Wuhan Coronavirus Resource Thread

suryag · Post by **suryag** » 07 Apr 2020 03:24

REminds me of an incident when I had spent sometime in the companies being mentioned above, we first saw a card that was exactly an E/// card with the same lady name on it, second incident I lost a laptop when I had gone for a test campaign there. Sad to see France being squeezed, these morons screwed up ALU and NSN anyways it is still not late, go whack some heads in Finland and get NSN to deliver to Europe

nam · Post by **nam** » 07 Apr 2020 03:48

in England, 26% of the ICU patients are current smokers. It could be one of the prime reason for younger people getting really sick.

There are enough people of all age group with this "underling condition", to cause havoc.

Primus · Post by **Primus** » 07 Apr 2020 06:28

milindc wrote:
Arun.prabhu wrote:Read my response to handmadu.

viewtopic.php?f=1&t=7800&start=4760#p2425882

The numbers of the ground. Not the Chinese made up numbers, but what we're seeing in the west. The official counts are skewed towards symptomatic cases and serious ones at that, thanks to selection bias. It will remain that way until people start doing random tests for the whole population.

I don't know if you really know the situation on the ground. The medical system is completely overwhelmed by the cases. Every hospital in UK has postponed non critical procedures and allocated those ICU units along with hospital beds for treating the infected. And all those ICU units are close to being full. They expect more cases coming in.

In US, similar situation where the staff is completely over worked and system has become over burdened.
Now you might say, let them die, but the current world order doesn't work that way.

With respect to our friend, one only has to see the situation in the hospitals in hotspots first hand to realize how this is different from anything else we've encountered before. I've had the flu several times myself, including the H1N1, with fever of 105F, so many of my patients and family members/friends have had it, nobody died from it. yes, people do die from the flu but typically these are the as expected, older and more infirm persons.

COVID is killing people of all ages, even young and healthy ones which rarely if ever happened in my experience with the flu. The closest we've seen is AIDS but it killed ever so slowly. I lived through the HIV epidemic working in a hospital with perhaps the largest population of AIDS pts in the world, entire wards dedicated to it. And yet, this virus scares me. One of my partners is sick at home with it, on oxygen. Only the really sick patients are in the hospital, everyone else is being sent home to recover. My PA is recovering at home too. Our local hospitals are overflowing, ERs are backed up with 40-50 patients waiting for beds, they have opened up wards which were closed for lack of use or renovations, there is a severe shortage of nurses, respiratory therapists and intensivists, people are being paid twice the normal for overtime work, I keep getting emails daily requesting more people to volunteer.

It is a healthcare crisis which is unprecedented, at least in the US and especially New York. All elective procedures are canceled, none of us are doing anything, since the hospital facilities are all tied up with COVID.

I don't care if the entire population is not being tested, or if the number of COVID positives that end up in the hospital is a minuscule fraction - the point is, there are enough sick, no, very sick people who are flooding the hospitals and people are dying within days of being admitted. Rarely have I seen a disease that kills so quickly and so randomly. The manner of death as our esteemed Dr. Ratnadip has pointed out, is also frightening and it does not kill instantly as a car crash would.

All those arguments about traffic accidents are pointless - death is death. I can't imagine how people - all with good intentions - cannot see this pandemic for what it is, a killer of humanity that is truly invisible and unpredictable. All the data means nothing to me, when you see it with your own eyes, you realize what the truth is.

Sorry for the rant but stuff like this really gets to me, when I see my brothers in arms putting their lives at risk and dying, while the narrative being spun is that it is all data manipulation.

Primus · Post by **Primus** » 07 Apr 2020 06:38

DrRatnadip wrote:
Primus wrote:Not sure if this makes sense but there is a video from an ER doc at Maimonides in Brooklyn claiming we've all got it wrong and that the virus does not cause ARDS but a form of hypoxia similar to HAPE and that PPV is in fact more harmful.

There is a paper out from China suggesting viral proteins binding with heme and porphyrin disabling its O2 carrying capacity and how Chloriquine and favipiravir may be helpful in this situation.

COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism

Any intensivists here with thoughts on this? Dr. Ratnadip?

Both video and article make some bold claims.. Both authers doesnt seem to come from medical background.. Study of viral protein binding to heme is just computer simulation and needs experimental evidence.. One more thing that comes to mind is if virus is affecting at such basic step of oxygen exchange why so many patients are spared of this effect??

