Covid in North Korea: Without drugs and vaccines, regime recommends tea and salt water

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Without vaccines and medicines, North Korea has been hit hard by the advance of Covid-19. More than 2 million people have fallen ill and at least 65 people have died, but Pyongyang’s central regime has only called the disease a “fever”, according to state media.

In early 2020, the country closed its borders to try to isolate itself from the pandemic that affected the world. North Korea shares land borders with South Korea and China, which have both recorded large outbreaks. China is now facing an omicron wave, with lockdowns in its major cities. But to date, North Korean officials have rejected foreign medical support.

Analysts point out that North Koreans are more vulnerable to the virus due to the lack of vaccines and the precariousness of the health system.

A national lockdown is in place in the country, but there is no precise information on whether the strategy has had an effect. In addition, state media said the country’s dictator, Kim Jong-un, has blamed health officials for “hindering” the distribution of national drug supplies.

BBC Reality Check has been monitoring media controlled by the North Korean regime, which has recommended several traditional treatments against common ailments, such as hot tea and gargling with salt water, but with no proven effectiveness against Covid-19.

Hot drinks and the relief of mild symptoms

For those who are not seriously ill, the state-run newspaper Rodong Simnun recommends treating yourself to hot tea with ginger or honeysuckle or a drink made from willow leaves.

Hot drinks can alleviate some milder symptoms of Covid, such as a sore throat and cough, and help some sick people to hydrate. Ginger and willow leaf can also relieve inflation and reduce pain. But they are not treatments for the virus itself, like the antivirals adopted around the world, such as Paxlovid and Molnupiravir.

Gargling with salt water and its limited effectiveness against symptoms

North Korean state media aired a report in which a couple interviewed recommended gargling with salt water morning and night to fight Covid. “Thousands of tons of salt” were sent to Pyongyang to produce the “antiseptic solution”, the state news agency announced.

For one, some studies point out that gargling with salt water and rinsing the nostrils with saline solutions can help fight viruses that cause the common cold. But there is no evidence of its effectiveness against Covid.

In addition, mouthwashes, which were also recommended, were shown to be effective against the virus in the laboratory. But again, there is no evidence of its effectiveness against Covid in humans.

Covid-19 is mainly transmitted through the air, invading the body through both the nose and mouth. So, gargle would only attack one of several entry points. Furthermore, once the virus has entered the human body, it replicates and spreads deep into other organs, where this strategy will not have reach or effectiveness.

Painkillers and antibiotics ineffective against Covid

North Korean state TV has also been advising patients to use painkillers and antipyretics like ibuprofen and antibiotics like amoxicillin. Ibuprofen (and acetaminophen) can lower your temperature and relieve symptoms such as a headache or sore throat. But they will not eliminate the virus or stop it from developing.

Antibiotics are effective against infections caused by bacteria, not infections caused by viruses. In addition, using antibiotics unnecessarily increases the risk of developing drug-resistant microbes. A large study of the antibiotic azithromycin, for example, found it made little or no difference to Covid symptoms, the likelihood of hospital admission or the chances of dying from the disease.

There are currently some drugs approved in several countries, including Brazil, to prevent people with Covid-19 from ending up in hospital: antivirals (paxlovid, molnupiravir and remdesivir) and antibody therapies that mimic the immune system. But the effectiveness varies greatly depending on the patient’s profile and when the treatment started in relation to the day of infection.

Health system in difficulty

North Korea’s healthcare system was created to provide free medical care, from basic services in villages to specialized treatment in public hospitals (usually in urban centers). But the national economy has declined in recent years because of international economic sanctions and extreme weather conditions such as droughts.

In addition, the closing of the country’s borders and strict lockdown measures also have negative impacts. Without the same structure as the capital Pyongyang, the health system in the rest of the country suffers from shortages of personnel, medicines and equipment.

Kee Park, a professor of Global Health and Social Medicine at Harvard University, says North Korea is a low-income country with a limited healthcare system. “Despite a relatively high density of healthcare workers, the system would struggle to cope with the increase in patients,” he says.

Alistair Coleman, an expert on North Korea, explains that Pyongyang’s response to Covid has always been to deny that the virus exists in the country. “The state’s response was to close its borders and implement a hygiene strategy to prevent infections, spraying public places such as train stations, schools, hospitals, etc.”

But the country could not be less prepared to fight the disease. A United Nations report last year said: “Some of the pharmaceutical, vaccination and medical device factories do not meet the WHO’s level of good practice. [Organização Mundial da Saúde] and also do not meet the local demand”.

Many North Korean defectors to South Korea said they had to pay for drugs or find treatment and drugs restricted to privileged members of the ruling party. State media, on the other hand, say it has increased drug production.

Refuse international aid

A country of nearly 26 million people, North Korea turned down 3 million doses of vaccines made in China last year — and is believed to have turned down other offers linked to Covax, the global sharing scheme. South Korea says it has had no response to its offer of vaccines, medical supplies and personnel.

North Korea reportedly recently sent three planes to collect medical supplies from Shenyang, China. But there were no “anti-pandemic supplies,” China’s Foreign Ministry said. In any case, the neighboring country said it was “ready to work with North Korea in the fight against the coronavirus”.

As a result of Pyongyang’s rejection of the international community’s help to vaccinate the population, herd immunity in the country is extremely low. Despite rumors that some of North Korea’s elite have been vaccinated, the vast majority of North Koreans have not received any Covid doses.

In fact, during the pandemic, state media misleadingly warned about the ineffectiveness and dangers of Covid vaccines. With no confirmed cases of Covid in the last two years, the population is “immunologically fragile to the Sars-Cov-2 virus” and all its variants, says Harvard professor Kee Park. “So far they haven’t had any outbreaks, so no one has developed immunity. Also, they still need to vaccinate the population. They essentially have no immune protection,” he adds.

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