I think result are biased either under reporting or over reporting. improper reporting methods and techniques can also affect the numbers.

The data provided must be re-checked

There are many factors to this matter. Some countries acted very fast despite the sudden impacts. The high-level measures at the earlier stage were truly impactful and effective.

Also, there are other factors that could be studied and here I have summarized few of them: http://global.chinadaily.com.cn/a/202005/12/WS5eb9e1d9a310a8b241154e3e.html

The mutation rate of SARS-COV-2 is higher and few researchers mentioned that SARS-COV-2 strains in India are less lethal. In India, the number of cases was less in May month due to Lockdown but after that, it is going to increase day by day.

Different countries had different strategies and even in lockdown implementation we saw the variations. Lots of issues are there: individual, social and national management system etc. and time will clear the confusion too.

V.K. Deshwal ,

Thank you for your reply. I appreciate it very much.

Dear Muhammed Ashraful Alam , Ministry of Health and Family Welfare,

I appreciate very much your answer.

Thank you, Ali Cheshmehzangi , University of Nottingham Ningo China, for your answer and link.

It is still a mystery... Some answers to the question

The novel Coronavirus in N. Italy, Lombardia 【 COVID19 / 2019nCoV / SARSCoV2 】 shows a fatality rate compatible with SARS-MERS. Why??

addressing the opposite situation should be helpful for resolving this mystery.

Unique micro RNA in Indians provide protection against COVID-19.

Preprint Comparative analyses of SAR-CoV2 genomes from different geog...

At present, three basic rules can be used for controlling any pandemic disease like COVID-19

1. Medical facility and medicine 2. Social distancing 3. mental status. most important is mental status means persons are following the rule/advice given by the health department. SARS-COV-2 is most lethal as compared to other coronaviruses.

Thank you, Janusz Pudykiewicz , for your reply.

Dear Arvind Singh , I thank you very much for your expert answer.

I thank you so much, V.K. Deshwal , for your comprehensive yet concise answer.

The current estimates of numbers of COVID-19 cases and deaths are very inaccurate. The sensitivity and specificity of the diagnostic tests for COVID-19 are not yet known in vivo. There are reports of very high sensitivity and specificity in vitro. However a number of confounding factors (e.g. the stage of illness and the way the swab was taken) mean that the false negative rate of these tests may be high in clinical practice.

Wenling Wang; Yanli Xu; Ruqin Gao; et al Detection of SARS-CoV-2 in Different Types of Clinical Specimens. Jama 2020 (in press).

The numbers of cases reported will also depend on strategies used for screening. Many countries are only screening symptomatic patients presenting to healthcare facilities. Others are attempting to screen a significant proportion of the population.

I believe the total number of cases of COVID-19 is significantly higher than that being reported. There are many confounding factors (both political and diagnostic) that make the initial number of deaths reported as being due to COVID-19 extremely difficult to interpret.

Article Making informed decisions and balancing risk-benefit ratios ...

This brief letter discusses some of the points outlined below

The availability of healthcare in general and specifically critical care will affect case fatality. In China and Italy where large numbers of healthcare professionals were infected the capacity to deliver healthcare was substantially reduced.

This has created a situation in the developed world that occurs routinely in the developing world. The ever-increasing demand for critical care in developing countries is similar to that of the developed world. However, the availability of resources is very different. In a typical intensive therapy unit (ITU) in a public hospital in Bangladesh resources are scarce and the demand for beds is high. There is always a very long ‘waiting list’ of outliers throughout the hospital. In this context the process of making informed decisions and balancing risk-benefit ratios is often straightforward; when there are no resources available, patients cannot receive advanced organ support. However, decision making is usually several orders of magnitude more complex than this. As a result, decisions that could be considered abhorrent and unethical in the developed world are made routinely.

These decisions are now being made in developed countries where the capacity for healthcare systems to provide organ support in intensive care units is exceeded. As a result excess deaths are occurring.

Another important factor to consider when trying to interpret variation in mortality rates between countries is differences in cultural interpretation of quality of life. This impacts the social and medical ethics and the delivery, limitation and withdrawal of life sustaining therapies.

In many Western cultures quality of life is valued far more than quantity of life. In those settings limitation and even withdrawal of life sustaining therapies resulting in cardiac arrest are a common mode of death.

