As the world grappled with the COVID-19 outbreak in April, Chinese medicine exports to the DPRK remained largely stable, with one notable exception: tetracycline derivatives.

The shipment of over 15,000 kg in April represented a substantial spike compared to the zero imports in March and only 2550 kg in the combined January-February trade data from China’s General Administration of Customs (GAC).

Tetracyclines are a type of antibiotic generally agreed upon by doctors to represent a second-class drug, due to undesirable side effects and established bacterial resistance.

But they are preferred for specific infections, and remain popular in developing countries, in veterinary medicine, and — perhaps most importantly — have been cited as a possible treatment for COVID-19.

In a letter to the editor of the journal Pharmacotherapy in April and in interviews, Drs. Mohit Sodhi and Mahyar Etminan of the University of British Columbia argued that tetracycline may prove helpful as a prophylactic and as a therapeutic treatment against COVID-19.

Treatment combinations of hydroxychloroquine paired with antibiotics such as azithromycin have been promoted in the U.S., while antibiotics to combat secondary complications are a regular part of coronavirus treatments in China.

“Tetracycline antibiotics are inexpensive[,] making them attractive for use in developing countries,” wrote the authors of the 2017 edition of “Microbiology and Molecular Diagnosis in Pathology,” which could explain their appeal in North Korea.

North Korea has also in the past claimed to be able to produce the drug itself, with a state media feature on the Pyongyang Pharmaceutical Factory reporting that the facility was able to make over 1200 kinds of products, including tetracycline.

But despite the potential link to COVID-19, April was not the first time North Korea has imported tetracycline derivatives in bulk: 2019 also saw China export an average of 6,627 kg a month to the DPRK.

While pre-pandemic trade saw exports of over 15 kinds of antibiotics from China, only three kinds of antibiotics were exported in April, with 15,350 kilos of tetracycline derivatives making up 97% of the total quantity.

North Korea has repeatedly insisted that it has detected no cases of COVID-19 in its territory, though it has reportedly only tested 740 people for the virus.

Tetracycline is also a popular veterinary antibiotic, and may be intended for North Korean farms to treat bacterial infection.

African Swine Fever, which the DPRK has been battling since late last year, cannot be treated by antibiotics and has no cure beyond culling infected animals.

Edited by Oliver Hotham