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In the few days since North Korea made the unprecedented admission of its first ever Covid-19 infection, the reclusive regime’s tally of “fever” cases has skyrocketed beyond 1.4 million, and the known death toll hit 56.
The sense of crisis has been underscored by Pyongyang’s rare willingness to publicly acknowledge any sign of weakness, with leader Kim Jong-un describing the outbreak as the “greatest turmoil” to befall the country since its founding more than 70 years ago.
The North’s extreme isolation – compounded by the exit of international diplomats during the pandemic – make it difficult to assess the true scale of the public health emergency, but outside experts warn that the impoverished nation could be facing a major humanitarian crisis that could spill beyond its borders.
“I don’t think we know the full extent of the problem. Without diagnostics and complete reporting, we are seeing the tip of the iceberg,” said Dr Jerome Kim, director general of the International Vaccines Institute in Seoul, South Korea.
But the country’s lack of prior exposure to Covid-19 and failure to vaccinate its 26-million-strong population pointed to a bleak outcome, he warned.
“We know what happens when Covid-19 hits populations that are naïve and lack the ability to socially distance and appropriately treat. It is a grim scene replayed too frequently in this pandemic,” he said.
North Korea’s high rates of malnutrition also put the population at greater risk of hospitalisation and death, he said.
The warning signs were already clear in 2021 that a mix of international sanctions against Kim’s nuclear missiles programme, pandemic border closures and a 2020 drought followed by typhoon rains were combining to create severe food shortages.
The Food and Agriculture Organisation revealed that as many as 10.9 million North Koreans, or 42.4 per cent of the population, were malnourished between 2018 and 2020.
‘Outbreaks beget variants’
“Covid-19 outcomes could be worse in people whose nutrition is suboptimal,” said Dr Kim.
But the catastrophic impact of the virus may not be confined to the local population, he cautioned.
“We know that outbreaks beget variants, and variants beget outbreaks – so the current outbreak in North Korea is worrisome. The relative isolation of DPRK [North Korea] may temporarily reduce spread to other countries, but for how long?” he said.
North Korea has mobilised its military and turned to promoting natural remedies to Covid-19 as its under-resourced health system struggles to cope.
In an interview on state television on Monday, Kim Hyong Hun, the vice-minister of public health, said the country had switched from a quarantine to a treatment system to handle the hundreds of thousands of suspected “fever” cases reported each day.
The broadcaster showed footage of the hazmat team, and masked workers opening windows, cleaning desks and machines and spraying disinfectant.
In the absence of adequate treatments, hospital beds and medical resources, state media has touted the questionable use of painkillers, antibiotics, gargling salt water and drinking lonicera japonica or willow leaf tea as potential virus remedies.
In recent days, several North Korean aircraft made the first known international flights since March 2020 to neighboring China to collect Covid-19 related supplies, NK News reported on Tuesday.
But the outbreak remains an alarming turn for a country with one of the most fragile public health systems which, even without a deadly pandemic, does not have the capacity to treat the basic medical needs of the population.
Kim’s regime has been offered but declined multiple opportunities to receive millions of doses of AstraZeneca and Sinovac vaccines via the WHO-led Covax programme, and separately from Russia. It has yet to respond to an offer of urgent assistance from Seoul this week.
Until last week, Pyongyang thought it could contain the spread through tight controls of its border. Analysts have warned that even the authoritarian regime will now need to contain the political fallout from these decisions.
Suspicion that an April 25 military parade may have been a superspreader event was compounding the pressure, particularly as Kim was leaning more heavily on shows of military strength for political legitimacy during the North’s pandemic isolation, said Leif-Eric Easley, a professor at Ewha University in Seoul.
“North Koreans are left to fight Covid without vaccines, adequate testing and modern treatments. Nuclear or missile tests won’t stop the coronavirus or put food on the table,” he said. “The Kim regime isn’t about to face a domestic reckoning, but the costs of its poor strategic decisions are mounting.”
However, North Korea has weathered severe natural catastrophes in the recent past. Experts suggest as many as 2 million died during a devastating famine in the 1990s.
John Delury, a professor at Seoul’s Yonsei University, said it was “premature” to discuss “regime collapse” during the current crisis but added that it would still present a problem for Kim that would “test his political skills.”
“He does get blamed even if people don’t say it publicly. So, there need to be scapegoats,” he said. “If he goes the whole thing goes so, he needs to be protected. I would expect them to be working on how this is not his fault and how do we acknowledge that it’s gotten bad?”
He added: “I think he is going to do what every leader has done throughout Covid which is to try to position themselves on the side of the solution, not the problem.”
All indications point to North Korea’s long-suffering citizens once again being the biggest victims of the failed policies of a dictatorial regime.
“It’s quite distressing how bad it could get for the average North Korean family and it's pretty scary to contemplate that,” said Mr Delury.
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