SEOUL — The coronavirus has been spreading across North Korea “explosively” since late last month, killing six people and leaving 187,800 people in quarantine, the country’s state media reported on Friday.
Health officials made the rare admission of an emerging public health crisis after the country reported its first outbreak of the virus — after long insisting it had no infections and refusing outside humanitarian aid to fight any spread. The announcement of fatalities came as the country’s leader, Kim Jong-un, was visiting the national disease-control headquarters on Thursday, the North’s official Korean Central News Agency said.
In a sign of growing urgency, the state-run Central Television for the first time showed Mr. Kim wearing a mask during a Workers’ Party meeting.
Mr. Kim criticized his heath officials, saying that the simultaneous spread of fever, with the capital as a center of the outbreak, “shows that there is a vulnerable point in the epidemic prevention system,” the North Korean news agency said.
Some analysts warned that North Korea could be headed into a major humanitarian crisis unless the international community persuades it to open up for outside aid to fight the virus.
“We are in the early stage of the spread of vast human misery,” said Lee Sung-yoon, a North Korea expert at the Fletcher School at Tufts University. “The nature and scale of the illnesses, deaths, hunger and starvation can only be established much later.”
North Korea said it had learned of its first outbreak after health officials on Sunday tested people in Pyongyang, the capital, who showed symptoms such as a fever. They were infected with the BA.2 subvariant of the virus, it said.
The country declared a “maximum emergency” and ordered all cities and counties in the nation of 25 million to lock down, and told them to isolate “each working unit, production unit and residential unit from each other.”
North Korea said 350,000 people had been found to have a fever since late April, including 18,000 on Thursday. It added that 162,200 people had completely recovered. The reports on the outbreak so far have been vague, blaming “a fever whose cause couldn’t be identified.” They did not clarify, for example, how many people with the fever had tested positive for the virus. But they said that one of the six who died had tested positive for the BA.2 subvariant.
“Like any other data from North Korea, the figures are up to debate, and we cannot fully trust them,” said Ahn Kyung-su, who operates the Seoul-based DPRKHealth.org, a website and network of public health experts who study North Korea. “But what’s clear is that North Korea has the Covid phenomenon, and by publicizing those figures, North Korea appears to be sending out signals that it is finally ready to accept Covid-related aid from the outside.”
So far, North Korea has not accepted any Covid-19 vaccine donations from world health organizations. South Korean officials hope that humanitarian shipments, including vaccines, could help restart diplomatic dialogue between North Korea and the United States and allies.
The danger posed by the Covid outbreak is greater in North Korea than in most other nations because most of its people are unvaccinated. In addition, the outbreak could increase the strain on the economy, which already has been hit by years of U.N. sanctions and North Korea’s decision two years ago to close its border with China, its only major trading partner.
“North Koreans are chronically malnourished and unvaccinated, there are barely any medicines left in the country, and the health infrastructure is incapable to deal with this pandemic,” said Lina Yoon, senior Korea researcher for Human Rights Watch. “The international community should offer medicine for Covid-19 related symptoms, Covid-19 treating anti-viral medicines, and provide vaccines and all necessary infrastructure for vaccine preservation, including fridges, generators and gasoline.”
Hours after admitting to the outbreak on Thursday, North Korea launched three ballistic missiles from near Pyongyang toward the sea off its east coast. It was the North’s 16th missile test this year.
In South Korea, the government of the newly inaugurated president, Yoon Suk-yeol, condemned the test as a “grave threat” and “provocation,” and accused the North of “duplicity” for testing weapons while its people were threatened by the coronavirus. But it said it was willing to ship vaccines, therapeutics and other humanitarian aid to the North.
In Washington, Jen Psaki, the White House press secretary, said that “the United States does not currently have plans to share vaccines” with North Korea. She said the country was “continuing to exploit its own citizens” through its policy of not accepting humanitarian aid during the pandemic.
“Instead, they divert resources to build their unlawful nuclear and ballistic missiles programs,” Ms. Psaki said, repeating Washington’s assessment that North Korea could be ready to conduct a nuclear test as early as this month. President Biden is scheduled to meet with Mr. Yoon in Seoul on May 21.
As the rest of the world learns to live with Covid-19, China’s top leader, Xi Jinping, wants his country to keep striving to live without it — no matter the cost.
China won a battle against its first outbreak in Wuhan, Mr. Xi said last week, and “we will certainly be able to win the battle to defend Shanghai,” he added, referring to the epicenter of the current outbreak in China.
But pressure is mounting for a change to the zero-Covid strategy that has left Shanghai at a standstill since March, kept hundreds of millions of Chinese citizens under lockdown nationwide and is now threatening to bring Beijing to a halt.
