Emergency due to "first" cases of covid-19 in North Korea 2:16
SEOUL, South Korea (CNN) --
Choi Jung-hun smiled as he read the latest official Covid-19 figures from North Korea's state media: Fewer than 5 million "fever" cases and just 73 deaths, one fraction of the death toll relative to all other countries in the world.
"The North Koreans call them rubber band statistics," he said, in a nod to Pyongyang's flexibility with the truth.
"It's hard even for North Korea to know its own numbers."
Speak with some authority.
Choi was a doctor for more than 10 years in North Korea, specializing in infectious diseases before fleeing his home country in 2011.
You may recall the SARS outbreak of 2002-2004, when you say that hundreds of people in the northeastern city of Chongjin, where he worked, began dying after reporting "cold or flu symptoms".
Doctors like Choi could only privately suspect that SARS was to blame.
North Korea did not have the ability to test for the disease, so it officially recorded zero infections.
Its neighbor China reported more than 5,000 cases and hundreds of deaths.
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Choi can also remember dealing with a countrywide measles outbreak in 2006, armed only with a thermometer;
and a 2009 influenza pandemic in which even "more people died than during SARS," a situation made worse by acute drug shortages.
In previous epidemics, Choi explains, there was never an incentive for local officials to travel from house to house to count cases accurately: They didn't have masks or gloves and thought the regime would manipulate the statistics to suit their needs.
He takes for granted that little has changed since he left and that history, if not repeating itself exactly, is at least similar.
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What is North Korea hiding?
As with previous disease outbreaks in North Korea, one of the biggest concerns surrounding the country's Covid outbreak is that Pyongyang's penchant for secrecy makes it difficult to accurately gauge its severity.
International NGOs and most foreign embassies have long since left the country and hermetically sealed borders mean access is impossible, making the accounts of defectors like Choi all the more important.
Many were surprised by Pyongyang's decision in May to admit it was dealing with an outbreak, even if the accuracy of its statements has since met with skepticism.
At first, leader Kim Jong Un had described the outbreak as the "greatest upheaval" that has ever occurred in the country.
Two months and millions of suspected cases later, he claimed "brilliant success" in stopping the disease in its tracks.
The incredibly low official death toll the country has reported inevitably raises suspicions that Pyongyang is trying to cover up a larger problem.
"I have some questions," South Korea's Unification Minister Kwon Young-se pointedly said last week, noting that the story being spread by the North's state media contrasts sharply with the experience of the rest of the world.
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Are there new variants of covid or is it cholera?
Initially, the biggest fear was that an outbreak in a malnourished and unvaccinated population with a primitive health system would be catastrophic.
Tomás Ojea Quintana, the UN special rapporteur for human rights in North Korea, said that knowing the magnitude of the outbreak is impossible at this time, although he had heard unconfirmed reports of deaths among the elderly and malnourished children.
"At least in my position, I cannot contrast this fear that we had at the beginning of 2020 about the catastrophic consequences of covid (in North Korea) and its current situation," Ojea Quintana said.
There are also fears that new, possibly more virulent, variants could emerge from uncontrolled transmission through North Korea's population of about 25 million.
A health official (left) takes a female worker's temperature upon her arrival at the workplace of the Pyongyang Cosmetics Factory in Pyongyang on June 16, 2022. (Photo by KIM Won Jin/AFP)
Dr. Kee B. Park, an American neurosurgeon who until the pandemic began had been visiting North Korea twice a year to work alongside his North Korean counterparts, training them and performing surgeries, said the country seemed unwilling to share information and that this was "not good for them (and) not good for the rest of the world.
"We have to share information about any kind of new changes in the characteristics of the virus, for example mutations, right?" he said.
"We need to be aware of the fact that high replication can lead to new variants. The only way to detect that is to share information with each other," added Park.
In June, North Korea said it was experiencing an outbreak of an unidentified intestinal illness in South Hwanghae province, about 120 kilometers south of the capital Pyongyang.
If nothing else, the announcement demonstrated the country's vulnerability to disease outbreaks and its lack of medicines.
Park believes that North Korea is probably dealing with an outbreak of typhoid or cholera.
