An employee of the Pyongyang Dental Hygiene Products Factory disinfects a dining room in Pyongyang, North Korea, on May 16. (Cha Song Ho/AP)
7 min

TOKYO — It’s always been difficult to get an accurate picture of what’s going on inside North Korea, one of the most closed-off countries in the world. But its handling of the pandemic has been particularly enigmatic, with potentially long-lasting ramifications for the welfare of its people — and neighboring countries — amid a worsening humanitarian crisis.

North Korea’s self-proclaimed “public health crisis” appears to have mysteriously subsided as quickly as it spread, according to state media. Less than three weeks after announcing its first official positive coronavirus case that led to an “explosive” spread of fever symptoms afflicting more than 3.7 million (out of a population of 25 million), North Korea is heralding a rapid fall in new cases and a “favorable turn” in epidemic response.

But international public health officials warn that there is no way to corroborate those claims. This week, a top official at the World Health Organization raised concerns that things might actually be getting worse inside the impoverished country, which has a fragile health-care system, limited supplies and no coronavirus vaccines.

“This is not good for the people of [North Korea]. It is not good for the region. This is not good for the world,” said Michael Ryan, WHO emergencies chief. “We assume the situation is getting worse, not better.”

What you need to know about the covid crisis hitting North Korea

When the latest outbreak was first announced, Ryan warned that with its poor health infrastructure and lack of vaccines, North Korea could become a breeding ground for new variants that could threaten people beyond its borders.

Expert analyses, limited trade data, satellite imagery and the accounts of North Korean defectors and informants provide clues to help make sense of the gravity of North Korea’s covid crisis — especially as authorities assess whether to ease lockdown measures as the outbreak supposedly ebbs.

Since the start of the pandemic in 2020, North Korea reported zero positive coronavirus cases — a dubious claim, given outside reports of likely exposure along its border with China. But on May 12, North Korea reported its first positive case of the BA.2 subvariant of omicron. It has since diligently released daily updates on the spread of “fever,” an apparent euphemism for potential coronavirus cases due to its lack of testing capacity.

The sudden change in behavior has experts wondering: Why did North Korea decide to disclose its cases now? Have cases really improved as rapidly as it claims?

The exodus of foreigners in the pandemic means the full impact of covid might not be known for many years, until aid workers can reenter and new defectors can provide firsthand accounts. For example, the extent of the 1990s famine in North Korea was not known until researchers interviewed the wave of defectors who fled in its aftermath.

Leader Kim Jong Un’s announcement of the spread of the coronavirus indicates the outbreak could no longer be contained quietly at local levels, especially given the heavy concentration of cases in its capital of Pyongyang, where the elites reside, said Rachel Minyoung Lee, a former intelligence analyst and an expert in North Korean media propaganda.

In fact, North Korea used an extremely rare, if not unprecedented, term to describe a crisis to its domestic audience, Lee said: the “great upheaval since the founding of the state.” Kim has also provided unusually detailed information about infection numbers and deaths, which risks inviting the public’s disbelief, she said.

The question is: Why?

One reason may be to project the regime’s control over the outbreak through its national public health campaign and to show that he takes concerns in Pyongyang seriously, experts say.

This week, North Korean authorities “positively assessed” control of the virus and reviewed plans to ease restrictions, according to state media. If North Korea’s figures are accurate, its fever cases sank to below 100,000 in recent days, a significant drop from nearly 400,000 in late May.

Coronavirus cases, deaths in North Korea surge as Kim blames officials

Tae Yong-ho, a former North Korean diplomat based in London who defected in 2016, said it is “quite probable” that the virus’s spread slowed because of Kim’s containment policy. In the past three weeks, Kim “has been depicted as the heroic and benevolent savior of the nation.”

“This is how North Korean governmental propaganda manipulates the situation in favor of the Kim Jong Un regime in any and every case; there is a crisis but it shall be solved and overcome by the dear leader who is benevolent, wise and capable like a god,” said Tae, now a South Korean National Assembly member.

