Analysis: Why the Covid-19 outbreak in North Korea could shock the world

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If I’ve learned one thing after performing countless operations alongside surgeons in Pyongyang, North Korea, over the past 15 years, it’s that North Koreans don’t throw anything away.

I used re-use blunt scalpels to make incisions. I once watched an anesthesiologist use his hands to squeeze a bag every three or four seconds to ventilate a patient for several hours during an operation.

It was as usual in a place where medical equipment like mechanical ventilators are in short supply. And I’ve always admired this ability to work with limited resources.

But now I fear for the safety of doctors and nurses, as well as their ability to care for the outbreak of Covid-19 patients in hospitals.

Last week, North Korea announced the first confirmed case of Covid-19 within the country. Since then, we’ve learned of at least 1.72 million “fever cases”, with about half in quarantine and dozens of deaths so far. The Ômicron BA.2 variant was found in at least one of the deaths.

With symptomatic cases representing around 7% of the population of 25 million, the outbreak is a disaster for the country.

We need to help North Korea immediately. Given that the entire population has not yet been vaccinated, the death toll could be unprecedented.

North Korea, like China, has adopted a zero Covid strategy to manage the virus. To its credit, this strategy of prioritizing preventing the virus from entering its borders seemed highly effective, apparently with no confirmed cases in over two years.

But highly transmissible Omicron variants changed everything. China had successfully thwarted the virus until recently, succumbing to drastic lockdowns in several cities, including Shanghai.

Now, the virus has breached North Korea’s defenses. And the country’s relatively weak ability to respond to the massive outbreak is alarming.

First, they have no medical countermeasures. The ability to treat large numbers of patients with severe respiratory illness is limited. They need oxygen, intravenous fluids, ventilators, personal protective equipment (especially for healthcare workers), and antibiotics.

But the most valuable items right now are the newly developed antivirals against Covid-19. Paxlovid appears to be effective against the BA.2 variant, can be taken orally, and does not require special methods of storage and transport.

We must send these medical countermeasures as soon as possible. People are dying now, and we can and must help.

Second, the testing capability is woefully inadequate. According to situation reports from the World Health Organization’s Southeast Asia office, North Korea is testing about 1,500 people a week for Covid-19.

If this is the maximum capacity, it would be impossible to test the current number of symptomatic patients – 1.72 million and counting – let alone their contacts. They also need Covid-19 tests to confirm the diagnosis before starting Paxlovid. We should send out enough exams now. They are flying blind.

Third, the country is food insecure. Lockdowns are difficult for people, especially the poorest. Even stricter isolation measures are expected now that the virus has entered the country.

Immediate food aid is needed to alleviate the hunger of those without supplies to weather the lockdowns.

North Korea has not vaccinated its population. They rejected vaccine offers, possibly believing they could face the pandemic in isolation until it subsides.

The risk of the virus entering via cargo and possibly by foreigners did not outweigh the benefit that vaccines provided. They were overly reliant on their ability to keep the virus out and therefore unprepared for the outbreak.

The breach and the resulting outbreak require a new strategy that can increase population protection against further outbreaks.

mRNA vaccines are effective against BA.2. Sufficient quantities of vaccines and deployment supplies must be offered to North Korea quickly. Research has shown that North Korea can deploy mRNA vaccines using the existing network of refrigerators.

The first group of people to be vaccinated should be frontline healthcare workers as they face an onslaught of Covid-19 patients every day.

When assisting North Korea, the “who” and “how” are just as important as the “what”. A national crisis requires all actors to work together.

The United Nations (UN) is in the best position to coordinate the different agencies, such as the World Health Organization (WHO), Unicef, the World Food Program and non-governmental organizations; manage complex regulations and logistics; and to help implement them together with the North Korean government.

Monitoring and evaluation requirements shouldn’t be a point of contention now – people’s lives are at stake. We must also take a solidarity approach and not demand that North Korea ask for help first. Our hands must come out first; your need is clear.

North Korea also needs to become more flexible. They should not try to manage the crisis by putting together isolated relief packages from individual organizations. We need a clear communication focal point to coordinate with the international community.

Undoubtedly, aid to North Korea is controversial. On the same day the outbreak was announced, North Korea fired three short-range ballistic missiles. Perhaps we can have a moratorium on any military activity on the Korean Peninsula until the outbreak is contained. Such activity diverts precious resources and attention from the urgent needs of the people.

All sides need to be vigilant to contain the pandemic. It is in everyone’s interest to help North Korea contain this outbreak – and prevent future ones.

Source: CNN Brasil

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