He speaks with some authority. Choi was a doctor for more than 10 years in North Korea, specializing in infectious diseases, before fleeing his country in 2011.
He can recall the SARS outbreak in 2002-2004, when he says hundreds of people in the northeastern city of Chongjin, where he worked, began to die after reporting “cold or flu symptoms.” Doctors like Choi could only privately suspect that SARS was to blame. North Korea was unable to test for the disease, so it officially recorded zero infections. Neighboring China has reported more than 5,000 cases and hundreds of deaths. Choi can also recall tackling a nationwide measles outbreak in 2006, armed only with a thermometer. and a 2009 flu pandemic in which even “more people died than during SARS” — a situation exacerbated by severe drug shortages.
In previous outbreaks, Choi explains, 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 figured the statistics would be massaged by the regime to fit the his needs.
He assumes that little has changed since he left and that history, if not repeating itself exactly, is at least repeating itself.

What is North Korea hiding?

As with previous disease outbreaks in North Korea, one of the biggest concerns about the country’s Covid outbreak is that Pyongyang’s penchant for secrecy makes it difficult to accurately gauge its severity. International NGOs and most foreign embassies have long since evacuated the country, and hermetically sealed borders mean access is impossible, making the accounts of defectors like Choi all the more important. Many were surprised by Pyongyang’s decision in May to admit it was facing an outbreak, even if the accuracy of its claims has since been met with skepticism. Earlier, leader Kim Jong Un had described the outbreak as the “biggest upheaval” ever to hit the country. Two months and millions of suspected cases later, he scored a “brilliant success” in stopping the disease in its tracks. The incredibly low official death toll reported by the country inevitably raises suspicions that Pyongyang is trying to hide a bigger problem. “I have some questions,” South Korea’s Unification Minister Kwon Young-se said strongly last week, noting that the story being promoted by the North’s state media contrasted sharply with the experience of the rest of the world.

New variants of Covid, cholera?

The biggest fear initially was that an outbreak in an unvaccinated, malnourished population with primitive health care would be catastrophic. Tomas Ojea Quintana, the UN Special Rapporteur on human rights in North Korea, said it was impossible to know the scale of the outbreak at this time — although he had heard unconfirmed reports of deaths among the elderly and malnourished children. “At least in my position, I’m not able to contrast that fear we had in early 2020 about the devastating effects of Covid on (North Korea) and its current situation.”
There are also fears that new, possibly more virulent, variants could emerge from uncontrolled transmission through North Korea’s population of about 25 million. Dr. Kee B. Park, an American neurosurgeon who until the start of the pandemic visited North Korea twice a year to work with North Korean counterparts, train them and perform surgeries, said the country seemed reluctant to share information and that “wasn’t good for them (and) it’s not good for the rest of the world.” “We have to share information about all kinds 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 reproduction can lead to new variants. The only way to detect this is to share information with each other.” In June, North Korea said it was dealing with an outbreak of an unknown enteric disease in South Hwanghae province, about 75 miles (120 kilometers) south of the capital Pyongyang. At the very least, the announcement highlighted the country’s vulnerability to disease outbreaks and drug shortages. Park believes that North Korea is likely experiencing an outbreak of typhoid fever or cholera. “Somewhere like North Korea, you can expect high rates of infectious diseases. In fact, for children under 5, diarrheal diseases are the number one killer.”

A ray of hope?

One glimmer of hope for Park was the country’s ability to rapidly vaccinate its population — demonstrated during the national measles vaccination program in 2006.
“In the first cycle, they averaged a million injections per day, then in the second cycle, later in 2007, they averaged over 3 million injections per day,” Park said. “If all the conditions are right, based on these numbers, they can vaccinate the entire population at least for the first vaccine in eight days.” But any optimism is tempered by the reticence of a country sometimes referred to as “the hermit nation” to accept outside aid. “They’ve been socialized out of scarcity,” Park said. “They struggled to supply hospitals with some of the things we take for granted,” he recalls of his time working in the country, saying surgeons would reuse equipment such as scalpels until they became dull and useless. Offers of help from the United Nations, the United States, South Korea and others have been ignored.
However, some aid has entered the country from China. Customs data shows from January to April, North Korea imported more than 10 million masks, 1,000 respirators and more than 2,000 kilograms of unspecified vaccines.
The global vaccine alliance Gavi said last month it understood North Korea had accepted Covid vaccines from China and had begun administering doses.
A Gavi spokesman 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 country’s isolation of Covid sufferers has been highlighted by recent efforts by a group of defector activists to ship medicine to the demilitarized zone — the de facto border between North and South Korea. The North Korean Freedom Fighters reported sending large balloons carrying medical supplies such as Tylenol and vitamin C over the border in June, as well as some carrying anti-regime leaflets in late April. These hot air balloon flights are against South Korean law and are discouraged. Unification Minister Kwon told reporters he understands “the feelings of such organizations, but I think they should stay away.”

