A case-by-case comparison...
It is not shocking that India's total infection numbers are enormously higher than its neighbors, considering it has a population of 1.35 billion and a stabler transportation structure allowing for better mobility. However, the number of cases spiked to over 45,000 after briefly dropping to 28,550 on November 16 and below 30,000 in 4 months. It indicates an uptrend in India (conducting 94,000 tests per million) while its neighbors seem to suffer from similar courses and possibly worse with a less-than-desired testing performance (15,000 to 55,000 tests per million).
In late October, Pakistan officially announced a worrying second wave, with daily cases surpassing 1,000, forcing the Pakistani authorities to impose extra constraints such as making masks mandatory and limiting public get-togethers. However, the daily figure rose to 2,738 on November 20. On the other hand, Nepal's cases climaxed with the highest ever single-day spike of over 5,700 cases on October 22, but the country continued to register ups and downs throughout November. Bangladesh's daily cases peaked around mid-June and dropped in late July and early August, but they are rising again with over 2,200 in late November.
Sri Lanka, which reports only 922 cases per 1 million population, forced strict movement restrictions across the island after discovering two clusters in a garment factory and a wholesale fish market in October. The authorities have identified other clusters within the police service and prisons, while Colombo's mayor has demanded an additional lockdown just two weeks after the removal of constraints.
Afghanistan, another country questioned about its official figures' reliability, has also reported a rise in new infections with a spike of 377 patients on November 19.
The question of how many tests should precede the number of cases
Not conducted at the same level worldwide, testing is of paramount importance in appraising the infection paces and patterns in a particular vicinity, which is rather challenging considering India's size. The Union Health Secretary Rajesh Bhushan had told at a press conference that the positivity rate came down to 7.18 percent before the recent increase despite the high number of tests conducted in India. Although the government surpassed the one million test threshold starting with late August, the Times of India worryingly reported on November 20 that the number of daily tests has been falling of late in several states, most of them mainly relying on the rapid antigen test rather than the more accurate PT-PCR tests.
Bangladesh has been questioned over its testing capacity, with over only 2.6 million tests as of late November and an average of 10,000-15,000 tests per day. The testing numbers declined significantly after the government's testing fee decision of 200 taka (1.99 EUR) in summer, which is high as 25% of Bangladeshis live below the poverty line (the private sector price was a daunting 34 EUR).
The number of tests in Afghanistan has neared only 150,000 as of late November despite a daily capacity of 5,500 tests.
Since September, Pakistan has increased its testing, and its positivity rate rose accordingly, but developments like tens of thousands attending the funeral of Khadim Hussain Rizvi, leader of religious and political party Tehreek-e-Labbaik Pakistan (TLP), will not help the country curb the disease quickly.
Nevertheless, testing levels in the South Asian countries are far beneath those in western ones, although India and Pakistan are now within the range assumed sufficient by WHO with the above situation regarding the RAT vs. PT-PCR tests. Separately, Sri Lanka increased its testing levels to more than 10,000 from a few thousand tests per day after the police and penitentiary cluster declarations.
India ranks third in terms of deaths, but the average number is proportionally lower
Although India currently ranks third globally in overall mortality, the ratio of people dying from the disease is below the global average, and it applies to elsewhere in South Asia both in absolute numbers and per capita figures. However, such statistics are not interpreted as a reassuring picture but approached with caution as issues prevail about data reliability in a region with comparatively feeble health spendings.
Also, India is thought to have missed or wrongly classified many deaths is scrutinized in a Lancet article by Patralekha Chatterjee, who refers to an example in Tamil Nadu.