An outbreak of the 2019 novel coronavirus was first identified in Wuhan, China, with the first cases reported in December 2019, and it soon turned into a pandemic infecting thousands of people in China and worldwide. As of April 10, 2020, more than 1.5 million people diagnosed with COVID-19, of whom more than 92,000 (case-fatality rate (CFR) = 6.1%) died (World Health Organization., 2020) . Iran became one of the most severely affected countries due to the rapid spread of the virus. By the time of this report on April 10, 2020, Iran is among the top ten countries reporting COVID-19, with 66,220 total confirmed cases and 4,110 total registered deaths (CFR = 6.2%) (World Health Organization., 2020).
Consistent with other countries, the COVID-19 outbreak in Iran has been associated with significant public fear given the rapid growth of the epidemic across the country with all 31 provinces affected (Bao, Sun, Meng, Shi, & Lu, 2020) . The shortage of medical care and diagnostic capacity, inconsistent implementation of COVID-19 prevention and mitigation strategies, sustained international pressures from economic sanctions (Takian, Raoofi, & Kazempour-Ardebili, 2020) , and limited public knowledge has resulted in misinformation being highly prevalent in Iran. In response to the rapid surge of the COVID-19 pandemic, Iran has applied several mitigation strategies, including the broader use of alcohol-based hand sanitizers.
In Iran, alcohol became more available to people and more accessible for them to buy from drugstores as justified for sanitization for COVID-19. However, disinformation has circulated, including that gurgling or drinking alcohol can prevent COVID-19. Recognizing that alcohol use is banned in Iran, people are more likely to consume bootleg alcohols that may include higher levels of methanol. Thus, in parallel with the increased number of COVID-19 cases, an alarming number of methanol-poisoning cases secondary to drinking bootleg alcohol containing methanol, has also been reported in Iran.
The two co-occurring rapidly emerging epidemics represent syndemics where the one has stimulated the increase of the other. Official reports from Iran's Health Ministry Spokesman indicated that more than 3,100 poisoning cases were reported throughout the country from the first official announcement of deaths due to COVID-19 on February 19, 2020, through April 7, . Although Iran has adopted a national strategy to reduce alcohol-related harms (Al-Ansari, et al., 2019; Shariatirad, et al., 2016) , alcohol-related problems have not been viewed through the lens of public health perspectives (Shokoohi, et al., 2019) . Instead, strategies have predominantly focused on palliative care and treating alcohol poisoning secondary to the consumption of bootleg methanol at individual levels. For example, Iran developed a national program on alcohol use (2013) (2014) (2015) (2016) (2017) , and integrated alcohol treatment units into the current illicit drug treatment programs (Shariatirad, et al., 2016) . However, such interventions have not yet been fully implemented in the primary health-care system, and their public health goals have consistently been overlooked.
The syndemics of alcohol and COVID-19-related mortality provide an opportunity to revisit policies surrounding alcohol use. Ongoing discussions surrounding the issue of alcohol use, in particular, methanol poisoning in Iran, are now more visible (Al-Ansari, et al., 2019; Shokoohi, et al., 2019) . These discussions are encouraging with national programs on alcohol treatment services being developed (Iranian National Committee for NCDs Prevention and Control., 2015) . Given difficulties in the implementation, policymakers in Iran could consider the development and support of alcohol use-related public health models to better support public education and increase awareness (Al-Ansari, et al., 2020) . Education policies do represent a key harm reduction strategy in response to alcohol use issues, without which the increased risks of morbidity and mortality associated with alcohol positioning will continue. The increasing number of methanol-poisoning cases that have maximized pressures to the health system while trying to contain the COVID-19 epidemic is an example of why Iran could benefit from more prevention and mitigation services for alcohol use disorders. However, in addition to the development of national guidelines in managing mass methanol-poisoning outbreaks (Hassanian-Moghaddam, et al., 2015) , the development and implementation of public health programs can also support Iran to better respond to ongoing alcohol use disorders as well as during times of crisis including COVID-19. a %s indicate case-fatality ratio (CFR), defined as the proportion of individuals with a particular condition who die from that condition; e.g., CFR for COVID-19 was calculated by dividing the total number of deaths due to COVID-19 (numerator) by the total number of COVID-19 cases (denominator); b Official number in Alborz province appeared to be between 150 to 200 cases
• While all activities surrounding alcohol is banned in Iran, mass methanol poisoning outbreaks (such as the one amid the COVID-19 epidemic with more than 5,000 poisonings and more than 700 deaths within only two months) have become a major public health concern.
• Iran's national policymakers should consider developing and implementing public health models to better address alcohol use problems.