Seoul, South Korea –

North Korea on Tuesday reported another large spike in diseases believed to be COVID-19 and promoted good health habits as a mass outbreak spreads among its unvaccinated population and military officers have been deployed to distribute medicines.

State media said the North’s anti-virus headquarters reported that another 269,510 people were found with fevers and six people died. This brings the number of deaths in North Korea to 56, after more than 1.48 million people had contracted a fever since the end of April. North Korea lacks testing materials to confirm large-scale coronavirus infections and the report didn’t say how many of the fever cases were COVID-19.

The outbreak is almost certainly larger than the fever record, given the lack of testing and resources to monitor and treat those who are sick. North Korea’s virus response is mainly isolating people with symptoms in shelters, and at least 663,910 people were in quarantine as of Tuesday.

In addition to lacking vaccines for its 26 million people, North Korea also struggles with malnutrition and other poverty conditions, and lacks public health tools, including antiviral drugs or intensive care units, that have stifled hospitalizations and deaths in other countries.

Some experts suggest North Korea is underreporting deaths to soften the blow to authoritarian leader Kim Jong Un, who has already weathered the toughest moment of his decade in power, with the pandemic further damaging an economy already plagued by mismanagement and abuse US-led sanctions against its nuclear ambitions had been broken.

Deaths in the north could increase in the coming weeks as those who develop symptoms later succumb to the disease.

It’s also possible fever cases may be underreported by officials worried about punishment, or people not reporting their symptoms because they fear the strict quarantine measures, analysts say.

North Korea last Thursday recognized domestic COVID-19 infections for the first time, ending a widely disputed claim that it had been virus-free during the pandemic.

Kim described the outbreak as a “major upheaval” and imposed preventive measures, including restrictions on movement and quarantines. But while sounding the alarm about the virus, Kim also stressed that his economic goals should be met, noting that large groups of people will continue to gather for agricultural, industrial and construction work.

The official Korean Central News Agency said Tuesday the military deployed officers from its medical units to help transport medicines to pharmacies in Pyongyang, which have remained open 24 hours a day to help deal with the virus crisis. It was unclear what types of drugs were given to sick people.

KCNA said the army units had “expressed their will to deliver to Pyongyang supporters the precious medicines, the lifeblood associated with Kim Jong Un’s great love for the people.”

North Korea’s state media is also pushing public campaigns to promote health and hygiene, including animated TV clips urging viewers to change their masks frequently and to keep at least three feet away from other relatives, even at home.

The North’s Rodong Sinmun newspaper on Tuesday published several articles on antivirus habits and other countries’ pandemic response. It mentioned vaccines and Pfizer’s Paxlovid antiviral pills without naming their American developer.

But the article, which credited its information to the Chinese internet, insisted that such drugs are costly and may be less effective against new virus variants and that strong pandemic restrictions are still needed.

It’s unclear if the North’s admission of an outbreak reflects a willingness to seek outside help. The country has shunned millions of vaccines from the United Nations-backed COVAX distribution program, likely due to international surveillance requirements associated with those vaccinations.

South Korea has publicly offered to send vaccines, medicines and health workers, but North Korea has so far ignored the proposal amid icy relations between the rivals over a stalemate in major nuclear talks between Washington and Pyongyang. Some experts say Kim’s praise of China’s response to the pandemic during a virus meeting last week suggests the North would be more willing to seek help from its key ally.

Experts say the only realistic outside help is to offer limited stocks of the vaccine to reduce deaths among high-risk groups, including the elderly and those with pre-existing conditions, as it is too late to stop the virus from spreading widely among northern populations to stop.

“As the country has yet to initiate COVID-19 vaccination, there is a risk that the virus will spread rapidly among the masses unless prompt and appropriate measures are taken to contain it,” said Dr. Poonam Khetrapal Singh, World Health Organization Regional Director for Southeast Asia, in a statement. He said the WHO stands ready to provide technical assistance to North Korea to step up testing, as well as essential medicines and medical supplies.

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