Despite their huge populations and often overburdened healthcare systems, deaths have been nothing like that seen in Europe or America.
At a press conference last week, the Pakistan government's point man for coordinating the response to the Covid-19 pandemic gave what appeared to be good news.
Dr Zafar Mirza said the number of reported cases in the country was running at a third what epidemiological modellers had forecast.
The prime minister's special adviser on health said models had predicted more than 18,000 cases by mid-April, but fewer than 6,000 had been recorded.
Recorded cases have also been surprisingly low in India. More than five weeks since the World Health Organization declared Covid-19 a pandemic, India and Pakistan are not reporting the high case tallies and death tolls seen in many other countries.
Despite their huge populations and often overburdened healthcare systems, deaths have been nothing like that seen in Europe or America. While numbers are starting to gather momentum, by April 20 the two countries which between them account for a fifth of the world's population had reported a total of only 735 deaths and 25,722 infections.
Yet there are worries that the real picture is being hidden by a lack of testing and the two countries may be badly underestimating the scale of the virus. If the number of cases is being underestimated, the number of deaths is also likely to be underrated.
Reports of an unexplained rise in deaths in Pakistan's port city of Karachi last week caused alarm. The Edhi charitable foundation said its white minivan ambulances had been much busier than usual.
The fleet which tends to millions of residents has in the first two weeks of April picked up 70 per cent more dead bodies from homes than it did last year. What has caused the rise is a mystery and Imran Khan has said linking it to the coronavirus pandemic is political scaremongering.
The head of the foundation has stressed he does not know the reason and cannot link it to Covid-19, but in a time of pandemic, the rise has caused worry. The lack of testing means there is no clarity.
Likewise major hospitals in the city have reported a rise in patients being brought in dead from medical complaints. The Jinnah Postgraduate Medical Centre wrote to the local health minister last week to inform him that the number of dead-on-arrival patients had risen at least two-fold in the first weeks of April.
Again, the cause is unknown and a lack of test kits mean the dead are largely not being swabbed for the new coronavirus sweeping the world.
Across the border in India, medical staff report chronic undertesting. One doctor in Gujarat told the Telegraph his superiors had told him there was no need to test medical staff.
"The senior doctors are saying, every one of us will get herd immunity sooner or later. So there is no need for extensive testing, isolation, quarantine and so on. So the numbers India is showing are grossly under represented," he said.
This lack of testing in the two countries is making tracking the outbreak difficult. While both countries are ramping up testing, Pakistan is currently carrying out 0.4 tests per thousand people, and India is carrying out 0.2 tests, compared with around 10 in the US and Korea.
“The deaths are likely to be much higher, the problem is that we are not testing enough,” said Dr Yogesh Jain, a public health expert based in Chhattisgarh, India.
“We are testing so little that people who may have the disease are not being tested and being labelled as a non-Covid death.
“Certainly it is more than ten times or one hundred times of cases because of our poor diagnostic methods and poor diagnostic ability.”
One international health official in Islamabad said: “The data available now may not be accurately representing the situation out there.” Pakistan has said it hopes to increase testing capacity to 10,000 a day this week. “Let’s hope that confirms as well the real situation on the ground,” said the official.
Tracking the progress of the pandemic has been made more difficult because officials suspect sick patients are not being taken to hospital. Pakistan's intensive care units have not been hit by a surge of patients and even its meagre supply of 2,000-odd ventilators remains largely unused.
“The hospitalisation is increasing but not at a significant rate,” said another international health official. “Partly it is due to the fact that hospitals are discouraging people from presenting at the facility if they are not so serious. So there is possibility of people staying at home for fairly serious illnesses.”
The lack of reported cases is so pronounced that it has launched another hypothesis among some Pakistani health officials however – that the virus is somehow behaving less virulently in South Asia, perhaps because of the heat.
Temperatures went above 35C in Lahore and Delhi this week. That could give a seasonal respite, until colder temperatures return and the virus strikes again, they argue.
World Health Organization officials have been reluctant to entertain that though. Not only is a lack of testing more likely to be the reason, they say, but the seasonal theory might lead to dangerous complacency.
As it stands, the lack of testing and low numbers are making the outbreak difficult to predict.
“The estimated figures that we have right now are three times less than expected,” said one Pakistani official. “There is no understanding on why it is not having that kind of effect. You could read the data in any direction you want because there is no surety on anything.
“You don't know what kind of response that should be there, so for now you just lock down and increase testing capacity, you are bringing people inside as much as your system can take and then hoping that nothing bad happens. A lot of this is actually pinned on hope.”
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