In many Eastern cultures quantity of life is valued more than quality of life. In these settings treatment limitations and withdrawals of therapy are rare.

Admission to intensive therapy units and prolonged organ support are common. Mode of death is often failure of resuscitation after cardiac arrest.

These differences are magnified when there are limited resources particularly in Western countries. The social and medical acceptance of treatment limitations is increased; this may significantly increase case fatality rates.

Rajkumar Rajendram ,

Thank you for alerting us to state-of-the-art research on the impact of COVID-19 on mothers with respect to their prenatal circumstances and unborn babies.

Rajkumar Rajendram ,

Thank you for indicating extenuating social and societal factors that may well be resulting in grossly inaccurate statistical counts of the COVID-19 impact.

Rajkumar Rajendram ,

Thank you. I agree that the COVID-19 pandemic is an equalizer that is leveling the ground between developed and developing nations.

Rajkumar Rajendram ,

I would tend to disagree, without being disagreeable, with your overview of a marked contrast between Western and Eastern Hemispheric nations, because mortality rates do not, in my view, correlate with relative valuation placed on "quantity" versus "quality" of life. I thank you nonetheless for your reply.

This is due to the severity of the protective instructions

People are more committed

Rajkumar Rajendram ,

One sign that Western nations value quantity just as much as, or more, than quality of life is the fact that European nations are currently winning their battle, and fewer citizens are catching the corona virus with each passing day because of their commitment to both quantity and quality. Perhaps the discrepancies can be traced to the form of government. For example, China has 1.4 billion people and is managing to lower the number of people catching the corona virus, maybe because the people are conditioned to strictly obey orders for social distancing, and moreover, they were already wearing face masks to protect themselves from the fallout from fossil fuel energy use.

We should wait to reach a conclusion about the fatality of COVID-19 in India.

Indeed, if you look at the statistics, June 25

https://www.worldometers.info/coronavirus/#countries

the mortality in countries such as China, India and some others in Asia is much lower than in developed countries of the West. I discussed this with my colleagues from different countries. Perhaps the answer is that, for example, in China, both Chinese medicine and Western methods were used for treatment. And if so, such an effect of "integrated" (traditional + Western) medicine is very impressive.

Galina Levina ,

Thank you for your very thoughtful answer!

Some countries with Covid-19 only counted fatalities that had no concurrent disease (cardio-pulmonary, diabetes, etc.). The number of deaths from the virus appears to be lower compared to other countries.

Harasit Kumar Paul ,

Thank you very much for your cautionary reply; I agree with you in that the collection of statistical data in a country of 1.4 billion people like India is not as instantaneous as in smaller nations. In addition, the spread of the novel COVID-19 virus does appear to be following a pattern such that larger land masses like India and Africa, where the population is spread out and where tourists are not a big economic factor, may be able to avoid, or at least, to experience less of a "spike" in the number of cases and fatalities, than in predominantly industrialized locations.

Paul Salme ,

Thank you for your astute observation that some nations are differentiating in their daily statistical reports between COVID-19 victims with (and without) pre-existing medical problems, as you say those who have "no concurrent disease (cardio-pulmonary, diabetes, etc.)" versus those who do.

How can we compare the compliance of a people in a country of democratic rule at all times with a country of dictatorial regime for long periods, concerning the number of cases of Covid-19, the fatalities and the protective measures taken in those different countries. In the first case protective measures are recommended while in the second they are imposed with prosecution of offenders may be.

I think the cruise ships give us part of the answer. Close proximity gives us a faster reproduction rate. A huge agrarian population will have a slower spread. Also, totalitarian regimes generally lie. We have a difficult 5 years ahead

Paul Salme ,

I thank you for your astute observation of the greater difficulty of dealing efficiently with the COVID-19 pandemic in a democratically governed nation than in a dictatorial or a totalitarian government.

Adrew Guy Battershill ,

I very much appreciate your calling attention to the geographical fact that a large agrarian continent has a built-in safeguard against the COVID-19 contagion, while densely populated urban environments unfortunately lack a natural barrier to protect the people who depend for their livelihoods and survival on the many different resources available in an industrialized metropolis where, during this epidemic, the advantages have become disadvantages.

Then and Now: From low to the present high in Indian COVID-19 cases and mortality

In June 1, 2020 India had 256,611 cases but only 7,200 deaths.