In youtube video gentleman is recommending change in currently used ventilator settings.. He is suggesting using low PEEP in stead of high PEEP.. Both settings have there own disadvantages.. High PEEP uses higher pressure to pump air in alveoli that are collapsed due to fluid.. More pressure can sometimes damage delicate alveoli causing Ventilator induced lung injury.. Lower pressure will have less chance of injury but optimal air delivery in each alveoli may not be achieved.. Current guidelines favour using High PEEP ( positive end expiratory pressure)..

Doc, thanks for your insights. It has been many, many years since I worked in an ICU, but I am familiar with PEEP and its use/misuse. Even in my time it was really difficult to decide how much PEEP to put on if at all. A lot of it was hit and miss, wait and watch.

However, there is still so much uncertainty about optimal management of COVID lung injury or the disease itself. Here in our area, they have finally started using Hydroxychloroquine. Not sure if it is helping or not since I am not directly involved any more.

What we do know is that it will be a few more weeks before enough data accumulates. Until then people like our friend from Maimonides will keep popping up with radical theories.

g.sarkar · Post by **g.sarkar** » 07 Apr 2020 08:20

https://www.theguardian.com/world/2020/ ... -equipment
US blocks millions of N95 face masks headed for Canada
US officials stop shipment at 3M factory after Trump invoked Defense Production Act to stop exports to Canada and beyond
Leyland Cecco in Toronto and Julian Borger in Washington, Mon 6 Apr 2020
US officials have stopped nearly three million specialized masks from being exported to Canada’s most populous province, amid mounting fears that Ontario will run out of supplies for medical staff battling coronavirus by the end of the week.
Donald Trump on Friday invoked the 1950 Defense Production Act giving the government “any or all authority” to stop 3M exporting N95 respirators to Canada and Latin America. The masks, which filter out 95% of airborne particles, are seen as a critical tool for frontline healthcare workers in the fight against Covid-19. But as supply shrinks, countries and local governments are locked in a desperate battle to access whatever equipment is available.
At a press conference on Monday, Ontario premier Doug Ford said the 500,000 masks had been cleared for release, but nearly three million masks were intercepted by US officials at 3M’s South Dakota Facility.
“We know that the US isn’t allowing supplies across the US border,” Ford said. “The hard truth is, our supplies in Ontario are getting very low and the more new cases we get, the more demand there is on our resources.” 3M initially resisted the president’s executive order, warning in a statement the move would have “significant humanitarian implications” for countries desperate for safety equipment.
Over the weekend, Trump harshly criticised the company, warning it would have “a big price to pay”. “We need the masks. We don’t want other people getting it,” Trump said in a Saturday briefing to reporters. “That’s why we’re instituting [the] defence production act. You could call it retaliation because that’s what it is: it’s a retaliation. If people don’t give us what we need for our people, we’re going to be very tough.”
.....
_____________________________________________________________________________________________________________________
https://www.hindustantimes.com/world-ne ... 1bVQJ.html
Trump talks of ‘retaliation’ if India turns down anti-malarial drug request
The American leader went on to add to the threat his long-running grievances with India on trade issues, which have history of eluding resolution.
WORLD Updated: Apr 07, 2020 07:13 IST
Yashwant Raj Hindustan Times, Washington
President DonaldTrump on Monday spoke of “retaliation” if India turned down his request to lift the hold on US orders of an antimalarial drug, which he has touted as a “game-changer” in the fight against the coronavirus despite its untested efficacy, resulting from a blanket ban on export of certain medicines.
The American leader went on to add to the threat his long-running grievances with India on trade issues, which have history of eluding resolution, including an ultimately failed rush by the two countries to stitch together a deal in time for Trump’s first state visit to India in February. This was the first time he had publicly brought up trade after the visit.
President Trump made the request for releasing the hold on hydroxychloroquine in a phone call with Prime Minister Narendra Modi Sunday morning (evening in India). “I said we’d appreciate you allowing our supply to come out, If he doesn’t allow it to come out. That would be okay but, of course, there may be retaliation,” the president said at the daily White House briefing on the coronavirus outbreak, adding, rhetorically for stress, “Why wouldn’t that be?” India has not yet decided either way yet. Prime Minister Modi had told the American leader during the call that India “will do all what we can”.
.....
Gautam

