The Immunity Numbers Are Too Low Antibody tests were supposed to be a “game changer,” but they are instead revealing that the majority of Americans are still vulnerable to COVID-19 infection. by SARAH ZHANG

For months, the lack of testing for the novel coronavirus in the United States has allowed, ironically, a small glimmer of hope: The official number of COVID-19 cases, currently 957,875, is almost certainly too low.

If people who want to get tested can’t get tested, and if people who are asymptomatic never think to get tested, then it stands to reason that many more Americans must be immune to COVID-19 than presently known. The only way to find the true number is by looking for immunity, which requires testing for proteins called antibodies in the blood that are evidence of past infection. Such antibody tests have been seen as key to reopening the country; other countries have even proposed using them for “immunity certificates” that would allow the immune to return to work.

But if the first results from antibody surveys, also known as “serosurveys,” in the U.S. are anything to judge by, simply not enough people are immune. Too many Americans are still vulnerable to COVID-19 infection for these tests to be the “game changer” that many were hoping for.

A pair of controversial surveys in the Bay Area and Los Angeles County found antibodies in 2.5 to 4 percent of the population—and even those numbers may be overestimates due to methodological flaws. In New York City, the country’s COVID-19 epicenter, 24.7 percent of people tested positive for antibodies. (The statewide number is 14.9 percent.) These rates do translate to many times more cases than officially documented, to be clear, but they are still a far cry from the 70 percent scientists believe is necessary to reach herd immunity and stop disease transmission. And if only a small fraction of the population can return to work without fear of getting the coronavirus, a return to something resembling normal is still a long way off.

“I think there was a lot of hope that we would do the antibody testing or do the serosurveys and then we would see there was a huge amount of immunity built up in the population,” Natalie Dean, a biostatistician at the University of Florida, told me. But earlier data from outside the U.S. have suggested otherwise. One study in the hard-hit municipality of Gangelt, considered “Germany’s Wuhan,” found 14 percent of people testing positive for antibodies. “It was clear from that point, for me, that we weren’t going to see big numbers,” Dean said.

The idea of reopening the country based on antibody tests runs into the technical limits of the tests themselves. Scientists don’t know exactly how long immunity to COVID-19 will last and what level of antibodies confers immunity. “There are just unknowns for an individual,” Gigi Gronvall, a senior scholar at the Johns Hopkins Center for Health Security and a co-author of a recent report on antibody testing, told me. “The ‘get out of jail free’ card we’re hoping for, it’s just not how it should be sold,” she said. The World Health Organization on Friday warned that issuing “immunity certificates” based on antibody testing would be premature.

Meanwhile, a flood of new test kits with varying rates of accuracy is now hitting the market. In the U.K., for example, Prime Minister Boris Johnson touted finger-prick antibody tests as a “game changer,” only for the government to realize that the 3.5 million tests it bought from China were not reliable enough to use. Of particular concern here is the false-positive rate: If the prevalence of COVID-19 is quite low in the population—say, 5 percent—and a test can identify people who are truly negative with 95 percent reliability, half of the “positives” it returns will be false positives. In other words, half of the people the test says have antibodies wouldn’t actually have them. “I wouldn’t want to tell a nurse or physician ‘Go back to work’ based on that,” Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told me.

Moreover, Osterholm said, antibody tests don’t give a snapshot of the present. It can take two weeks for a patient to develop a detectable amount of antibodies in their blood, so antibody surveys are necessarily backward-looking. But when public-health officials are deciding whether schools or businesses are safe to reopen, the key piece of information is the number of people currently infected. “I want to know what is happening now,” Osterholm said, “and antibody testing will not get that to you.”

The key strategies for stopping the disease are still the same ones experts have been promoting from the beginning: testing, contact tracing, isolating for those who test positive for COVID-19, and social distancing for everyone else. “There’s going to have to be some level of new normal for a while,” Dean said. Ongoing antibody surveys will help clarify the true scope of the pandemic and the true proportion of asymptomatic carriers, and those data can indeed help inform public-health decisions. But as far as antibody testing goes, Gronvall said, “it’s not the silver bullet for everything.”