Starvation and a second “hard march”

Meanwhile, disease — whether it’s Covid or anything else — may not be the biggest problem facing North Koreans. A defector, 44, who lives in South Korea, said she was contacted by her family in the North soon after the outbreak was reported. Instead, when it came to Covid, they were more concerned about it — a reflection of Pyongyang’s considerable propaganda ability. “They said [North Korean television had] he mentioned that a lot of people in South Korea were dying from Covid, so they were worried about me,” he said. “They weren’t too worried about the virus.” But what her family was extremely worried about was the lack of food. “I was told that the food situation was worse than during the hard march of the 1990s… I am very concerned knowing how difficult things were (then).” The arduous course refers to a period of devastating famine when North Korea’s economy took a hammering from the collapse of the Soviet Union, which ended the flow of aid to the country. Hundreds of thousands of people, or 10% of the country’s population, are estimated to have starved to death. Some estimates put the death toll even higher. The renegade did not ask her family if anyone was starving, as she never talks about anything political during these rare contacts with her family. The likelihood that the authorities will listen is very high. She asked CNN not to be named in case her family faced retaliation. But Quintana, the UN Special Rapporteur, said the risk was very real and urged 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 has covered the North Korean leader touring pharmacies, ordering his military to stabilize medical supplies and even donating some of his private medical supplies last month to fight the still-unknown intestinal epidemic.
For Choi, the doctor who fled North Korea in 2011, such images are to be expected when the truth is treated like rubber. It’s a show and nothing more, he said. “The North Korean authorities are not fighting, it’s the North Korean citizens who are having a hard time … if you survive it’s great, but there’s nothing we can do if you die.”

title: “Is North Korea Hiding A Bigger Problem Behind The Covid 19 Outbreak " ShowToc: true date: “2022-12-12” author: “Charleen Pappan”

