Over the weekend, when Kee Park saw the latest figures on what North Korea calls a “malignant fever” sweeping the country, he realized how dark the outlook had become. New cases of the illness—almost certainly COVID-19, caused by the Omicron variant of SARS-CoV-2—appear to be doubling every 2 days in the last significant population in the world, some 25 million people, that has no immunity to the disease from vaccination or infection.
“The outbreak is now nationwide,” says Park, a global health specialist at Harvard Medical School. “We’re looking at a major, major catastrophe.”
Aid agencies are gearing up for a robust response—if North Korea is willing to open its doors. The North Korean government has ignored past offers of COVID-19 vaccines, presumably to avoid international monitoring of vaccine distribution, humanitarian experts who have worked in North Korea say. But they believe the crisis – which North Korea’s leader Kim Jong Un has acknowledged is causing a “great upheaval”—will in the coming days persuade the reclusive nation to request assistance. In the meantime, they are compiling a list of what will be needed to combat the outbreak, which organizations could provide those items, and how to get them into North Korea.
Early in the pandemic, North Korea closed itself off from the world in a bid to keep the virus at bay. That strategy largely succeeded for 2 years, despite occasional reports of possible outbreaks that authorities managed to snuff out. Until last month the country, hampered by shortages of reagents, had tested just 66,000 people for COVID-19 and reported zero cases.
But now the Korean Central News Agency, a government outlet, has reported that new cases of presumptive COVID-19 have skyrocketed from 18,000 on 12 May to 392,920 on 15 May, including several confirmed as caused by the BA.2 Omicron subvariant. Since late April, North Korean health authorities have tallied more than 1.2 million cases of symptomatic illness and 50 deaths, including six children. “That’s 5% of the population with symptoms,” says Park, who directs Harvard’s Korea Health Policy Project and has made more than 20 trips to North Korea since 2007. “And the slope of new cases is on its way up. We’re not anywhere near the plateau.” Assuming a conservative mortality rate from Omicron of 1%, the death toll from the current case number could exceed 12,000, he says.
North Korean officials have ordered a nationwide lockdown that confines people to their homes or workplaces, and students to their dorms. The lockdown has also severed communications between international agencies and local staff. But there’s no doubt that the country is ill-prepared to cope with COVID-19. Going into the pandemic, its health care system ranked 193rd in the world, and it has struggled to combat other infectious diseases such as tuberculosis and maintain food security, a challenge exacerbated by a widespread drought this spring.
If North Korea embraces outside assistance, topping Park’s list as a potential lifesaver is Paxlovid. The antiviral would reduce the number of patients who get seriously ill or die, easing the burden on North Korea’s frail health system, he notes. But it needs to be taken within 5 days of diagnosis, so health workers will have to respond fast to new cases. He and other experts also cite rapid diagnostic tests as a high priority, and food to boost nutritional status—and thus the body’s immune response. “We need to fast track the aid,” Park says.
First, though, North Korea will have to accept it.
Source: Science Mag