COVID-19: From Pharmaceutical And Economic Prospective

COVID-19 also known as Novel Coronavirus is an infectious disease caused by a newly discovered coronavirus. It is one of the three diseases which occur from the corona viruses. The other two are commonly known as Severe Acute Respiratory Syndrome [SARS] Middle East Respiratory Syndrome Corona virus [MERS]. The novel coronavirus that first reportedly emerged in the city of Wuhan, China in December 2019. The severity and causality created a worldwide panic and World Health Organization declared it a Pandemic in the month of March 2020.The name COVID-19 simply comes from corona virus disease. The number 19 stands for the year when the disease was first reported.  The virus that causes the disease is named Severe Acute Respiratory Syndrome Corona virus 2 acronym as SARS-CoV-2. Corona virus is zoonotic [spread from a relatable animal reservoir to another and when it meets humans there is community spreading] which means they are first originated in animals before they are developed in humans. However, world is aggressively debating its origin as natural or genetically engineered. Public genome sequence data from SARS-CoV-2 is under analysis to establish its origin in a laboratory. Fingers have been pointed towards certain countries and also on its sponsorship studies. Possible origin of virus could be –

1. The virus evolved to its current pathogenic state through natural selection in a non-human host and then jumped to humans. Studies made till date are suggesting BAT as a source of origination of the virus for SARS-CoV-2 combining to an intermediate host in order to jump to humans.
2. A non-pathogenic version of the virus jumped from an animal into humans in order to evolve to its current pathogenic.

Figure 1: Structure of Corona virus

Disease Symptoms

The symptoms prominently reported in human, affected by this Virus are -sore throat, tiredness, headache, dry cough Shortness of breath, excessive cough formation [ leads to the destruction of the alveolar capillary walls of the lungs which could lead to a severe case of Pneumonia ],Fever, Chest congestion /pain, drowsiness, running nose, loss of smelling capability. Further research is also suggesting that COVID patient is having digestive system discomfort as their primary complaint.

Figure 2: Symptoms-Corona virus -On Human

Key Points:

1. Coronaviruses are a large family of viruses that can cause illnesses ranging widely in severity.
2. SARS-CoV-2 can enter humans in its current pathogenic form from an animal source.
3. Strain of the virus could remain circulating in the animal population and might once again jump into humans.
4. The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes.
5. It is not proven that if a person can get the virus by touching an infected surface.
6. Corona virus family of viruses can survive between four to five days on various materials like aluminium, wood, paper, plastic and glass.
7. Some of veterinary coronaviruses could even persist for longer period.
8. Low temperature and high air humidity further increase their lifespan.
9. COVID patient may have digestive system complaint as their primary complaint.
10. COVID -19 virus is actively shed in the stool of infected patient apart from nasal and respiratory secretion.
11. To reduce the spread of corona viruses, the surfaces are recommended for cleaning with solutions like  sodium hypochlorite ,hydrogen peroxide or ethanol.
12. There are no specific vaccines or treatment currently available for COVID-19.
13. This is asymptomatic.

Treatment Methodology:

This virus is air borne and highly contagious. As per medical review, the virus can live up to five days on metal, glass, ceramic paper and wood. Lesser time on plastic, steel and cardboard and up to few hours on nonferrous material. Doesn’t seem to spread through food and has not been detected in water. The best method to prevent the spread of the infection is by following social distancing and to avoid or limit contact with people who are showing the symptom of COVID-19. Washing hands is another essential part to be safe. Disinfecting the usable items, washing the hands, social distancing and lukewarm water usage for drinking and bathing could be a control measure. Herbal / spices like turmeric with hot milk (boosts immune), garlic in raw form (high antimicrobial property) might be booster for immune system. Chirata (Swertia Chirayaita) is also considered as potential immune and metabolic stimulator for human specially those who are diabetics. Many immune stimulants can be taken in order to help the human body to be away from the disorder.  According to studies high dose of intra venous Vitamin C may improve the lung function in the patients who have are undergoing the treatment for COVID-19. Evidences of Vitamin D intake may reduce the risk of COVID-19 is negligible, but Vitamin D levels can enhance immune health. Vitamin D supplements have a general effect on protecting respiratory infections.