When the pandemic first broke out, North Korea quickly halted land-based trade with China and banned travel between its provinces. But in the first quarter of 2022, it reopened to low levels of trade with China, which may have exposed it to covid.

Cases began spreading in April, state media said. A massive military parade on April 25 may have contributed to the spread as soldiers from across the country traveled to Pyongyang to practice and perform, said Ryu Hyun-woo, North Korea’s former ambassador to Kuwait who defected in 2019.

“The military parade on April 25 in Pyongyang appears to have been a fertile ground for a super-spreading event,” Ryu said. “The military parade gathered tens of thousands of people from capital Pyongyang and different parts of the country. A large number of people were seen without masks, which shows a complacency among North Koreans about covid-19 at that time.”

Biden visit showcases hardened stances on North Korea

Even as North Korea reports a decline in cases, it has emphasized quarantine measures, a sign that the regime does not feel the situation has stabilized yet, said Lee, the former intelligence analyst. North Korea has twice turned down offers of vaccines from Covax, the U.N.-backed initiative to distribute vaccines globally.

Meanwhile, the quality of life for ordinary North Koreans outside of the privileged Pyongyang area appears grim. Kim’s lockdown order came amid what the United Nations believes is a worsening food and medication shortage caused by its border closure.

The country’s public health situation “is the worst one can imagine,” Ryu said, describing a lack of supplies, proper sanitation and reliable electricity even in the country’s top hospitals for Pyongyang residents.

Lockdown fatigue is spreading among many residents, said Lee Sang Yong, editor in chief of Daily NK, a Seoul-based website that reports from informants inside North Korea. Those who had fever were ordered to isolate at home, with no way to access food from the outside, he said.

“In areas under stringent lockdown, people were starving to death as access to new harvests or market purchases were restrained by the lockdown measures,” Lee said.

China draws North Korea closer than ever as Pyongyang’s nuclear ambitions rise

Kim also needs workers to focus on the rice-planting season and has an incentive to tout success in controlling the virus, Lee said. The supply of rice harvested in the fall is dwindling, and North Korea appears to be experiencing a prolonged drought — which does not bode well for this autumn’s harvest and could deepen the severe food crisis.

Satellite images of North Korean rice fields suggest delays in meeting the country’s planting targets compared with last year, said Chung Song-hak of South Korea’s Kyungpook National University.

Rice-planting appeared to be only about two-thirds complete in images of five main rice fields this month, lagging behind a nearly 90 percent completion rate during the same period last year, according to Chung.

This week, state media reminded the public that North Korea endured the 1990s famine and other hardships and can overcome its current challenges.

“This is the strong fighting spirit peculiar to the Korean people pushing ahead with the anti-epidemic struggle and the economic construction simultaneously,” it urged.

Kim reported from Seoul.

Coronavirus: What you need to know

End of the public health emergency: The Biden administration ended the public health emergency for the coronavirus pandemic on May 11, just days after WHO said it would no longer classify the coronavirus pandemic as a public health emergency. Here’s what the end of the covid public health emergency means for you.

Tracking covid cases, deaths: Covid-19 was the fourth leading cause of death in the United States last year with covid deaths dropping 47 percent between 2021 and 2022. See the latest covid numbers in the U.S. and across the world.

The latest on coronavirus boosters: The FDA cleared the way for people who are at least 65 or immune-compromised to receive a second updated booster shot for the coronavirus. Here’s who should get the second covid booster and when.

New covid variant: A new coronavirus subvariant, XBB. 1.16, has been designated as a “variant under monitoring” by the World Health Organization. The latest omicron offshoot is particularly prevalent in India. Here’s what you need to know about Arcturus.

Would we shut down again? What will the United States do the next time a deadly virus comes knocking on the door?

For the latest news, sign up for our free newsletter.