"In some place like North Korea, you can expect high rates of infectious disease. In fact, for children under 5, diarrheal disease is the leading cause of death."
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Is there a ray of hope?
A ray of hope for Park was the country's ability to vaccinate its population quickly, demonstrated during its national inoculation program for the 2006 measles outbreak.
"In the first cycle, they were averaging a million shots a day, then in the second cycle, later in 2007, they were averaging over 3 million shots a day," Park said.
"If all the conditions are right, based on those numbers, they can vaccinate the entire population for at least the first dose in eight days," Park said.
But any optimism is tempered by the reluctance of a country sometimes referred to as "the hermit nation" to accept foreign aid.
"They're socialized for scarcity," Park said.
"They were struggling to supply hospitals with some of the things we take for granted," he recalled of his time working in the country, saying surgeons reused equipment like scalpels until they became dull and useless.
Offers of help from the United Nations, the United States, South Korea and others have been ignored.
However, some aid has reached the country from China.
Customs data shows that from January to April, North Korea imported more than 10 million masks, 1,000 ventilators and more than 2,000 kilograms of unspecified vaccines.
Members of North Korea's military medical section work to distribute medicines to citizens at a pharmacy in Pyongyang on May 18, 2022, to contain the spread of COVID-19 infections. North Korea reported what it claims is its first Covid-19 outbreak on May 12. (Credit: Kyodo News via Getty Images)
The global vaccine alliance Gavi said last month that it was aware that North Korea had accepted China's Covid vaccines and had started administering doses.
A Gavi spokesperson told CNN that North Korea "has not yet made a formal request to COVAX for vaccine support, but we remain ready to help if they do."
The isolation of Covid-sufferers in the country was highlighted by recent attempts by an activist group of defectors to send medicine across the demilitarized zone, the de facto border between North and South Korea.
The North Korean Freedom Fighters said they had sent large balloons with medical supplies such as Tylenol and vitamin C across the border in June, as well as some with anti-regime leaflets in late April.
These balloon flights are against South Korean law and have been discouraged.
Unification Minister Kwon told reporters that he understands "the feelings of such organizations, but I think they should refrain."
ANALYSIS |
North Korea is facing a covid-19 disaster, what does that mean for Kim Jong Un?
Starvation and a second 'arduous march'
In the meantime, illness, be it Covid or something else, may not be the biggest problem facing North Koreans.
A defector, 44, who lives in South Korea, said her family in the North had contacted her shortly after the outbreak was reported.
When it came to covid, her family in North Korea was more concerned about her, a reflection of Pyongyang's considerable propaganda prowess.
"They said that [North Korean television had] reported that many people in South Korea were dying of covid, so they were worried about me," he said.
"They weren't too worried about the virus."
However, what worried his family most was the lack of food.
“I was told that the food situation was worse than during the Hard March of the 1990s… I am very concerned to know how difficult things were (back then).”
The Hard March refers to a period of devastating famine when North Korea's economy was hit hard by the collapse of the Soviet Union, which ended the flow of aid to the country.
It is estimated that hundreds of thousands of people, or up to 10% of the country's population, have starved to death.
Some estimates put the death toll even higher.
The defector did not ask her family if anyone was starving, as she never discusses anything political during these rare contacts with her family.
The possibility that the authorities may be listening is too great.
She asked CNN not to be identified in case her family faced retaliation.
But Ojeda Quintana, the UN special rapporteur, said the danger was very real and that he was urging the Kim regime and others involved in North Korea to "basically understand that there is a serious risk of famine in North Korea."
Whether Kim is likely to listen is another question.
State television has been covering the North Korean leader by touring pharmacies, ordering his military to stabilize medical supplies and even donating some of his private medical supplies last month to the fight against the as-yet-unidentified intestinal outbreak.
For Choi, the doctor who fled North Korea in 2011, these images are to be expected when the truth is treated like a rubber band.
It's a show and nothing more, she said.
"The North Korean authorities aren't fighting, the North Korean citizens are the ones having a hard time... if you survive it's great, but there's nothing we can do if you die."
Covid-19