Convalescent- Plasma therapy, the treatment aims at using the immune power gained by are covered person to treat a sick person is also proving very potent.

Medications and method of treatment of COVID-19:

As of now, there are no specific therapeutic agents or vaccines have been developed for as SARS-CoV-2, thus no specific treatment for the given disorder. However, many of the symptoms can be treated separately and are therefore treated with the medicines available such as Paracetamol, Hydroxychloroquine, however antiviral efficacy of such drugs still to be established.

Blood Serum Treatment Method: 

The technique was used previously in Spain during Spanish Flu pandemic around eighty years back. In this a patient who has recovered from covid-19, is drawn and is screened for virus neutralizing antibodies. The serum containing these virus neutralizing antibodies are administered to prevent infection in high risk cases. The serum could potentially be used in individuals with clinical diseases to reduce symptoms and mortality.

As the world is still far way in finding the vaccine for this virus, we need to relook the vaccine development protocol and the time required for that. The food and drug administration’s three phase rule for clinical trials is mandatory to confirm – is  new vaccine is safe and effective and benefits outweigh risks. Also, manufacturer must test all lots to make sure that they are potent, safe and pure. Statutory bodies monitor the vaccine’s safety after the public starts using. Considering all the norms of   research and development period it can well be understood that the journey is long and this virus is going to stay for longer. Certain medicines are being used currently to treat the patients are Hydroxychloroquine, Azithromycin, Paracetamol etc.

Why Hydroxychloroquine?

Hydroxychloroquine (HCQ), is an immunosuppressive, anti-autophagy and anti-malarial drug widely being prescribed for the treatment /prevention of malaria (Viral load reduction), rheumatoid arthritis has been found to have an anti-SARS-Coactivity. It is likely to suppress immune function by interfering with the processing and presentation of antigens and the production of cytokines. As malarial parasites target human red blood cells and HCQ actions to prevent breaking down of haemoglobin in human red blood cells. It raises intralysosomal pH impairing autophagic protein degradation.   It is a chemotherapeutic agent that acts against erythrocytic form of malarial parasites.  It also accumulates in WBCs stabilizing lysosomal membranes and inhibits the action of many enzymes. Though unproven, but currently it is widely been used globally. All India Institute of Medical Sciences has a caveat saying – like any other drug, HCQ also has side effect. It can do more harm than good for general public. Hydroxychloroquine suppresses the immune system and is not recommended in combination with drugs that also suppress the immune system. The combinations of Hydroxychloroquine and Azithromycin have shown encouraging clinical result.

Global health scenario as of today.

*Figures are rounded off to lower value.

Possibility for a person to be infected by COVID-19 twice:

As of now when no vaccines and medications are prepared for the pandemic doctors and scientists and Para-medical staffs are not fully convinced about someone getting fully recovered. From the perspective of it being a viral disease the person might be temporarily be immune to the disorder but in the long run there is a chance that the person might become even prone to the virus due to unavailability of the vaccines and medications. A study also predicts that if the human can maintain immunity for a prolonged period for instance of 12 to 24 months post recovery they could be able to return to public spaces even when the virus is prevalent ad continues to spread itself.

Global Economic Effect:

As we review the human health condition due this pandemic, it is vital to get a glance how it has affected the world economy and has proved to be a tough time for developing countries. The monetary debts on industries are increasing at a considerable rate and companies are starring bankruptcy. The sectors which may suffer the most from these are the leather, gems and jewellery, textiles, handicrafts, carpets and engineering sectors. These sectors employ largest number and which are having a the highest risk of them all.  The major concern for these sectors is the labour, liquidity and logistics which is going to be a key concern for the stake holders. Coronavirus lockdown may impact real estate price drop substantially. As per a simple estimate around 15 million export jobs may succumb only in India, to COVID blows, mainly in handicraft exports and textile. India foreign exchange reserve plummet by 900 million within seven days after declaring the lockdown. Growth projection of Indian economy for FY 21 as projected by World bank stands at 1.9%, Standard and Poor says 3.5%, ICRA research put it at 2% and Fitch also @ 0.8%.

