An employee of Pyongyang Dental Hygiene Products Factory disinfects the floor of a dinning room as the state increased measures to stop the spread of illness in Pyongyang, North Korea on May 16, 2022.
Credit: AP Photo/Cha Song Ho, File
For many of us, Pyongyang’s announcement of a COVID-19 case on May 12 had long been expected. The event was an inevitability, especially when considering how communicable the Omicron variant is, precipitating unprecedented infection rates during the winter even in countries like South Korea, which, at the time, had boasted one of the world’s highest vaccination rates and an effective mitigation system.
Now that North Korea has released more outbreak reports, however, I must admit I am skeptical about their reliability. Simply put, the numbers don’t add up.
At the time of writing, North Korea has reported over 3 million incidences of “fever” over a two-week period. Since the country has virtually no testing capacity to confirm COVID-19 infection, the use of this descriptive diagnosis is not surprising. At the same time, Pyongyang has reported only 68 deaths related to those cases. At least one of these figures must be wrong.
If the fever numbers are to be taken at face value as COVID-19 infections, the death numbers need to be higher. We know, for example, that Omicron causes fever symptoms in somewhere between 25 to 50 percent of infected people. If the fever numbers are real, this means at least 6 million must have been infected, with 68 deaths calculating into a death rate of only 0.001 percent. Given that South Korea experienced a much higher death rate of 0.12 percent during the winter Omicron wave despite a vaccination rate of over 82 percent, I must conclude the North Korean figures are unbelievable.
It is, of course, theoretically possible that some significant portion of the reported fevers were caused by other diseases like seasonal flu. However, as mentioned above, North Korea reported 3 million cases in just two weeks, a time course that is very atypical for common diseases. South Korea, in comparison, usually has about 10-20 percent of its adult population suffer seasonal disease in an entire year, with fever being an associated symptom in less than half of those cases. Since 3 million is roughly 12 percent of North Korea’s population, it seems highly unlikely that common seasonal diseases would be able to spread that quickly, accounting for so many cases in such a short period of time. The month of May is also not a typical time for seasonal diseases to spike in the Northern Hemisphere, casting further doubt on the possibility.
Another thing that stands out as odd is the way Pyongyang appears to have gone ahead with a massive funeral service for General Hyon Chol Hae. If COVID-19 cases were really in the millions and an outbreak was ongoing, would North Korean authorities really permit thousands to line up in the streets? Would Kim Jong Un be carrying the coffin without a mask? I think not.
So what might be going on here? I can think of three plausible scenarios. As usual, I want to reiterate that each is predicated on the limited information we, as public observers, have.
The first scenario is that North Korea is not suffering from any outbreak at all. Given that this would be a serious deception internally, it seems unlikely. How could authorities claim fevers in the millions if none of the doctors in Pyongyang – who must talk to each other on some level – ever diagnosed one? As powerful and effective as Kim Jong Un’s propaganda machine might be, the sheer scale of the ruse would be prohibitive.
The second scenario is that North Korea has suffered a minor COVID-19 outbreak that it now believes is extinguished. To glorify the success of this event, North Korean media is exaggerating the degree to which the country was able to successfully keep deaths low. In this scenario, perhaps the death numbers are real while the fevers are not. Here too, a similar logic applies: It would be extremely difficult to fabricate nonexistent events but less so to exaggerate them. Exaggerating reports of fever might even create a useful pretext for Kim to tighten the reins of power by passing new laws quickly, mobilizing military personnel under the guise of epidemic management, or using claims of COVID-related incompetence to threaten or remove political opponents.
The third scenario is one in which North Korea is in the early stages of a real outbreak that it believes it can control. Exaggerating fever numbers might again facilitate power consolidation or internal political maneuvers while projecting an international image of desperation that can be used to request medical or food aid. Some humanitarian organizations in South Korea, for example, have already lined up to donate.
Alternatively, it might be the fever numbers that are real, with death numbers being suppressed, perhaps in an effort to maintain calm and order. This too, however, seems like an endeavor with diminishing returns. As China’s Wuhan outbreak demonstrated, it is just not feasible to hide deaths when they start numbering in the thousands.
At the end of the day, the truth is there is a lack of information at this juncture to make a decisive determination about why North Korea’s numbers are off. The fact that they are off is the only detail I would consider beyond dispute. Observers with entrenched skepticism about North Korea will likely be in a hurry to favor the first scenario, but I think the second and third are much more likely. Having an exaggerated fever rate, in addition to providing the other benefits I mentioned, would also be a useful way for Pyongyang to prepare for a real outbreak by putting people through unfamiliar mitigation protocols. A dress rehearsal, if you will.
As things continue to unfold, it should be reemphasized that widespread Omicron infection in North Korea is a guaranteed inevitability. Even if it is not happening now, it will sooner or later. I think it is also important that North Korean authorities do not overestimate their ability to control the virus. With China in the midst of its own struggles and South Korea having just passed the milestone of 18 million confirmed cases, I would venture to say total containment of Omicron is not possible. Unfortunately, a misguided belief in the possibility of control might explain why North Korea seems to have been slow in responding to South Korean and American offers of assistance. That lethargy fails to convey the sense of urgency that should normally be associated with an ongoing epidemic affecting millions.