It's been more than two years since the pandemic began and in that time North Korea has claimed to have had zero COVID cases. But now the country's government has said it is experiencing its first outbreak, though it is still not labeling what people have as COVID.
On Wednesday, North Korean state media said more than 1.7 million people had experienced fevers and 62 people had died since late April — but those numbers are hard to confirm, according to journalist Jean Lee, who specialized on North Korea.
North Korea does not have enough COVID tests to confirm that all the patients have the virus, and the country of 26 million people has still not reported any official cases to the World Health Organization, Lee said. The lack of tests and the fact that there are no outside observers inside North Korea make getting an accurate picture of what's happening inside the country — and confirming all cases of fever are indeed the coronavirus — extremely difficult.
"Kim Jong Un is painting this as the first outbreak of COVID in North Korea, but I find that very hard to believe because North Korea shares a very long border with China, and there would have been many people going across the border between China and North Korea in the early weeks of the outbreak in 2019 and early 2020," Lee said. "And so it's hard to imagine that the virus didn't didn't make its way to Pyongyang."
Why North Korea would admit to an outbreak now
Lee said that acknowledging a COVID outbreak now could be a political move by Kim.
"He has spent his energy shutting the world out during a period when he needed to focus on boosting his legacy, and now I think his attention is shifting," she said. "And part of this might be a calculation to re-engage with the outside world."
It is also possible that COVID has reached a point where it is no longer feasible for North Korea to ignore or deal with it on its own, Lee said. But it could be the case, she added, that Kim sees the election of Yoon Suk Yeol as South Korea's new president, and an upcoming summit between Yoon and President Biden, as an opportunity to re-establish communication, especially if North Korea says it has an outbreak.
North Korea has refused help in the past though. The country declined millions of vaccines that were offered by the U.N.-backed COVAX initiative earlier in the pandemic, and as NPR's Anthony Kuhn reports, the country has not publicly accepted offers of vaccines and medical assistance from China and South Korea since this outbreak began.
"There is speculation that they don't trust the drugs, or they don't want to be seen to be depending on outside help," Kuhn said.
Can North Korea handle an outbreak on its own?
North Korea's government has declared a nationwide emergency, and a lockdown has been instituted within the country as its military is working to distribute medicine.
This, along with outspoken criticism from Kim of how North Korean officials have handled the outbreak, raises questions on whether the country has the medical infrastructure to respond to the crisis.
Previously, North Korean officials have said they are not well-equipped to deal with this, Kuhn said, noting that many hospitals in rural areas of the country lack ventilators and other basic equipment, as well as essential utilities including water and electricity.
There's also the issue of malnutrition in the country, which is a chronic issue facing nearly 40% of the population.
"They don't have the kind of nutrients that the average human being needs to withstand illness, and on top of that they're not vaccinated," Lee said. "It's hard for me to imagine how without vaccination, without medication, without robust health, how they will survive even a milder variant."