Iran has been hit hard by the novel coronavirus, and things may get far worse. On Tuesday, a state television reporter who is also a medical doctor warned that the death toll could be in the “millions” as worshipers forced their way into two Shiite shrines closed by the outbreak.

That’s not idle speculation. The death toll in Iran from covid-19 infections surged past 1,000 on Wednesday after the largest single-day rise in the number of deaths since Iran’s outbreak began. Deutsche Welle reported this week that researchers at Sharif University of Technology in Tehran created a computer simulator to analyze scenarios.

Under current circumstances, the researchers said, infections would not peak until late May. The death toll could be as high as 3.5 million.

That figure might seem enough to stop anyone in their tracks. But this week, the United States announced that it would be expanding its sanctions on Iran, as well as on entities that aided the Iranian government in its trade in petrochemicals and other restricted activities. It’s a strategy that worries allies and enemies alike.

The Guardian reported on Wednesday that Britain was privately pressing the United States to ease sanctions on Iran amid the crisis, while China has publicly called on the United States to lift its Iran sanctions.

But the United States, which reimposed sanctions on Iran after President Trump unilaterally pulled out of the nuclear agreement with Iran and other nations in 2018, has refused; on Tuesday, Secretary of State Mike Pompeo called for Iran to release U.S. citizens being held in the country “as a humanitarian gesture, given the risk that is posed” by the coronavirus pandemic.

There’s little doubt that U.S. sanctions have hindered Iran’s response to the virus. They have left an already dysfunctional government scrambling for supplies and made officials desperate to avoid taking societal measures that would further harm an economy in free fall.

Last year, Human Rights Watch warned that U.S. sanctions on Iran had “drastically constrained the ability of the country to finance humanitarian imports, including medicines, causing serious hardships for ordinary Iranians and threatening their right to health.”

The first cases of the coronavirus in Iran were announced Feb. 19 in Qom, with officials suggesting that an infected businessman may have brought the illness from China. The virus has since spread throughout the country, with more than 17,000 confirmed cases — a number widely thought to be a serious underestimate.

The virus has struck the political elite, with dozens of officials infected and parliament members and an adviser to Iran’s supreme leader among the dead. Javad Zarif, Iran’s foreign minister, has placed the blame on “unlawful U.S. sanctions” and said they literally are killing people.

Others agree. The Intercept’s Mehdi Hasan has contrasted the Trump administration’s sanctions during the coronavirus crisis unfavorably with the 2003 decision by the Bush administration to temporarily lift sanctions after an earthquake killed 26,000. “The U.S. government is run by sociopaths,” Hasan writes.

But to many, the Iranian government’s mishandling of the crisis underscores its own culpability. The initial refusal to impose lockdowns and evidence that it has not released an accurate death toll undermine its credibility.

Signs of a power struggle between President Hassan Rouhani’s government and Ayatollah Ali Khamenei, Iran’s supreme leader, have only added to the sense of dysfunction in the country. The United States has offered some assistance to Iran through Switzerland, its diplomatic representation in Tehran, yet Iranian officials have criticized the move as just “hullabaloo.”

That skepticism may be warranted. The Guardian reports that British diplomats think the Swiss channel is too full of conditions to be of use, and that many in Europe fear that the United States could block Iran’s request for a $5 billion loan from the International Monetary Fund to help deal with the crisis.

Richard Ratcliffe, husband of the imprisoned British citizen Nazanin Zaghari-Ratcliffe, told the Guardian that the coronavirus could be a diplomatic opportunity. “It would make such a difference if the U.K. was to provide more medical, humanitarian and drug supplies to Iran,” said Ratcliffe, whose wife has been released temporarily because of the coronavirus.

But both the United States and Iran fear capitulation. In Foreign Policy, Rob Malley — who worked on the 2015 Iran deal while in the Obama administration — and Ali Vaez of Crisis Group argue that while the Trump administration may view Iran’s crisis as “a validation of its so-called maximum pressure strategy,” if it fails it will increase the risk of a conflict that neither side wants.

Indeed, despite the novel coronavirus in Iran — and the January killing of military leader Qasem Soleimani — U.S. troops in the Middle East continue to be harassed by Tehran’s allies, with serious injuries during a base attack in Iraq this week. Rouhani suggested this week that the country planned to retaliate further for Soleimani’s killing.

The Trump administration’s maximum-pressure campaign against Iran has resulted in little tangible benefit to the United States, but at the same time, the costs of the U.S. policy are growing. If it succeeds now, will it have been worth it?