Now September 15, 2020 India has 4,963,097 cases and 81,168 deaths.

What is the reason for this turn-around in COVID-19 statistics? Can anybody explain.

Muhammad Yousuf ,

Thank you very much for your reply and question.

My guess is that India has the world's highest population at more than 1.5 billion, so everything, including reporting, testing, and medically treating, cases of the novel COVID-19 virus will happen more slowly than in smaller countries.

Best regards.

This article may provide further insight on the novel COVID-19 crisis in India, relative to other countries, including the U.S. and Brazil:

"COVID seems to be spreading faster in India than any other nation, but officials claim success

BY ARSHAD R. ZARGAR

AUGUST 19, 2020 / 11:13 AM / CBS NEWS New Delhi — India reported more than 64,500 new coronavirus cases on Wednesday, taking the total number of people in the South Asian country who have tested positive for the disease over 2.76 million. India remains the third worst affected nation, behind the U.S. and Brazil, in terms of the total number of cases, but it's at the top in terms of new infections.  For the past 15 days, India has clocked more new COVID-19 cases on a daily basis than any other country in the world. The country has added 913,473 new cases in the past 15 days, averaging 60,898 per day. The total number of confirmed cases since the pandemic began has doubled in just 24 days.  If India's infection rate keeps climbing, India may soon overtake Brazil to become the world's second worst affected country in terms of the number of cases.  India has largely phased out what began as the world's biggest coronavirus lockdown. In March the government ordered its 1.3 billion people to stay indoors for all but essential reasons. Most businesses and services were allowed to reopen across large parts of the country weeks ago, but limited restrictions remain on large gatherings and in some virus hotspots.          While India's infection numbers are alarming, the country has reported a lower death rate and a higher recovery rate than most other countries hit hard by the pandemic. But on Wednesday, India reported 1,099 coronavirus deaths, its highest single-day toll yet, taking the overall death toll over 53,000. That's still less than half the number who have officially died of the disease in Brazil, and it pales in comparison to the more than 175,000 lives lost in the U.S., even though both of those countries have much higher case totals. 

Good strategy, or bad numbers?

Of the total 2.76 million cases in India, more than 2 million people have recovered — better than a 73% recovery rate. In comparison, the U.S. has a recovery rate just over 53%.  "Higher number of recoveries and declining fatality has shown that India's graded strategy has worked," the Indian Health Ministry said in a statement Wednesday. But experts continue to voice fears that India's government may be under-reporting coronavirus deaths. The World Health Organization and independent experts have raised concerns about low testing rates in the world's second most populous country. India has administered over 31 million tests, but that's only about 23,000 tests per million inhabitants — much lower proportionally than in the U.S., Russia and many European countries."

It has become increasingly clear during the past several weeks that the proliferation of novel COVID-19 SARS-CoV2 corona virus variants is sweeping through certain parts of the world, including the United States of America, with increasing force and rapidity, striking hardest at those who are in their thirties and forties, yet sparing no demographically identifiable group.

Now that a significantly high percentage of adults have received one of the many vaccines, a small number of individuals are being diagnosed with the novel COVID-19 SARS-CoV2 viral infection who were fully vaccinated.

Another rare occurrence but significant enough to cause authorities to call a temporary halt to the innoculation with, for example, the Johnson and Johnson vaccine, which has caused serious side effects in recipients, and most especially, in women. One of the serious side-effects is inflammation and debilitating thrombosis in vaccinated persons who did not have any pre-existing medical conditions.

The only good news is the incredible reduction in the number of seasonal flu and influenza cases, which usually have resulted in hospitalizations and even many fatalities.

In the cases of both the novel COVID-19 SARS-CoV2 and seasonal influenza, the single most important preventive measure is still the wearing of a protective face mask along with social distancing. Implementing this procedure on a universal order of global magnitude is preventing the spread of the disease. In fact, the vaccine is only a stop-gap measure because (1) At best, the vaccination is effective for only six months to one year; (2) The United Kingdom, South African, and Brazilian variants of the novel COVID-19 SARS-CoV2 corona virus spread the disease faster and cause worse symptoms than the original Wuhan strain; and (3) In addition to these three known variants, unknown variants are being found in localized places because the novel COVID-19 SARS CoV-2 viral cells are volatile and unstable, being genetically constructed to multiply rapidly once they invade the body of an animal or a human being.