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COVID-19 in North Korea

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On 13 and 14 May 2022, North Korea reported 1,74,400 and 2,60,000 new COVID-19 cases and 21 and 15 deaths, respectively. It is thus hard to believe that the country was officially free from the pandemic until 11 May the same year. On 12 May, Pyongyang admitted to around 5,24,440 total COVID-19 cases in the period late-April to 13 May 2022. Reportedly, 2,43,630 are now fully cured and 2,80,810 are being treated. In a 12 May Politburo meeting, Kim Jong-un went to the extent of saying that North Korea was facing “great turmoil since the country’s founding.”

It is important to underline that North Korea closed its border very early and implemented other strict restrictions when the pandemic began in early-2020. In the wake of the latest episode of lockdowns in China, North Korea has re-emphasised its own “zero COVID-19 policy” and undertaken border lockdowns and quarantine measures to keep the country ‘pandemic-free’.

This is disturbing news as North Korea is one of only two countries in the world that hasn’t adopted a COVID-19 vaccination initiative until now (the other is Eritrea). COVAX, the global vaccine programme, has made several requests but North Korea has declined these offers. This means that the current mass outbreak is going to be disastrous in the short-run—even though we are unlikely to learn the extent of it. North Korean health infrastructure is already tottering and is “exceedingly vulnerable.” The pandemic will further augment the crisis.

Most foreigners gradually left North Korea over the several waves of the pandemic. Due to the recent lockdowns, even the last batch of UN technical experts and senior managers have also departed. Their absence will be another big problem in coordinating any vaccine delivery to North Korea.

The pandemic will also lead to other auxiliary challenges. Due to the lockdowns and authoritarian pressures, secondary health services are already under stress. As per different reports, medicine availability is insufficient, routine immunisation pending, and access to hospitals denied. As per a US assessment, more than 60 per cent of the population is food insecure because of border closures and low crop yields. In 2020, global economic sanctions, border closures, and natural calamities had already led to a 4.5 per cent contraction ofthe North Korean economy (the worst decline since the great famine of the mid-1990s).

North Korean media reports that around 1.3 million people are mobilised to fight the spread of the pandemic. The state has been trying to assure people that most of the COVID-19 deaths so far were a result of people being “careless in drug taking” and “relaxation, irresponsibility, inefficiency and failing”on the part of the country’s anti-epidemic sector—and not because of the virus itself. China has sought to assure Pyongyang of its assistance in fighting the outbreak. Even South Korea’s new President Yoon Suk-yeol has offered to help North Korea procure vaccines as well as other medical supplies.

It is not clear whether North Korea will accept these offers, or how useful they would be in the short-run. Pyongyang may be more likely to turn down assistance from a ‘hawkish’ South Korean administration under Yoon Suk-yeol, and rely only on China. However, Chinese measures to curb the pandemic such as through lockdowns and its zero COVID-19 policy have been problematic. A resourceful China might be able to provide food, healthcare, and other amenities to its own people under lockdown, but the same may not possible for North Korea. Furthermore, even if North Korea acquires and administers Chinese vaccines, their efficacy is reportedly doubtful. In any case, such consignments will take time to reach the North Korean people.

North Korea also doesn’t have enough testing kits and has been determining positive cases through body temperature measurement and symptom detection.This suggests that that they are in a position to report only symptomatic cases: all of them might not be COVID-19, and many asymptomatic cases that are in fact COVID-19 positive may not be reported or counted.

North Korea has consistently denied any COVID-19 cases within the country for the past 2.5 years. Pyongyang spent its scarce resources on defence, kept its economy isolated, didn’t try to vaccinate its people, and doesn’t even have enough basic equipment to fight the virus, including testing kits. The only solace is that reportedly, the outbreak is essentially caused by the Omicron BA.2 variant, which is generally considered less deadly. Chinese assistance, the Chinese model of dealing with COVID-19, and authoritarian measures: none of these are going to be effective in dealing with the current outbreak in North Korea. This is a situation of extreme human tragedy that is largely state-made.

What is monkeypox and its signs and symptoms?

