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| As Coronavirus Disrupts Factories, India Curbs Exports of Key Drugs | As Coronavirus Disrupts Factories, India Curbs Exports of Key Drugs |
| (about 1 hour later) | |
| MUMBAI, India — The spreading coronavirus may soon affect people’s health in a different way: The outbreak is now starting to hurt the supply of essential drugs. | MUMBAI, India — The spreading coronavirus may soon affect people’s health in a different way: The outbreak is now starting to hurt the supply of essential drugs. |
| Drug makers are struggling to get vital raw ingredients for common antibiotics and vitamins from Chinese factories, which were closed for weeks as China battled to contain the coronavirus. Now, even as some of the country’s factories have restarted, shortages of some drugs may develop. | Drug makers are struggling to get vital raw ingredients for common antibiotics and vitamins from Chinese factories, which were closed for weeks as China battled to contain the coronavirus. Now, even as some of the country’s factories have restarted, shortages of some drugs may develop. |
| The disruption is being felt most acutely in India, where the authorities on Tuesday ordered the country’s vast pharmaceutical industry to stop exporting 26 drugs and drug ingredients, most of them antibiotics, without explicit government permission. | The disruption is being felt most acutely in India, where the authorities on Tuesday ordered the country’s vast pharmaceutical industry to stop exporting 26 drugs and drug ingredients, most of them antibiotics, without explicit government permission. |
| That’s a problem for the rest of the world, which relies on India’s drug makers for much of its supply of generic drugs. India exported about $19 billion of drugs last year and accounted for about one-fifth of the world’s exports of generics by volume, according to the India Brand Equity Foundation. | That’s a problem for the rest of the world, which relies on India’s drug makers for much of its supply of generic drugs. India exported about $19 billion of drugs last year and accounted for about one-fifth of the world’s exports of generics by volume, according to the India Brand Equity Foundation. |
| The shortage of Chinese drug ingredients is the latest example of the global economy’s dependence on products made in China, from iPhones to auto parts. Last month, Apple cut its sales expectations, partly because production of its gadgets was ramping up more slowly than expected as China reopened its factories. Much of the fallout may still be hidden and is likely to play out over months. | The shortage of Chinese drug ingredients is the latest example of the global economy’s dependence on products made in China, from iPhones to auto parts. Last month, Apple cut its sales expectations, partly because production of its gadgets was ramping up more slowly than expected as China reopened its factories. Much of the fallout may still be hidden and is likely to play out over months. |
| India’s decision to limit drug exports was particularly delicate since other countries rely on its manufacturers. On Tuesday, one Indian official, who spoke on the condition of anonymity because of the sensitivity of the issue, said the government wanted to ensure an adequate supply of medicines for Indians before allowing exports. | India’s decision to limit drug exports was particularly delicate since other countries rely on its manufacturers. On Tuesday, one Indian official, who spoke on the condition of anonymity because of the sensitivity of the issue, said the government wanted to ensure an adequate supply of medicines for Indians before allowing exports. |
| Last week, the Food and Drug Administration warned that one undisclosed drug was already in short supply in the United States because of problems related to the virus outbreak. The agency said it was watching about 20 other drugs whose manufacturers relied solely on China for finished products or active pharmaceutical ingredients. | Last week, the Food and Drug Administration warned that one undisclosed drug was already in short supply in the United States because of problems related to the virus outbreak. The agency said it was watching about 20 other drugs whose manufacturers relied solely on China for finished products or active pharmaceutical ingredients. |
| Dr. Stephen Hahn, the head of the F.D.A., told the Senate Health Committee on Tuesday that the agency had learned of India’s export curb that morning. | Dr. Stephen Hahn, the head of the F.D.A., told the Senate Health Committee on Tuesday that the agency had learned of India’s export curb that morning. |
| “We’re working very closely to look at that list to assess how that will affect the medical supply chain,” he said. | “We’re working very closely to look at that list to assess how that will affect the medical supply chain,” he said. |
| Lawmakers and Trump administration officials have been eyeing the global supply chains that deliver drugs and other medical supplies to the United States, wary that the coronavirus might lead to shortages of key supplies. | Lawmakers and Trump administration officials have been eyeing the global supply chains that deliver drugs and other medical supplies to the United States, wary that the coronavirus might lead to shortages of key supplies. |
| In a hearing in July, experts told the United States-China Economic and Security Review Commission that America had a troubling reliance on China for its drug supply — but that purchasing from India instead would also have its downsides. | In a hearing in July, experts told the United States-China Economic and Security Review Commission that America had a troubling reliance on China for its drug supply — but that purchasing from India instead would also have its downsides. |
| Rosemary Gibson, a co-author of “China Rx: Exposing the Risks of America’s Dependence on China for Medicine,” who testified at that hearing, said India also imported the bulk of the active pharmaceutical ingredients, or A.P.I.s, that it used to manufacture drugs from China. She added that sourcing those raw ingredients for drugs within India would have implications for drug prices. | Rosemary Gibson, a co-author of “China Rx: Exposing the Risks of America’s Dependence on China for Medicine,” who testified at that hearing, said India also imported the bulk of the active pharmaceutical ingredients, or A.P.I.s, that it used to manufacture drugs from China. She added that sourcing those raw ingredients for drugs within India would have implications for drug prices. |
