Seoul, South Korea - More than 160 countries across the world are battling COVID-19, but as coronavirus challenges even the world's most sophisticated health systems, there is one nation that claims to have no cases at all: North Korea.

"Not one novel coronavirus patient has emerged," Song In Bom, an official from North Korea's emergency health committee said last month in the official Rodong Sinmun newspaper.

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But even if North Korea is free from coronavirus, the Kim Jong Un regime is not doing a good job at convincing the rest of the world.

In South Korea, analysts and medical experts are highly sceptical of Pyongyang's claims - and those with sources in North Korea said the virus is already ravaging its way through the country.

"Despite the fact that North Korea closed its borders or refused to allow Chinese or foreign travellers in, it is very likely that some North Koreans are already infected," said Roh Kyoung-ho, a doctor at the National Health Insurance Service Ilsan Hospital Department of Laboratory Medicine.

"I don't think it's even possible to measure cases there because North Korea's medical system is not well-established or advanced."

Virus verified?

Nobody knows for sure if anyone in North Korea has already contracted coronavirus, but recent political moves seem to signal worry in Pyongyang.

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Earlier this month, North Korean leader Kim Jong Un broke months of diplomatic silence by penning a personal letter to South Korean President Moon Jae-in.

The letter's contents were not released, but a briefing from Moon's senior press secretary stated that it was full of well-wishes and concern about South Korea's COVID-19 outbreak. The sudden move has some experts wondering if North Korea is working on an appeal for coronavirus aid.

"I think that the North Koreans would probably accept masks or hand sanitiser or respirators, and maybe also some other forms of health assistance. And I think it should be done for humanitarian reasons," said Peter Ward, a researcher on the North Korean economy and writer for NK News.

"But at the same time, I think we should be under no illusions that such humanitarian support will give us any leverage in dealing with North Korea in terms of denuclearisation."

Talks over North Korea's nuclear and missile capabilities have been on hold for months after the collapse of a summit between Kim and US President Donald Trump in February last year.

North Korea has carried out a series of missile launches since then, most recently on Saturday, when the state-run KCNA also revealed that Kim had received a letter from Trump.

A senior White House official confirmed the letter had been sent saying it was "consistent with efforts to engage global leaders during the ongoing pandemic," according to Reuters.

Seo Jae-pyoung, an activist originally from North Korea who now heads the Seoul-based Association of North Korean Defectors, said that he had heard reports of COVID-19 in North Korea.

"I've spoken directly with people in North Korea and have heard that North Korea declared a state of emergency," Seo said.

"I heard that the first case in North Korea was confirmed on January 27, and that the People's Army locked down roads and railways in provincial cities, and that people were not even able to walk in the streets."

Information coming out of North Korea's tightly controlled borders is often scarce and hard to verify.

Nevertheless, Seo claims he has received messages from sources stating that face masks are being smuggled into the country through China, and that masks from South Korea are being sold on the black market and given as gifts to high-ranking officials.

And because of the country's limited access to test kits, North Korea is often basing its diagnosis on patients' symptoms, he said.

"Regular, everyday North Korean people don't really know about this virus," Seo said. "In North Korea, they're just seeing it as some scary disease."

North Korean leader Kim Jong Un last week addressed a groundbreaking ceremony for the new Pyongyang General Hospital [KCNA via Reuters]

Journalists and researchers have also heard about an outbreak.

Robert Lauler, a former NGO worker and English editor at the Daily NK, an online publication that has contacts in North Korea, said its sources reported 82 people in quarantine and 23 dead from COVID-19 in the country.

"That information is from a couple of weeks ago," Lauler said.

"Last week, we also ran a story about a military report that stated that around almost 200 soldiers had died from symptoms that appeared to be coronavirus. But in all these cases, the numbers we put out are not necessarily 100 percent from coronavirus. The sources we have suggest that there has been an outbreak and that people are dying."

Risk of devastation

A coronavirus outbreak would be devastating to the North Korean people and an economy that is already suffering under economic sanctions.

"We're talking about an amazing level of devastation to the North Korean economy and particularly to the breadbasket region in North Korea, which is on the northwestern side of the country," Lauler said. "I'm pessimistic … Given that sanctions and all the other conditions are still in place, it doesn't really bode well for the economy going forward."

As an authoritarian state, the North Korean government does have the power to unilaterally order people into lockdown or stop travel throughout the country. Some foreign diplomats were reportedly forced into quarantine, for example, and ultimately flown out of the country after being released.

Swedish ambassador to North Korea Joachim Bergstrom poses for a selfie in Pyongyang's Kim Il Sung Square on March 3, after being allowed to leave following a month-long quarantine imposed on foreign diplomats over coronavirus fears [Joachim Bergstrom via Reuters]

North Korea is already vulnerable to devastation because of last year's blows from Hurricane Lingling and African Swine Fever. Moreover, North Korea's weak healthcare infrastructure would probably be overwhelmed by a rapid spread of COVID-19.

"Outside of Pyongyang and Hamhung, I believe there are virtually no medical institutions where everyday people can easily get treatment," Seo said. "Most cities do not have an ambulance or transportation for patients, and many people who quarantine would have to do so at home."

Malnutrition and disease across North Korea have been rising since the middle of 2019, when harvests were significantly damaged by droughts and floods. More than 10 million people suffered from "severe food shortages," according to the UN.

"Given the relatively low levels of nutrition in the country and the chronic disease rates, you would imagine the fatality rate would be higher in North Korea than a lot of other places," Ward said.

That is why he believes North Korea is keeping its suspected outbreak a secret from the rest of the world.

"The government is concerned about a public awareness of a serious outbreak that could kill hundreds of thousands of people," he said. "They are trying to avoid social panic and social instability."

Mitch S Shin contributed to this report.