Attempting to access information about the SARS-CoV-2 coronavirus crisis in North Korea is much like attempting to research other issues in the country. Reliable facts are in short supply, and instead propaganda, guesswork and rumors circulate. Only one thing is certain: The regime of North Korean leader Kim Jong Un began to react to the invisible threat at the end of January — long before Europe did so. The state newspaper Rodong Sinmum described the fight against the virus as a matter of "national survival."

On March 13, North Korea's government informed the World Health Organization (WHO) that the country did not have a single case of COVID-19, the disease that results from the virus. At the time, neighboring China had reported more than 80,000 people infected, and, in South Korea, the other half of the divided Korean Peninsula, there were just under 8,000.

Read more: China hid scale of outbreak — US intelligence report

No drills, flights

Public life in North Korea has largely been brought to a standstill. There is a ban on entries and exits, air and rail traffic are suspended, and schools and universities are closed. All foreigners were put under a 30-day quarantine, from which even diplomats were not exempt — and are only allowed to move to a very limited extent. Germany subsequently withdrew its embassy staff at the end of February.

On March 13, General Robert Abrams, the commander of the US Forces in South Korea, reported that North Korea's armed forces had "been on lockdown for about 30 days, and only recently have they started routine training again." According to the general North Korea's air force "didn't fly an airplane for 24 days." The US Army is "fairly certain," Abrams said, that there are COVID-19 cases in North Korea.

The dictatorship is based on total control, and North Korea is now sending a clear signal to the outside world that things are fine. In March, as more and more countries reported rising infection rates, North Korea made a show of testing more ballistic missiles than ever.

Read more: North Korea fires projectiles into sea in latest apparent missile test

Trump contacts Kim

On March 22, a day after the third of four North Korean missile tests, a message from the state news agency hit the headlines: KCNA reported on a personal letter from Donald Trump to North Korean leader Kim Jong Un, in which the US president not only pushed for an improvement in bilateral relations, but also suggested cooperation in the fight against the pandemic. The White House confirmed the letter without going into details.

This picture was published by North Korea's state-controlled news agency KCNA on March 22

As of April 7, there are nearly 1.4 million infections confirmed worldwide, and more than 74,000 patients have died of the disease. But nothing has changed in the regime's official statement in Pyongyang: zero cases of COVID-19 in North Korea are still reported.

Read more: Coronavirus latest: South Korea declares red alert after rapid spike in cases

Truth or lies?

British researcher Andray Abrahamian says that it is "extremely unlikely" that there are no infections yet. He teaches at the Center for Security Policy at George Mason University in Incheon, South Korea and has traveled to North Korea repeatedly over the past 15 years. The information situation in the country has deteriorated further due to the coronavirus, he tells DW. "The border being closed means there are fewer people going in and out than usual, so less news is available than usual."

US journalist Jean H. Lee, who was regularly in North Korea between 2008 and 2017, agrees. From 2011 to 2013, she spent considerable time in Pyongyang as a foreign correspondent for the American news agency Associated Press. Today she heads the Korea program at Woodrow Wilson Center in Washington.

"Unfortunately, there are very few foreigners on the ground at the moment to provide a clear view of what's happening, and the few who are there have been kept in quarantine. Coronavirus has enabled the regime to enforce restrictions on movement even more so than usual, so it would be difficult for foreigners to get close to seeing what's happening at hospitals," reports Lee. She is also convinced that there are coronavirus cases in the country and does not trust the government's denial. "I find it hard to believe, given the traffic across their long shared border with China."

Shoppers wear masks at a supermarket in Pyongyang on February 28

Read more: China's Xi in North Korea: It's the economy

The border stretches for more than 1,400 kilometers (870 miles), and without its protective power China, North Korea can hardly survive. According to the respected North Korean portal 38North, the country closed its border crossings with China towards the end of January for travelers and freight traffic. Only one checkpoint is open officially for the import of goods, under strict quarantine regulations. But by then the virus had spread in China for two months — and it seems unlikely that it would have stopped at the border of North Korea, the neighbor who relies on the exchange with China.

