“The North Koreans call it elastic statistics,” he said, in a nod to Pyongyang’s flexibility with the truth. “It’s even difficult for North Korea to know its own numbers.”
He speaks 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.
He recalls the SARS outbreak of 2002-2004, when he says 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 privately suspect that SARS was to blame. North Korea did not have the capacity to test for the disease, so it has not officially recorded any infections. Its neighbor China has reported more than 5,000 cases and hundreds of deaths.
Choi also remembers dealing with a nationwide measles outbreak in 2006, armed only with a thermometer; and an influenza pandemic in 2009 in which even “more people died than during SARS” – a situation made worse by an acute shortage of drugs.
In previous outbreaks, Choi says, local officials were never encouraged to go house to house to accurately count cases — they had no masks or gloves and they thought the statistics would be manipulated by the regime. to meet his needs.
He assumes that little has changed since he left and that history, if not repeating itself exactly, at least rhymes.
What is North Korea hiding?
As with past outbreaks in North Korea, one of the biggest concerns about the country’s Covid outbreak is that Pyongyang’s penchant for secrecy makes it difficult to accurately assess its severity.
International NGOs and most foreign embassies have long since left the country and tightly sealed borders make access impossible, making the testimonies of defectors like Choi all the more important.
The incredibly low official death toll reported by the country inevitably raises suspicions that Pyongyang is trying to hide a bigger problem.
“I have a few questions,” South Korea’s Unification Minister Kwon Young-se said last week, noting that the story peddled by northern state media stood in stark contrast to the experience of the rest. of the world.
New variants of Covid, cholera?
The biggest fear at the outset was that an outbreak in an unvaccinated and malnourished population with primitive health care would be catastrophic.
Tomas Ojea Quintana, UN special rapporteur for human rights in North Korea, said it was impossible at this time to know the extent of the outbreak – although he had heard reports un confirmed reports of deaths among the elderly and malnourished children.
“At least in my position, I am not able to contrast this fear that we had at the beginning of 2020 about the catastrophic consequences of Covid in (North Korea) and its current situation.
There are also concerns that new, possibly more virulent, variants could emerge from uncontrolled transmission through North Korea’s population of around 25 million.
Dr. Kee B. Park, an American neurosurgeon who until the start of the pandemic had visited North Korea twice a year to work alongside his North Korean counterparts, train them and perform surgeries, said the country seemed unwilling to share information and it was “not good for them (and) it’s not good for the rest of the world.”
“We need 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 that high replication can lead to new variants. The only way to detect this is to share information with each other.”
In June, North Korea said it was experiencing an outbreak of an unidentified bowel disease in South Hwanghae province, about 120 kilometers south of the capital Pyongyang.
At the very least, the announcement demonstrated the country’s vulnerability to epidemics and its lack of medicine.
Park thinks North Korea is likely struggling with an outbreak of typhoid fever or cholera.
“Somewhere like North Korea, you can expect high rates of infectious disease. In fact, for children under 5, diarrheal diseases are the leading cause of death.
A glimmer of hope ?
A glimmer of hope for Park was the country’s ability to quickly vaccinate its population – demonstrated during its nationwide inoculation program for the 2006 measles outbreak.
“Cycle one, they were averaging one million injections a day, and then cycle two, later in 2007, they were averaging over 3 million injections a day,” Park said.
“If all the conditions are met, based on these numbers, they can vaccinate the entire population at least for the first vaccine in eight days.”
But any optimism is tempered by the reluctance of a country sometimes described as a “hermit nation” to accept outside help.
“They’re socialized for scarcity,” Park said. “They struggled to provide hospitals with some of the things that we take for granted,” he recalls from his time working in the country, saying surgeons reused equipment such as scalpels until they are blunt and unusable.
Offers of aid from the United Nations, the United States, South Korea and others have all been ignored.
Some help, however, has made its way into 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.
Global vaccine alliance Gavi said last month it understood North Korea had accepted Covid vaccines from China and had started administering doses.
A Gavi spokesperson told CNN that North Korea has “still not submitted a formal request to COVAX for vaccine support, but we remain ready to help them if they do.”
The isolation of people with Covid in the country has been highlighted by recent attempts by a group of defector activists to send medicine across the demilitarized zone – the de facto border between North Korea and South Korea.
The Fighters to Free North Korea said it sent large balloons carrying medical supplies such as Tylenol and vitamin C across the border in June, as well as some carrying anti-diet leaflets in late April.
These hot air balloon flights are against South Korean law and have been discouraged. Unification Minister Kwon told reporters he understood “the feelings of these organizations, but I think they should refrain.”
Famine and a second “Hard March”
Meanwhile, disease — whether Covid or otherwise — may not be the biggest problem facing North Koreans.
A 44-year-old defector, who lives 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 it – 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 weren’t very concerned about the virus.”
However, what worried her family the most was the lack of food.
“They told me that the food situation was worse than during the arduous March of the 1990s… I am very worried about how difficult things were (back then).”
The Arduous March refers to a period of devastating famine when North Korea’s economy suffered a hammer blow following 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, died of starvation. According to some estimates, the death toll is even higher.
The defector did not ask her family if anyone was starving because she never talks about anything political during these rare contacts with her family. The possibility that the authorities will listen is too great. She asked CNN not to be identified in case her family faces reprisals.
But Quintana, the UN special rapporteur, said the danger was very real and he urged the Kim regime and others involved in North Korea “to fundamentally understand that there is a serious risk of starvation. in North Korea”.
Whether Kim is likely to listen is another matter.
State television covered the North Korean leader on a tour of pharmacies, ordering his army to stabilize medical supplies and even donated some of his private medical supplies last month to fight the yet unidentified gut outbreak. .
For Choi, the doctor who fled 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 says.
“The North Korean authorities are not struggling, it’s the North Korean citizens who are struggling…if you survive that’s great, but we can’t do anything if you die.”
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