Current antibody surveys are revealing, furthermore, that immunity to COVID-19 can vary widely from location to location. Take New York City, which had a relatively high antibody positive rate of 24.7 percent, while the rest of New York State was at just 3.2 percent. The pandemic may be global but, as Yonatan Grad, an immunologist at Harvard University, told me, “it is made up of hyperlocal epidemics that are differentially impacting communities.” If neighboring cities, states, or countries are at very different points in their outbreak trajectory, it could create difficult questions about when and how to reopen. The places that have best succeeded in stopping COVID-19 will be the ones most vulnerable to infections in the future. Singapore, for example, succeeded in containing the virus early on, only to see a huge surge of cases in March and April. “At some point,” Grad said, “we’re going to need to think about How do we all get to the same place?”

The Democrats Have No Good Options If they are successful in their cooperation with Trump, they potentially throw him an electoral lifeline. But if they fail, the country will suffer. by Quinta Jurecic and Lawfare Benjamin.

President Donald Trump signed the latest coronavirus-relief legislation as he was managing the fallout of Bleachgate. The president insisted at the signing of the $484 billion package that his comments the previous day—he had mused at an April 23 press conference, “I see the disinfectant that knocks [the virus] out in a minute, one minute,” and asked, “Is there a way we can do something like that by injection inside, or almost a cleaning?”—had been sarcastic.

After Trump made those comments, the manufacturer of Lysol issued a statement that nobody should be using disinfectant internally. Authorities in Maryland warned against ingesting cleaning products, noting that the state’s emergency hotline had already received “several calls” about the possible use of disinfectant to treat COVID-19. New York City’s poison-control center announced that it had recorded an unusually high number of calls about incidents with bleach and other cleaning products in the day after the initial press conference. Presumably Nancy Pelosi had not anticipated this backdrop to the bill’s signing when she pushed it through the House.

The incident highlights a dilemma with which congressional Democrats are grappling as their ongoing confrontation with the Trump presidency crashes into the era of the coronavirus: How does one work with this deranged president in order to respond to the virus and the economic catastrophe it is unleashing, while also holding him accountable for his fantastic mismanagement of the crisis, and drawing sharp contrasts to him for the election coming up in six months?

Democratic leaders have to work with Trump for several distinct reasons. It is the right thing to do, for starters. Morally, no alternative exists. The country is in crisis and Trump is the only president Americans have at the moment—even though he might want people to inject themselves with disinfectants, even though he is bullying governors and displaying a self-absorption that is pronounced even for him, even though he is partly responsible for the disaster the country is experiencing.

Besides, from the perspective of congressional Democrats, addressing the crisis while working around the president is impossible. Trump supervises all the agencies they wish to see doing more to combat the virus. He spends the money they appropriate. He is, after all, the executive—the person who does the things Congress may authorize, direct, or pay for.

More broadly, working with the president on this involves doing things Democrats tend to believe in. The Democratic Party is, after all, the party of more generous social welfare. It’s also, generally speaking, the party of Keynesian economics, which is to say spending one’s way out of economic downturns. So the House majority has reason to push forward in working with the White House on aid legislation, in a way that Republicans skeptical of government spending would not.

Political factors also favor cooperation. The public expects its leaders to come together for the good of the country in national emergencies. To fail to do so would look terrible—particularly in an election year, as Democrats try to present themselves as the party of responsible government in contrast to the Republican cult of an erratic personality.

Yet working closely with the president undermines a key—and very righteous—concurrent Democratic objective: holding Trump accountable. It is a strange thing to accuse the president of continuing to grossly mishandle the crisis and to simultaneously put trillions of dollars at his disposal, even as he is urging people to inject Lysol and shine ultraviolet light on their internal organs. It is stranger still to do so after he has removed the inspector general set to keep watch over how coronavirus-aid money is spent. Somehow, Democrats have to make clear on an ongoing basis that although the parties may broadly agree on certain aspects of coronavirus-response policy, that agreement does not reflect any kind of approval of the administration’s conduct.

Because even as Congress pours money into Trump’s hands, this is an election year, and the Democrats have to run against Trump and the congressional and Senate Republicans who enable him.