suryag · Post by **suryag** » 07 Apr 2020 09:59

Dr Sirs how is Hydroxychloroquine+zinc+azithromycin doing ?Read a number of anecdotal accounts that emerged today that it is clearing it up in a few hours. Additionally, ivermectin, favipiravir, BCG studies also seem underway. Anyways, am pretty sure you are all reading up on all new emerging studies/anecdotal accounts. My daily routine is check google news for hcq+Zn+zpak, favipiravir, ivermectin , BCG in the evening or morning. Just stay safe all of you, kind of is scary, I heard an account of an Indian family where mother and father(passed away) both are in ICU and the kid has fever. Imagine the situation who can help the kid

DrRatnadip · Post by **DrRatnadip** » 07 Apr 2020 10:24

suryag wrote:Dr Sirs how is Hydroxychloroquine+zinc+azithromycin doing ?Read a number of anecdotal accounts that emerged today that it is clearing it up in a few hours. Additionally, ivermectin, favipiravir, BCG studies also seem underway. Anyways, am pretty sure you are all reading up on all new emerging studies/anecdotal accounts. My daily routine is check google news for hcq+Zn+zpak, favipiravir, ivermectin , BCG in the evening or morning. Just stay safe all of you, kind of is scary, I heard an account of an Indian family where mother and father(passed away) both are in ICU and the kid has fever. Imagine the situation who can help the kid

To determine Exact efficacy of these drugs large study will be needed.. But in limited patients they seem to work fine.. Currently used protocol in all COVID positive pts in MH is as follows.:
1) asymptomatic but without comorbidities receive HCQ only
2) asymptomatic but with comorbidities receive HCQ and oseltamivir
3)symptomatic but those without comorbidities get Azithromycin in addition to above
4) symptomatic plus with comorbidities Lopinavir/ritonavir is added

Cain Marko · Post by **Cain Marko** » 07 Apr 2020 10:27

suryag wrote:Dr Sirs how is Hydroxychloroquine+zinc+azithromycin doing ?Read a number of anecdotal accounts that emerged today that it is clearing it up in a few hours. Additionally, ivermectin, favipiravir, BCG studies also seem underway. Anyways, am pretty sure you are all reading up on all new emerging studies/anecdotal accounts. My daily routine is check google news for hcq+Zn+zpak, favipiravir, ivermectin , BCG in the evening or morning. Just stay safe all of you, kind of is scary, I heard an account of an Indian family where mother and father(passed away) both are in ICU and the kid has fever. Imagine the situation who can help the kid

Well that's was a RCT that showed promise in China although the sample was somewhat small. N = 60

suryag · Post by **suryag** » 07 Apr 2020 10:32

Ratnadip Garu, thats great this was the Zn addition link sir

https://abc7.com/coronavirus-drug-covid ... e/6079864/

Rahul M · Post by **Rahul M** » 07 Apr 2020 10:33

DrRatnadip wrote:
suryag wrote:Dr Sirs how is Hydroxychloroquine+zinc+azithromycin doing ?Read a number of anecdotal accounts that emerged today that it is clearing it up in a few hours. Additionally, ivermectin, favipiravir, BCG studies also seem underway. Anyways, am pretty sure you are all reading up on all new emerging studies/anecdotal accounts. My daily routine is check google news for hcq+Zn+zpak, favipiravir, ivermectin , BCG in the evening or morning. Just stay safe all of you, kind of is scary, I heard an account of an Indian family where mother and father(passed away) both are in ICU and the kid has fever. Imagine the situation who can help the kid
To determine Exact efficacy of these drugs large study will be needed.. But in limited patients they seem to work fine.. Currently used protocol in all COVID positive pts in MH is as follows.:
1) asymptomatic but without comorbidities receive HCQ only
2) asymptomatic but with comorbidities receive HCQ and oseltamivir
3)symptomatic but those without comorbidities get Azithromycin in addition to above
4) symptomatic plus with comorbidities Lopinavir/ritonavir is added

Hello Doc, is this protocol devised by ICMR or someone else. Also, are treatment results being shared nationwide? For example are you getting info regarding how similar treatment regimes elsewhere in the country are doing?

vimal · Post by **vimal** » 07 Apr 2020 10:36

g.sarkar wrote: _____________________________________________________________________________________________________________________
https://www.hindustantimes.com/world-ne ... 1bVQJ.html
Trump talks of ‘retaliation’ if India turns down anti-malarial drug request

Gautam

India should just export the malaria drug for 10x the price to USA or anyone else who wants it just like what China is doing. Clear as much old stock as possible. I'm sure there is a huge stock for this drug in India given the yearly malaria/dengue season. Nobody knows if this drug even works for Wuhan Virus so let the idiots take it at 10x price if they are hell bent on taking it.

