“North Koreans call it the rubber band statistic,” he said, nodding to the truth in the direction of Pyongyang’s flexibility. “Even North Korea finds it hard to know its own numbers.”
He speaks with some authority. Choi worked as a doctor in North Korea for over 10 years, specializing in infectious diseases, before he left his native country in 2011.
He remembers the 2002-2004 SARS outbreak, when he said hundreds of people in the northeastern city of Chongjin, where he worked, began to die after reporting “cold or flu symptoms.”
Doctors like Choi could only secretly suspect that SARS was to blame. In North Korea, it was not possible to test for the disease, so not a single case of infection was officially recorded. Neighboring China has reported more than 5,000 cases and hundreds of deaths.
Choi also remembers battling a nationwide measles outbreak in 2006 with nothing but a thermometer; and the 2009 influenza pandemic, when “even more people died than during SARS” — the situation was exacerbated by a severe shortage of medicines.
During previous epidemics, Choi explains, there was never an incentive for local officials to go door to door to accurately count cases—they didn’t have masks or gloves and assumed the regime would process the statistics to suit its needs.
He suggests 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 in North Korea, one of the biggest problems with the country’s Covid outbreak is that Pyongyang’s penchant for secrecy makes it difficult to accurately assess its severity.
International non-governmental organizations and most foreign embassies have long since left the country, and tightly closed borders mean access is impossible, making the reports of defectors like Choi all the more important.
The incredibly low official death toll in the country is reportedly inevitably raising suspicions that Pyongyang is trying to cover up a bigger problem.
“I have a few questions,” South Korean Unification Minister Kwon Yong-seo pointedly said last week, noting that the story being circulated by state media in the North contrasted sharply with the experience of the rest of the world.
New variants of Covid, cholera?
At first, the biggest fear was that an outbreak in an unvaccinated, undernourished population with primitive medical care would have catastrophic consequences.
Thomas Ohea Quintana, the UN special rapporteur on human rights in North Korea, said it is not possible to know the extent of the outbreak at this time, although he has heard unconfirmed reports of the deaths of the elderly and malnourished children.
“At least in my position, I cannot counter this 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 fears that new, possibly more dangerous variants could emerge from uncontrolled transmission through North Korea’s population of about 25 million.
Dr. Key B. Park, American neurosurgeon, before the pandemic visited North Korea twice a year to work alongside North Korean counterparts, training them and conducting operations, said the country seemed unwilling to share information and it was “not good for them (and) it’s bad for the rest of the world.” “
“We need to share information about any new changes in the characteristics of the virus, such as mutations,” he said.
“We have to be aware of the fact that high replication can lead to new variants. The only way to discover this is to share information with each other.”
In June, North Korea said it was experiencing an outbreak of an unidentified intestinal disease in South Hwanghae province, about 75 miles (120 km) south of the capital Pyongyang.
At the very least, this announcement demonstrated the country’s vulnerability to disease outbreaks and drug shortages.
Park thinks North Korea is probably dealing with an outbreak of typhoid or cholera.
“Somewhere, for example, in North Korea, you can expect a high level of infectious diseases. In fact, for children under 5 years of age, diarrheal disease is the number one killer.”
Ray of hope?
One ray of hope for the Park was the country’s ability to rapidly vaccinate its population, which was demonstrated during a nationwide immunization program during the 2006 measles outbreak.
“In 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 conditions are met, based on these numbers, they can vaccinate the entire population for at least the first injection in eight days.”
But any optimism is tempered by the unwillingness of the country, sometimes called a “hermit nation”, to accept outside help.
“They are socialized out of scarcity,” Park said. “They struggled to supply hospitals with some of the things we take for granted,” he recalled of his work in the countryside, saying that surgeons would reuse equipment such as scalpels until they became blunt. and unusable.
Offers of assistance from the UN, the US, South Korea and other countries were ignored.
However, some aid entered 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 kg of unspecified vaccines.
The Gavi Global Vaccine Alliance said last month that it understood North Korea had received Covid vaccines from China and started administering doses.
A Gavi spokesperson told CNN that North Korea “still hasn’t made a formal request to COVAX for vaccine support, but we’re still ready to help if they do.”
The isolation of Covid patients in the country is evidenced by recent attempts by a group of defector activists to smuggle medical supplies across the demilitarized zone – the de facto border between North and South Korea.
The North Korean Liberation Fighters said they sent large balloons across the border filled with medical supplies such as Tylenol and vitamin C in June, and in late April some of them carried anti-regime leaflets.
These hot air balloon rides are against the laws of South Korea and are discouraged. Unification Minister Kwon told reporters that he understands “the sentiment of such organizations, but I think they should refrain.”
Famine and the second “difficult march”
Meanwhile, illness – whether it’s Covid or something else – may not be the biggest problem facing North Koreans.
One 44-year-old defector living in South Korea said she was contacted by her family in the north shortly after the outbreak was reported. Conversely, when it came to Covid, they were most concerned about her — a reflection of Pyongyang’s considerable propaganda prowess.
“They said [North Korean television had] reported that many people in South Korea were dying from Covid, so they were worried about me,” she said. “They didn’t really care about the virus.”
However, her family was extremely worried about the lack of food.
“They told me that the food situation was worse than during the Hard March in the 1990s … I am very worried knowing how difficult things were (then).”
The arduous march dates back to a period of devastating famine when North Korea’s economy was hit hard by the collapse of the Soviet Union, which cut off aid to the country.
It is estimated that hundreds of thousands of people, or up to 10% of the country’s population, died of starvation. According to some estimates, the death toll is even higher.
The defector did not ask her family if anyone was dying of starvation, as she never talks about anything political during these rare contacts with her family. The likelihood that the authorities might be eavesdropping is too high. She asked CNN not to give her name in case her family faces retaliation.
But Quintana, the UN special rapporteur, said the danger is very real, and that he urged the Kim regime and others associated with North Korea to “basically understand that there is a serious risk of starvation in North Korea.”
Another question is whether Kim will listen.
State television covered the North Korean leader’s trip to pharmacies, orders to his military to stabilize medical supplies, and even the donation of some of his personal medical supplies last month to fight an as-yet unidentified intestinal outbreak.
For Choi, a doctor who fled North Korea in 2011, such images are to be expected when the truth is treated like a rubber band. He said it was a show and nothing more.
“The North Korean authorities are not fighting, the citizens of North Korea are having a hard time … if you survive, that’s great, but there’s nothing we can do if you die.”