Unexplained deaths

On March 9, the Daily NK newspaper reported that 180 North Korean soldiers had "died of symptoms that may have been caused by the new coronavirus." According to its sources, the critical outlet said, military hospitals had sprayed methanol to disinfect affected areas. A little more than two weeks later, on March 25, another headline noted that prisoners had died of a respiratory ailment. Officially, a "weak immune system" was given as the cause of death, but according to Daily NK the entire prison was later disinfected.

The editorial office of the online newspaper, founded in 2005, is based in the South Korean capital of Seoul and maintains a comprehensive network of informants in the northern neighbor. Daily NK is silent on how many there are, maintaining that sources should be protected. The outlet told DW that its contact people are spread across the country and that every story has at least two sources — but this information cannot be checked independently.

"In general, our informants have reported that the authorities have classified many deaths with COVID-19 symptoms as acute pneumonia," Daily NK told DW. The evidence of an outbreak of the viral disease in North Korea is "overwhelming."

State propaganda

The North Korean state media — such as the news agency KCNA or the daily Rodong Sinmun — also report extensively on the pandemic. On the KCNAWatch portal, where English versions of all articles are collected, there were 523 reports featuring the search term COVID-19 as of April 7.

The tenor is clear: the regime mouthpieces are focusing on showing what North Korea is doing to prevent a domestic outbreak. At the same time, they report on how the number of cases is developing among the archenemy in the south in order to emphasize the superiority of its own system. As of April 7, the Johns Hopkins University database had recorded 10,331 cases for South Korea, including 192 deaths.

This picture, taken on March 19, shows disinfectants at a soap manufacturing plant in Pyongyang

Weak health care system

If the suspicions of a coronavirus outbreak in North Korea are confirmed, the health care system, with its 25 million inhabitants, would be faced with a task that cannot be accomplished without outside help. "The overall population is very susceptible to infectious diseases due to chronic malnutrition," says former North Korean correspondent Lee. She was last in the country in 2017, and has visited hospitals many times over the years.

North Korean "hospitals are ill-equipped to deal with a contagion of this magnitude." The simplest things are missing. "One of the key tactics globally has been to wash our hands with soap and warm water, but both soap and running water are in scarce supply in North Korea. Many hospitals and clinics do not have adequate soap, running water and sanitizer."

Read more: Is North Korea concealing dire health statistics?

In such an event, the North Korean health system would be overwhelmed, wrote the UN Emergency Relief Agency (UNOCHA) on March 25. Especially in rural areas, medical facilities are already lacking basic equipment such as sanitary facilities or electricity. "About nine million people are estimated to have limited access to essential health services."

UNOCHA: "95,000 children suffering from acute malnutrition" might not get treatment

UNOCHA warns of dramatic supply shortages — which could lead to, for example, 95,000 children suffering from acute malnutrition not being treated. The measures taken by North Korea, such as the border closures and the ten-day quarantine for imported goods, would have resulted in "delays in importation of materials (and) a near halt of trading." Medical supplies are also affected. It is expected that "most in-country supplies (including vaccines) will be depleted through the second quarter of 2020."

Aid deliveries from abroad

On February 26, the Russian Ministry of Foreign Affairs announced that it had sent 1,500 test kits to North Korea. Aid organizations such as Doctors Without Borders (MSF) and the International Federation of Red Cross and Red Crescent Societies (IFRC) have also launched aid deliveries. Medical goods such as protective gloves, face masks, test kits and antibiotics are explicitly excluded from the UN sanctions. However, any help must be approved by the relevant UN Sanctions Committee.

Read more: UN chief 'deeply concerned' over North Korea missile tests threat

The MSF delivery is said to have left the Chinese border town of Dandong on the way to Pyongyang on March 28, but the materials of the IFRC are not yet on site. The "IFRC is currently at the procurement stage with the items that have been requested by the Red Cross Society of DPRK," IFCR spokeswoman Ellie van Baaren wrote to DW. This is not easy due to the increased demand worldwide, she noted. The organization is also "working with government authorities to secure a priority entry permit and clearance in advance".

Like all other goods, medical products are covered by North Korea's quarantine rules, but even if the goods are in the country: how they are distributed and used cannot be controlled by foreign aid organizations. It is also unclear where and to what extent testing is carried out by Kim's regime.

DW's Kyra Levine contributed to this report.