SEOUL, South Korea (AP) — North Korea on Tuesday reported another large jump in illnesses believed to be COVID-19 and encouraged good health habits, as a mass outbreak spreads through its unvaccinated population and military officers were deployed to distribute medicine.

State media said the anti-virus headquarters reported another 269,510 people were found with fevers and six had died. That raises North Korea’s deaths to 56 after more than 1.48 million people became ill with fever since late April. North Korea lacks test kits to confirm coronavirus infections in large numbers, and the report didn’t say how many of the fever cases were COVID-19.

North Korea’s virus response comes down to isolating people with symptoms at shelters, and as of Tuesday, at least 663,910 people were in quarantine.

In addition to lacking vaccines for its 26 million people, the country also grapples with malnourishment and chronic poverty, and lacks public health tools, including antiviral drugs or intensive care units, which suppressed hospitalisations and deaths in other countries.

North Korea acknowledged domestic COVID-19 infections for the first time last Thursday, ending a widely doubted claim it was virus-free throughout the pandemic.

It’s unclear whether the North’s admission of an outbreak communicates a willingness to receive outside help. The country shunned millions of vaccines from the U.N.-backed COVAX distribution program, likely because of international monitoring requirements attached to those shots.

South Korea has publicly offered to send vaccines, medicine and health personnel, but North Korea has so far ignored the proposal amid icy relations between the rivals over a stalemate in larger nuclear negotiations between Washington and Pyongyang. Some experts say Kim’s praise of China’s pandemic response during a virus meeting last week indicates that the North would be more willing to receive help from its main ally.