This week, the World Health Organization called China’s current pandemic strategy “unsustainable.” An economist summarized it as “zero movement, zero G.D.P.” Multinational companies have grown wary of further investments in the country.
For more than two years, China kept its Covid numbers enviably low by doggedly reacting to signs of an outbreak with testing and snap lockdowns. The success allowed the Communist Party to boast that it had prioritized life over death in the pandemic, unlike Western democracies where deaths from the virus soared.
More transmissible variants like Omicron threaten to dent that success, posing a dilemma for Mr. Xi and the Chinese Communist Party. Harsher lockdowns have been imposed to keep infections from spreading, stifling economic activity and threatening millions of jobs. Chinese citizens have grown restless, pushing back against being forced to stay home or to move into grim, government-run isolation facilities.
Yet abandoning the strategy risks a surge in deaths, especially among the country’s tens of millions of unvaccinated older people. Researchers this week warned of a “tsunami” of deaths if the virus surged unchecked, leaving China’s fragile national hospital system overwhelmed and raising the possibility of social unrest.
Fearing any dissent during a politically important year for Mr. Xi, China’s censors have moved quickly to muffle calls for a change in course on Covid-19. The head of the World Health Organization, whose recommendations China once held up as a model, was silenced this week when he called on the country to rethink its strategy.
Photographs and references to Tedros Adhanom Ghebreyesus, the director general of the W.H.O., were promptly scrubbed from the Chinese internet after the statement. The foreign ministry responded by calling Mr. Tedros’s remarks “irresponsible,” and accusing the W.H.O. of not having a “proper understanding of the facts.”
China’s state-controlled media has also glossed over the draconian measures officials have deployed to deal with outbreaks. This week, as some authorities in Shanghai erected new fences around quarantine zones, boarded up more homes and asked residents not to leave their apartments, state media painted a picture of a city slowly returning to normal.
One article described the “hustle and bustle of city life” returning, while another focused on statistics for how many stores had reopened.
But rosy state media reports cannot hide a looming challenge facing Mr. Xi.
To date, the coronavirus has claimed 569 lives and infected more 777, 565 people since March 1, according to official statistics. If unchecked, the outbreak could lead to 112 million infections and nearly 1.6 million deaths between now and July, according to a study from researchers at Fudan University in Shanghai and Indiana University in the United States.
“The situation is pretty grim, and the study shows clearly the huge importance in vaccinating and boosting the elderly,” said Marco Ajelli, an infectious disease modeler at Indiana University’s School of Public Health, who contributed to the study.
Less than half of people aged 70 or older in Shanghai have received two jabs, according to the study. Across China, the number is 72 percent, a figure that health experts say should be 95 percent or higher. In dozens of cities where there have been outbreaks or partial lockdowns in anticipation of rising cases, resources have been devoted to stamping out the virus rather than to vaccinations.
Currently the vaccines available in China are also not as potent as foreign ones available in other countries. Chinese vaccines use traditional technology that has been shown to be less effective than breakthrough mRNA technology. China said last year that it was close to approving BioNTech, a German mRNA shot made in partnership with Pfizer, but that has not happened. Several Chinese companies are in the testing phase of a homegrown mRNA option, and China also recently approved for emergency use a Covid-19 antiviral pill made by Pfizer called Paxlovid.
Administering three vaccine shots, using antiviral therapies and offering more effective vaccines could help China find a path out of zero Covid, Mr. Ajelli said.
Investors and business leaders worry that China’s rigid adherence to its zero-Covid policy could send the economy into free fall. “It is high time for the government to change its strategy,” said Fred Hu, a prominent Chinese investor. The benefits of zero Covid no longer outweigh the economic costs, he added. “Sticking to the zero-Covid strategy would decimate its economy and undermine public confidence.”
By one estimate, nearly 400 million people in 45 cities have been under some form of lockdown in China in the past month, accounting for $7.2 trillion in annual gross domestic product. Economists are concerned that the lockdowns will have a major impact on growth; one economist has warned that if lockdown measures remain in place for another month, China could enter into a recession.
European and American multinational companies have said they are discussing ways to shift some of their operations out of China. Big companies that increasingly depend on China’s consumer market for growth are also sounding the alarm. Apple said it could see a $4 billion to $8 billion hit to its sales because of the lockdowns.
Howard Schultz, the interim chief executive of Starbucks, said the company has “virtually no ability to predict our performance in China.”
Foreign investments have nearly dried up, and some projects have been on hold for more than two years because pandemic restrictions have made it essentially impossible for foreign executives to visit China. When executives at multinational companies appeal to senior Chinese officials, their calls are met with silence, said Michael Hart, the president of the American Chamber of Commerce in China.