(CNN) — Choi Jung-hun smiled as I read the latest official Covid-19 figures from North Korea’s state media: fewer than 5 million “fever” cases and just 73 deaths — a fraction of the deaths from any other country of the world.
“The North Koreans call them statistics rubber,” he said, in a nod to Pyongyang’s flexibility with the truth.  “It’s hard even for North Korea to know its own numbers.”
He speaks with some authority.  Choi was a doctor for more than 10 years in North Korea, specializing in infectious diseases, before fleeing his country in 2011.
He can recall the SARS outbreak in 2002-2004, when he says hundreds of people in the northeastern city of Chongjin, where he worked, began to die after reporting “cold or flu symptoms.”
Doctors like Choi could only privately suspect that SARS was to blame.  North Korea was unable to test for the disease, so it officially recorded zero infections.  Neighboring China has reported more than 5,000 cases and hundreds of deaths.
Choi can also recall tackling a nationwide measles outbreak in 2006, armed only with a thermometer.  and a 2009 flu pandemic in which even “more people died than during SARS” — a situation exacerbated by severe drug shortages.
In previous outbreaks, Choi explains, 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 figured the statistics would be massaged by the regime to fit the his needs.
He assumes that little has changed since he left and that history, if not repeating itself exactly, is at least repeating itself.
What is North Korea hiding?
As with previous disease outbreaks in North Korea, one of the biggest concerns about the country’s Covid outbreak is that Pyongyang’s penchant for secrecy makes it difficult to accurately gauge its severity.
International NGOs and most foreign embassies have long since evacuated the country, and hermetically sealed borders mean access is impossible, making the accounts of defectors like Choi all the more important.
Many were surprised by Pyongyang’s decision in May to admit it was facing an outbreak, even if the accuracy of its claims has since been met with skepticism.  Earlier, leader Kim Jong Un had described the outbreak as the “biggest upheaval” ever to hit the country.  Two months and millions of suspected cases later, he scored a “brilliant success” in stopping the disease in its tracks.
The incredibly low official death toll reported by the country inevitably raises suspicions that Pyongyang is trying to hide a bigger problem.
“I have some questions,” South Korea’s Unification Minister Kwon Young-se said strongly last week, noting that the story being promoted by the North’s state media contrasted sharply with the experience of the rest of the world.
New variants of Covid, cholera?
The biggest fear initially was that an outbreak in an unvaccinated, malnourished population with primitive health care would be catastrophic.
Tomas Ojea Quintana, the UN Special Rapporteur on human rights in North Korea, said it was impossible to know the scale of the outbreak at this time — although he had heard unconfirmed reports of deaths among the elderly and malnourished children.
“At least in my position, I’m not able to contrast that fear we had in early 2020 about the devastating effects of Covid on (North Korea) and its current situation.”
There are also fears that new, possibly more virulent, variants could emerge from uncontrolled transmission through North Korea’s population of about 25 million.
Dr. Kee B. Park, an American neurosurgeon who until the start of the pandemic visited North Korea twice a year to work with North Korean counterparts, train them and perform surgeries, said the country seemed reluctant to share information and that “wasn’t good for them (and) it’s not good for the rest of the world.”
“We have to share information about all kinds 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 reproduction can lead to new variants. The only way to detect this is to share information with each other.”
In June, North Korea said it was dealing with an outbreak of an unknown enteric disease in South Hwanghae province, about 75 miles (120 kilometers) south of the capital Pyongyang.
At the very least, the announcement highlighted the country’s vulnerability to disease outbreaks and drug shortages.
Park believes that North Korea is likely experiencing an outbreak of typhoid fever or cholera.
“Somewhere like North Korea, you can expect high rates of infectious diseases. In fact, for children under 5, diarrheal diseases are the number one killer.”
A ray of hope?
One glimmer of hope for Park was the country’s ability to rapidly vaccinate its population — demonstrated during the national measles vaccination program in 2006.
“In the first cycle, they averaged a million injections per day, then in the second cycle, later in 2007, they averaged over 3 million injections per day,” Park said.
“If all the conditions are right, based on these numbers, they can vaccinate the entire population at least for the first vaccine in eight days.”
But any optimism is tempered by the reticence of a country sometimes referred to as “the hermit nation” to accept outside aid.
“They’ve been socialized out of scarcity,” Park said.  “They struggled to supply hospitals with some of the things we take for granted,” he recalls of his time working in the country, saying surgeons would reuse equipment such as scalpels until they became dull and useless.
Offers of help from the United Nations, the United States, South Korea and others have been ignored.
However, some aid has entered the country from China.  Customs data shows from January to April, North Korea imported more than 10 million masks, 1,000 respirators and more than 2,000 kilograms of unspecified vaccines.
The global vaccine alliance Gavi said last month it understood North Korea had accepted Covid vaccines from China and had begun administering doses.
A Gavi spokesman 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 country’s isolation of Covid sufferers has been highlighted by recent efforts by a group of defector activists to ship medicine to the demilitarized zone — the de facto border between North and South Korea.
The North Korean Freedom Fighters reported sending large balloons carrying medical supplies such as Tylenol and vitamin C over the border in June, as well as some carrying anti-regime leaflets in late April.
These hot air balloon flights are against South Korean law and are discouraged.  Unification Minister Kwon told reporters he understands “the feelings of such organizations, but I think they should stay away.”
Starvation and a second “hard march”
Meanwhile, disease — whether it’s Covid or anything else — may not be the biggest problem facing North Koreans.
A defector, 44, who lives in South Korea, said she was contacted by her family in the North soon after the outbreak was reported.  Instead, when it came to Covid, they were more concerned about it — a reflection of Pyongyang’s considerable propaganda ability.
“They said [North Korean television had] he mentioned that a lot of people in South Korea were dying from Covid, so they were worried about me,” he said.  “They weren’t too worried about the virus.”
But what her family was extremely worried about was the lack of food.
“I was told that the food situation was worse than during the hard march of the 1990s… I am very concerned knowing how difficult things were (then).”
The arduous course refers to a period of devastating famine when North Korea’s economy took a hammering from the collapse of the Soviet Union, which ended the flow of aid to the country.
Hundreds of thousands of people, or 10% of the country’s population, are estimated to have starved to death.  Some estimates put the death toll even higher.
The renegade did not ask her family if anyone was starving, as she never talks about anything political during these rare contacts with her family.  The likelihood that the authorities will listen is very high.  She asked CNN not to be named in case her family faced retaliation.
But Quintana, the UN Special Rapporteur, said the risk was very real and urged 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 has covered the North Korean leader touring pharmacies, ordering his military to stabilize medical supplies and even donating some of his private medical supplies last month to fight the still-unknown intestinal epidemic.
For Choi, the doctor who fled North Korea in 2011, such images are to be expected when the truth is treated like rubber.  It’s a show and nothing more, he said.
“The North Korean authorities are not fighting, it’s the North Korean citizens who are having a hard time … if you survive it’s great, but there’s nothing we can do if you die.”