The incentives this situation creates are in conflict with one another. If Democrats are too successful in their cooperation with Trump—if they help the administration avert the worst economic consequences of the virus—they potentially throw Trump an electoral lifeline. Conversely, if the policy interventions fail, the Democrats become implicated in those failures in ways they would not be if they had not engaged deeply. Democrats have so far acquiesced to the spending of roughly $2.7 trillion. To whatever extent this spending fails to avert disaster, Trump can reasonably point to Congress as having worked with him hand in glove. When the magnitude of the federal deficit this year becomes clear, that will be Congress’s handiwork as much as the president’s.

A further complication is that a strategy of engagement and cooperation will not elevate Democratic priorities to an equal footing with Republican ones—leaving some progressives unsatisfied. By and large, House Democrats have lined up behind Pelosi, including members on the left flank of her caucus. The most prominent exception is Representative Alexandria Ocasio-Cortez, who voted against the recent legislation as insufficient to the scale of the economic need, arguing, “We cannot bow to the logic that a crumb is better than nothing.” Outside Congress, a number of progressive political organizations opposed the bill on similar grounds.

And these critics have a point. Pelosi and Senate Democratic leader Chuck Schumer gained significant policy influence as a result of their engagement with the process. The bill the president signed last week is notably improved from the one the administration requested. It is bigger in scope, has additional money for small businesses without access to traditional banking, and it has money for coronavirus testing as well. But as Jordan Weissmann notes in Slate, the fact that Democrats needed to bargain for obvious necessities such as increased testing is a sign of the absurdity of this political moment and the irresponsibility of the Republican Party. And Democrats have been unable, so far at least, to win urgently needed support for state and local governments, and significant money to push states to implement remote-voting options in time for the November election. Also, as several freshman Democratic lawmakers have complained, House leadership has been unable to implement procedures to conduct business remotely—a failure that compromises the chamber’s ability to respond quickly to the pandemic and conduct oversight.

In the background is a certain awareness that if roles were reversed, it is not at all clear that Republicans would allow their interests similarly to conflict. Back in 2009, with the economy in free fall, Republicans were not nearly as interested in Keynesian economics as they appear to be today. They refused to play ball with the newly inaugurated Barack Obama on his stimulus bill, leaving Democrats solely responsible for those hard political choices. To be fair, a significant element of anti-spending ideology was at play then too—one that has mysteriously vanished in the years since. And House Republicans had likewise opposed Bush-administration emergency spending, before allowing a key bill to pass. But a lot of what was at work was sheer cynicism and political hardball. And it worked. This was the birth of the Tea Party, and Republicans rode that wave to take back the House in 2010.

Pelosi may reasonably resent the asymmetry, but the path of pure hardball is not available to her. Whereas conservative ideologues can oppose big spending as a response to crisis with a straight face, liberals cannot. And though Republicans could build a potent electoral movement out of blanket opposition to all the works of a new Democratic president—even in a time of crisis—Pelosi would be doing neither presumptive Democratic presidential nominee Joe Biden nor her caucus any favors by adopting Mitch McConnell–style obstructionism as they run campaigns based on sane and responsible government.

And so she lives with the dilemma. The confrontation goes on—always. The House is still litigating to get former White House Counsel Don McGahn’s testimony, a case that will be argued this week.

But the party that impeached Trump now also passes bill after bill reflecting deep cooperation and negotiation with him. And the president signs these bills with his own inimitable flourishes.

Medication Shortages Are the Next Crisis The frequency of alerts and the number of drugs in undersupply are shocking developments in a rich country. by Jeremy Samuel Faust

Widespread critical-medication shortages are the next big crisis of the coronavirus pandemic. Some hospitals, including in New York, are running low on paralytic agents that are needed to safely intubate patients. Steve Corwin, the president and CEO of New York–Presbyterian, recently noted on MSNBC that his hospital is even running short on solutions needed for dialysis. I am fortunate to work in the emergency department of one of the best-resourced hospitals in the country, Brigham and Women’s Hospital in Massachusetts. But already, when I order intravenous fentanyl, which doctors use to minimize pain and keep patients breathing safely and comfortably while on mechanical ventilators, an alert pops up reminding me that there’s a national shortage. Am I sure I want to use this medication? Of course I’m sure. The frequency of alerts and the number of drugs in undersupply are shocking developments in a rich country.
Throughout the pandemic, the United States has been playing catch-up. We’re still not testing enough, even though public-health officials saw that problem coming from miles away. Hospitals continue to run low on personal protective equipment. It is too soon to know whether 11th-hour attempts to increase those supplies will succeed. Too many lives hang in the balance to play wait-and-see with our medications too.