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An extremely rare disease called monkeypox, a cousin of smallpox, has again made its way to the United States. A case of monkeypox was reported Wednesday in a patient hospitalized in Massachusetts who had recently traveled to Canada in private transportation.

In 2021, two people traveling from Nigeria to the US were diagnosed with the disease, according to the Centers for Disease Control and Prevention.
Monkeypox is mostly found in West and Central Africa, but additional cases have been seen in Europe, including the United Kingdom, and other parts of the world in recent years. Those cases are typically linked to international travel or imported animals infected with the pox, the CDC said.
On Thursday, Spain confirmed seven cases of monkeypox in Madrid and are investigating another 22; Italy confirmed its first case; and Canadian public health officials announced they are investigating 17 suspected cases of monkeypox in Montreal.

Rare case of monkeypox reported in England, UKHSA says

Rare case of monkeypox reported in England, UKHSA says
Several cases of monkeypox in the UK among people who have no known travel or contact with others with the virus have health officials there and at the CDC concerned, but there is no cause for alarm, US Surgeon General Dr. Vivek Murthy said Thursday on CNN’s “New Day.”
“At this time, we don’t want people to worry,” Murthy said. “These numbers are still small; we want them to be aware of (the) symptoms, and if they have any concerns to reach out to their doctor.”

What are the initial symptoms of monkeypox?

There is an incubation period of some seven to 14 days, the CDC said. Initial symptoms are typically flu-like, such as fever, chills, exhaustion, headache and muscle weakness, followed by swelling in the lymph nodes, which help the body fight infection and disease.
“A feature that distinguishes infection with monkeypox from that of smallpox is the development of swollen lymph nodes,” the CDC said.
Next comes a widespread rash on the face and body, including inside the mouth and on the palms of the hands and soles of the feet.
The painful, raised poxes are pearly and fluid-filled, often surrounded by red circles. The lesions finally scab over and resolve over a period of two to three weeks, the CDC said.
“Treatment is generally supportive as there are no specific drugs available. However, a vaccine is available that can be given to prevent the development of disease,” Jimmy Whitworth, professor of international public health at the London School of Hygiene & Tropical Medicine, said in a statement.

How is monkeypox spread?

Close contact with an infected individual is required for the spread of the monkeypox virus, experts say.
Infection can develop after exposure to “broken skin, mucous membranes, respiratory droplets, infected body fluids or even contact with contaminated linen,” Neil Mabbott, personal chair in immunopathology at the veterinary school of the University of Edinburgh in Scotland, said in a statement.
“When the lesions have healed, the scabs (which might carry infectious virus) can be shed as dust, which could be inhaled,” said Dr. Michael Skinner, who is on the faculty of medicine in the department of infectious disease at Imperial College London, in a statement.
Transmission between people occurs primarily through large respiratory droplets, and because such droplets typically travel only a few feet, “prolonged face-to-face contact is required,” the CDC said.

This 2003 electron microscope image made available by the US Centers for Disease Control and Prevention shows mature, oval-shaped monkeypox virions, left, and spherical immature virions, right, obtained from a sample of human skin associated with the 2003 prairie dog outbreak.

This 2003 electron microscope image made available by the US Centers for Disease Control and Prevention shows mature, oval-shaped monkeypox virions, left, and spherical immature virions, right, obtained from a sample of human skin associated with the 2003 prairie dog outbreak.
“Monkeypox can be a serious infection, with mortality rates from this type of monkeypox virus having been around 1% in other outbreaks. These are often in lower-income settings with limited access to health care,” said Michael Head, senior research fellow in global health at the University of Southampton in the UK.
However, in the developed world, “it would be very unusual to see anything more than a handful of cases in any outbreak, and we won’t be seeing (Covid)-style levels of transmission,” Head said in a statement.
Common household disinfectants can kill the monkeypox virus, according to the CDC.

Where did monkeypox originate?