“China has been very steadfast in its views that it has the right strategy and it doesn’t want people to criticize it,” Mr. Hart said.
Some of China’s top leaders have also started to share concerns about the economy. China’s premier, Li Keqiang, described the employment situation as “complicated and grave” as migrant workers and college students struggle to find and keep jobs during lockdowns.
Even as daily virus cases in Shanghai are steadily dropping, authorities have tightened measures in recent days following Mr. Xi’s call last week to double down. Officials also began to force entire residential buildings into government isolation if just one resident tested positive.
The new measures are harsher than those early on in the pandemic and have been met with pockets of unrest, previously rare in China where citizens have mostly supported the country’s pandemic policies.
In one video widely circulated online before it was taken down by censors, an exasperated woman shouts as officials in white hazmat suits smash her door down to take her away to an isolation facility. She protests and asks them to give her evidence that she has tested positive. Eventually she takes her phone to call the police.
“If you called the police,” one of the men replies, “I’d still be the one coming.”
Isabelle Qian contributed reporting, and Claire Fu contributed research.
Public health officials in Africa raised concern on Thursday that a dip in surveillance and testing for the coronavirus, as well as the loosening of public health measures, would make it harder to detect and respond to new waves as cases rise in parts of the continent.
The surge has mostly come in southern Africa, where cases have risen significantly over the previous week, according to the World Health Organization. As of Wednesday, new reported cases in South Africa have increased 80 percent from the average two weeks ago and deaths have increased 44 percent, according to the Center for Systems Science and Engineering at Johns Hopkins University.
Many countries on the continent have reported significantly fewer tests administered, which could make it difficult to track new waves, said Dr. Abdou Salam Gueye, the director of emergency preparedness and response at the W.H.O. regional office for Africa.
“It makes us a little bit blind in knowing what exactly is the situation,” he said during W.H.O. Africa’s weekly briefing, adding that African countries should “put in place a system that will help with earlier detection and better response for Covid-19.”
Although testing levels have dropped in South Africa, public health officials have been able to detect an increased burden of the virus by testing wastewater, said Dr. Kerrigan McCarthy, a specialist pathologist at the National Institute for Communicable Diseases in South Africa.
Meanwhile, vaccine distribution and use in Africa has also been slow. The first factory in Africa licensed to produce Covid-19 vaccines for the African market has not received a single order and may shut down that production line within weeks if the situation doesn’t change, according to executives of the company, Aspen Pharmacare.
The primary driver of the latest wave is the Omicron variant and the highly transmissible subvariants BA.2, BA.4 and BA.5, W.H.O. officials said. People in South Africa are still required to wear masks indoors, including in schools, and the government is still limiting the size of public gatherings. But as winter approaches in the Southern Hemisphere, the country’s most onerous social distancing and other public health restrictions have been eliminated.
The pandemic measures were loosened “primarily for economic reasons, and not necessarily for medical or public health reasons,” Dr. McCarthy said.
Despite the growing number of known cases, there are some promising signs. Hospitalizations in South Africa have remained low, according to the W.H.O. And deaths, a lagging indicator, have climbed at a slower rate than cases.
JOHANNESBURG — The first factory in Africa licensed to produce Covid-19 vaccines for the African market has not received a single order and may shut down that production line within weeks if the situation doesn’t change, according to executives of the company, Aspen Pharmacare.
The factory, in the coastal South African city of Gqeberha, formerly known as Port Elizabeth, was celebrated as a solution to the continent’s unequal access to vaccines when it announced a deal to start manufacturing Covid vaccines in November of 2021.
But no purchasers have appeared, as the slow distribution of vaccines in Africa has left health agencies with a backlog of supplies. Commercial production never started, in what officials say is an ominous sign for other African countries that had considered manufacturing Covid-19 vaccines.
Throughout the coronavirus pandemic, many African countries have lagged far behind much of the world in getting their people vaccinated — and some countries have had difficulty distributing what doses they did get.
Less than 20 percent of the total population in Africa is fully vaccinated against the coronavirus. Officials and politicians blamed wealthy countries for hoarding vaccine doses when vaccines first became available. Countries reliant on donations of vaccines were at the back of the line. Building the capacity to manufacture vaccine doses in Africa was billed as a solution to this vaccine inequity as well as a way to prepare for future pandemics.
South African drug maker Aspen Pharmacare was lauded when it signed a deal with Johnson & Johnson in November last year that would allow it to produce and market the single-dose vaccine as Aspenovax. The vaccine, identical to the one created by Johnson & Johnson, was intended for the African market.
