India has the second-largest number of coronavirus cases in the world with nearly nine million cases.
But while there are some signs of the pandemic slowing in India, some of its neighbours are seeing spikes in cases.
Daily cases are rising in some countries
India’s population of 1.3 billion dwarfs that of its neighbours, so it’s no surprise that its overall infection numbers are much higher.
But the rate of growth in cases has slowed, and it had less than 30,000 new cases on 16 November for the first time in four months.
In some other countries in South Asia, there seems to be a renewed increase in infections.
In late October, Pakistan officially announced a second “wave” with a rise in daily cases and deaths.
The authorities in Pakistan have imposed new restrictions making masks mandatory and restricting public gatherings.
Nepal’s cases peaked in October with the highest ever single day spike of nearly 6,000 cases on 22 October.
But this dropped to 570 new cases on 27 October before another spike in early November.
Bangladesh’s daily cases peak around mid-June before they dropped in the last week of July and beginning of August. Daily cases are rising again with over 2,000 reported on 17 November.
Afghanistan has also reported a rise in new cases this month, but there are questions about the reliability of its official figures.
Sri Lanka is witnessing a spike in cases after two clusters were found in October in a garment factory and in a wholesale fish market.
There’ve been other clusters detected within the police service and in prisons.
And with cases continuing to rise, the mayor of the capital, Colombo, has called for a further lockdown just two weeks after restrictions were lifted.
How much testing is done in South Asia?
Testing is key to finding out how the virus is spreading.
The Indian government ramped up testing, achieving one million tests in a single day since 21 August. But this has dropped during the Hindu festival of Diwali.
Virologist Dr Shahid Jameel points out that given the size of the population, testing numbers are still relatively low.
The “total numbers of cases per million people in India and the rest of South Asia are low, but so is the number of tests per million,” he says.
Bangladesh was testing over 18,000 a day in June when it witnessed a spike in cases, since then, daily testing has hovered at between ten and fifteen thousand.
Bangladesh’s testing numbers fell after the government introduced a high testing fee in July. There’s also been a scandal around the sale of fake negative test certificates.
Afghanistan has tested 128,643 samples as of 17 November, but the Red Crescent warned earlier this year that the actual number of cases could be much higher than officially announced.
Pakistan has increased its testing since September, and its positivity rate rose to 6%, highest since July.
But the level of testing in these countries is generally far lower than in other countries.
The World Health Organization (WHO) has set a benchmark range for adequate testing of between 10 and 30 per confirmed case in a country or region.
South Asian countries have ramped up testing and India and Pakistan do now just fall within the range deemed adequate by the WHO.
Sri Lanka ramped up its testing massively after the two clusters were reported in October. It’s testing over 10,000 samples a day against 2,000 to 3,000 a day.
But Bangladesh is identifying one positive case for every eight tests carried out – well below the WHO benchmark.
What about the death rate in South Asia?
The overall death toll in India is currently the third highest in the world, although the proportion of people who die after getting sick remains low compared to the global average.
Deaths recorded elsewhere in South Asia are lower than in many other parts of the world, both in terms of absolute numbers and per capita figures.
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This appears to be an encouraging sign, but questions remain about the reliability of data in a region with relatively low levels of public health spending.
“Many deaths are not reported within the vital registration system and the causes of deaths are incorrectly classified,” says Professor Kamran Siddiqi, a public health expert at the University of York.
But even if deaths are under-reported, the difference from other areas of the world is noticeable.
“The most plausible explanation is that the populations in South Asia are made up of far younger people than say in Europe and the US,” Prof Siddiqi says.