Monkeypox got its name in 1958 when “two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research,” the CDC said.
However, the main disease carrier of monkeypox is still unknown, although “African rodents are suspected to play a part in transmission,” the agency said.
The first known case of monkeypox in people was “recorded in 1970 in the Democratic Republic of Congo during a period of intensified effort to eliminate smallpox,” the CDC said.
After 40 years with no reported cases, monkeypox reemerged in Nigeria in 2017, the CDC said. Since then, there have been more than 450 reported cases in Nigeria and at least eight known exported cases internationally, the agency said.
A outbreak occurred in the US in 2003 after forty-seven people in six states — Illinois, Indiana, Kansas, Missouri, Ohio and Wisconsin — became ill due to contact with their pet prairie dogs, the CDC said.
“The pets were infected after being housed near imported small mammals from Ghana,” the CDC said. “This was the first time that human monkeypox was reported outside of Africa.”

CNN’s Michael Nedelman, Paula Newton, John Bonifield, Naomi Thomas, Alex Hardie and Benjamin Brown contributed to this report.

Monkeypox: Time to worry or one to ignore?

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If you’re still reeling from the Covid pandemic, well sorry but there’s another virus to get to grips with. This time it’s monkeypox and there are around 80 confirmed cases in 11 countries, including the UK, that would not normally expect to have the disease.

So what is going on? Is it time to worry or are we getting overly excited having just lived through Covid?

Let’s be clear: this is not another Covid and we’re not days away from lockdowns to contain the spread of monkeypox.

However, this is an unusual and unprecedented monkeypox outbreak. It has taken scientists who specialise in the disease by complete surprise and it is always a concern when a virus changes its behaviour.

Until now, monkeypox was pretty predictable.

The virus’s natural home is wild animals, which are actually thought to be rodents rather than monkeys. Somebody in the rainforests of Western and Central Africa comes into contact with an infected creature and the virus makes the jump across species. Their skin erupts in a rash, which blisters and then scabs over.

The virus is now outside its usual home and struggles to spread so it needs prolonged close contact to keep going. So outbreaks tend to be small and burn out on their own.

Small numbers of cases have cropped up elsewhere in the world before, including the UK, but all can be immediately linked to somebody travelling to an affected country and bringing it home.

That is no longer the case.

  • For the first time the virus is being found in people with no clear connection to Western and Central Africa
  • It is not clear who people are catching it from
  • Monkeypox is spreading during sexual activities with most cases having lesions on their genitals and the surrounding area
  • Many of those affected are gay and bisexual young men

“We’re in a very new situation, that is a surprise and a worry,” Prof Sir Peter Horby, the director of the University of Oxford’s Pandemic Sciences Institute, told me.

While he says this is “not Covid-Two”, he said “we need to act” to prevent the virus getting a foothold as this is “something we really want to avoid”.

Dr Hugh Adler, who has treated patients with monkeypox, agrees: “It’s not a pattern we’ve seen before – this is a surprise.”

graphic

So what’s going on?

We know this outbreak is different, but we don’t know why.

There’s two broad options – the virus has changed or the same old virus has found itself in the right place at the right time to thrive.

Monkeypox is a DNA virus so it does not mutate as rapidly as Covid or flu. Very early genetic analysis suggests the current cases are very closely related to forms of the virus seen in 2018 and 2019. It is too early to be sure, but for now there is no evidence this is a new mutant variant at play.

Monkeypox virus particle, TEM: Monkeypox virus particle, coloured transmission electron micrograph (TEM)SCIENCE PHOTO LIBRARY

Symptoms include fever, headache, muscle aches, backache, swollen lymph nodes, chills and exhaustion

But a virus doesn’t have to change in order to take advantage of an opportunity, as we have learned from unexpected large outbreaks of both Ebola and Zika virus in the last decade.

“We always thought Ebola was easy to contain, until that wasn’t the case,” said Prof Adam Kucharski, from the London School of Hygiene and Tropical Medicine.

It’s not clear why gay and bisexual men are disproportionately affected. Are sexual behaviours making it easier to spread? Is it just coincidence? Is it a community that is more aware of sexual health and getting checked out?