Graph 1: GDP Growth Revision for Financial Year 21-India

Organization for Economic Cooperation and Development (OECD) predicts China growth projection with reduced percentage just below 5 for the year 2020, which will be the weakest growth, and for world at 2.5%. USA, UK, Germany and other giants will be having around or below 2%. The Middle East and North Africa economy is likely to contract by 3.3% in 2020. This damage to the economy is likely to be severe than all previous slumps. The global economic outlook is heading towards the deep recession as the epidemic is getting severe. The sweeping lock down in Arabian region has significantly dented the local economies. The oil revenues is on deep turn down and even with OPEC+ decision to curtail the output the  scenario will remain grim. The extreme uncertainty surrounds as the fallout of the pandemic depends on the pathways of the diseases and the intensity of containment efforts.

Graph 2: Middle East & North Africa Growth Contraction

Global oil demand is seriously affected due to lockdown across the world. The US energy information administration reported the least gasoline consumption for at least 30 years. The US oil demand has fallen to 14.4 Million barrel (a drop of 30%), UK gasoline sales dropped by 60%. Crude demand in India collapsed by 70 %, Spain by 23 %, Canadian Oil production reduced by 325,000 barrels a day. The global oil price (Brent) stood at $ 20 across the world, where as WTI has slipped in the negative zone.

US jobless claims reached a record high of 6.6 Million in the month of March- April. India’s unemployment rate stood at 24%.[ March =8.4% ,April 26.2 % ] Joblessness is likely to surpass financial crisis rates in some countries like Greece .

Job losses due to Pandemic in India (Projection)

Graph 3: Loss of Jobs in India and Worldwide

Chinese industrial production fell by 13.5% in first two months of the year. Car sales in China fell by 86%. The value of gold jumped to a record high of $1650 and is projected to reach $4000 in near future.

World leading Browses dropped drastically.  A sharp decline of major financial stock markets was recorded across the globe. Three months data of major stock market / index review reflects the loss of almost 33%. Thus all major advanced economies will be in recession in year 2020.

Graph 4: World Index Growth in Percentage

As it can be seen that inverse of healthy economy signals are quite active where business productivity, jobs, consumer confidence, spending have taken a beating. The future of start-ups, medium and small enterprises and most of the economy growth is linked to the pandemic. Unless the spread is controlled no amount of stimulus will work. All new development project will be stalled. States have suffered a hefty loss of income due to mass closure and everywhere austerity measures are being applied. The public sectors investment in capital projects, expansion, revamping, modernization of units, salaries, wages all are on anvil for slashing. Release of grants, waiver of loans all are likely to be stopped, lay off and scale back the production are the certain measure commonly taken.

Economy revival requirement / Methodology:

The global business cycle contraction will ultimately lead the economy to recession. Spending will drop and the effect could be longer. All economic indicators like GDP, Retail, Manufacturing, Employment and individual income are under severe stress. This pandemic may cascade the economic recession and no one knows how long it will last. World my see a drastic policy changes in the coming days which might/ should include the following actions-

• Reduced interest rates in banking sectors on saving and deposits. Focus on protecting the health of real economy.
• Pushing of money (Stimulus) in economy through infrastructure program.  To be careful of the fiscal packages and structuring the schemes that should not shake the currency and hike rates.
• Review of the taxation system to develop a program to attract funds.
• Cut on imports of gem and jewellery / Change in Foreign Direct Investment (FDI) policy.
• Recalibration of the currency.
• Wage cut / lay off. Companies to retain employees even if at moderate wages.
• More focus on agriculture sector and engage with the world on goods- food exchange tie ups. Protection of small and medium enterprises.

CONCLUSION:

Human is fighting for survival. Research and development has become temporarily muted. So called economically superpowers are exposed.  Who knows what will be the outcome, if this is a genetically engineered war and what will be fall out in future? Will it lead to new threats? Sorry Einstein, you are proved wrong…. People will not fight with stone…. They are fighting with virus!!

From Yashaswee Raman (PGP 1, Section 6)