North Korea has an "explosive" COVID outbreak and 0% vaccination rate

Driving the news: At an emergency Politburo meeting on Sunday, Kim scolded officials for the “irresponsible” execution of the quarantine policy and blamed them for shortages of medicines, according to state media. He has started wearing a mask in public.

• State media reported Thursday that some samples taken from symptomatic people in Pyongyang came back positive for a highly contagious Omicron sub-variant.
• Since then, the number of "fever" cases has ballooned to over 1 million. It would be impossible to verify the official figures even if North Korea had the capacity for mass testing, but Pyongyang has called the spread "explosive."

Between the lines: "I think there’s probably an effort here to get on top of the narrative and to show Kim is addressing this head-on, while also pushing blame down the chain to the lower levels," says Jenny Town, director of ​​the Stimson Center’s 38 North program.

• State media has acknowledged the virus is spreading in Pyongyang, and "it has probably hit some of the elites,” she adds.
• An out-of-control virus is a "nightmare scenario" for the Kim regime and could be a deeply destabilizing event, says Victor Cha, Korea chair at the Center for Strategic and International Studies and a former senior U.S. official.

How it happened: North Korea responded to the pandemic as it did to Ebola, MERS and SARS: "They sealed their borders and waited for the pandemic to die off," says Kee Park, a neurosurgeon and lecturer at Harvard Medical School.

• Severing most trade with neighboring China meant taking a major economic hit, and it put the North's ideology of "juche," or self-reliance, to the test.
• North Korean officials were highly confident until recently that the "extreme zero-COVID" policy was working, says Park, who has a license to practice in North Korea, has visited more than 20 times and leads a program to support medical care there.
• "There was really no need, in North Korea's eyes, to entertain external assistance," including the AstraZeneca vaccines offered by the COVAX initiative, he says.

Now that the Omicron variant has "breached their defenses" and spread throughout much of the country, North Korea is ill-equipped to deal with it, Park says.

• Even at Pyongyang's top teaching hospital, there are perhaps only a dozen ventilators, he says. Medical facilities outside the capital city are much more limited.
• North Korea does have two things going for it: a high number of doctors per capita and a population that is accustomed to following orders from above, says a humanitarian worker with extensive experience in the country.
• But those doctors have limited training and no experience caring for COVID patients. Transportation is so poor, particularly outside of Pyongyang, that it will be difficult to get sick people to hospitals and clinics, especially during a lockdown, says the humanitarian source, who requested anonymity due to the sensitivity of the issue.

"I shudder to think about a prolonged lockdown in North Korea, the human cost of that. The country's already food insecure. And what it means is we have to give them assistance immediately," says Park.

• In addition to vaccines and essential medications, North Korea will need food, the humanitarian source adds.
• "We’re coming into the lean season in North Korea, with a drought there and almost no international support. So I’m very concerned."
• “I wouldn’t be surprised if there is at least a quiet call for assistance — nothing announced publicly but just done through their diplomatic channels over the next couple of weeks,” the source says.

Yes, but: Accepting international aid is always politically sensitive for North Korea, and officials could worry letting in people and supplies will also bring more cases, ​the Stimson Center’s Town says.

• "I don’t see them suddenly saying, 'Oh, well we have COVID now so let’s open everything back up,'" she says. "I think there's still going to be an abundance of precaution, even if it’s counter-intuitive and possibly detrimental to the situation."
• North Korea is particularly unlikely to accept direct help from South Korea, which has offered to send vaccines, medical personnel and other supplies.

But the very public pronouncements about the severity of the situation could be a step toward accepting aid, the humanitarian source says, adding that the UN will likely be the key player in any such effort.

• Cha, of CSIS, says that in private communications with nongovernmental organizations and medical groups, North Korea has expressed interest in mRNA vaccines.

What to watch: If North Korea does accept help from South Korea and the U.S., even indirectly through the UN, “it would be interesting to see if this humanitarian effort would open up space for diplomacy on the nuclear issue,” Cha adds.

• The WHO said Monday that it had not received any data from North Korea about the outbreak but confirmed that the country had not begun vaccinations.