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


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SEOUL — The coronavirus pandemic has finally entered North Korea, an impoverished country with a fragile health system and no vaccination program.

If the figures are correct, the country seems to be living the beginnings of the catastrophe that the rest of the world faced in early 2020: a national health crisis that will quickly overwhelm an already strained health system, with the most vulnerable people . at greater risk of death. North Korea is one of two countries in the world without coronavirus vaccines after twice refusing shipments from Covax, the UN-backed initiative providing doses to countries in need. .

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 unknown number of BA.2 omicron subvariant cases. Until then, North Korea had maintained that it had no positive cases, although many experts doubted the veracity of this claim.

The disease appears to have since spread rapidly, reaching more than 1.7 million suspected cases, according to state media on Wednesday. North Korea is calling the cases “fever,” an apparent euphemism for covid-19, as it likely lacks the ability to diagnose properly due to a shortage of test kits.

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

“This notion that the omicron is soft is wrong; what we are seeing is that people who are vaccinated have a significantly reduced risk of serious illness and death,” said Maria van Kerkhove, the World Health Organization’s lead on covid-19, during a briefing on Tuesday. “This narrative is really deadly because people think they’re not at risk.”

So far, reported deaths in North Korea are well below the rough estimate. At least 61 patients with “fever” died on Wednesday, including from related issues such as medical negligence and complications from drug use.

North Korea’s population is around 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 population.

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

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Malnutrition and poor hygiene

Outside the country’s favored capital, Pyongyang, residents are chronically malnourished and around 40% of its population is considered malnourished, according to the United Nations and UNICEF.

In 2020, the UN estimated that around a third of North Korea’s population had “limited access to adequate health services”. Although access to water, sanitation and hygiene services differs between rural and urban areas, access to these services is generally poor everywhere, and in 2020 the UN estimated that one third North Koreans also lacked access to clean water.

The Challenges of Health Care Delivery

North Korea claims to have free health services for all citizens, but in reality this only applies to the wealthy and elite in Pyongyang due to a chronic lack of medical supplies and infrastructure in the country.

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Apart from some 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 operating illegally from their homes or black market drug vendors.

In the wake of the covid outbreak, leader Kim Jong Un mobilized medical units from his army to distribute drugs to 24-hour pharmacies, but the scope of his order was limited to pharmacies in Pyongyang.

North Korea’s healthcare system also faces logistical and systemic issues, including an ill-defined intensive care system and a lack of emergency transport 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, preventing it from producing its own medical supplies, Hong said.

In a 2021 report to the UN, North Korea said it was grappling with “lack of capacity of healthcare personnel, weak technical base of pharmaceutical and medical device factories, and shortage of medicines essential”. The country added that some of its pharmaceutical, vaccination and medical device factories do not meet WHO manufacturing standards and are not sufficient for local demand.

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Lack of access to medicines, supplies

North Korea had a drug shortage even before its border closed in 2019 due to dwindling donor funds to agencies supplying drugs and sanctions that limited local production, said Nagi Shafik, a former director of the bureau. WHO in Pyongyang, who was last there in May 2019.

The country’s most urgent needs are test kits, personal protective equipment and medicines – especially antiviral drugs used to treat covid-19, he added.

Hong said North Korea is unlikely to be able to ramp up production of these supplies, which would limit the country’s ability to contain outbreaks and leave healthcare workers vulnerable.

“It could be very catastrophic for the North Korean people,” Hong said. “And with limited communication with experienced physicians, they will have to determine on their own the appropriate treatment paradigms for what has been a new and difficult to manage disease 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. China’s foreign ministry did not confirm the reports, but said it was ready to help North Korea fight covid.

Food shortages and home remedies

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

State media focused on home treatments. In an article titled “How to Treat Patients with Fever,” official Rodong Sinmun recommended “Korean-style treatment” for patients with mild symptoms. One of the suggested remedies was to infuse willow leaves in hot water and drink them three times a day.

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Over the past week, Ishimaru said, sources in the border region said they were concerned about the spread of covid, especially during the rice planting season when labor demand is high, and the reduced supply of rice harvested in the fall.

Those with “fever” are being told to self-isolate at home and self-medicate, with no clear way to access food – raising fears that people are starving in quarantine, Ishimaru said. Residents fear citywide and countywide lockdowns, similar to Shanghai’s, with no access to food, he said.

“Since the beginning of the covid, [cross-border] trade was halted and the flow of drugs halted. The whole medical system collapsed,” Ishimaru said. “People risk death because they don’t have access to medicine. It 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.


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