North Korea is uniquely vulnerable to the virus, and the options to control its spread are limited.
The scene in the capital Pyongyang - much of the country is inaccessible to foreign visitors
Now, the authorities are not only acknowledging the virus' presence but declaring an all-out battle to control it, with North Korean leader Kim Jong-un calling it the "greatest turmoil" to fall on the nation since its founding. A national lockdown is in place. Testing is also very limited. The World Health Organization says North Korea has carried out about 64,000 tests since the start of the pandemic. In South Korea, which made test and trace a central part of its Covid strategy, the figure stands at about 172 million.
"The healthcare system has been and is quite dire," said Jieun Baek, the founder of Lumen, an NGO which monitors North Korea. "Look how difficult it is in Shanghai, for them to stop Omicron - and that's throwing absolutely everything they can think of at the epidemic, at the outbreak," said Professor Ben Cowling, an epidemiologist from the University of Hong Kong."In North Korea I think it's going to be very tough to stop this. I'd be very, very worried at this point."
But, he adds, North Korea might not want other outside help, which would mean a return to the 1990s when large numbers of aid agencies were present. It would be "very destabilising for the rulers to deal with this monitoring on their own territory", he said.
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