“North Koreans call it rubber band statistics,” he said, referring to Pyongyang’s flexibility with the truth. “It’s hard even for North Korea to know their numbers.”
He speaks with some power. Choi was a doctor for more than 10 years in North Korea, specializing in infectious diseases before fleeing his homeland in 2011.
He can remember the SARS outbreak in 2002-2004, when he said hundreds of people in the northeastern city of Chongjin, where he worked, began dying after reporting “cold or flu-like symptoms.”
Doctors like Choi can only secretly suspect that SARS is to blame. North Korea has not had the capacity to test for the disease, so it has not officially recorded any infections. Its neighboring China has reported more than 5,000 cases and hundreds of deaths.
Choi can also remember dealing with a nationwide measles outbreak in 2006, armed only with a thermometer; and the 2009 influenza pandemic in which “more people died than during SARS” – a situation exacerbated by severe shortages of medicines.
Choi explains that in previous epidemics, there was never an incentive for local officials to travel from house to house to accurately count cases — they didn’t have masks or gloves and thought the system would use them to suit its needs.
He assumes that little has changed since his departure and that history, if not exactly repeating itself, is at least a rhyme.
What is North Korea hiding?
As with previous outbreaks in North Korea, one of the biggest concerns surrounding the country’s COVID-19 outbreak is that Pyongyang’s penchant for secrecy makes it difficult to accurately gauge its severity.
International NGOs and most foreign embassies have long left the country and tightly closed borders mean access is impossible, making the calculations of dissidents 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 larger problem.
“I have a few questions,” South Korean Unification Minister Kwon Young-se said clearly last week, noting that the story peddled by North Korea’s state-run media contrast sharply with the experience of the rest of the world.
New variants of the covid virus, cholera?
The biggest fear at first was that an outbreak of the disease among an unvaccinated and malnourished population with rudimentary health care would be disastrous.
Thomas Ojea Quintana, the UN special rapporteur on human rights in North Korea, said that knowing the scale of the outbreak is currently impossible – although he has heard unconfirmed reports of deaths among the elderly and malnourished children.
“At least in my position, I am not able to compare this fear we had at the beginning of 2020 about the catastrophic consequences of Covid in (North Korea) and the current situation.”
There are also fears of new, and possibly more virulent, variants of unchecked transmission across North Korea’s population of about 25 million.
Dr. KP Park, an American neurosurgeon Until the epidemic started He visited North Korea twice a year to work alongside his North Korean counterparts, train them and perform surgeries, and said the country seemed unwilling to share information and that “it was not good for them (and) not good for the rest of the world.”
“We have to share information about what kind of new changes in the characteristics of the virus, for example, mutations, right,” he said.
“We need to be aware of the fact that high repetition can lead to new variants. The only way to find out is to share the information with each other.”
In June, North Korea said it was experiencing an outbreak of an unidentified intestinal disease in South Hwanghae Province, about 75 miles (120 kilometers) south of the capital, Pyongyang.
At the very least, the announcement showed the country’s vulnerability to disease outbreaks and drug shortages.
Park believes North Korea may be dealing with an outbreak of typhoid or cholera.
“Somewhere like North Korea, you can expect high rates of infectious diseases. In fact, for children under the age of five, diarrheal diseases are the number one cause of death.”
Gleam of hope?
One glimmer of hope for Park was the country’s ability to vaccinate its population quickly – and that was shown during the national vaccination program for the 2006 measles outbreak.
“In the first cycle, they averaged 1 million shots per day, and then in the second cycle, later in 2007, they averaged over 3 million shots per day,” Park said.
“If all conditions are right, based on these numbers, they can vaccinate the entire population at least for the first time in eight days.”
But any optimism is tempered by the reticence of a country sometimes referred to as the “hermit nation” to accept outside help.
“They are social because of scarcity,” Park said. “They struggled to provide hospitals with some of the things we take for granted,” he recalled, saying that surgeons would reuse equipment such as scalpels until it was blunt and unusable.
Offers of assistance from the United Nations, the United States, South Korea and others were ignored.
However, some aid has made its way into the country from China. Customs data from January to April shows North Korea imported more than 10 million masks, 1,000 ventilators and more than 2,000 kilograms of unspecified vaccines.
The Global Vaccine Alliance, Gavi, said last month that it understood North Korea had accepted Covid vaccines from China and had begun administering doses.
A Gavi spokesperson told CNN that North Korea “has not yet made a formal request to COVAX for vaccine support, but we remain ready to help if they do.”
The isolation of Covid patients in the country has been highlighted by recent attempts by a group of defector activists to send medicines across the demilitarized zone – the de facto border between North and South Korea.
Free North Korean fighters said they sent large balloons carrying medical supplies such as Tylenol and Vitamin C across the border in June as well as some carrying anti-regime leaflets in late April.
These balloon flights are against South Korean law and have been discouraged. Unification Minister Kwon told reporters he understood “the feelings of such organizations, but I think they should refrain.”
Hunger and a ‘hard walk’ again
Meanwhile, disease – whether it’s Covid or something else – may not be the biggest problem facing North Koreans.
One of the defectors, 44, who lives in South Korea, said her family contacted her in the North shortly after the outbreak was reported. On the contrary, when it came to Covid, they were more concerned about it – a reflection of Pyongyang’s great propaganda prowess.
they said [North Korean television had] I mentioned that many people in South Korea are dying from Covid so they were worried about me. “They weren’t too concerned about the virus,” she said.
But what her family was very worried about was the lack of food.
“They told me the nutritional situation was worse than it was during a hard March in the ’90s…I’m very concerned to see how difficult things were (at the time).”
The uphill march refers to a period of devastating famine when North Korea’s economy took a heavy blow from the collapse of the Soviet Union, ending the flow of aid into the country.
It is estimated that hundreds of thousands of people, or up to 10% of the country’s population, have died of starvation. Some estimates put the death toll even higher.
The defector did not ask her family if anyone was dying of starvation because she never spoke about anything political during these rare contacts with her family. The possibility that the authorities might listen is very high. She asked CNN not to reveal her identity in case her family faces reprisals.
But Quintana, the UN special rapporteur, said the danger was very real and that he was urging the Kim regime and others involved in North Korea to “basically understand that there is a serious risk of starvation in North Korea”.
Whether Kim is likely to listen is another matter.
State television broadcast coverage of the North Korean leader touring pharmacies, ordering his army to stabilize medical supplies, and even donating some of his own medical supplies last month to combat a hitherto unknown intestinal outbreak.
For Choi, a doctor who fled North Korea in 2011, images like this are to be expected when the truth is treated like a rubber band. He said it was a show and nothing more.
“The North Korean authorities are not struggling, the North Korean citizens are the ones who are having a hard time… If you survive, that’s great, but there’s nothing we can do if she dies.”