In addition to drugs for patients on mechanical ventilators, including sedatives such as etomidate, paralytics, and pain meds, we also need to fast-track the production of antibiotics such as azithromycin, cefepime, and others that we use to treat pneumonia. We need a steady supply of hydroxychloroquine, although not for patients with COVID-19—no compelling evidence shows that it actually benefits those with the virus. Yet because many are using it for the coronavirus, we are now low on the drug for patients with conditions it’s known to help, such as lupus and rheumatoid arthritis.

Here are steps the federal government can take now to make sure that hospitals are well stocked during the pandemic and after it passes, when doctors turn to operations delayed by the COVID-19 surge. First, it needs to improve data collection to track how manufacturing capacity is stacking up against medical demand. Then, it needs to compel pharmaceutical companies and their suppliers to accelerate the production of needed drugs.

The data infrastructure is already in place. For some 20 years, the FDA has run a drug-shortage tracking program. In 2011, in response to a deficit of cancer treatments, anesthesia, and other critical-care medications, President Barack Obama issued an executive order urging drug manufacturers to report supply issues early so that any bottlenecks in production could be addressed in a timely way.

The FDA should build on this program by requiring drug manufacturers to disclose the companies that make their ingredients. Right now, this disclosure is voluntary. The FDA would then need to take tracking a step further and demand that suppliers of ingredients also release production information. Although obtaining this kind of authority may require a change in executive rules at the FDA or a presidential executive order, it is worthwhile. By knowing where companies get their essential compounds, the FDA can keep tabs on the supply of ingredients, identify any production hiccups early, and guarantee that the ingredients are reserved for medical use. Some reagents needed to make vital medications, for example, are also used in cosmetics and other nonessential products.

State and federal officials can already anticipate equipment and staffing shortfalls at hospitals by looking at the Centers for Disease Control and Prevention’s records on caseloads and capacity. But expanding the system to allow hospitals to report the undersupply of medications as well will help public-health officials know when and if it is prudent for the government to step in to direct deliveries, prioritizing areas of maximal need and anticipating other shortages before they become critical.

More robust tracking will help the White House wield the Defense Production Act to its fullest extent and in the most effective way. Although in normal times the government is not involved in the distribution of drugs, these are not normal times. The president should therefore use the DPA’s allocation authority to direct private companies to sell and ship drug ingredients only to priority users. Companies including Amazon are already voluntarily prioritizing the sale of supplies such as hand sanitizer to hospitals. But if medical-ingredient companies sell to producers of nonessential products such as skin care instead of to drug manufacturers, the government should coerce them to act. If domestic companies increase production of these active chemical substances, the U.S. will also be less reliant on manufacturers in China, which are of course outside the authority of the DPA and therefore can’t be forced to respond to the needs of American hospitals. And finally, the White House should use DPA authority to direct manufacturers to sell medications to hospitals or regions most in need according to expanded CDC reports.

If the president is reluctant to continually use the DPA, the government can also compel companies to fill the medication gap in other ways. Recently, for example, the FDA issued guidelines to allow compounding pharmacies, which typically fill prescriptions only for individuals, to temporarily fill them for hospitals. Money can always incentivize companies to speed up production too. The Department of Health and Human Services and the Centers for Medicaid and Medicare Services can temporarily offer higher payments for medications, including generics. Better financial margins will spur manufacturers to make these drugs more quickly.

Finally, after improving the tracking of drugs and increasing production, the government should make sure that hospitals don’t face scarcity again in the near future. It can do that by replenishing the Strategic National Stockpile now with medicine that doctors use in treating the coronavirus, as the pandemic will likely be here for many more months before a vaccine is available.

