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January 28, 2020

Concerns about Rx drug shortages emerge amid coronavirus outbreak

Daily Briefing

    As the new coronavirus continues to spread rapidly throughout China and other countries, experts are warning about the effects the virus could have on the global economy and the prescription drug market.

    About the outbreak

    Reports of the new coronavirus first surfaced in early December 2019 among people in Wuhan, which is the capital of China's Hubei province. According to the World Health Organization (WHO), the main symptoms of infection from the Wuhan coronavirus, called 2019-nCoV, are fever and lesions in both lungs. Some patients also have reported difficulty breathing, WHO said.

    Reported cases of the virus have climbed quickly and extended beyond Wuhan. As of Jan. 28, officials had reported more than 4,500 confirmed cases of the virus. Reported cases involve patients in Australia, Cambodia, Canada, China, France, Germany, Japan, Korea, Macau, Malaysia, Nepal, Singapore, South Korea, Sri Lanka, Taiwan, Thailand, Vietnam, and the United States. In the United States, CDC is monitoring 110 people across 26 states for possible infection from the new coronavirus.

    Officials in China also said there have been 107 reported deaths, all occurring in China, linked to the virus. China's health commission said the deaths largely occurred among older men, many of whom had underlying health conditions, such as cirrhosis of the liver, diabetes, hypertension, and Parkinson's disease. However, officials said one of the deaths occurred among a 36-year-old man.

    Ma Xiaowei, head of China's National Health Commission, on Sunday warned that infected patients who aren't showing symptoms of the virus still could pass the virus to others, after a study published Friday in The Lancet suggested infected patients without symptoms might be able to spread the virus. The virus' incubation period is between 10 to 14 days, according to Ma.

    Some experts expressed concern that it might be impossible to contain the new virus if it in fact can be transmitted from infected individuals who aren't displaying symptoms. However, Nancy Messonnier, director of CDC's National Center for Immunization and Respiratory Diseases, said CDC doesn't "have any clear evidence of patients being infectious before symptom onset," though officials "are actively investigating that possibility."

    Could the coronavirus cause a US drug shortage?

    But experts also are worried about the potential effects the outbreak could have on the prescription drug market, STAT News' "Pharmalot" reports.

    According to "Pharmalot," China over the past 10 years "has become a bigger player in the market for active pharmaceutical ingredients, which are the building blocks found in each drug." FDA has said 13% of all facilities that make ingredients for treatments that are sold in the United States are located in China.

    Steven Lynn, former director of FDA's Office of Pharmaceutical Quality and a former pharmaceutical official who currently heads his own consulting firm, said, "The time to worry is now," adding, "I would be asking my supply chain folks what do we have coming from China, what's our inventory, and if we don't have enough, can we get as much as fast possible? And remember, this isn't just a U.S. problem. It's a global problem if China starts shutting down its borders."

    So far, FDA has said the agency has not received any notifications of ingredient shortages for U.S. products as a result of the coronavirus outbreak, "Pharmalot" reports. And a spokesperson for the Association for Accessible Medicines, which represents generic drugmakers in the United States, told "Pharmalot" that "most of [the group's] members have a second source for all active pharmaceutical ingredients." The spokesperson continued, "In addition, they don't order per batch. Rather, each order is for two to five years of manufacturing needs."

    Experts raise concerns about outbreak's effects on global economy

    Experts also have raised concerns about the outbreak's potential effects on the global economy, noting that global markets experienced sharp declines on Monday, particularly among stocks tied to the travel industry and Chinese markets. According to the Washington Post, the Dow Jones industrial average decreased by about 1.6%, or 454 points, on Monday, while the Standard & Poor's 500 and Nasdaq indexes also declined, by 1.6% and 1.9%, respectively. Meanwhile, stocks in Japan and Europe fell by more than 2%, the New York Times reports.

    Ed Yardeni, president of Yardeni Research, said, "Stock markets are selling off … on fears that the coronavirus might be harder to contain than previous viral outbreaks."

    According to the Times, investors' apprehension also stems from increasing travel restrictions throughout China and abroad, as well as extensions of the Lunar New Year holiday in China, which will keep some Chinese businesses closed or limit their ability to conduct business.

    For instance, CDC on Monday issued its strictest level of travel advisory warning Americans against any nonessential travel to China in light of the coronavirus outbreak. The Department of State on Monday also bolstered its travel advisory, warning Americans to "reconsider travel" to China.

    Overall, the outbreak could have a significant impact on China's economy, which is second only to the United States and therefore "makes any upheaval there a serious factor in the pace of global economic growth," the Times reports.

    However, the outbreak is unlikely to have a major effect on the United States' economy, as long as the virus doesn't become widespread in the country. Currently, CDC officials say the risk of widespread transmission of the virus in the United States is low.

    But overall, experts predict that any economic downturns stemming from the coronavirus outbreak likely wouldn't last long, citing economic declines that initially occurred during the 2003 SARS outbreak but lasted only a few months.

    "Our baseline is that it will be a fairly big impact but relatively short-lived," Louis Kuijs, the head of Asia economics at Oxford Economics, said (Griffiths, CNN, 1/28; Shih et al., Washington Post, 1/27; Zhou et al., Reuters, 1/27; Ehley, Politico, 1/27; Weixel, The Hill, 1/27; Phillips/Robertson, New York Times, 1/28; Goodman, New York Times, 1/27; Silverman, "Pharmalot," STAT News, 1/27; Masson, Becker's Clinical Leadership & Infection Control, 1/28).

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