But the initial enthusiasm has not led to purchases, for complicated reasons.
South African president Cyril Ramaphosa, speaking on Thursday at a global summit on the pandemic organized by the White House, blamed “international agencies” for failing to buy vaccines from a pioneering African manufacturer.
“This immediately just devalues the whole process of local manufacturing and local production of vaccines. This, ladies and gentlemen, must change,” Mr. Ramaphosa said.
Gavi, an international nonprofit agency that manages vaccine purchasing deals for low-income countries through the Covax alliance, said in a statement that under its existing contract with Johnson & Johnson, the company has provided vaccines from sources of its choosing. Of the nearly 450 million vaccine doses Gavi has shipped to Africa, 28 percent have been the Johnson & Johnson vaccine, second only to Pfizer-BioNTech’s, at 30 percent.
Gavi said in the statement: “Covax is still under contract with J & J and we would be very happy for any doses that we are still expecting to be supplied by Aspen. We have communicated this to J & J. However, again this is solely a decision that rests with J & J.”
But given the unpredictable demand for Covid vaccines in Africa, Gavi also said, it could not guarantee that it would be in a position to purchase directly from Aspenovax in the coming year.
Vaccine procurement contracts are protected by nondisclosure agreements that have made the process opaque.
Johnson & Johnson has not yet responded to a request for comment.
U.S. regulators have restricted use of the Johnson & Johnson shot, preferring the Pfizer-BioNTech and Moderna vaccines instead. But recent evidence suggests that over time, the Johnson & Johnson vaccine is preventing infections and illnesses about as effectively as the others, and may prove to offer more durable protection.
Gavi said the U.S. regulators’ limitation would not discourage it from purchasing the single-dose vaccine if demand increased. Adenovirus-based vaccines like Johnson & Johnson’s do not need below-freezing storage like the Pfizer and Moderna vaccines, both mRNA vaccines. That makes it an attractive choice in countries that lack the needed medical infrastructure, the nonprofit added.
Stavros Nicolaou, Aspen’s head of strategic trade development, said that if there are no orders in the next six weeks, Aspen plans to repurpose the sterile production line to produce anesthetics and other drugs. The company said it feared that not all of the 500 staffers trained to produce vaccines could be redirected to other manufacturing lines.
“That good will” that accompanied the initial launch, said Mr. Nicolaou, has “not been matched with orders from the multilateral procurement agencies.”
In talks with multilateral agencies, Aspen was hoping orders would roll in at the beginning of 2022, in time for it to start producing commercial batches of the Aspenovax vaccine by the end of March.
But by then agencies had already secured enough vaccines from other sources to begin large-scale vaccination drives. Those efforts were hobbled by logistical and other issues that slowed vaccinations, leaving the continent with a glut of doses that is ongoing.
Recent studies found that more than two-thirds of Africans had already had a Covid infection before the Omicron wave, but reported death rates remain among the lowest in the world. That, combined with the lengthy wait for vaccines, has driven down demand and it remains low. Some public health officials advocate scaling back large-scale vaccination efforts and focusing instead on the most vulnerable groups.
As a result, the African Union and agencies like Covax have not placed new orders in recent months with other manufacturers either.
“Our disappointment remains that Aspen’s capacity has been known for quite some time and we would have liked to be scheduled in the procurement process,” said Mr. Nicolaou.
Aspen’s vaccine “came very late in the process,” said Dr. Abdou Salam Gueye, director of emergency preparedness and response for the W.H.O.’s Africa region. The global health agency and its partners have shifted their focus to delivering vaccines to patients, rather than procuring additional vaccine doses, he added.
Unicef, which is the largest single vaccine buyer in the world, said the South African-made vaccines had yet to go through all the W.H.O. approvals.
“The Aspen products have not yet received an ‘Emergency Use Listing’ from W.H.O. and cannot be procured by UNICEF until that is in place,” said Gisela Henrique, Unicef’s deputy director of supply division.
Dr. John Nkengasong, the outgoing head of the African Union’s Centres for Disease Control and Prevention, recalled a 2021 summit where thousands participated in a Zoom call to pledge to build up Africa’s vaccine manufacturing.
Dr. Nkengasong, who said he has been in talks with Aspen as well as with African leaders to find a solution, described the lack of orders as “very worrying,” adding that it would discourage other African companies from developing the capacity to manufacture Covid-19 vaccines.
“If those companies are not supported, the whole pronouncement and commitment that we all made at the height of this pandemic would really not have been translated into facts,” he said.
Reporting was contributed by John Eligon from Johannesburg, Lauren McCarthy from New York and Stephanie Nolen from Halifax, Nova Scotia.