What Comes Next in North Korea’s Battle With Omicron?

Now that Pyongyang has officially confirmed arrival of the Omicron variant of the coronavirus, it is time to consider the implications. Where might things go from here? How bad might the fallout be? What opportunities and challenges might the international community face as a result?

Predicting the Epidemiological Damage

Despite negativity from some critics, all initial signs indicate Pyongyang does understand the gravity of the situation they are in. Kim Jong Un’s public presence in a COVID-19 response meeting last month and his description of the situation as “[the greatest] turmoil to fall on our country since [its] founding” convey the understanding that this outbreak is not something that can be ignored or spun out of existence through censorship or propaganda. When considering the added facts that the North Korean population is entirely unvaccinated, often malnourished, and served by an obsolete healthcare system that harkens back to the 1990s, the looming peril should be obvious, even for those who might have political motivations to hide bad news.

Accepting the reality that North Korea is in the early stages of a major outbreak, what kind of fallout can we expect? In January, my company and I assembled a statistical model to predict the number of hospitalizations and deaths North Korea might suffer in a nation-wide epidemic. This model pooled together a variety of numbers from different sources, taking into account things like North Korea’s age demographics and the rate at which unvaccinated people are hospitalized after Omicron infection. Depending on how quickly the virus spreads, our model predicts around 10 million adults will be infected over the next year or two (roughly half of the nation’s adult population). Our model also predicts 280,000 will need hospitalization. For COVID-19, hospitalization is generally characterized by severe breathing difficulty accompanied by the need to use a ventilator.

Predicting death is not as easy since there are many factors (like underlying disease rates) that we don’t have information for. Focusing on the numbers we do have, our model predicts 10 million adult infections will precipitate between 44,000 and 220,000 deaths. Given that North Korean healthcare will likely be ineffective in combatting the virus, with many already suffering from weak immune systems due to malnutrition, I would hazard a guess that North Korea is on course to be much closer to the higher end of this range, rather than the lower.

Pyongyang’s Limited Options

So what can North Korea do? In a piece I wrote in February, I expressed the opinion that Pyongyang’s initial pandemic strategy was likely to wait things out by isolating from the international community. Now that Omicron is in the country, however, Pyongyang has unceremoniously been thrust into the new phase of epidemic management, something they are woefully unequipped for.

Given that effective healthcare will be severely limited, most of Pyongyang’s focus will have to be on mitigation. Simply put, it matters immensely whether tens of thousands of patients needing hospitalization appear over the course of a few weeks or are spread out over the course of a full year. The latter would be a daunting crisis; the former would collapse the healthcare system.

To slow virus dissemination, Pyongyang will need to follow China’s playbook, instituting lockdowns in as organized a manner as possible. Unlike China, however, North Korea lacks anything resembling systematic testing, meaning they will have to make decisions based on limited information. These decisions will be guided, at best, by fever incidence, something we already know is an ineffective marker of infection, with some COVID-19 patients never developing symptoms at all and those who do develop symptoms being infectious for at least two days prior. This lag in information and responsiveness means North Korean authorities will always be a step behind when instituting lockdowns based on symptom reports, likely forcing them to adopt the more aggressive approach of resorting to preemptive or preventative lockdowns when things get bad.

Predicting Economic and Social Damage

As anyone who has been in a lockdown will tell you, such events are incredibly disruptive. Productivity comes to a halt, people have trouble accessing necessities, and unattended burials often take place for virus victims, putting harsh strains on family, sustenance, and the cultural fabric. Similar events are destined to occur in North Korea, although it remains unclear yet to what degree.

It also remains unclear how much disruption the fragile North Korean economy can take, especially given that its export income in 2020 and 2021 was already 1 and 12 percent of pre-pandemic levels, respectively. Unlike other countries, the North Korean government has significant difficulty borrowing money, meaning civilians and businesses will have little support from state-funded relief programs to deal with losses due to lockdown. An even greater concern is whether civilians who depend on day-to-day work to make a living will starve if they abide by lockdown mandates. However you cut it, any reasonable scenario predicts serious societal strain and at least some sort of recession, yet another challenge to be added on top of North Korea’s running five-year decline in GDP.

Panic buying and social unrest due to the pandemic have been observed in virtually every country, especially in the early stages of large outbreaks. There seems no reason to believe similar events will not happen in North Korea, especially given its delicate food situation. Yes, given its prior history, Pyongyang will likely be much more willing to deploy military personnel to maintain order, but fear of disease, hunger, and discontent do have a way of mixing in volatile ways, making an unprecedented clash between civilians and the military a real possibility in upcoming months.

On the political side, the Kim family seems destined to come under a lot of pressure, especially when difficulties mount. One of the long-held tenets of North Korea’s internal propaganda machine is a glorification of the Kim family, a messaging campaign that frequently portrays them as a superior bloodline with something akin to a divine right to rule. If North Korean civilians find themselves in a situation where their government is unable to save their loved ones and feed their children, there may be significant damage done to this myth, threatening, at the very least, Kim Jong Un’s perceived right to lead. What consequences may result is anyone’s guess.

What About International Aid?

Put simply, Pyongyang is destined for a grueling test of stewardship over the next year. The upcoming summer months will likely help keep infections low for a while, but the looming fall and winter seasons are sure to be great sources of anxiety. Even South Korea, with its sophisticated mitigation methods and high vaccination rate, was unable to control Omicron dissemination this past winter. One can only imagine how much harder it will be for North Korea.

In my February piece, I opined that North Korea’s January missile tests seemed like a strategy to signal the international community for pandemic-related assistance. In my mind, these tests indicated Pyongyang, well-aware of the threat posed by Omicron, was using the aggression to try to leverage for food and vaccines. Now that North Korea’s epidemic has started, however, it is unclear how much harder Pyongyang will continue pressing in that direction. Will they continue to launch more missiles as they did the day after announcing their first COVID-19 case, or will they try something even more provocative out of desperation? Only time will tell.

For its part, in mid-May South Korea did signal its willingness to provide medical supplies and vaccines. The volume of this assistance was not specified, but, curiously, Pyongyang, at the time of writing, has not yet offered a response, suggesting they are still evaluating the situation. If this silence is due to indecision, that might suggest Pyongyang has already failed to implement a predetermined comprehensive action plan for epidemic management, indicating any systematic response may be marred by unnecessary delays.

With the outbreak still in early stages, there is ample room for useful humanitarian intervention. Donations of medical supplies, vaccines, ventilators, and food would all be helpful, both now and in the coming months. Aid also offers some potential to encourage North Korea back to a discussion of denuclearization at a later date. Despite the (admittedly muted) potential for this progress, I must imagine many world leaders outside of the Korean Peninsula are quietly wondering whether a “let them suffer” approach might be easier, potentially destabilizing the authoritarian regime. In my mind, destabilization risks putting North Korea’s nuclear arsenal in unwieldy hands, but that has always been an argument difficult to make to those who don’t live in the neighborhood.

Even if some change of heart does take place, there are real limitations on the aid that the international community can provide. Even with the best of intentions, countries will not be lining up to donate ventilators in the thousands, nor will anyone be willing, in the next few months at least, to offer enough vaccines to cover the entirety of North Korea’s 25.8 million population. Perhaps the most realistic assistance in the long run is food. But then again, if the unspoken goal is to use the epidemic to destabilize the Kim regime, why would you provide the one ingredient that can most effectively inhibit that outcome?