Its weak healthcare system and impoverished population led to concerns over the country's vulnerability to an outbreak, though its cold chain vaccination program had proven capable in prior pandemics.

In January 2020, the North Korean government began taking extensive measures to protect itself from the initial COVID-19 outbreak, including the establishment of quarantine facilities, and strict travel restrictions.

[10] In May 2022, the Korean Central News Agency reported that an unspecified number of people in the capital Pyongyang tested positive for the virus, and announced the country's first confirmed deaths.

[7] Diplomatically and economically isolated,[7] North Korea is an impoverished country with a weak healthcare system and is subject to sanctions, rendering it vulnerable in the event of an outbreak.

The authorities also started placing patients with suspected COVID, including those with slight, flu-like symptoms, in quarantine for two weeks in Sinuiju.

[28] South Korean media outlet Daily NK reported that five suspected COVID-19 patients in Sinuiju, on the Chinese border, had died on 7 February.

Rodong Sinmun, the Workers' Party of Korea newspaper, reported that the customs officials at the port of Nampo were performing disinfection activities, including placing imported goods in quarantine.

[37] All international flights and railway services were suspended in early February, and connections by sea and road were largely closed over the following weeks.

Kim told a newspaper linked to the ruling Workers' Party of Korea that the construction of new hospitals was being done for general improvement of the nation's healthcare system, without mentioning COVID-19.

[44] On 26 March, The New York Times reported that satellite imagery shared by the Royal United Services Institute showed that the illicit trafficking of coal and other goods had stopped, with the commercial vessels idling in their North Korean home ports.

[44] The North Korean military fired five test missiles on two occasions in early March 2020, possibly as "an effort to ensure the country remains on the agenda for other nations amid the virus outbreak".

[48] In February and March, U.S. officials observed a decrease in military activity in North Korea, which they believed to be a sign that there were COVID-19 cases in the country.

The meeting adopted a joint resolution by the Central Committee, State Affairs Commission, and the Cabinet, "on more thoroughly taking national measures for protecting the life and safety of our people from the worldwide epidemic disease".

[54] From mid to late April, restrictions on foreigners travelling in Pyongyang were relaxed, Nampo harbour was reopened to container ships, and the 14th Supreme People's Assembly with hundreds of delegates was held without the wearing of face masks.

[56] According to a statement from the British Foreign Office, this was due to restrictions on entry to the country, making it a challenge to rotate staff and sustain the operation of the Embassy.

[57][58] The underground network that assists defectors in escaping North Korea was reported as being almost unable to operate amidst the strict controls implemented to stop the virus, and defection attempts were largely suspended.

[59] Defection rates had been declining already, probably due to increased security under the administrations of Kim Jong Un in North Korea and Xi Jinping in China.

[57] KCNA and Rodong Sinmun released images from a meeting on 2 July with Kim Jong Un and dozens of officials, none of whom were shown wearing masks.

[66] On 14 August, the three week lockdown in Kaesong and nearby areas was lifted by Kim Jong Un,[9] after "the scientific verification and guarantee by a professional anti-epidemic organisation".

A source to the Daily NK reported that some residents were suspecting a government cover-up, and that doctors were being ordered to not discuss COVID-19 as to not "damage the image" of Kim Jong Un.

The translation as "worst-ever" had also been previously used in the 8th Congress of the Workers' Party of Korea to refer to the past five years, yet the economy is in nowhere near as much difficulty as in the 1990s.

Similarly, in the North Korean context, "Arduous March" does not directly refer to economic hardship, but a firm resolve to carry out tasks of the party.

[83] American activist Tim A. Peters said that there were signs of "enormous stress on the North Korean population" due to the pandemic and associated restrictions, and that he suspected COVID-19 was spreading within the country despite the lack of confirmed cases.

[84] In July 2021, North Korea rejected shipments of around two million doses of the Oxford-AstraZeneca vaccine, citing concerns over potential side effects.

[90] A South Korean–based humanitarian organisation, the Inter-Korean Economic Cooperation Research Center (남북경제협력연구소, IKECRC), received a UN sanctions exemption to send 20 thermal imaging cameras to North Phyongan province for detection of fever symptoms, while the WHO was granted 18 more months to deliver shipments for stalled projects.

The Korean Central News Agency stated that Supreme Leader Kim Jong Un had called an emergency meeting of the Politburo of the Workers' Party of Korea after learning of the samples, which were sourced from residents of Pyongyang and had symptoms "consistent with" the Omicron variant.

[98][97] NK News reported that the entire country had been placed under a lockdown two days prior, though farmers in border regions close to South Korea were seen still tending the fields.

[99] On 13 May, Kim Jong Un held a meeting at the State Emergency Epidemic Prevention Headquarters, where he called for further anti-pandemic work, lockdowns, and isolation of suspected cases.

On 27 August 2023, the Korean Central News Agency reported that North Korea would allow its citizens living abroad to return to the country for the first time since travel restrictions were imposed in early 2020.

[120] North Korean people reported scarcity of food after the strict closing of the border because of the pandemic, in an exclusive interview by the news broadcaster BBC in June 2023.