It took almost two and a half years for SARS-CoV-2 to travel from the Chinese city of Wuhan to the North Korean capital Pyongyang.
That’s according to the North Korean government, which until late last week had firmly denied any confirmed cases of the virus within their borders—a distinction that had made them one of only three countries worldwide to have remained uncontaminated by the pandemic to date.
But Thursday saw state media confirm that an “obscure febrile disease” had infected 350,000 people nationwide, in what experts believe is almost certainly an outbreak of COVID-19. Then, three days later, state media confirmed a total of more than 1.2 million people across the country reporting symptoms of a “fever.”
As of Sunday, 564,860 people are being treated for this “fever,” which appears to have been spreading explosively throughout North Korea since late April. At least 50 people are confirmed to have died, eight of them on Sunday alone, in what is almost certainly a gross underestimate of mortalities by local authorities. One expert told VICE World News last week he expects “mass death” to occur.
In the space of just 72 hours, North Korea’s epidemiological status has shifted from a self-proclaimed success story to a public health catastrophe. Given the so-called hermit kingdom’s notorious secrecy and extremely limited testing capacity, the exact case numbers are impossible to quantify, and these official figures almost certainly represent the low end of the scale.
One thing is certain though: North Korea, one of only two countries in the world along with Eritrea not to have rolled out COVID vaccines, is uniquely vulnerable to a viral outbreak of this calibre. The reality is that there is little to no pre-existing COVID immunity among North Koreans, the BA.2 Omicron variant that was detected in Pyongyang last week is five to six times more transmissible than the original strain found in Wuhan, and the nation’s crumbling public health infrastructure is among the world’s worst.
In the coming weeks and months, experts are worried the situation could spiral into a complete humanitarian disaster.
“You're just looking at a perfect storm: it's like China's COVID zero, except your entire population is extremely compromised and vulnerable and set up for a disaster,” Ethan Jewell, a Seoul-based data correspondent with outlet NK News, which provides news and analysis about North Korea, told VICE World News.
“People are not vaccinated, people are in poor health, and the government doesn't seem to have a responsible approach to prevent all this to begin with.”
How did we get here?
While global pundits continue to question whether these are in fact North Korea’s first cases of COVID, it remains unclear how this particular strain entered and spread through the country in the first place. The nation was one of the first to seal its foreign borders in January 2020 and grind international trade to a standstill—including with primary patron China—while even before the pandemic, citizens within North Korea were subject to severe movement restrictions.
The prevailing theory seems to be that the virus did in fact cross the border from northeastern China, which in recent months has been ravaged by its own biggest outbreaks to date. Though trade between the two nations was abruptly suspended in early 2020, there have been multiple reports of people illegally moving back and forth across sections of the 880-mile border—marked by a river that in some areas is only a few metres wide—smuggling goods in a bid to provide essential resources to impoverished and famished North Korean communities.
Several experts have suggested that these smuggling networks may have funnelled the virus into North Korea by creating a porous border and facilitating transnational contact.
Some have further pointed to a recent, potential superspreader event—a military parade held in Pyongyang on April 25 to celebrate the 90th anniversary of the founding of the army. It was attended by several thousand unmasked people, including numerous soldiers who have since tested positive.
“You have tens of thousands of people in one spot, some units flown in from other parts of the country, maybe some from the border regions as well, where smuggling does happen,” Jewell noted. “It's very possible that units from the northern border regions came into contact with someone who had come into contact with the smugglers, and then they went down into Pyongyang and marched in this giant condensed military formation smack in the middle of the city.”
“I think it's fair to say that the timing seems like more than a coincidence.”
Hong Min, a researcher at the Seoul-based Korea Institute for National Unification, also told AFP the current COVID outbreak is “closely linked to the April 25 parade.”
That seems to square with revelations on Friday from North Korea’s international broadcasting service, the Voice of Korea, which indicated that an “obscure febrile disease has been explosively spread and expanded on a nationwide scale since late April, producing more than 350,000 persons in a fever in a short time.”
What’s happening on the ground?
That number has tripled over the weekend—and North Korea’s public health services are already seemingly crumbling under the weight of the rapidly escalating outbreak, according to reports emerging from the country.
The official Korean Central News Agency (KCNA) reported on Monday that Kim Jong Un scolded officials for failing to deliver medicine to people in time, despite “an emergency order to immediately release and timely supply the state reserve medicines” and an “order for all pharmacies to switch over to the 24-hour operation system.”
Kim subsequently called for the mobilisation of military personnel from the People's Army to stabilise the supply of medicine in Pyongyang, accusing the public health sector of not having “rolled up their sleeves” or “properly recognizing the present crisis.”
“In the city you have a very big general hospital… but if you go deep inside the villages, they barely even have clinics. It's just a very mixed picture. But the [strained] medical system, and the shortage of medicines, is obvious.”
In truth, though, North Korea’s health infrastructure is under-resourced, under-supplied, and severely unequipped to deal with a mass outbreak of COVID-19.
Dr Sojin Lim, senior lecturer in North Korean Studies at the UK’s University of Central Lancashire, told VICE World News about reports of surgeries being performed without anaesthesia and cannabis being administered for pain relief. Jewell similarly cited cases of patients having to buy their own medicine on the black market and then pay someone to administer it for them—or just administer it themselves
The further into the countryside one goes, Lim added, the worse the problem gets.
“In the city you have a very big general hospital… but if you go deep inside the villages, they barely even have clinics,” said Lim. “It's just a very mixed picture. But the [strained] medical system, and the shortage of medicines, is obvious.”
