Widespread disbelief at North Korea’s tiny COVID death toll

A teacher takes a schoolgirl’s body temperature to stem the spread of the coronavirus before entering Kim Song Ju Elementary School in the Central District in Pyongyang, North Korea, on October 13, 2021. 19 was impressive: about 3.3 million people were reported sick with fever, but only 69 died. Credit: AP Photo/Cha Song Ho, File

According to North Korea, its fight against COVID-19 was impressive: About 3.3 million people were reported to have contracted a fever, but only 69 died.

If all are coronavirus cases, that’s a 0.002% fatality rate, something no other country, including the world’s wealthiest, has matched against a disease that has killed more than 6 million people.

But the North’s claims are met with widespread doubt about two weeks after it acknowledged its first domestic COVID-19 outbreak. Experts say the impoverished north should have suffered far more deaths than reported due to very few vaccines, significant numbers of malnourished people and a lack of critical care facilities and testing kits to detect virus cases in large numbers.

North Korea’s secrecy makes it unlikely that outsiders can confirm the true extent of the outbreak. Some observers say North Korea underreports deaths to protect leader Kim Jong Un at all costs. There is also a possibility that the outbreak was exaggerated to tighten control over the 26 million people.

“Scientifically, their numbers cannot be accepted,” said Lee Yo Han, a professor at Ajou University Graduate School of Public Health in South Korea, adding that the public data “probably were all controlled (by the authorities) and embedded in theirs political intentions.”

The most likely path is that North Korea will soon announce victory over COVID-19, perhaps during a political meeting in June with full credit to Kim’s leadership. Observers say the 38-year-old ruler is desperate to garner greater public support as he grapples with severe economic difficulties brought on by border closures, UN sanctions and his own mismanagement.

“Various public complaints have been piling up, so it’s time to (strengthen) internal control,” said Choi Kang, president of the Asan Institute for Policy Studies in Seoul. “Kim Jong Un has taken the lead in efforts to fight the epidemic to show his campaign is very successful and to strengthen his position of power.”

Before admitting an Omicron outbreak on May 12, North Korea had maintained a widely disputed claim that there had been no native infections in more than two years. When the North finally made the outbreak public, many wondered why now.

It was initially seen as an attempt to exploit the outbreak to secure foreign humanitarian aid. There were hopes that possible help from Seoul and Washington could help restart long-stalled diplomacy on Pyongyang’s nuclear program.

Kim has described the outbreak as a “great upheaval” and launched what his propaganda teams are calling an all-out effort to quell it.

He has held several Politburo meetings to criticize officials, inspected pharmacies at dawn and mobilized troops to help deliver medicines. A health official explained responses to the pandemic on state television, while state newspapers ran articles on how to manage fevers, including gargling with salt water and drinking honey or willow leaf tea.

Widespread disbelief at North Korea's tiny COVID death toll

An employee at Pyongyang’s dental hygiene products factory disinfects the floor of a dining room as the state stepped up measures to curb the spread of disease May 16, 2022 in Pyongyang, North Korea. According to North Korea, its fight against COVID-19 has been impressive: about 3.3 million people were reported to have contracted a fever, but only 69 died. Credit: AP Photo/Cha Song Ho, File

“Honey is a rarity for ordinary North Koreans. They probably felt bad when their government asked them to drink honey tea,” said Seo Jae-pyong, a North Korean defector-turned-activist in Seoul. “I have an older brother in North Korea and I’m very worried about him.”

Every morning, North Korea releases details about the number of new patients with symptoms of fever but not with COVID-19. Experts believe most cases should be counted as COVID-19 because, while North Korean health officials don’t have diagnostic kits, they still know how to distinguish symptoms from fevers caused by the other common infectious diseases.

North Korea’s daily fever count hit nearly 400,000 early last week; it has fallen to around 100,000 in the past few days. Another death was added on Friday after three consecutive days of no deaths being reported.

“Our country has set a world record for not having a single (COVID-19) infection for the longest period of time… and we have now managed to reverse the tide of the abrupt outbreak in a short period of time,” lead actor Rodong Sinmun told Das the newspaper on Thursday with “This obviously proves the scientific nature of our country’s emergency response measures to combat the epidemic.”

Medical experts question the validity of North Korea’s reported 0.002% death rate. Given that South Korea’s unvaccinated mortality rate for the Omicron variant was 0.6%, North Korea must have similar or higher mortality rates due to its low capacity to treat patients and the poor nutrition of its population, said Shin Young-jeon, professor of Preventive Medicine at Hanyang University in Seoul.

In a study released last year by Johns Hopkins University, North Korea ranked 193rd out of 195 countries for its ability to cope with an epidemic. UN reports in recent years indicated that around 40% of the population was malnourished. North Korea’s free socialist public health system has been in shambles for decades, and defectors testify to having bought medicines at markets or elsewhere while in the north.

“North Korea would not care at all about deaths,” said Choi Jung Hun, a defector who worked as a doctor in North Korea in the 2000s. “Many North Koreans have died from malaria, measles, chickenpox and typhoid. There are all kinds of infectious diseases there.”

Choi, now a researcher at an institute in South Korea affiliated with Korea University, said North Korea probably chose to admit to the Omicron outbreak because it sees it as less deadly and more manageable. He surmised that North Korea had devised a scenario to increase and then decrease fever cases in order to bolster Kim’s leadership.

Lee, the Ajou professor, said North Korea may have overstated its past fever cases to give the public “a powerful shock” to rally support for the government, but avoided releasing details of too many deaths to public to fend off riots.

The outbreak could eventually kill more than 100,000 people if people remain unvaccinated and die at the same death rate as South Korea, Shin, the Hanyang professor, warned.

The North Korean outbreak is likely to last several months, said Moon Jin Soo, director of the Institute for Health and Association Studies at Seoul National University. There is an urgent need to send antiviral pills and other essential medicines to North Korea instead of vaccines, which would take at least a few months to roll out, he said.

“North Korea could spend a few more months massaging the stats, but it could also abruptly announce its victory this weekend,” said Ahn Kyung-su, head of DPRKHEALTH.ORG, a website that focuses on health issues in North Korea . “North Korea is always beyond your imagination. It’s hard to predict what they’re going to do, but they have a plan.”

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