North and South Korea are reporting outbreaks of different strains of influenza, less than two weeks before thousands of visitors from around the world arrive for the 2018 PyeongChang Winter Olympics in the South.

North Korea’s Ministry of Public Health reported over 80,000 confirmed cases of the influenza strain H1N1 that is endemic in pigs, known as swine flu, between December 1, 2017 and January 16, 2018, according to a bulletin issued by the International Foundation of Red Cross and Red Crescent Societies.

Aid and sanctions

The Red Cross cited North Korean health ministry officials saying that three children and one adult have died so far in the outbreak and that there are over 120,000 suspected swine flu cases in the country, and that the outbreak is nationwide with 28 percent of the cases reported in the capital of Pyongyang.

The North Korean government has requested medication to vaccinate high-risk individuals from the World Health Organization and the U.N. International Children’s Emergency Fund (UNICEF), as well as training and equipment for prevention, detection, and treatment to limit the impact of the influenza outbreak. The WHO and UNICEF have not publicly commented on the request.

The Red Cross is planning for $270,000 in emergency aid that includes sending volunteers with masks and protective clothing to conduct training in at risk areas in North Korea.

“The majority of the component of what we are gong to do is hygiene promotion and health education,” said Gwendolyn Pang, acting head of the Red Cross office in Pyongyang.

In September, the South Korean government reportedly delayed sending an $8 million humanitarian aid package to North Korea after Pyongyang conducted its sixth nuclear test earlier that month. The planned donation included $3.5 million going to UNICEF for medicine and nutrition to help children and pregnant women, and $4.5 million to the World Food Program for food aid to North Korean hospital South Korea suspended all humanitarian aid to the North in 2016 following Pyongyang’s fourth nuclear test.

Last year’s delay of aid by the administration of South Korean President Moon Jae-in was seen as a show of support for U.S. President Donald Trump’s “maximum pressure” strategy that emphasizes strong economic sanctions along with the threat of military action to force the Kim Jong Un government in Pyongyang to give up its nuclear weapons.

Cross border exposure

This year, Pyongyang has taken a seemingly more conciliatory approach to Seoul by agreeing to participate in the Olympics in South Korea, and has so far refrained from conducting any further provocative missile or nuclear tests. Washington has also supported this Olympic truce by agreeing to postpone joint military exercises with South Korea, until after both the Olympic and Paralympic games end in late March.

However increased Olympic related inter-Korean travel, with South Korean athletes training for skiing events at Kumgang Mountain in North Korea, and a large delegation of North Korean athletes, artists and cheering squads poised to compete and perform across the South, has raised concerns of the virus spreading across borders.

“We are continuing to monitor trends in the North Korean flu. And I will do my best to be more thorough about quarantine (contingencies) in relation to the North Korean people ’s visitation and our visit to North Korea,” said Ministry of Unification spokesperson Baek Tae-hyun on Monday.

The majority of human infections of the highly contagious H1N1 flu virus come from direct contact with infected animals or contaminated environments, according to WHO, and the virus can be be transmitted through human to human contact.

Once transmitted to humans, the influenza virus may cause a mild upper respiratory tract infection (fever and cough), and in some cases a rapid progression to severe pneumonia, acute respiratory distress syndrome and even death.

South Korean outbreak

This weekend a highly pathogenic strain of H5N6 avian influenza was also found on a chicken farm in South Korea near Seoul. Provincial authorities have reportedly ordered that over 500,000 chickens be culled and more than 450,000 eggs destroyed in farms where the virus was detected. . The government is also conducting inspections and disinfections at all poultry farms in the area, quarantining workers at infected poultry farms for a week, and imposing a regional ban on poultry distribution to urban areas.

According to the Ministry of Agriculture, Food and Rural Affairs there have been a total of 15 cases of bird flu in South Korea since last November, which has forced the authorities to cull nearly 2 million birds.