| “The main reason that India wants to import A.P.I.s from China is because it’s cheap,” said Ms. Gibson, a senior adviser with the Hastings Center, a bioethics research institute. “If we choose to move from China to India, even if it has the capacity to manufacture its A.P.I.s, it would make it more expensive.” | “The main reason that India wants to import A.P.I.s from China is because it’s cheap,” said Ms. Gibson, a senior adviser with the Hastings Center, a bioethics research institute. “If we choose to move from China to India, even if it has the capacity to manufacture its A.P.I.s, it would make it more expensive.” |
| India’s exports of the specified drugs are unlikely to be completely stopped, said Sudarshan Jain, secretary general of the Indian Pharmaceutical Alliance, which represents most of the country’s large pharmaceutical companies. | India’s exports of the specified drugs are unlikely to be completely stopped, said Sudarshan Jain, secretary general of the Indian Pharmaceutical Alliance, which represents most of the country’s large pharmaceutical companies. |
| “It’s not a ban on export,” he said. “It’s a restriction. What we want to do is monitor the movement of the drugs.” | “It’s not a ban on export,” he said. “It’s a restriction. What we want to do is monitor the movement of the drugs.” |
| The antibiotics facing export limits are tinidazole, metronidazole, chloramphenicol, erythromycin salts, neomycin, clindamycin salts and ornidazole. | The antibiotics facing export limits are tinidazole, metronidazole, chloramphenicol, erythromycin salts, neomycin, clindamycin salts and ornidazole. |
| Other drugs on the restricted list include the painkiller acetaminophen, the hormone progesterone, the antiviral drug acyclovir, and the vitamins B1, B6 and B12. | Other drugs on the restricted list include the painkiller acetaminophen, the hormone progesterone, the antiviral drug acyclovir, and the vitamins B1, B6 and B12. |
| Updated June 24, 2020 | |
| Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. | |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| India decided to restrict exports after a high-level government committee analyzed the country’s dependence on Chinese drug ingredients and concluded last week that 34 drugs had no alternative suppliers, according to a report on Tuesday in The Economic Times, a major Indian newspaper. | India decided to restrict exports after a high-level government committee analyzed the country’s dependence on Chinese drug ingredients and concluded last week that 34 drugs had no alternative suppliers, according to a report on Tuesday in The Economic Times, a major Indian newspaper. |
| Indian drug makers depend on Chinese factories for important ingredients, particularly for antibiotics and vitamins. Although Indian companies had stockpiled extra ingredients ahead of the Lunar New Year holiday, those reserves are now running low. | Indian drug makers depend on Chinese factories for important ingredients, particularly for antibiotics and vitamins. Although Indian companies had stockpiled extra ingredients ahead of the Lunar New Year holiday, those reserves are now running low. |
| Krishnanath Munde, who follows the pharmaceutical industry for India Ratings and Research, a unit of Fitch Group, said that for now Indian manufacturers are getting by, in part by sourcing some ingredients from European and Indian suppliers. | Krishnanath Munde, who follows the pharmaceutical industry for India Ratings and Research, a unit of Fitch Group, said that for now Indian manufacturers are getting by, in part by sourcing some ingredients from European and Indian suppliers. |
| “But if this trend continues beyond March and the coronavirus spreads to other regions in China and around the globe, we expect a disruption of the supply chains,” he said. “Then everyone will be hit — every sector.” | “But if this trend continues beyond March and the coronavirus spreads to other regions in China and around the globe, we expect a disruption of the supply chains,” he said. “Then everyone will be hit — every sector.” |
| Mr. Jain said that larger manufacturers had ingredient stocks to last until May for most drugs, but some products could be affected earlier. India’s scores of small manufacturers are already struggling to cope with rising prices for some ingredients, such as those that go into acetaminophen. | Mr. Jain said that larger manufacturers had ingredient stocks to last until May for most drugs, but some products could be affected earlier. India’s scores of small manufacturers are already struggling to cope with rising prices for some ingredients, such as those that go into acetaminophen. |
| Cipla, one of India’s largest drug makers, whose main generic products include asthma inhalers and H.I.V. drugs, declined to comment on Tuesday on the export limits but said in a statement that it had enough inventory to last one to two months. | Cipla, one of India’s largest drug makers, whose main generic products include asthma inhalers and H.I.V. drugs, declined to comment on Tuesday on the export limits but said in a statement that it had enough inventory to last one to two months. |
| “We see shipments coming in,” the company said. “We have also secured some additional inventory from vendors who have ready stocks available. This will ensure that we do not face any disruptions in case the situation does not resolve in the coming weeks.” | “We see shipments coming in,” the company said. “We have also secured some additional inventory from vendors who have ready stocks available. This will ensure that we do not face any disruptions in case the situation does not resolve in the coming weeks.” |
| Over the longer term, the Indian government is considering pushing forward with a long-stalled plan to make more drug ingredients domestically and reduce the country’s reliance on Chinese suppliers. | Over the longer term, the Indian government is considering pushing forward with a long-stalled plan to make more drug ingredients domestically and reduce the country’s reliance on Chinese suppliers. |
| “For any product, you cannot be dependent on one location,” Mr. Jain said. “Health care security for every country is important.” | “For any product, you cannot be dependent on one location,” Mr. Jain said. “Health care security for every country is important.” |
| Karan Deep Singh contributed reporting from New Delhi, Katie Thomas from New York and Ana Swanson from Washington. | Karan Deep Singh contributed reporting from New Delhi, Katie Thomas from New York and Ana Swanson from Washington. |