Nuclear war or “loose nukes” isn’t the only prospect worrying Washington, Beijing, Seoul and Tokyo. Internal collapse in North Korea could spark armed clashes among competing factions for control and trigger massive refugee flows, taxing the region’s ability to respond.

The current pandemic would only amplify a humanitarian disaster in North Korea. Of its total population of 25 million people, North Korea has 10 million citizens who are malnourished and 8 million who lack access to clean water, making them more vulnerable to the coronavirus and other diseases. Internal instability could also unravel the state’s strict measures to contain the coronavirus. Last week, the state ramped up its anti-coronavirus campaign, including reinforcing existing border lockdowns and the inspection and quarantining of imported goods—an acknowledgement of the ongoing necessity of pandemic vigilance, even though Pyongyang still insists that it has zero infections. A few days earlier, the regime reportedly announced restrictions on some imports to “prevent the spread of the virus,” alarming North Koreans whose survival depends on smuggling and trading goods from China. Pyongyang residents this week are reportedly panic-buying, according to NK News, mirroring similar behavior around the world as a result of the uncertainty about the pandemic and availability of daily necessities. Adding to the North’s woes, one of China’s biggest cities in its northeast, close to North Korea, is tackling an outbreak of coronavirus.