The ongoing wave of omicron infections in North Korea could cause tens of thousands of deaths in the unvaccinated country, according to Dr. Oh Myoung-don, who heads the National Medical Center’s committee for clinical management of emerging infectious diseases.

Speaking at a virtual forum organized by Seoul National University’s Institute for Health and Unification Studies on Monday, Oh estimated that the omicron death toll in North Korea could reach around 34,000 at the end of the current wave. He said he arrived at the numbers based on his analysis of an April 15 US Centers for Disease Control and Prevention report and other data out of Hong Kong.

The US CDC report, which looked at cases that occurred over Hong Kong’s omicron outbreak from Jan. 6 to March 21 this year, noted that the high overall mortality there was mainly driven by deaths among unvaccinated people aged 60 and up.

The report said the mortality rate was highest among people in their 80s and older who have never received a vaccine at 1.725 percent -- or 17,250 deaths per million population. Among unvaccinated people in their 60s and 70s, the rate was 0.278 percent and 0.584 percent, respectively.

North Korea has 2,409,986 people in their 60s and older who make up 9 percent of its entire population, according to the United Nations’ 2019 statistics, all of whom are probably unvaccinated, Oh pointed out.

“Considering that North Korea does not have the kind of advanced health care system that Hong Kong does, death rates could be even higher there,” he said.

The outbreak in North Korea is growing rapidly, with about 5 percent of its 26 million population reported having experienced a fever between late April and now. The cumulative estimated count has climbed to 1,483,060 cases and 56 deaths in less than a week since admission of domestic cases on May 12. 

In the last 24 hours alone, 269,510 cases of “fever” and six associated deaths were newly registered, the North’s official Korean Central News Agency announced Monday.

South Korean public health authorities say the official estimates of cases and deaths across North Korea are likely to be vastly undercounted.

Lee Sang-won, who is leading the Korea Disease Control and Prevention Agency’s epidemiological analysis team, on Tuesday suggested a possible underreporting of deaths in North Korea.

Speaking to reporters, he said, “Based on announcements so far, North Korea’s rate of deaths per cases is lower than that observed in South Korea, or elsewhere in the world despite a widespread outbreak that appears to be taking place.”

Ministry of Health and Welfare spokesperson Son Young-rae pointed out that North Korea’s lack of diagnostics to confirm COVID-19 meant cases without symptoms were going unreported. Citing ministry data, he said “more than half of younger patients with omicron do not exhibit any symptoms.”

Son said North Korea’s reliance on the presence of a fever to sift out suspected cases also “leaves large loopholes.” “Only about 1 in 10 omicron patients develop a fever,” he said.

He said South Korea’s low case fatality rate of 0.13 percent was a result of “mass testing and high vaccine rate, without which even omicron can prove deadly.”

Oh of the National Medical Center said at this point, vaccines “unfortunately, would make a little difference to the situation facing North Korea.” He said the omicron outbreak in North Korea likely began around April 15, weeks before the official announcement.

“Even if the vaccines were to arrive now, it would take at least a month for both doses to get to the arms of people and for the full protective effects to kick in,” he said. “By that time, omicron will have already have peaked and done its damage.”

Rather, what was more urgently needed were treatments including antivirals and anti-inflammatory drugs to stop people from becoming very sick as well as basic over-the-counter medications like fever reducers, he said.

The lack of access to essential medicines may force North Koreans to resort to nonmedical alternatives.

North Korea’s state-operated daily Rodong Sinmun on Sunday ran a story about home remedies for COVID-19 symptoms, recommending honey for cough, willow tea leaf for other mild symptoms and ventilating the room for breathlessness.

Dr. Paik Soon-young, a virologist at Catholic University of Korea, agreed that the omicron outbreak in North Korea has grown past a size containable through vaccination.

“The 300,000-something cases a day now being reported in North Korea is comparable to the 600,000 daily cases logged at the peak of South Korea’s omicron surge in March, seeing that our population is roughly double theirs,” he told The Korea Herald.

Paik said North Korea would still need the vaccines to fend off possible second and third waves of infection coming their way. “Easily storable vaccines like Novavax might be better suited for use there than the mRNA types,” he said.

Throughout the pandemic North Korea has refused international offers of vaccines and other assistance.

In a phone call with The Korea Herald, North Korea-trained physician Dr. Choi Jung-hun said North Korea does not have the cold chain supply or the capacity to monitor adverse events that are necessary to carry out a population-wide vaccine campaign.

Similarly, the ruling People Power Party Rep. Tae Young-ho, a former North Korean senior ambassador to the United Kingdom, said in a series of Facebook posts that COVID-19 support to North Korea should be provided in the form of a “full package” to be of meaningful help.

“This means not only sufficient amount of vaccine doses to inoculate enough of the population, but the infrastructure to store and deliver them,” he said.

By Kim Arin (arin@heraldcorp.com)