The severity of the coronavirus pandemic in Iran seems surprising on the surface: The country has suffered nearly 20,000 cases—far more than any country outside Europe or East Asia. While the disease itself is, of course, an apolitical phenomenon, Iran’s repressive, theocratic political system has played a role in the especially high toll that coronavirus is taking on the Iranian people.

There is a direct chain of causality linking last year’s protests in Iran to the heightened severity of this year’s pandemic. Many of those protestors were disillusioned youth who’d come to realize that the promise of gradual political “reform” was empty. The regime succeeded in suppressing the protestors, but only until the regime’s destruction of a Ukrainian civilian airliner (and botched response to the tragedy) brought protestors back out onto the streets.

Parliamentary elections took place in February. Having struggled in recent years to bring Iranians to the polls, leaders were unsettled by indications that this would be the lowest turnout in the regime’s 41-year history. They also were eager to get a pro-regime boost from the country’s annual February 11th marches in celebration of the 1979 Revolution, not to mention a weeks-long “Magnificent Iran” cultural festival in the western Iranian city of Hamedan, which coincided with the Chinese New Year. Desperate to boost the economy, regime-affiliated news outlets ran promotional articles aimed at Chinese tourists. So, on all counts, news of an epidemic was off message. Regime officials had little incentive to spread news of the early outbreak in January—and much incentive to censor emerging rumors that some Iranians already had become infected.

Making the situation all the more potentially explosive was the fact that many Iranians have a special antipathy for China, as it is one of the few powerful countries that has openly supported the Iranian regime. News of Chinese tourists heading into Iran, some of them potentially sick with a contagious disease, predictably inflamed public sentiment. On social media, especially Instagram, I saw videos of Chinese tourists being cursed and shouted at by Iranians and being told to return to China with “their virus.”

Yet, everything continued as scheduled. The elections were held (with abysmal turnout), the festival went on, Chinese tourists kept coming, and “Victory Day” celebrations took place. Most Iranians were still unaware of the severity of the coronavirus risk. And despite the mounting number of confirmed cases, the regime kept denying that there was any real risk to speak of.

In February, most countries were canceling flights to and from China. This was not the case with Mahan Airlines, which is owned by the Islamic Revolutionary Guard Corps (IRGC), Iran’s equivalent of a modern Praetorian Guard. (Estimates suggest that the IRGC, which also manages the military’s international paramilitary apparatus, controls at least 20 percent of the Iranian economy.) In fact, Mahan Airlines officials even agreed to pick up Chinese nationals from third countries and take them to China following a stop in Iran. When Mahan finally did stop flying to China, it wasn’t the IRGC that made the decision. Rather, it was Chinese officials, who ended the flights based on suspicions that the virus had mutated in Iran.

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Eventually, the regime bowed to the inevitable, and the deputy health minister confirmed the existence of a coronavirus problem in Iran, though he claimed it was under control. In a sad episode of poetic justice, that deputy minister himself was confirmed to be one of the country’s infected citizens the very next day. One of Iran’s vice presidents, Masoumeh Ebtekar (who’d gained infamy as the hostage-takers’ spokeswoman in 1979, when some knew her as “Bloody Mary”) also tested positive; as did Iran’s first vice president, Eshagh Jahangiri; and some of Supreme Leader Ali Khamenei’s closest advisors. Some members of parliament tested positive, too. (Earlier this month, one of them died.)

These events marked a turning point, and people went into self-quarantine. With Iranians dying from coronavirus at the rate of about 150 per day—one every 10 minutes—a large portion of the population now has at least one friend, co-worker or family member who’s been seriously affected.

Iran is not the only country whose leaders’ early response to coronavirus was to minimize (or even deny) the public risk. But the low level of trust that Iranians have in their regime made matters worse. Crises are petri dishes for rumors. Conspiracy theories and toxic rumors are common in Iran even on the best of days. The pandemic has made everything worse, exacerbating the problem of communicating best health practices to citizens.

Doctors and nurses have taken it upon themselves to send out messages on social media about shortages of medical goods. Most of them, including my cousins, who still live in Iran, have visited infected patients without wearing safety kits—because there are few to be had. There is also a shortage of test kits. Dozens of physicians have died, and hundreds more are infected.

The mask shortage is especially sensitive because the IRGC had taken these items off the retail market in 2019, after Iranian protestors used them to cover their faces to avoid arrest. Meanwhile, regime cronies are manipulating the wholesale supply to enrich themselves. At one point, Ali Javanmardi, an opposition journalist known to receive information from regime informants, used Telegram (an app used by everyone in Iran) to send out the locations where masks were being stored. The building was duly looted, and the masks were discovered.

Iranians also may simply be more vulnerable to the virus because of the negative health effects of regime policies. Public hygiene has been neglected for years. A Food and Agriculture Organization survey from 2016 showed high rates of vitamin D deficiency in Iran—an issue that has been linked to coronavirus in early research. This should not come as a surprise given that vitamin D is produced through exposure to sunlight, and Iran is a country where men are not allowed to wear shorts or sleeveless shirts, and women can show only their faces, hands, and feet. More broadly, a constant state of economic crisis, corruption and mismanagement has left many Iranians poor and often badly nourished, thereby weakening their immune systems. Some protestors last year complained about how they hadn’t eaten meat in years. Meanwhile, many factories are refusing to suspend business. In one notorious instance, when a Coca-Cola employee fainted inside his facility, managers responded by threatening to fire anybody who failed to show up for work the next day.

The crisis also has served to highlight the regime’s hypocrisy. On one hand, the regime made a show of refusing a US aid offer. On the other hand, while flights to Kish, an Iranian island in the Persian Gulf, have been declared off limits for ordinary Iranians, videos of the regime’s leaders and clerics enjoying themselves on the island have gone viral on social media. Leaders are perfectly happy to act on “principle” when the effect is to deprive ordinary Iranians of help. But the leaders themselves apparently continue to live large. In fact, even some members of parliament—hardliners and reformists alike—now are condemning the government’s performance. (There is also infighting over the closure of holy shrines, which provide a great source of revenue for the clergy.)

For now, most Iranians are in some form of self-quarantine, and so the mood is as quiet as it is tense. Nobody knows when the crisis will end, and they are resorting to social media to express their outrage. Once people finally leave their homes, that will change, however. For the regime, the worst is likely yet to come.