Doctors are only as good as our teams, our equipment, and our medicines. If we get the PPE we need, our teams will stay safe. If we receive much-needed equipment—tests, ventilators, IV pumps—in time, fewer of our patients will die needlessly. But if we can’t provide medications that make what we do effective, all our efforts will be for naught.

No Testing, No Treatment, No Herd Immunity, No Easy Way Out We need to start preparing for a darker reality. by Yascha Mounk

The past few months have been bleak. Every day has brought word of new casualties from the coronavirus. The world economy entered free fall. And even for those who do not have a sick relative or a mortgage that can’t be paid, the isolation imposed by social distancing has begun to take a heavy psychological toll.

In these circumstances, I—and, I imagine, many others—couldn’t resist latching onto any piece of news that promised quick deliverance from the pandemic. I scoured the papers for positive stories. And I found at least three reasons to hope that the suffering the virus imposed might end sooner than the most pessimistic experts warned.

First, because some people who have COVID-19 don’t seem to show any symptoms, I wondered whether the disease might be far more widespread than the initial data suggested, raising the prospect of the United States’ reaching herd immunity without mass casualties. Second, reports that some existing drugs might prove effective against the disease led me to hope that doctors could soon be in a much better position to heal patients who contract the virus. And third, because some foreign governments have seemed successful in containing the virus through ambitious test-and-trace programs, I thought the United States might find a way to open up its economy without inducing a large resurgence of cases.

There was real reason to indulge in each of these hopes. But in the past several days, a series of developments have undermined the factual basis for all of them. So I am, finally, starting to reconcile myself to a darker reality: The miracle of deliverance is not in sight.

On thursday, New York Governor Andrew Cuomo released preliminary results from a coronavirus-antibody study to determine the true caseload in his state. (Antibodies remain in a patient’s body even after the disease has cleared.)

According to official statistics, a quarter of a million people, or about one in 100 residents of the state, have contracted the coronavirus, and more than 21,000 have died from it. This would put the fatality rate for the coronavirus at a staggering 8 percent.

The new study suggests that the real caseload is much higher. About one in seven New Yorkers who were administered the test were found to have antibodies to the virus. This is good news. If that rate holds for the general population, and a lot more people than previously known have already had COVID-19, then the true fatality rate could be a little less than 1 percent.

Some researchers have cast doubt on that one-in-seven figure. Existing antibody tests are far from accurate, and may include a lot of false positives. And because the New York study recruited many participants in public spaces such as supermarkets, those selected might have taken social distancing less seriously than the average resident of the state—which would make them more likely to have been exposed to the disease.

But even if the New York antibody study didn’t overestimate the infected population, its findings suggest that there’s no easy way out of social distancing. Experts estimate that for a population to reach herd immunity, up to 80 percent of it would have to be exposed to the coronavirus. Even if the virus has a fatality rate of a little less than 1 percent, this means that letting it spread through the population of the United States would cause about 2 million deaths.

Although the New York study gives us a lot of valuable information, we still don’t know how deadly the coronavirus really is. Some antibody tests, including one in Miami-Dade, suggest a lower fatality rate than the New York study. Others, including one in the Netherlands, come to a similarly pessimistic conclusion. But so long as we can’t rule out that millions would die in the United States alone, plans to brave the virus by going back to normal remain in the realm of the stupid or the sociopathic.

A vaccine is likely at least a year away, according to most experts, making finding an effective treatment against COVID-19 all the more important.

President Donald Trump, for his part, has been touting hydroxychloroquine as a potential miracle drug. But two studies—one by scientists in France, another by doctors working for the U.S. Department of Veterans Affairs—have dashed such hopes. As the VA found, patients who took hydroxychloroquine were actually more likely to die than those who did not.

Most scientists have, from the very beginning, been highly skeptical that an antimalarial drug such as hydroxychloroquine could prove effective against COVID-19. But many did have real hopes for a drug that had proved effective in battling other coronaviruses in lab studies: remdesivir.

Now results from the first randomized clinical trial of remdesivir in patients with COVID-19 have become publicly available. Depressingly, the study concludes that remdesivir “was not associated with clinical or virological benefits.”

