The limited testing capacity suggests that the numbers published may represent a small fraction of total cases.

North Korea reported 21 deaths and tens of thousands of people with fever on Saturday, as leader Kim Jong Un said the COVID-19 outbreak had plunged the country into “tremendous turmoil.”

The isolated country made an unprecedented admission of its first COVID-19 outbreak earlier this week after claiming it had no infections since the pandemic began more than two years ago.

State media on Friday announced the first suspected death from the virus.

Since late April, the total number of new deaths and cases has risen to 27 deaths and 524,440 illnesses as the fever spreads rapidly. North Korea says 243,630 people have recovered and 280,810 remain in quarantine.

State media did not detail how many fever cases and deaths were confirmed as COVID-19.

North Korea is one of only two countries in the world without a COVID-19 vaccination campaign and has limited testing capacity, suggesting the numbers released may represent a small fraction of the total number of infections.

Amid the outbreak, the country’s ruling Workers’ Party held an emergency meeting to discuss the situation, KCNA reported.

“The spread of the vicious epidemic is a huge turmoil that has brought our country since the founding of the country,” Kim Jong-un was quoted as saying at the meeting by the state news agency.

However, he expressed optimism that officials could bring the outbreak under control, saying that most transmission occurred within isolated communities and did not spread from one area to another.

Since Thursday, the country has adopted stronger precautionary measures aimed at limiting the movement of people and supplies between cities and counties, but state media descriptions of the measures suggest that people are not confined to their homes.

Given the state of North Korea’s medical system and its largely unvaccinated population of 26 million, failure to control the spread of COVID-19 could have devastating consequences in North Korea, experts say.

North Korea tests about 1,400 people a week, Kee Park of Harvard Medical School, who has worked on a health care program in North Korea, told Reuters.

KCNA said 524,440 people had shown signs of fever since late April.

“In most cases, casualties are caused by negligence such as drug overdose due to a lack of understanding of treatments,” epidemic prevention officials told a Workers’ Party meeting, state media said.

North Korea has previously rejected offers to provide COVID-19 vaccinations, and although South Korea, China and the World Health Organization have all offered aid to help with the outbreak, Pyongyang has not indicated whether it will accept their aid.