Combine that with the country’s lack of COVID-19 vaccines and treatment drugs, an inability to perform mass-testing, and a population that is already famished and malnourished as a result of a faltering, isolated economy that has only worsened during the pandemic, and conditions seem primed for fatalities to skyrocket.
“I imagine that you're going to see higher death rates than in other countries, simply because one: no one's vaccinated, and two: health overall is poorer in North Korea than it is in most of the rest of the world,” said Jewell. “You're looking at an existential crisis for some portions of the population.”
Until last week, North Korea appears to have had all its eggs in a single basket, banking on a “zero COVID” strategy that sought to completely prevent a viral outbreak while neglecting to pursue any preemptive measures that might mitigate the damage if that failed. Most crucially, this saw the Kim regime refusing multiple offers of vaccines from the outside world, pledging instead to fight the pandemic in “our style.”
In September, UNICEF, which manages the global supply of COVID vaccines as part of the COVAX program, claimed that the North Korean government rejected roughly 3 million doses of China’s Sinovac vaccine, offered at no cost, saying they should be sent to severely affected countries instead. It also rejected 2 million doses of AstraZeneca, due to apparent concerns about potential side effects.
But attempts to sever all contact with the outside world have also had a devastating impact on North Korea’s economy and food stocks, as supplies from neighbouring countries like China have dried up and fuel shortages have forced agriculture workers to farm their land manually. In April, Daily NK cited reports from multiple North Korean civilians claiming that people were starving to death in their homes, “dying one after the other,” or begging for food “only for smoke to stop rising from the chimneys of their homes a short time later.”
“It’s nothing short of a disaster,” said Jewell. “[The North Korean government] have spent years under the impression that they could keep this thing out, they spent millions and millions of dollars to construct these disinfection centres along the border so that they could disinfect goods, and that didn't seem to do them a lot of good in the long run, mainly because they neglected to vaccinate their people.”
“So basically what you're looking at is now a situation where they deprived themselves of meaningful local trade for years. And now you're going to have a major shock to the country.”
What could come next?
It’s difficult to tell how the situation is going to unfold, and it’s fair to assume that some shade of murkiness is likely to remain given the nation’s reputation for clandestinity. The case numbers are almost certainly much higher than what is currently being reported, and expert fears of a mass death event are plausible, given the already volatile health situation inside the country.
Jacob Lee, professor of infectious diseases at South Korea’s Hallym University Kangnam Sacred Heart Hospital, compared the situation to early-days Wuhan, China—where the virus was first detected in December 2019.
“You can think of what happened in Wuhan when it first broke out, when no one had been infected before. But what’s spreading in North Korea now is five to six times more transmissible than the one in Wuhan,” he told VICE World News last week. “The infection rate will be rising fast. No North Korean is immunised and well-nourished, so it’ll probably result in mass death.”
“The entire city of Pyongyang is basically under complete lockdown; no one's allowed to leave, people aren't even allowed to get near a bird [or] pick up trash off the ground. It's pretty extreme.”
One point of curiosity among experts is whether the deteriorating situation will weaken or embolden North Korea’s lone wolf stance when it comes to global relations; whether it will prompt them to relax their position and accept aid from the outside world, or reaffirm their geopolitical isolationism.
“If the positive cases increase, then eventually they will have no options but to open and bring in the vaccines and the medical teams coming in as humanitarian aid,” said Lim. “People already are suffering and the government can't help the people itself. So North Korea will not be able to keep this locked down for a long time.”
Jewell, however, disagrees, pointing to the great famine of the 1990s—the last time North Korea faced a national disaster of this scale, when up to 3.5 million people starved to death between 1994 and 1998 due to economic crisis—as an example of the government’s unwillingness to accept external aid even in catastrophically dire straits.
“It was only when literally millions of people were dying that the leadership finally admitted its fault in all of this and opened up its borders to external aid,” he said. “The entire city of Pyongyang is basically under complete lockdown; no one's allowed to leave, people aren't even allowed to get near a bird [or] pick up trash off the ground. It's pretty extreme… they're telling their citizens you can't even catch fish in the ocean because it might be contaminated with COVID.”
Even before the pandemic, failed rains and poor harvests in 2019 meant food supplies were running low, while flows of international aid into the country have steadily dropped over the past decade as relations between Kim Jong Un’s regime and the international community have grown only more tense over the country’s nuclear weapons programme.
A diplomatic source privy to details of Pyongyang-Beijing relations revealed on Sunday that North Korea had used its diplomatic channel to reach out to China for COVID-19 supplies and equipment, and that talks between the two sides were ongoing, according to Yonhap News Agency—although it wasn’t immediately clear what specifically Pyongyang was requesting.
This call for help will be made with some reluctance. While China remains North Korea’s primary patron—representing 90 percent of its total trade volume prior to the pandemic, and a lifeline for its otherwise totally isolated, sanction-hit economy—relations have become strained in recent years due to Kim’s provocative nuclear stance and unwillingness to cooperate with Beijing on the issue.
One thing experts seem to agree on is that, in lieu of an effective public health system or a mass vaccination program, North Korea is likely set to use hardfisted lockdowns as a way to curb the spread of the virus. Whether they’ll have the intended effect remains to be seen.
In any case, things will almost definitely get worse before they get better.
“Kim Jong Un is probably going to be fine, and the elites of Pyongyang are probably going to do just fine. But it wouldn't be the first time that Pyongyang has protected itself and not protected the rest of the country,” said Jewell.
“All around it's not good news for North Koreans. I think that kind of goes without saying.”
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