Coronavirus disruptions could hurt North Korea’s efforts to treat tuberculosis

North Korea watchers warn that the country’s aggressive measures to defend itself against COVID-19, the illness caused by the novel coronavirus, are hobbling efforts to combat tuberculosis (TB) and other infectious diseases.

Sandwiched between two COVID-19 hot spots—China and South Korea—North Korea at the end of January suspended international flights and severed its rail link with China. Since then, cargo containers headed to North Korea’s port in Nampo have stalled in Dalian, China, snagged on red tape in China and new quarantine procedures in Nampo. The only way in and out of North Korea now is a road crossing on its northern border with China. North Korea’s state media has said the border restrictions will remain in effect until COVID-19 has stopped spreading or a vaccine is available.

That puts North Korea’s thousands of TB patients in a precarious situation. Three containers with first-line TB drugs are among hundreds held up in Dalian, says a U.S.-based humanitarian organization official, who requested anonymity. The official notes that North Korea’s supply of first-line TB drugs is expected to run out in May or June. The situation is even more perilous for North Koreans infected with multidrug-resistant TB strains. Treatment lapses can lead to even more recalcitrant strains. “Truly it opens grave concern” about the development of extensively drug-resistant TB in North Korea, the official says.

In the meantime, the COVID-19 situation in North Korea is a black box. “If someone has respiratory symptoms potentially related to COVID-19, these patients would be hidden due to political and social stigma,” says Jiho Cha, a global health scholar at the Humanitarian and Conflict Response Institute at the University of Manchester. “It would make epidemiological investigation very difficult.” North Korea has reportedly placed groups of individuals under quarantine for observation, but it’s unknown whether it can test accurately for the virus.

All foreigners who were still in North Korea as of 1 February were subject to a compulsory 30-day quarantine that ended on 1 March. Reports indicate that North Korea intends to clear a single flight early next week from Pyongyang to Vladivostok, Russia, to allow foreigners who wish to leave to do so and bring in medical supplies, including COVID-19 test kits provided by Russia.

The humanitarian official, who travels regularly to North Korea when conditions allow, fears for the well-being of the country’s public health workers. “We are concerned about the political jeopardy [they] may be in as they try to manage the coronavirus situation, and the health risks they may face by being on the front lines of care,” the official says. “Truly we are deeply concerned about what we may find—or who may not be there—whenever we are able to return.”