This is not the final word on either of these treatments. Different trials could bring better news. We have good reason to hope that effective drugs will, eventually, be discovered. And it’s not inconceivable that a vaccine could become available faster than most experts expect. But the chances of finding a transformative treatment against COVID-19 that could be deployed very soon have dwindled considerably.

We won’t get to herd immunity in the near future. A miracle drug is not in sight. The only way to restart the economy, then, is to put a highly effective system in place to test millions of people, trace their movements, and quickly quarantine those who might have been infected.

But even as the past few days have brought bad news about the science of the pandemic, they have brought terrifying news about its politics: It now seems less likely than ever that the United States will do what is necessary to reopen the economy without causing a second wave of deadly infections.

America is still behind on testing for COVID-19. Although Trump promised almost two months ago that anyone who wanted a test could get one, the U.S. has still conducted only about 5.4 million. The country needs to increase its testing rate at least threefold to reopen safely.

America is also behind on test and trace. Some countries, such as South Korea, now have robust systems in place to inform people that they have been exposed to the coronavirus, and need to self-isolate. But implementing such a system requires two things the United States sorely lacks: widespread trust in the government and a coordinated response from the White House.

In the absence of a federal strategy, some states, such as New York and Massachusetts, are trying to develop their own test-and-trace systems. But without help from Washington, they will likely lack both the resources to build a comprehensive system and the ability to persuade a large majority of their residents to sign up for an app that tracks their movements. Even if, against the odds, they should succeed in both these tasks, they face another obvious obstacle: Viruses don’t respect state lines.

If he were truly interested in limiting the damage to America’s economy, and opening up the country, Trump would be laser-focused on remedying these problems. Instead, the president has doubled down on culture wars and quack cures.

Early last week, Trump fanned the flames of the irresponsible protests against stay-at-home orders that are now being staged in cities across the country. A few days later, he vowed to “suspend immigration” to the United States. Then he suggested that scientists look into the possibility of injecting patients with bleach.

For all his blustering demands to get the country back to normal, the president is failing to take the steps that are required to reopen the economy without a horrific death toll. And for all the ingenuity shown by individual governors, the absence of a coordinated federal strategy may prove impossible to overcome.

I haven’t written much about the pandemic recently. The reason is, quite simply, that I didn’t feel there was much to say. Though every day brought a ton of news, a lot of it was contradictory; for long, painful weeks, I felt as though my overall understanding of the situation was barely improving.

Now I finally feel on firmer ground. Some of what we have learned over the past few weeks has been positive. The fatality rate from COVID-19 is likely to be significantly lower than early estimates suggested. Americans have followed social-distancing guidelines to an impressive degree. So far, we have succeeded in flattening the curve, and have not had to turn thousands of people in desperate need of medical treatment away from the emergency room. Even in New York City, the American epicenter of the pandemic, the number of new infections and new fatalities is ebbing.

We are not in the worst of all possible timelines. And yet, our hopes for the pandemic’s quick resolution should clearly be shelved. Taken together, the three major developments of the past few days paint a bleak picture of the months that lie ahead: COVID-19 is too deadly to let it rip through the population. An effective cure is not in sight. And the federal government is incapable of formulating a coherent pandemic response.

After weeks in which it made sense to hope that something would happen to end this nightmare, the prospects for deliverance are more remote than ever.

The Day After Kim Jong-un Dies: Will the Rule of Kim Yo-jong Begin? Whether Kim survives or comes out of his latest ordeal, Kim Yo-jong is bound to play an ever more central role in North Korean politics. by Richard Javad Heydarian

Every nation, as in every person, is a constellation of contradictions, yet North Korea is in a league of its own. 

The Asian nation is the quintessential Churchillian riddle wrapped in a mystery inside an enigma. Thus, it’s really hard to know the exact conditions of the secretive country, never mind the exact health condition of its most prized member, Kim Jung-un. '

Yet, even within that limited epistemological horizon, it wasn’t too difficult to discern the physiological struggles of the country’s Supreme Leader. As biographer Anna Fifield has correctly argued, the greatest factor in North Korean politics is the fragility of its leader.

