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What you need to know about the covid crisis hitting North Korea

Workers disinfect a Pyongyang railway station in a photo released on May 18. (Korean Central News Agency/AFP/Getty Images)

SEOUL — The coronavirus pandemic has finally penetrated North Korea, an impoverished country with a fragile health-care system and no vaccine program.

If the figures are accurate, the country appears to be experiencing the beginnings of the disaster that the rest of the world faced in early 2020: a national health crisis that will quickly overwhelm a health-care system already under duress, with the most vulnerable people at greatest risk of death. North Korea is one of two countries in the world that has no coronavirus vaccines after twice refusing shipments from Covax, the U.N.-backed initiative providing doses to countries that need them.

Here’s what to know about covid and health care in North Korea.

The spread of covid in North Korea

On May 12, North Korea reported its first covid outbreak of an unspecified number of BA.2 omicron subvariant cases. Until then, North Korea had maintained it had no positive cases, though many experts doubted the veracity of that claim.

The illness seems to have since spread rapidly, surging to more than 1.7 million suspected cases, according to state media on Wednesday. North Korea calls the cases “fever,” an apparent euphemism for covid-19, as it probably lacks the capacity for proper diagnosis because of a shortage of test kits.

William Hanage, co-director of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health, said that firm estimates for BA.2 death rates had not been established, but that they appeared to be close to that of the original virus that struck in 2020. The fatality rate then was roughly 0.5 percent, which would translate to 125,000 people in North Korea.

“This notion that omicron is mild is false; what we are seeing is that people who are vaccinated have much reduced risk of severe disease and death,” Maria van Kerkhove, the World Health Organization’s leader on covid-19, said in a briefing Tuesday. “That narrative is really deadly because people think they are not at risk.”

So far, North Korea’s reported fatalities are far below the rough estimate. At least 61 “fever” patients have died as of Wednesday, including from related issues like medical negligence and complications from drug usage.

North Korea’s population is about 25 million and relatively young, with a median age of around 35, so it would be less likely to experience the level of serious illness and death seen in countries with older populations.

Still, global health experts worry about the emergence of a new variant from North Korea. “Where there is unchecked transmission there is always a higher risk of new variants,” the WHO’s director of health emergencies, Michael Ryan, said at the Tuesday briefing when asked about North Korea.

North Korea admits to coronavirus outbreak for the first time

Malnutrition and poor sanitation

Outside the country’s privileged capital of Pyongyang, residents suffer from chronic malnutrition, and about 40 percent of its population is considered malnourished, according to the United Nations and UNICEF.

In 2020, the U.N. estimated that about one-third of North Korea’s population has “limited access to adequate health services.” Though access to water, sanitation and hygiene services differ between rural and urban areas, there is generally poor access to such services everywhere, and in 2020, the U.N. estimated that one-third of North Koreans also lack access to clean drinking water.

Challenges in health-care delivery

North Korea claims it has free health-care services for all citizens, but in reality, that applies just to the wealthy and elite in Pyongyang because of a chronic lack of medical supplies and infrastructure in the country.

Coronavirus cases, deaths in North Korea surge as Kim blames officials

Other than certain hospitals in Pyongyang, most hospitals in North Korea are poorly equipped and lack a reliable supply of electricity and heating. As a result, many North Koreans turn to informal health-care practitioners who operate illegally at their homes or to black-market medicine sellers.

In the wake of the covid outbreak, leader Kim Jong Un mobilized medical units of his military to distribute medicines to pharmacies with 24-hour availability, but the reach of his order was limited to pharmacies in Pyongyang.

North Korea’s health-care system also faces logistical and systemic problems, including an ill-defined intensive care system and a lack of emergency transportation systems, said David Hong, a pediatric neurosurgeon who last visited North Korea on a humanitarian trip in November 2019.

International sanctions have limited North Korea’s ability to repair and obtain new parts for machines, keeping it from producing its own medical supplies, Hong said.

In a 2021 report to the U.N., North Korea said it struggles with the “lack of the capacity of health personnel, low technical foundation of pharmaceutical and medical appliance plants and shortage of essential medicines.” The country added that some of its pharmaceutical, vaccination and medical appliance plants do not reach the manufacturing standards of the WHO and aren’t sufficient for local demand.

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Lack of access to medicines, supplies

North Korea had a shortage of medicine even before its border closure in 2019 because of dwindling funds from donors to the agencies procuring medicine and sanctions that limited local production, said Nagi Shafik, former manager at the WHO office in Pyongyang, who was last there in May 2019.

The country’s most urgent needs are test kits, personal protective equipment and medication — particularly, the anti-viral medicines used to treat covid-19, he added.

Hong said North Korea probably will not be able to ramp up production of such supplies, which will limit the country’s ability to contain outbreaks and leave health-care workers vulnerable.

“This could potentially be very catastrophic for the North Korean people,” Hong said. “And with limited communications with experienced physicians, they will need to determine appropriate treatment paradigms on their own for what has been a new and difficult-to-manage illness for most of the world.”

Planes from North Korea’s Air Koryo flew to the Chinese city of Shenyang on Monday to pick up medical supplies, according to local media reports. China’s Foreign Ministry did not confirm the reports but said it is willing to help North Korea battle covid.

Food shortages and at-home cures

Kim has restricted travel around the country, and the response is being handled at the “inminban” level, in which small groups of neighbors monitor one another’s activities, said Jiro Ishimaru, founder of the Japan-based news service Asia Press’s Rimjingang, which has informants in North Korea.

State media outlets have emphasized at-home treatments. In a story titled “How to treat fever patients,” official Rodong Sinmun recommended “Korea-style treatment” for patients with light symptoms. One of the suggested remedies was brewing willow leaves in hot water and drinking it three times a day.

North Korea heads into ‘tense’ winter: Closed borders and food supplies in question

In the past week, Ishimaru said, sources in the border region said they were worried about the spread of covid, especially during rice-planting season when there is high demand for work, and about a dwindling supply of rice harvested in the fall.

Those who have “fever” are required to isolate at home and treat themselves, without a clear way to access food — increasing fears of people starving to death in quarantine, Ishimaru said. Residents fear citywide and countywide lockdowns, similar to those Shanghai, with no access to food, he said.

“Since the beginning of covid, [cross-border] trade was stopped and the flow of medication halted. The entire medical system has collapsed,” Ishimaru said. “People are risking death because they can’t access medication. This is a man-made crisis. The most important thing for North Koreans right now is access to food.”

Adam Taylor in Washington contributed to this report.

Coronavirus: What you need to know

Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot. New federal data shows adults who received the updated shots cut their risk of being hospitalized with covid-19 by 50 percent. Here’s guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.

New covid variant: The XBB.1.5 variant is a highly transmissible descendant of omicron that is now estimated to cause about half of new infections in the country. We answered some frequently asked questions about the bivalent booster shots.

Guidance: CDC guidelines have been confusing — if you get covid, here’s how to tell when you’re no longer contagious. We’ve also created a guide to help you decide when to keep wearing face coverings.

Where do things stand? See the latest coronavirus numbers in the U.S. and across the world. In the U.S., pandemic trends have shifted and now White people are more likely to die from covid than Black people. Nearly nine out of 10 covid deaths are people over the age 65.

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