North Korea has demonstrated its ability to respond quickly, and South Korea flattens the curve | Column by Jenny Town (Spring 2020 issue)
As many countries are now squarely in the middle of a brutal battle against COVID-19, North Korea continues to claim it has no confirmed cases in the country.
It was one of the first countries to close its borders, halt travel by train and air and eventually prohibit almost all cross-border traffic with China. While many experts question whether these measures were truly effective in preventing the spread of COVID-19 to North Korea, the Kim regime has, at the very least, demonstrated a more robust strategy for handling this pandemic than it has during past epidemics.
For the Kim regime, prevention has been the key objective. On January 21, just after cases of COVID-19 were confirmed in the U.S. and South Korea, North Korea began notifying tourism companies that tourism would be suspended. Days later it banned all travel in and out of the country, suspended flights from China and Russia and instituted 30-day mandatory quarantines for incoming foreigners and diplomats.
For an economy which is heavily dependent on tourism (especially from China) and cross-border trade, these moves were significant and risked huge economic losses for an already struggling economy, but demonstrated how severe the regime viewed the situation. Schools were also reportedly closed until April 15, and high-profile events such as the Pyongyang Marathon were postponed.
In addition to these early, “high-intensity” prevention strategies, the Kim regime engaged in a public awareness campaign not seen during past epidemics. Information about the risks of the disease was distributed both via state media and local briefings, and for the first time, reportedly even included medical professionals in the discussion.
These briefings were also used to inform the public on ways to help prevent contracting and spreading the disease, encouraging good hygiene and social distancing, and communicated efforts the government was taking to mitigate the situation including frequent disinfection campaigns and barring use of public transportation unless wearing protective clothing, such as face masks.
However, despite these efforts to prevent or mitigate the effects of COVID-19, North Korea’s public healthcare system is presumably strained. In normal times, the country experiences widespread shortages of medicines and medical supplies and often inadequate provision of electricity and clean water to medical facilities, especially outside of Pyongyang. Global shortages of critical supplies such as face masks and respirators used to treat infected patients do not bode well for North Korea’s ability to handle an outbreak should it occur. Jong Un Kim recently spoke at a hospital groundbreaking ceremony, admitting that even the capital, Pyongyang, does not have “modern medical service” establishments. The state has also communicated unsubstantiated ways to curb the spread of COVID-19, including reports of using burdock root as a cure or using salt water to prevent infection.
Serious questions loom about the North’s capacity to even test for the disease, especially on a large scale. Pyongyang reportedly accepted 1,500 test kits from Moscow in February, and the United Nations has granted sanctions exemptions to deliver more kits and equipment. Both the U.S. and South Korea have also offered humanitarian assistance and cooperation, but have not yet received a response.
As seen in South Korea’s success in containing the spread of COVID-19, early and widespread testing is key to effective prevention and treatment of the disease; countries like the U.S. and Italy who did not prepare for such a strategy now struggle with an overwhelmed healthcare system and higher mortality rates. Presumably, inadequate testing to scale can have similar consequences for North Korea.
While the Kim regime has attempted to demonstrate transparency in its handling of COVID-19, many experts question whether the public statements by the regime truly reflect the situation on the ground as unconfirmed reports cite numerous suspected cases and deaths. North Korea’s continued conduct of military drills and missile testing, along with commencing construction of a new hospital in Pyongyang, seem to be attempts to show that North Korea is business as usual.
However, global struggles with COVID-19 raise huge concerns for North Korea’s ability to respond to a large-scale outbreak without massive deaths, if it’s not struggling with this challenge already. And economic disruptions to supply chains, retail, tourism and industries caused by global pandemic stand to hit North Korea just as hard.
South Korea and U.S.’s response
On January 20, 2020, both the U.S. and South Korea confirmed their first cases of COVID-19, but how they handled the situation from that point on could not have been more different. While the U.S. downplayed the severity of the situation, the South Korean government, informed by its experiences with Severe Acute respiratory Syndrome (SARS), influenza A (H1N1), and Middle East Respiratory Syndrome (MERS), quickly took a whole of government approach, implementing aggressive measures to try to test, treat and contain the spread of the virus. They also worked to educate and mobilize the public to play an active role in the process.
Their moves have become a case study in how to “flatten the curve” of transmission rates, reducing new infections from a peak of 909 cases on February 29, to under 100 per day in recent days, and with mortality rates under 1 percent, without having to impose the kind of widespread lockdowns currently happening in the U.S. and other countries.
South Korea’s experience with MERS in 2015 was instrumental in its ability to respond quickly to COVID-19. After recording the highest rate of MERS infections (186) outside of Saudi Arabia, with a 20 percent mortality rate, the South Korean government internalized the reality that new pathogens would emerge in the future and institutional changes were needed to improve their ability to respond. As such, they established a center dedicated to handling infectious diseases, which became a central actor in dealing with the COVID-19 outbreak.
The center began researching the coronavirus as soon as it was able to acquire genome sequencing data from China on January 13, before the first case of COVID-19 was even confirmed in South Korea. With “emergency-use authorization” being granted to expedite the development of COVID-19 testing, test kits hit the market by February 4, and within weeks, a total of five companies were able to produce up to 130,000 test kits per day.
Testing has been central to the government’s pandemic response. Free, widescale testing was conducted, both in healthcare institutions and make-shift drive through testing stations, with results texted to patients the next day. Early detections enabled early treatment and larger scale quarantine measures when clusters of infections were detected to help minimize the spread. New laws were also enacted to allow prosecution of people who were suspected of being infected but refused to get tested, as well as to deny entry into the country of people confirmed or suspected of being infected.
Additionally, strict screening and monitoring of visitors entering the country from areas of high infections were also put in place. Those subject to a 14-day quarantine period were also required to download and use a monitoring app to help the authorities verify compliance —- anyone refusing to the use the app can be denied entry and anyone caught violating the quarantine faces major fines and potential deportation.
In addition to enforcing timely, preventive policies, the South Korean government emphasized the importance of transparency and openness with the public about the situation. In February, health authorities tracked and publicized movements of those who tested positive, enabling citizens to verify if they made contact with an infected person.
The government also took measures to address a shortage of masks and hygiene products, cracking down on illegal hoarders, banning the export of masks and eventually taking “full control” of distribution and logistics with hopes of increasing the speed of local production and rationing the distribution.
While the total number of Korean patients discharged from isolation has exceeded the number of newly confirmed cases, the Korea Centers for Disease Control and Prevention has called for continued social distancing, and child care facilities and schools were scheduled to stay closed until early April. Additionally, the National Assembly recently approved an extra budget of 11.7 trillion won ($9.42 billion USD) to fight the spread of the virus.
Public opinion of the Moon administration’s handling of the COVID-19 outbreak has been largely favorable, with South Korea offering medical expertise and test kits to other countries, and Moon’s public approval ratings have rebounded in recent polls.
However, Moon’s legacy on COVID-19 management still faces serious and daunting challenges. The economic impact of COVID-19 has already started to take a toll on South Korean companies and industries, causing disruptions in supply chains, retail and tourism, and will likely worsen in the coming months given the global reach of the pandemic despite the government’s preliminary relief efforts.
Moreover, South Korea is only in an early stage of getting the pandemic under control, but plans to conduct its National Assembly elections on April 15 as scheduled, risking a resurgence of infections if elections are not handled properly. While South Korea’s early successes on flattening the curve have been praised globally, the situation is still far from over.
Jenny Town is deputy director of Stimson’s 38 North, a website devoted to providing policy and technical analysis on North Korea. She is the former assistant director of the US-Korea Institute at Johns Hopkins School of Advanced International Studies.