The North Korean leader is well known for less-than-healthy habits, including chain-smoking and binge-eating, likely driven by the precarity of his political position and the scale of his ambitions. This may have exacerbated predispositions, which afflicted his forefathers who struggled with their own lifelong health scares. Back in 2014, he disappeared from public view for almost six weeks, just to return with a limp.

The strain of high-stakes global diplomacy, accelerated by word wars then ‘summits of the century’ with President Donald Trump, has made life perhaps even lonelier at the helm of an improbable nuclear power. As Niccolò Machiavelli warned more than half-a-millennium ago, “there is no more delicate matter to take in hand, nor more dangerous to conduct, nor more doubtful in its success, than to set up as a leader in the introduction of changes.”

His latest surgery--that he had one--likely didn’t go as perfectly as they wished, and Chinese doctors will likely make necessary interventions to enhance his chances of recovery. But what if he doesn’t make it? Or manages to come back, but never quite the same as before.

For all its antiquated ideology and infrastructure, North Korea is among few nations on earth led by millennials, namely the Supreme Leader and his siblings, most especially the chief consiglieri, if not de facto co-ruler, Kim Yo-jong.

Whether Kim survives or comes out of his latest ordeal, she is bound to play an ever more central role in North Korean politics. In a Stalinist dystopia, oversight over propaganda departments and organization of (and access to) the Supreme Leader’s daily routine brings unprecedented powers.

One could even say there is a precedence for this. As high-profile defectors such as Jang Jin-sung, a former agent at the United Front Department of the Korean Workers' Party, have noted, Kim Jung-un’s father’s (Kim Jung-il) improbable rise to power was through control over crucial elements of the state apparatus, which have now come under Kim Yo-jong’s jurisdiction.

Kim Jung-un may have overcome ageism in traditional culture, much at the expense of his late uncle Jang Song-thaek, who was partly executed for not taking the young Supreme Leader seriously enough. His sister may overcome sexism too, although ‘femininity’ reportedly disqualified Kim Jung-un’s dashing older brother, Kim Jong-chul from the succession.

In fact, North Korea is replete with stories of strong women, including  Ko Yong-hui (the late mother of the Supreme Leader) and Kim Song-ae (second wife of Kim Il-Sung). Thus, it’s more probable than not that Kim Yo-jong’s will play an ever more central role, almost regardless of what happens to her brother.

How Kim Jong-Un’s Death Would Be Handled (Per North Korean Law) The country would be managed by its No. 2, Choe Ryong-hae, until the legislature elects a new supreme leader. But there is a real and worrying potential for instability. by Henri Féron

The sudden death of North Korean leader Kim Jong-un could theoretically destabilize what remains a tense standoff with the United States and its allies. While power has up to now passed through hereditary succession, Kim has today no heir of age, implying the risk of an internal power struggle. The North Korean Constitution gives us some guidance over the parameters of a transition of power but cannot eliminate the worrying prospect of factional strife in the nuclear-armed state. 

Under the Constitution, the supreme leader of North Korea is elected by North Korea’s legislature, the Supreme People’s Assembly (SPA). There is no formal system of hereditary succession—it has just been a practical convention up to now. More precisely, the symbolic title of “supreme leader” goes to the Chairman of the State Affairs Commission (SAC), which under the current Constitution is the highest executive authority and the commander-in-chief of the armed forces. Note that Kim Jong-un is both SAC Chairman and Chairman of the Worker’s Party, implying a remarkable concentration of executive, military, and political power. 

If something were to happen to Kim, it is presumably SAC First Vice-Chairman Choe Ryong-hae who would manage executive functions until the legislature elected a new leader. Choe also holds important procedural keys to manage the transition in his other capacity as President of the SPA Presidium. The Presidium stands for the legislature when it is not in session and has the power to interpret the constitution and call extraordinary SPA sessions, a necessary step for electing a new supreme leader. Finally, note that Choe’s concurrent capacity as Vice-Chairman of the Worker’s Party means he embodies the concentration of power typical of North Korean supreme leaders, should he try to claim the position for himself.