DrRatnadip · Post by **DrRatnadip** » 07 Apr 2020 10:42

Rahul M wrote:
DrRatnadip wrote:
To determine Exact efficacy of these drugs large study will be needed.. But in limited patients they seem to work fine.. Currently used protocol in all COVID positive pts in MH is as follows.:
1) asymptomatic but without comorbidities receive HCQ only
2) asymptomatic but with comorbidities receive HCQ and oseltamivir
3)symptomatic but those without comorbidities get Azithromycin in addition to above
4) symptomatic plus with comorbidities Lopinavir/ritonavir is added
Hello Doc, is this protocol devised by ICMR or someone else. Also, are treatment results being shared nationwide? For example are you getting info regarding how similar treatment regimes elsewhere in the country are doing?

This is protocol currently given by DMER.. Used in all medical colleges in maharashtra..

Suraj · Post by **Suraj** » 07 Apr 2020 10:55

JayS · Post by **JayS** » 07 Apr 2020 11:12

Rahul M wrote:https://www.mohfw.gov.in/pdf/3Containme ... 9Final.pdf

The govts very detailed containment plan. This is the one coupta was talking about. It seems our administration is also rising to the challenge.

Rahul M, some of these documents are being released post facto i.e. the plan is already in place and even used in practice, the details are being released as and when wide-spread implementation is needed. The administration has risen long back. This document mentions the whole Strategic plane which is a 5-stage plan, strategic plan for each of the 5 stages of infection level. Though the document stops at 3rd stage while giving details. We know the some of the details of 5th stage i.e. endemic stage from the doc released for the 4-yr preparedness plan. 4th stage is when there is large scale outbreak. In such case no intervention policy would be effective in containment, so the govt plan is to drop all containment plan and focus on managing the peak and saving as much lives as possible. The strategic plan exists from the very beginning I think, and very likely even before this particular pandemic started as a strategic lessons learned from SARS/H1N1 outbreaks. The earliest I have seen it was on 3rd March. Everything is happening according to the plan.

Even this containment plan is nothing new, its already used in real life in multiple places in March itself, best example is Bhilwada, but there are at least 4-5 other districts too. This is an extension of the cluster management plan and a lot of the protocols from the cluster management are equally applicable for containment plan. Only difference is that the containment zone in case of cluster management was of 3km surrounded by buffer zone of 5km, and here the containment zone would be an administrative unit like a City, town or a whole district based on the spread of the infection and realistic boundaries which can be kept watertight for extended period.

chola · Post by **chola** » 07 Apr 2020 11:58

vimal wrote:
g.sarkar wrote: _____________________________________________________________________________________________________________________
https://www.hindustantimes.com/world-ne ... 1bVQJ.html
Trump talks of ‘retaliation’ if India turns down anti-malarial drug request

Gautam

India should just export the malaria drug for 10x the price to USA like what China is doing and clear as much old stock cleared as possible. I'm sure there is a huge stock for this drug in India given the yearly malaria/dengue season. Nobody knows if this drug even works for Wuhan Virus so let the idiots take it at 10x price if they are hell bent on taking it.

https://www.news18.com/news/india/under ... 67403.html

NEWS18 » INDIA 1-MIN READ
Under Pressure from US, India Lifts Restriction on 24 Drug Exports, Paracetamol Still on Restricted List
India had restricted the exports of 26 ingredients and medicines on March 3. Paracetamol and its formulations accounted for two items on the original list.

