overwhelmed, Tehran now seeks to sway international opinion on U.S. sanctions by highlighting its struggles with COVID-19, the illness caused by the virus. Iran asked for $5 billion from the International Monetary Fund even as it enriches uranium beyond the limits of its 2015 deal with world powers.

The U.S., which unilaterally withdrew from the deal in 2018 under President Donald Trump, insists that aid can reach the Islamic Republic — though humanitarian organizations say Washington's sanctions disrupt even permitted trade.

At the same time, the U.S. is now withdrawing troops from Iraqi bases, redeployments it insists are pre-planned even as Trump alleges Iran plans "a sneak attack" against them.

The risk of open conflict between the countries is overshadowed by the pandemic. Yet it persists — some say at levels as high as immediately after the January drone strike by the U.S. that killed Iranian Gen. Qassem Soleimani in Iraq.

"After Soleimani's killing, everybody thought there will be war, but nothing happened," said Mahsa Rouhi, a research fellow at the International Institute for Strategic Studies. "Whereas we were so close to war that it's not that nothing happened. And we are not back to normal. ... We are back to a situation where any move could easily escalate into a conflict."

The current tensions can seem trivial, compared to the pandemic, which has infected at least 1.9 million people worldwide and killed over 119,000. This perception has been helped by mocking social media posts from the U.S. State Department and a former leader of Iran's paramilitary Revolutionary Guard seemingly backing the fringe idea of California seceding from the U.S.

The stakes, however, are anything but. The night Iran retaliated for the Soleimani killing, it also accidentally shot down a Ukrainian jetliner, killing all 176 people aboard. Allied Shiite militias in Iraq also continue to threaten American forces deployed there in the aftermath of the fight against the Islamic State group.

While largely silent in the initial days of the outbreak in Iran, Foreign Minister Mohammad Javad Zarif has begun a concerted campaign targeting American sanctions. It's a way to absolve Iran's civilian government of responsibility for an outbreak it hasn't contained. But Zarif's allegations of "medical terror" by the U.S. also highlight the challenge Tehran faces in accessing some medical supplies.

While the U.S. says medical and humanitarian aid remains exempt, Human Rights Watch said American laws as written affect Iran's access to crucial equipment, "including ventilators, CT scanners, decontamination equipment and full-mask respirators." Meanwhile, international firms remain leery of running afoul of U.S. sanctions even for authorized transactions with Iran.

"One of the problems for international aid has been to clarify the legal issues related to sanctions to ensure that medical supplies and medicines can be brought into Iran," Olivier Vandecasteele, Relief International's country director for Iran, said in a statement "This slowed down the health response in the first weeks of the outbreak."

A European system called INSTEX did get aid through, as has a Swiss channel. China also has contributed, as have regional Gulf Arab countries, likely worried about Iran further spreading the virus into their own nations. Meanwhile, Iran insists it can produce masks and gloves, something the U.S. has argued undercuts Tehran's $5 billion request to the IMF, which would be its first loan since 1962.

All this comes as Iran continues to produce low-enriched uranium with equipment and sites barred by the nuclear deal. Its nuclear program chief recently reiterated a threat that Iran could withdraw from the Nuclear Nonproliferation Treaty, though Iran didn't make a show of its program during its recent annual National Day of Nuclear Energy.

That bolsters suspicions of behind-the-scenes talks between intermediaries, particularly over the release of U.S. prisoners and  other Westerners. Iran's judiciary acknowledged ongoing prisoner-swap discussions on April 6, without elaborating.

But overall tensions remain extraordinarily high. Online video and Iranian media reports suggest Iran has deployed Fajr-5 missile batteries on beaches along the crucial Strait of Hormuz, the narrow mouth of the Persian Gulf through which a fifth of all oil traded in the world passes.

There have been reported maritime incidents in and around the strait as well. On March 27, two boats with a raised ladder approached a U.S.-flagged container ship, while Revolutionary Guard vessels approached a ship on April 2, according to private maritime security firm Dryad Global.

The U.S. Navy's Bahrain-based 5th Fleet, which routinely has tense interactions with Iranian forces. declined to comment. However, last summer saw a series of tense encounters at sea and on land that included the seizure of oil tankers.

The U.S. pressure campaign in part seeks to force Iran into spending at home rather than on its regional allies. Tehran views such groups as part of its defensive deterrence in the region.

Meanwhile, people continue to die of the virus in Iran in the pandemic that could spread further into American allies in the region, forcing the world to still work with Tehran, Rouhi said.

"At the end of the day, it's still that bad actor that is governing a country of more than 80 million," she said. "You don't have an alternative."