India has the second largest number of coronavirus cases in the world, and its infection numbers are rising again.
Neighbouring countries are also seeing cases rising, as they attempt to ramp up vaccination programmes which only started in the last couple of months.
What’s happening to cases in India?
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.
It’s now reporting more than 100,000 cases in a single day, which is higher than the daily peak during last year’s initial coronavirus wave.
And the Indian authorities recently reported the presence of a “double mutant” variant, leading to concerns that this might make the virus more transmissible.
Virologist Dr Shahid Jameel says this variant could be one of the reasons for a sudden surge in India.
He explains that such a mutation in key areas of the virus’s spike protein “may…allow the virus to escape the immune system”.
However, more research is needed to understand exactly what this mutation might mean for the spread of the disease and its impact on those who are infected.
What’s happening elsewhere in the region?
Some of India’s neighbours are also experiencing an increase in infections.
After going through a second wave in October, Pakistan is witnessing a third surge with infections picking up sharply throughout March.
It has imposed new restrictions in areas with rising cases, making masks mandatory and limiting public gatherings.
After watering down plans for a lockdown in early April, the Bangladesh government now says there will be a full lockdown for a week from 14 April.
In Nepal, there are fears of a second wave as infections began to show an increase in late March.
Afghanistan has also reported a rise in new cases at the start of April, but there are questions about the reliability of its official figures.
In Sri Lanka, daily cases are going up but not at the rate of its neighbours.
How are the vaccination drives going?
India is now ramping up its vaccination programme, which began in mid-January.
Nearly 80 million people have had one dose, and over 10 million two doses, with the criteria for those eligible for a jab being expanded.
India has also donated vaccines manufactured by the Serum Institute of India and Bharat Biotech to its immediate neighbours.
But India recently temporarily halted exports to other countries to prioritise domestic requirements amid rising cases.
Bangladesh, Nepal, and Sri Lanka have received vaccine doses through donations from India and other countries, as well as via commercial deals.
They began their vaccination programmes in the last two months, starting with frontline health workers.
So, the proportion of their populations who are vaccinated is currently very small.
With a supply halt from India, Nepal and Sri Lanka had to stop their vaccination drive until they received donations of the Sinopharm vaccine from China.
Sri Lanka’s government has said that they would only use Sinopharm after World Health Organization (WHO) approval after concerns were raised about using vaccines yet to be given official approval.
Pakistan has so far vaccinated over a million elderly people after it received its first vaccine donation from China last month.
What are the testing levels?
Testing is the key to finding out how the virus is spreading in populations.
But testing rates can vary over time, and counties have adopted different approaches to it.
The Indian government ramped up testing last year, and on a number of occasions achieved over a million tests a day by deploying increasing numbers of rapid antigen tests.
This fell back after cases subsided in December 2020, but has picked up pace again recently.
However, there’ve been concerns that the rapid tests are not as reliable in detecting cases as other types of test.
Dr Shahid Jameel also points out that absolute testing numbers do not really show the scale of the pandemic.
“Testing has to increase based on the test positivity rate, not arbitrarily.” said Dr Jameel.
Bangladesh was testing over 18,000 a day during its last peak in June last year, but with the recent surge, nearly 35,000 tests a day are being conducted.
But it’s still only identifying one positive case for every five tests carried out – which according to the WHO means that the number of confirmed cases is likely to represent only a small proportion of the real number of infections.
Pakistan has also increased its testing levels.
Sri Lanka ramped up its testing massively to nearly 20,000 a day when it witnessed its peak in February this year. It’s come down to around 10,000 now as cases have subsided since mid-March.