Despite these relatively clear constitutional guidelines, a non-hereditary transition process deviates from historical precedent and in that sense could potentially degenerate into factional strife. Sections of North Korea’s leading elite may disagree on whom to support for supreme leader. The powerful military leadership may also weigh in. Some might seek assurances against the sort of purges Kim Jong-un conducted when he rose to power, while some might hope for them as an opportunity for quick promotion. 

Where the chips ultimately fall depends on something we know very little about: the personal relations, alliances, and rivalries in North Korea’s ruling elite. Some facts can completely change expected dynamics. For instance, if it turned out to be true that Kim Jong-un’s sister married Choe Ryong-hae’s son, it would make unlikely what otherwise would have been a probable conflict.

Whatever happens, major domestic instability in North Korea would in principle be very bad news for neighboring countries. Nobody wants to see the words “nuclear weapons” in the same sentence as “civil war,” “warlords” or “failed state.” What if a faction starts selling nuclear materials to create revenue? While there are contingency plans imagining a U.S.-South Korean or Chinese intervention to enter the country and go secure the weapons in the event of major instability, this could very rapidly escalate the situation for the worse, as it could set in motion long-drilled North Korean counterstrike plans. 

Ultimately, the relative predictability of a North Korea under Kim Jong-un’s rule appears preferable to the potential danger and chaos of one without him. That said, the United States and its allies would clearly be much better informed and better equipped to deal with instability in North Korea if there were peace, regular channels of communications, and an arms control agreement with nuclear inspectors on the ground. The current rumors about Kim Jong-un’s demise, although almost certainly false, should serve as a reminder of how dangerous it is to leave the standoff in Korea unresolved.

What Happens to the North Korean People if Kim Jong-un Dies? Driven mostly by informal markets, forces of social and economic change have advanced during the Kim Jong-un era. If these trends persist, we may see long term positive change for North Koreans. Until the dust fully settles following leadership transition, however, North Koreans may experience greater restrictions and hardship before seeing improvements in their human rights. by Andrew Yeo

Would the death of Kim Jong-un bring greater freedom and change inside North Korea? That is certainly the hope. However, Kim Jong-un’s own rise to power in 2011 following the death of his father, Kim Jong-il, suggests that life may first get harder before the human rights situation improves. 

Kim Jong-un’s early education in Switzerland and love for the Chicago Bulls raised expectations that the third generation leader might become a reformist. Instead, to consolidate power and legitimacy, the young Kim ruled with a tighter fist. In his first six months, he signed then breached the 2012 “Leap Year” nuclear agreement with the United States by launching a satellite rocket. Kim also tightened illegal border-crossings between North Korea and China which reduced North Korean defections by more than one-half from its peak in 2011 based on statistics from the South Korean Ministry of Unification. In 2013, Kim executed his uncle, once the de facto caretaker of Kim’s transfer of hereditary power. In 2017, he ordered the assassination of his older half-brother Kim Jong-nam. In short, Kim Jong-un turned out to be equally if not more ruthless than his father. 

Granted, the young Kim did place a greater emphasis on economic development, permitting North Korea’s market economy to grow. He also opened the door to high-stakes diplomacy with the United States (but only after significantly advancing his country’s nuclear and missile capabilities). Unfortunately, however, the human rights situation has remained virtually unchanged. Political prisons, arbitrary arrests and detention, chronic food shortages, and the lack of free speech and expression continue to persist. The lack of concrete information regarding North Korea’s COVID-19 situation, and rumors now swirling about Kim Jong-un’s death, further attest to the absence of information transparency and a free press in North Korea. 

Whether an individual such as Kim’s younger sister, Kim Yo-jong, or a collective body ends up filling the political void in a post-Kim Jong-un scenario, the next leader(s) will need to shore up her/his/their legitimacy and mettle to avert potential domestic instability. To do this, the regime will have to control its internal messaging even more tightly. North Korea’s leaders would therefore unlikely proclaim any sudden policy shifts that would enable their people to access more information or experience wider political freedoms. 

Driven mostly by informal markets, forces of social and economic change have advanced during the Kim Jong-un era. If these trends persist, we may see long term positive change for North Koreans. Until the dust fully settles following leadership transition, however, North Koreans may experience greater restrictions and hardship before seeing improvements in their human rights.