With North Korea confirming its first COVID-19 case on Thursday, the list of countries untouched by the virus is approaching zero.
Officials in North Korea said on Friday morning that there had been six deaths and that health care workers were treating 18,000 people with fevers.
It suggests that even an isolationist approach cannot stop the spread of the coronavirus.
North Korea sealed its borders in January 2020. But it shares a long border with China and relies on its neighbor for imports and exports. So blocking the virus fully has been near-impossible.
Zero-COVID policies "failed" to protect Australia and New Zealand
North Korea's new COVID-positive status leaves just two countries — Turkmenistan and Tuvalu — untouched by the pandemic. That's based on global data from official reports of COVID-19 cases and compiled by the Johns Hopkins University in the US.
Many countries, including New Zealand, Australia and Fiji took strict isolationist measures at the start of the pandemic. They closed their borders and enforced prolonged lockdowns.
New Zealand and Australia pursued "zero-COVID" policies, locking down their entire countries or states within the countries if a single COVID-19 case was detected.
The strategy was successful at reducing outbreaks early in the pandemic.
But, as the pandemic went on, cases of COVID-19 rose all the same. New Zealand's Prime Minister Jacinda Ardern said in October 2021 that their Zero COVID policy had failed to halt the spread of COVID-19.
Globalization has created a dependency on imports and exports of foods, medicines, other goods and raw materials, and that means that all countries require some degree of international travel — with people crossing borders with different standards and health checks.
Most nations have dropped isolationism and reopened borders to allow trade and travel.
Tonga: Emergency aid brought COVID-19
The pacific archipelago nation Tonga also closed its borders when the pandemic started and successfully managed to keep COVID-19 at bay.
But volcanic eruptions and a tsunami in January 2022 forced Tonga to open its borders to enable the delivery of medical aid.
That also meant that COVID-19 reached the nation via shipment handlers, causing its first outbreak.
Like most nations, Tonga had prepared for a potential COVID-19 outbreak, with vaccination strategies and measures to reduce the spread of the virus.
Vaccination kept death rates low
At the time of Tonga's COVID-19 outbreak in January 2022, roughly 61% of Tongans were fully vaccinated against the virus and the country introduced lockdowns.
By May 12, there had been 11 confirmed deaths in Tonga from a total of 11,000 COVID-19 cases.
Other nations that took isolationist approaches at the start of the pandemic have also seen low death rates thanks to successful vaccination strategies, according to experts.
New Zealand reopened its borders on May 2 for tourists and visa holders for the first time in two years. The country has seen a dramatic rise in cases from 20,000 cumulative cases on February 11 to 1.02 million on May 11.
But, despite the rise in case numbers, death rates have remained low. To date, New Zealand has seen 863 deaths from its 1.02 million cases, while Australia had 7,668 deaths from 6.4 million cases.
North Korea heading towards a healthcare crisis
The situation is different for North Korea. Analysts predict that a large-scale outbreak of COVID-19 would be dire for the country.
The nation has repeatedly rejected offers of vaccines from global vaccination initiatives, suggesting that most of the population is unvaccinated.
While it is hard to find reliable information from North Korea, it is said that the nation's medical and health care infrastructure would struggle to cope with high case numbers and hospitalizations.
Coupled with limited testing capabilities and access to personal protective clothing, such as face masks, controlling the virus may be challenging without further lockdowns.
And that's exactly what North Koreans face now after officials ordered the country into a state of "maximum emergency."
Edited by: Zulfikar Abbany