Paula Hancocks and Yoonjung Seo, CNN Posted on Wed Jul 6, 2022 7:35 am EDT
(CNN) — Choi Jung-hoon smiled as I read the latest official Covid-19 figures from North Korean state media: fewer than 5 million cases of “fever” and only 73 deaths – a fraction of the deaths of each another country in the world.
“The North Koreans call them rubber band statistics,” he said, a nod to Pyongyang’s flexibility with the truth. “It’s hard even for North Korea to know its own numbers.”
He spoke with some authority. Choi was a doctor for more than 10 years in North Korea, specializing in infectious diseases, before he left his homeland in 2011.
He can recall the 2002-2004 SARS outbreak, when he says hundreds of people in the northeastern city of Chongjin, where he worked, began to die after reporting “cold or flu-like symptoms.”
Doctors like Choi could only privately suspect that SARS was to blame. North Korea had no way to test for the disease, so it officially registered zero infections. Its neighbor China has reported more than 5,000 cases and hundreds of deaths.
Choi can also recall dealing with a national measles outbreak in 2006 armed only with a thermometer; and the 2009 flu pandemic, in which even “more people died than during SARS” – a situation exacerbated by acute drug shortages.
In previous outbreaks, Choi explains, local officials never had the incentive to travel from house to house to accurately count cases—they didn’t have masks or gloves, and thought the statistics would be massaged by the regime to suit its needs.
He accepts that little has changed since he left, and that history, if not exactly repeating itself, at least rhymes.
What is North Korea hiding?
As with past outbreaks of disease 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 measure its severity.
International NGOs and most foreign embassies have long since left the country, and tightly closed 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 epidemic, although the accuracy of its claims has since faced skepticism. At first, leader Kim Jong Un described the outbreak as the “biggest turmoil” ever to hit the country. Two months and millions of suspected cases later, he said he had achieved “brilliant success” in stopping the disease in its tracks.
The incredibly low official death toll reported by the country inevitably raises suspicions that Pyongyang is trying to hide a bigger problem.
“I have some questions,” South Korea’s Unification Minister Kwon Yong-se insisted last week, noting that the story spread by the North’s state media stood in stark contrast to the rest of the world’s experience.
New variants of Covid, cholera?
Initially, the greatest fear was that an epidemic among an unvaccinated, malnourished population with primitive health care would be catastrophic.
Tomás Ojea Quintana, the UN’s special rapporteur on human rights in North Korea, said it was currently impossible to know the scale of the outbreak – although he had heard unconfirmed reports of deaths among the elderly and malnourished children.
“At least in my position, I can’t counter that fear that we had at the beginning of 2020 about the catastrophic effects of Covid in (North Korea) and its current situation.”
There are also concerns that new, possibly more virulent, variants could emerge from unchecked transmission through North Korea’s population of about 25 million.
Dr. Key B. Park, an American neurosurgeon who, until the start of the pandemic, visited North Korea twice a year to work alongside North Korean colleagues, training them and performing surgeries, said the country seemed reluctant to share information and that “it’s not good for them (and) it’s 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 have to be aware of the fact that high replication can lead to new variants. The only way to find that is to share information with each other.”
In June, North Korea said it was experiencing an outbreak of an unidentified enteric disease in South Hwanghae province, about 75 miles (120 kilometers) south of the capital, Pyongyang.
At the very least, the announcement demonstrates the country’s vulnerability to disease outbreaks and lack of medicine.
Park believes North Korea is likely battling an outbreak of typhoid or cholera.
“Somewhere like North Korea you can expect high levels of infectious diseases. In fact, for children under the age of 5, diarrheal diseases are the number one killer.”
A ray of hope?
One ray of hope for Park was the country’s ability to vaccinate its population quickly – demonstrated during the national vaccination program for the 2006 measles outbreak.
“The first cycle they averaged a million injections per day, then in the second cycle, later in 2007, they averaged over 3 million injections per day,” Park said.
“If all the conditions are right, based on these numbers, they can vaccinate the entire population at least for the first shot in eight days.”
But any optimism is tempered by the reluctance of a country sometimes called the “hermit nation” to accept outside aid.
“They’re socialized to 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 would reuse equipment like scalpels until they became dull and unusable.
Offers of help from the United Nations, the United States, South Korea and others were ignored.
However, part of the aid is making its way into the country from China. Customs data show 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.
Global vaccine alliance Gavi said last month it understood North Korea had received Covid vaccines from China and had started administering doses.
A Gavi spokesperson told CNN that North Korea “has not yet submitted a formal request to COVAX for vaccine support, but we remain ready to help if they do.”
The isolation of the country’s Covid sufferers was highlighted by recent attempts by a group of defector activists to ship medicine across the demilitarized zone – the de facto border between North and South Korea.
North Korean freedom fighters said they sent large balloons of 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 are not recommended. Unification Minister Kwon told reporters he understood “the sentiments of such organizations, but I think they should refrain.”
Hunger and a second “Hard March”
Meanwhile, disease — whether it’s Covid or something else — may not be the biggest problem facing North Koreans.
One defector, 44, who lives in South Korea, said her family in North Korea contacted her soon after the outbreak was reported. Conversely, when it came to Covid, they were most concerned about it – a reflection of Pyongyang’s considerable propaganda power.
“They said [North Korean television had] reported that a lot of people in South Korea were dying from Covid, so they were worried about me,” she said. “They weren’t too concerned about the virus.”
What her family was extremely worried about, however, was the lack of food.
“I have been told that the food situation is worse than during the hard March of the 1990s… I am very worried knowing how difficult things were (then).”
“Hard March” refers to a period of devastating famine when North Korea’s economy took a hammer blow from 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 about 10% of the country’s population, starved to death. According to some estimates, the death toll is even higher.
The deserter did not ask her family if anyone was starving, as she never talked about anything political during these rare contacts with her family. The possibility of the authorities eavesdropping is too great. She asked CNN not to be identified in case her family faces retribution.
But Quintana, the UN special rapporteur, said the danger was very real and that he urged the Kim regime and others involved in North Korea “to understand that there is a serious risk of starvation in North Korea.”
Whether Kim will listen is another matter.
State television has shown the North Korean leader touring pharmacies, ordering his army to stabilize medical supplies and even donating some of his private medical supplies last month to fight the as-yet-unidentified intestinal epidemic.
According to Choi, the doctor who defected from North Korea in 2011, such images are to be expected when the truth is treated like a rubber band. It’s a show and nothing more, he said.
“The North Korean authorities are not fighting, it’s the North Korean citizens who are suffering… if you survive, that’s great, but there’s nothing we can do if you die.”
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