It may also be getting easier for monkeypox to spread. The mass smallpox vaccinations of the past would have given older generations some protection against the closely related monkeypox.

“It is probably transmitting more effectively than in the smallpox era, but we’re not seeing anything suggesting it could run rampant,” said Dr Adler, who still expects this outbreak to burn itself out.

Monkeypox rashUKHSA

The rash changes and goes through different stages, and can look like chickenpox or syphilis, before finally forming a scab, which later falls off

Understanding how this outbreak started will help predict what happens next.

We know we’re only seeing the tip of the iceberg as the cases being detected don’t fit into a neat picture of this person passed it on to that person etc. Instead many of the cases appear unrelated, so there are missing links in a chain that seems to spread across Europe and beyond.

A recent massive superspreading event, in which large numbers of people gathered and caught monkeypox at the same venue such as a festival and then took it home to different countries, could explain the current situation.

The alternative explanation for so many unconnected people getting infected is if the virus has actually been bubbling along unnoticed for quite some time involving a lot of people.

Either way, we can expect to continue to find more cases.

“I don’t think the general public need to be worried at this stage, but I don’t think we’ve uncovered all of this and we are not in control of this,” said Prof Jimmy Whitworth, from the London School of Hygiene and Tropical Medicine.

But remember we are not in the same situation as we were with Covid.

Monkeypox is a known virus rather than a new one, and we already have vaccines and treatments. It is mostly mild, although it can be more dangerous in young children, pregnant women and people with weak immune systems.

But it spreads more slowly than Covid and the distinctive and painful rash makes it harder to miss than a cough that could be anything. This makes the job of finding people who may have been infected and vaccinating those at risk of catching it easier.

However, the World Health Organization’s regional director for Europe, Hans Kluge, has warned that “as we enter the summer season… with mass gatherings, festivals and parties, I am concerned that transmission could accelerate”.

Monkeypox: 80 cases confirmed in 12 countries

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More than 80 cases of monkeypox have been confirmed in at least 12 countries.

The World Health Organization has said another 50 suspected cases are being investigated – without naming any countries – and warned that more cases are likely to be reported.

Infections have been confirmed in nine European countries, as well as the US, Canada and Australia.

Monkeypox is most common in remote parts of Central and West Africa.

It is a rare viral infection which is usually mild and from which most people recover in a few weeks, according to the UK’s National Health Service.

The virus does not spread easily between people and the risk to the wider public is said to be very low.

There is no specific vaccine for monkeypox, but a smallpox jab offers 85% protection since the two viruses are quite similar.

So far, public health agencies in Europe have confirmed cases in the UK, Spain, Portugal, Germany, Belgium, France, the Netherlands, Italy and Sweden.

In a statement on Friday, the WHO said that the recent outbreaks “are atypical, as they are occurring in non-endemic countries”.

It said it was “working with the affected countries and others to expand disease surveillance to find and support people who may be affected”.

The WHO also warned against stigmatising groups because of the disease.

“It can be a barrier to ending an outbreak as it may prevent people from seeking care, and lead to undetected spread,” it said.

WHO’s Europe regional director Hans Kluge warned that “as we enter the summer season… with mass gatherings, festivals and parties, I am concerned that transmission could accelerate”.

He added that all but one of the recent cases had no relevant travel history to areas where monkeypox was endemic.

The first case of the disease in the UK was reported on 7 May. The patient had recently travelled to Nigeria, where they are believed to have caught the virus before travelling to England, the UK Health Security Agency said.

There are now 20 confirmed cases in the UK, Health Secretary Sajid Javid said on Friday.

Authorities in the UK said they had bought stocks of the smallpox vaccine and started offering it to those with “higher levels of exposure” to monkeypox.

Spanish health authorities have also reportedly purchased thousands of smallpox jabs to deal with the outbreak, according to Spanish newspaper El País.

Australia’s first case was detected in a man who fell ill after travelling to the UK, the Victorian Department of Health said.

In North America, health authorities in the US state of Massachusetts confirmed that a man has been infected after recently travelling to Canada. He was in “good condition” and “poses no risk to the public”, officials said.