North Korea reported 21 more deaths and 174,440 new “fever cases” on Friday, according to state media KCNA, although it did not specify how many of the deaths and cases were linked to Covid, likely due to the country’s extremely limited testing capacity.
But given the opaque nature of the regime and the country’s isolation from the world – a trend that has only worsened since the pandemic – it is extremely difficult to assess the actual situation on the ground.
But reports from North Korea’s state media have been vague, and many key questions remain unanswered, including the country’s immunization coverage and the impact of the lockdown on the livelihoods of its 25 million people.
Here’s what we know and don’t know about the outbreak:
How did the eruption come about?
North Korean authorities have not disclosed the cause of the outbreak.
It remains unclear how the virus slipped through the country’s tightly sealed borders.
When KCNA reported the country’s first identification of Covid-19 on Thursday, it didn’t even specify how many infections had spilled over. It said only that samples collected from a group of people with a fever on May 8 had tested positive for the highly contagious Omicron variant.
As of Friday, KCNA reported Thursday had recorded 18,000 new “fever cases” and six deaths, including one that tested positive for Omicron’s BA.2 subvariant.
“A fever, the cause of which could not be identified, has spread explosively across the country since the end of April,” the newspaper said. “As of now, up to 187,800 people are isolated.”
On Saturday, KCNA said a total of 524,440 people reported “fever” symptoms between the end of April and May 13. Among them, 280,810 people are still being treated in quarantine while the rest have recovered.
Can North Korea deal with a large-scale outbreak?
An outbreak of Covid-19 could prove disastrous for North Korea. The country’s ailing healthcare infrastructure and lack of testing equipment are unlikely to be up to the task of treating large numbers of patients with a highly contagious disease.
North Korea’s lack of transparency and unwillingness to share information also pose a challenge.
North Korea has never officially acknowledged how many died during a devastating famine in the 1990s that experts estimate killed up to 2 million people. Those who fled the country at the time told terrifying tales of death and survival and a country in chaos.
“North Korea has such a limited supply of essential medicines that public health officials must focus on preventative medicine. They would be ill-equipped to deal with any type of epidemic,” Jean Lee, director of the Hyundai Motor-Korea Foundation Center for Korean History at the Woodrow Wilson Center in Washington, told CNN at the start of the pandemic.
Doctors who have defected in recent years often speak of poor working conditions and shortages of everything from medicines to basic medical care.
Choi Jung-hun, a former doctor in North Korea who fled the country in 2011, said when he helped fight a measles outbreak in 2006-07, North Korea didn’t have the resources to run around-the-clock quarantine and isolation facilities.
He reminded that in manuals for doctors, patients should be taken to a hospital or quarantine facility for monitoring after suspected cases have been identified.
“The problem in North Korea is that manuals are not followed. When insufficient food was provided to people in hospitals and quarantine facilities, people fled to look for food,” Choi said during an interview with CNN in 2020.
How has North Korea reacted so far?
North Korean state media declared the situation a “major national emergency” when admitting the first officially reported Covid infection.
On Thursday, Kim locked down all cities and ordered “people with fevers or abnormal symptoms” into quarantine; According to KCNA, he also led the distribution of medical supplies that the government was reportedly stockpiling in case of a Covid emergency.
Kim later chaired a meeting of the country’s powerful Politburo, which agreed to implement “maximum” emergency measures to combat the epidemic. Measures include isolating work units and proactively conducting medical screening to find and isolate people with “fever and abnormal symptoms,” the KCNA reported Friday.
“Practical measures are being taken to keep production at high levels in key sectors of the economy and to maximally stabilize people’s lives,” KCNA said.
According to KCNA, the Politburo has criticized the country’s anti-epidemic sector for “carelessness, carelessness, irresponsibility and incompetence” and said it has “failed to respond sensitively” to the rising Covid-19 cases around the world, including in neighboring regions.
A reporter from Chinese state media CGTN released a rare video from Pyongyang on Friday, sharing his experiences on the ground.
“As far as we know, not many people have been vaccinated in Pyongyang, and medical and disease prevention facilities are scarce,” reporter Zang Qing said in a Weibo post.
“Because the capital is in lockdown, the food I have at home is only enough for a week. We are still waiting to see what policy the government will announce next.”
At a meeting on Saturday, Kim inspected the country’s emergency response and medical supplies. He also urged North Korean officials to learn from China’s “advanced and rich quarantine results and experiences they have already gained in their fight against the vicious infectious disease,” according to KCNA.
What about North Korea’s vaccine coverage?
North Korea is not known to have imported any coronavirus vaccine – although it is eligible for the global Covid-19 vaccine sharing programme, Covax.
Assuming most North Koreans are unvaccinated, an outbreak in the country — which has limited testing capabilities, inadequate medical infrastructure, and has isolated itself from the outside world — could quickly become deadly.
Demands are mounting for the country’s leadership to provide access to vaccines.
“There is no evidence that North Korea has access to enough vaccines to protect its population from Covid-19. Yet it has turned down millions of doses of AstraZeneca and Sinovac vaccines offered by the WHO-led Covax program,” Amnesty International East Asia researcher Boram Jang said in a statement.
“With the first official news of a Covid-19 outbreak in the country, continuing down this path could cost many lives and would be a ruthless violation of the right to health.”
Covax reportedly reduced the number of doses allocated to North Korea in February because the country had failed to arrange shipments, according to Reuters.
A spokesman for Gavi, the Vaccine Alliance, said Covax had moved to “needs-based vaccine allocations” and had “not currently committed any volume” for North Korea.
“If the country decides to launch a Covid-19 vaccination program, vaccines could be made available based on the Covax target criteria and technical considerations to allow the country to catch up with international vaccination targets,” the spokesman said.
CNN’s Joshua Berlinger and Yoonjung Seo contributed to this report.