Reports of a pneumonia case of unknown origin documented in late 2019 in China eventually traced to the SARS-CoV-2 virus, which would become the COVID-19 pandemic. In North Korea, the government initially resisted accepting foreign reports and rejected vaccines offered by several countries, including China and Russia.
From late January 2020, North Korea implemented sweeping travel bans for foreigners and internal movement restrictions, and it tightened import controls. Official announcements described a population survey for COVID-19, with results reportedly negative at the time.
The World Health Organization’s weekly updates, covering the period of May 2–8, 2022, indicated no confirmed COVID-19 cases within the country, aligning with months of reports suggesting an absence of confirmed infections in the DPRK. In contrast, data aggregators such as Johns Hopkins University listed a single case, and some external trackers did not publish consistent reporting for the country.
Official confirmation of the first COVID-19 case in North Korea came on May 12, 2022. The authorities attributed the detected infection to the Omicron variant. North Korea’s leadership had previously described the disease as a fever of unknown origin and claimed that up to half a million people had been affected since late April. This period coincided with heightened border controls and calls for stricter quarantine measures, according to state media.
As cases rose, the DPRK reported a high fever count surpassing 1.2 million, though the state continued to classify the illness broadly as fever due to limited testing capacity. Within a 24-hour window, reported febrile symptoms rose by hundreds of thousands.
Global comparisons noted similar surges in late 2021 and early 2022 in the United States and in several European countries, with the WHO documenting substantial daily case numbers in multiple regions and nations also experiencing waves of infection during that period.
Is this a sudden outbreak or a pattern?
Independent experts highlighted the challenge of interpreting data from a tightly controlled country. Virologist Anatoly Altshtein suggested that the country’s late pandemic visibility does not prove the virus was absent earlier; rather, it indicates that widespread illness became apparent only after Omicron’s entry. He noted that the epidemic might not have developed uniformly across neighboring states and could reflect different timing and exposure patterns.
Virologist Alexei Agranovsky explained that entry controls likely restricted virus carriers, making a later outbreak plausible. He warned that low or non-existent herd immunity—due to limited infection experience and vaccines—could mean that introduction of the virus would trigger a broader epidemic if unchecked.
Both experts discussed the potential for vaccine options to influence the trajectory of the outbreak. Agranovsky speculated about the availability and effectiveness of vaccines in the DPRK, while Altshtein predicted that the overall global trajectory would trend toward a decrease in cases over time, with regional variation persisting for a period.
The possibility of new variants arising within North Korea was acknowledged by the scientists, who cautioned that future strains could emerge where transmission is high. They also noted that cross-border movement could enable limited spread, particularly via neighboring states or trade partners.
Scientific and political commentary
Historian Konstantin Asmolov offered a perspective on how information about the outbreak might have been managed within a closed society. He emphasized the importance of understanding hospitalizations and ventilator use, rather than simply counting cases, to gauge the strain on the health system. He also pointed out that, given the geopolitical context, there is ongoing skepticism about reporting accuracy. Nevertheless, Asmolov argued that North Korea has publicly acknowledged the outbreak as cases appeared, a fact that factors into assessments of transparency.
The discussion from analysts pointed to a potential shift in policy, with officials potentially accepting medical aid and equipment from international partners in response to mounting needs. They attributed the initial period of reported low cases to stringent border controls and aggressive epidemiological measures, which may have limited early transmission.
In summary, the North Korean experience during the pandemic illustrates how open reporting and international data-sharing impacted global understanding. It also shows how a country with strict border controls may experience delayed visibility of outbreaks, while still facing significant public health challenges as transmission dynamics evolve.