North Korea on Friday went public with its first “explosive” COVID-19 outbreak, reporting six fatalities and raising concerns about the hermit state’s defenses against the coronavirus after two years of claiming to have warded off infections.

The state-run Korea Central News Agency (KCNA) says that one of the six people who died had tested positive for the BA.2 subvariant of Omicron.

Up to 187,000 North Koreans are now reportedly being “isolated and treated” after some 18,000 developed a fever on Thursday. KCNA adds that a fever “whose cause couldn’t be identified explosively spread” since late April, appearing in some 350,000 people. It says that leader Kim Jong Un visited “the state emergency epidemic prevention headquarters” on May 12 and “learned about the nationwide spread of COVID-19.”
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The situation may be worse than what is reported, says Leif-Eric Easley, associate professor of international studies at Ewha Womans University in Seoul. “People desperately need coronavirus vaccines and therapeutics,” Easley tells TIME.

According to the Yonhap news agency, South Korea plans to donate COVID-19 vaccines to the North. “We will hold discussions with the North Korean side about details,” a spokesperson for President Yoon Suk-yeol told the agency.

Read more: China Doubles Down on Zero-COVID in the Face of Its Worst COVID-19 Outbreak Since Wuhan

Until today, North Korea was among a handful of countries, including Turkmenistan and Tuvalu, that have not reported a case of COVID-19. Its borders have been closed since the start of the pandemic in early 2020.

It is also believed that the country has not administered COVID-19 vaccines to its 25 million people, having refused COVID-19 vaccines from global vaccine sharing program COVAX. In February, the WHO-led program scaled back North Korea’s allotment after millions of doses were rejected last year.

“There is no evidence that North Korea has access to enough vaccines to protect its population from COVID-19. Yet it has rejected millions of doses of AstraZeneca and Sinovac vaccines offered by the WHO-led COVAX program, which requires transparent distribution and monitoring,” says Amnesty International’s East Asia researcher Boram Jang.

North Korea shares a border with ally China, which is trying to stamp out infections with a stringent zero-COVID policy. Beijing on Thursday said it was “ready to go all out” to assist Pyongyang in combating the outbreak.

North Korea Covid
AP–Korean Central News Agency North Korean leader Kim Jong-un addresses officials at the state emergency epidemic prevention headquarters in North Korea May 12, 2022.

How COVID-19 could break North Korea

A COVID-19 outbreak may prove disastrous for North Korea. The country has poor medical infrastructure; a 2021 index assessing the epidemic and pandemic preparedness of 195 countries ranked North Korea at 193rd. Its seeming lack of a vaccination program makes its people more vulnerable to severe infections and death.

There is no evidence that North Korea has access to enough vaccines to protect its population from COVID-19Jang says that if North Korea continues to pursue an isolationist strategy, it “could cost many lives” and would be an “unconscionable dereliction” of its duty to citizens. “It is vital that the North Korean government acts now to protect the right to health of one of the world’s populations with lowest access to vaccines and one of the most fragile health systems.”

Acording to the KCNA, Kim has criticized the spread of the disease in the capital Pyongyang, highlighting a vulnerable point in the epidemic prevention system. He has also ordered a swift lockdown and isolation of infected cases, but added that residents should be “provided with every convenience” in their attempt to curb the spread of COVID-19, the agency says.

North Korea’s two-year border closure has battered its economy, on top of the U.S.-led sanctions over the nuclear-armed country’s ballistic missile tests.

But the hermit state may be welcoming more outside help now. Ahn Kyung-su of Seoul-based research center dprkhealth.org said North Korea’s announcement signals its need for international support and that it needs COVID-19 medication more than vaccines. “This is because drugs are much simpler in terms of transportation, distribution and management personnel than vaccines.”

But according to Easley, engagement with Pyongyang won’t be easy. Says the international studies professor: “Even international humanitarian assistance has to navigate Pyongyang’s political pathologies.”