North Korea stands on the brink of a Covid-19 catastrophe unless swift action is taken to provide vaccines and drug treatments, experts have said, as the number of people reported to have fallen ill rose to almost 1.5 million. The isolated country reported another big rise in new cases of what it continues to refer to as “fever” on Tuesday, days after it admitted it had identified Covid-19 infections for the first time since the start of the global pandemic. It recorded 269,510 additional cases and six more deaths, bringing the total number killed to 56 since late last month. About 1.48 million people have become ill with the virus since the first case was reported last Thursday and at least 663,910 people were in quarantine, according to official figures. The outbreak is almost certainly greater than the official tally, given a lack of tests and resources to monitor and treat the sick. A significant Covid-19 outbreak could unleash a humanitarian crisis in North Korea, where the economy has been battered by the pandemic-enforced closure of its border with China – its main trading partner – natural disasters, and years of international sanctions imposed in response to ballistic missile tests. The regime is not thought to have vaccinated any of its population and does not have access to antiviral drugs that have been used to treat Covid-19 in other countries. Its hospitals have few intensive-care resources to treat severe cases, and widespread malnourishment has made the population of 26 million more susceptible to serious illness. “It looks really bad,” said Owen Miller, a lecturer in Korean studies at the School of Oriental and African Studies, London University. “They are facing the rampant spread of Omicron without protection from vaccines, without much – if any – immunity in the population and without access to most of the drugs that have been used to treat Covid elsewhere.” Offers of outside help have so far been met with silence. Instead, there is concern that the country’s leader, Kim Jong-un, may be willing to accept a large but “manageable” number of cases and deaths to avoid opening his country up to international scrutiny. Since it reported its first cases last week, North Korea’s propaganda machine has portrayed the virus as an enemy that can be defeated through lockdowns, quarantine and greater vigilance. The state-run KCNA news agency has reported the delivery of unspecified drugs – “the elixir of life” – to pharmacies by army medical units, and public health campaigns calling for mask-wearing and social distancing. But testing levels are far below what is needed to form an accurate picture of the outbreak and to quickly identify and isolate patients. Some observers speculated that authorities were deliberately underreporting cases to ease the pressure on Kim. North Korea has tested just 64,200 people since the start of the pandemic’s start, according to the World Health Organization, compared with 172 million in the neighbouring South. “We were talking about a 0.1% fatality rate for Omicron in South Korea, but that’s going to be significantly higher in North Korea, possibly even reaching 1%, although it’s difficult to make accurate predictions at this point,” said Jung Jae-hun, a professor of preventive medicine at Gachon University. Kim, who says the outbreak is causing “great turmoil”, finds himself having to balance public health measures with efforts to revive the crumbling economy. A ruling party member in North Hamgyong province said people were still going to work and markets remained open, reported the Japan-based Asia Press. “There are no bans on going outside. However, we’ve been ordered to double mask,” the unidentified official told the website, which receives information from citizen journalists equipped with contraband Chinese mobile phones. “People are going to factories and to their places of work as normal. The authorities don’t want work to be disrupted. People get fever checks when they go to and from work.” The official said people were more concerned about being locked down and prevented from working than catching Covid-19. “People are worried about how to survive.” Some initially interpreted North Korea’s admission that it was battling the virus – after two years of denying it had found a single case – as a plea for help. But it has already refused millions of vaccine doses via the UN-backed Covax scheme, while South Korea says it has yet to receive a response to its offer this week of vaccines, drugs and medical staff. “I’m sure the North Koreans will still be very wary of accepting major international aid and going back to the situation of the 1990s, when there were multiple different aid agencies operating in the country and this was felt by the leadership to be humiliating and potentially destabilising,” Miller said, adding that the regime was more likely to turn to China for medical aid. The Omicron variant has caused significantly fewer deaths and serious cases than previous strains in countries with high vaccination rates, proper medical services and previous exposure to Covid-19. But that pattern is unlikely to be repeated in North Korea, said Kim Sin-gon, a professor at Korea University College of Medicine in Seoul. “North Korea has many vulnerable people who don’t have strong immune systems,” he said. “Its official inoculation rate is zero and it has no Covid-19 treatment pills.” Without urgent international help, Kim added, “North Korea may end up with the pandemic’s worst death and infection rates in the world for its population size.”