Though there is no scientific evidence for young people being affected at a higher rate, it is easily predictable that they are more likely to avert the interventions such as the use of face masks in public spaces, social distancing and quarantining. Regarding gender distribution, males are more susceptible to SARS-CoV-2 than females as females are genetically and immunologically more resistant to SARS-CoV-2 infection [30] (Figure 2) [23–29]. It has been found that SARS-CoV-2 utilizes angiotensin-converting enzymes 2 (ACE-2) both as receptors and the route of infection. Analysis of the expression level and pattern of human ACE-2 using a single-cell RNA-sequencing (RNA-seq) has revealed that Asian males have elevated expression of ACE 2 receptor than females and female ovaries have much lower levels of ACE-2 than male testes [31, 32]. Another reason is that the X chromosome possesses a significantly elevated amount of immune-related genes and regulatory elements. These genes and elements are directly involved in the modulation of the innate, as well as adaptive immune responses and hence, women have much immunologically stronger immunity against infectious diseases [33]. Several other social and cultural factors are deemed to be the reasons behind this. For example, smoking, tobacco use and alcohol consumption are more prevalent in men [34, 35]. Moreover, in the case of awareness and hygiene practices of the COVID-19, females act more responsibly and are reported to take necessary precautionary measures than men [36].

Diagnostics Approaches

Since the discovery of this ongoing COVID-19 pandemic, every country is trying to overcome it by following several courses of action. Among these, diagnostic measures have gotten prime concern as no reliable vaccines are available as yet.
Different methods are being used to find the presence of this fatal virus in people which are mainly categorized into molecular tests such as reverse transcriptase Real-Time Polymerase Chain Reaction (rRT-PCR) and serological tests such as rapid diagnostic test, Enzyme-Linked Immunosorbent Assay (ELISA), neutralization assay and chemiluminescent immunoassay [37]. The rRT-PCR of nasopharyngeal swabs has been regarded as the ‘gold standard’ testing method and various rRT-PCR based protocols have been uploaded to WHO technical guidance for laboratory testing of COVID-19 [38]. Though the detection of SARS-CoV-2 RNA is highly specific and less sensitive in some cases which can take a relatively long time and may produce false-negative results [39], still rRT-PCR assay is currently the most prevalent and accurate method to detect all types of coronaviruses including SARS-CoV-2 [40–42].
Among the South Asian countries, India has the highest number of testing facilities with 2134 SARS-CoV-2 detection labs including 1115 rRT PCR labs, 851 TrueNat test labs and 128 Cartridge-Based Nucleic Acid Amplification test (CBNAAT) labs [43]. In Afghanistan, there are only 14 COVID-19 designated labs, while there are 109 in Bangladesh, 6 in Bhutan, 9 in the Maldives, 76 in Nepal, 146 in Pakistan and 17 in Sri Lanka [44–51]. Table 2 lists different diagnostic methods approved and used in the South Asian countries.
Table-2: COVID-19 diagnostic methods in South Asian countries.
Country name Screening Method Synopsis References
Afghanistan rRT-PCR Sample: Oropharyngeal and nasopharyngeal swab. [52]
    rRT-PCR Sample: Nasopharyngeal swab, oropharyngeal swab, nasal swab, throat swab, sputum. Result: within 24 -48 hours. [53]
Bangladesh GeneXpert Covid-19 Test Sample: Saliva. Result: within 45 mins. [54]
  Rapid Dot Blot Sample: Blood Result: within 15 mins. Reliability: 90% accuracy. [55]
  rRT-PCR Sample: Upper respiratory sample (nasal and throat swab) [56]
Bhutan Rapid Diagnostic Test Sample: Blood Result: 30 mins Reliability: 90% sensitivity. [57]
  rRT- PCR Sample: Nasal, oral and throat swab, sputum. Result: within 3-8 hours [58]
  Feluda-CRISPR Test   Sample: Nasal or throat swab. Result: within 45 mins. Reliability: 96% sensitivity, 98% specificity [59]
  Rapid Antibody Test Sample: Blood. Result: within 20-30mins. [58]
India Rapid Antigen Test Sample: Nasal swab. Result: within 30 mins. [58]
  TrueNat Sample: Nasal swab, oral swab. Result: within 60 mins. [58]
  CBNAAT Result: within 60 mins [60]
  ELISA based antibody test   Sample: Blood serum or plasma. Reliability: 92.37% sensitivity, 97.9% specificity. [61]
  rRT-PCR   Sample: Combined oropharyngeal and nasopharyngeal swab, sputum. [52]
  Maldives GeneXpert Test Sample: Swab sample. Result: Within 45 mins. [62]
  Rapid Antigen Test (BinaxNOW COVID-19 Ag Card) Reliability: 97% sensitivity, 98.5% specificity. [63]
  Antibody Test Reliability: 100% sensitivity, 99% specificity. [64]
  rRT-PCR Sample: Nasal swab or throat swab. [52]
Nepal Rapid Diagnostic test Sample: Blood. Reliability: 50% sensitivity, 99.5% specificity. [65]
  rRT-PCR (N-CovKit) Sample: Nasopharyngeal swab, oropharyngeal swab. Reliability: 90% accuracy. [52]
Pakistan Rapid Digital Test Sample: Blood Result: within minutes. Reliability: 95% accuracy. [66]
Sri Lanka rRT-PCR Sample: Nasopharyngeal swab, oropharyngeal swab, sputum. [67]