Hydroxychloroquine next? Or is this to reduce pressure on having to release hydroxychloroquine exports?

syam · Post by **syam** » 07 Apr 2020 12:10

since when did the world start relying on indians for anything at all? we are those dirty third world people who shit on streets. great countries like amerikis shouldn't ask help from dirty curry indians.

we are not even their great allies anyway. are we expected to help them out or what? last year by this time, we were wondering if amerikis secretely helping pakis with sat-int. they invested their monies in wrong place. it's time they should get their dividends from said investments. modiji shouldn't give them anything more than the humanitarian amounts.

nam · Post by **nam** » 07 Apr 2020 12:17

Our babus have a habit of leaking policy circular to the press. They add masala to it, the jokers in other countries join in and we then scramble for an response.

India abviously would have allowed the export to needy countries. All GoI had to do was to announce the ban policy, along with criteria for countries to acquire these medicine from us.

MEA just announced this criteria, after the horse has bolted, allowing the press jokers to peddle these stories.

Sachin · Post by **Sachin** » 07 Apr 2020 12:33

Mean while "secularisation" of COVID-19 continues.
TN avoids using 'Delhi conference'; move to prevent stigmatisation of a community

.

srin · Post by **srin** » 07 Apr 2020 12:46

I saw some discussions on herd immunity and I'm a bit confused.

Absent a vaccine, it seems the way to get immunity is to get infected first and recover from it. So, the question is: if someone is infected and recovers, does that confer immunity to covid-19 (like in chickenpox) against re-infection ?

Suraj · Post by **Suraj** » 07 Apr 2020 13:10

Please don’t just post news stories about the lifting of restrictions on medicines . There’s far too much noise in those stories - they add opinions of their own regarding why, but don’t even list the medicines involved . Please find the actual press release on pib.gov.in or elsewhere and post only official information as far as possible .

Cyrano · Post by **Cyrano** » 07 Apr 2020 13:39

Why this heart burn on exporting medicines ? We manufacture them. Since the day lockdown has been announced in India, continuous process industries have been exempt. So our Pharma industry has been producing normally, one can even assume it has ramped up the production of HCQ, Azithomycin and others relevant to treat COVID19 .

Given our current case counts are still quite low by global standards, I would trust the govt to make an informed decision to export the quantities medicines we can, to nations that need them.

If anything we should prioritise what we are able to export, to SAARC countries and poor countries in Africa for instance, since they can't afford to provide the protective equipment, uber hospital care with TFTA ventilators, and maintain "strategic stockpiles" that Europe & US can. Their only hope is to treat their limited health care staff prophylactically and treat infected patients with appropriate combination of medicines.

If the reports of Trump threatening India are true, Modi & the whole Indian Govt should go silent on this matter until Trump calls and apologises.

DrRatnadip · Post by **DrRatnadip** » 07 Apr 2020 13:42

srin wrote:I saw some discussions on herd immunity and I'm a bit confused.

Absent a vaccine, it seems the way to get immunity is to get infected first and recover from it. So, the question is: if someone is infected and recovers, does that confer immunity to covid-19 (like in chickenpox) against re-infection ?

Immunity against any infection is divided in two broad categories..1) Innate immunity is present in all and doesn't require prior exposure to antigen.. Suppose one person is exposed to COVID virus He is not totaly defenceless.. Our innate immune system will detect presence of foreign antigen and will try to neutralise it..

2) Acquired immunity is much more specific.. After someone survives new infection then subset of his immune B cells and T cells develope into something called memmory B cells and memmory T cells.. These cells mount swift antibody response if there is re exposure to antigen.. These antibodies may prevent entry of virus in cells/ they can mark infected cells which are later neutralized by phagocytes..
All patients who are infected and recovered will have much less chance to get Covid 19 again.. Again exact duration for which this protection lasts is unknown.. But it should be enough to tide over this epidemic at least..

Herd immunity is sort of indirect protection.. Immagine a chain of 100 people.. person A at begining of chain and person B at end of chain.. If A gets infection and nobody in chain has aquired immunity then disease will most likely reach at person B in no time.. On other hand if approx 20 to 30 people in middle of chain develop acquired immunity due to mild infection then disease is unlikely to reach person B..In this case person B is protected without direct exposure to antigen.. This is herd immuninty..

Disease spread will slow and will be localised after sufficient people are exposed to disease and develop herd immunity.. Only thing is that there is no short cut to achieve this by sudden lifting of lockdown.. It has to be gradual process otherwise it will cost too many lives..

Cyrano · Post by **Cyrano** » 07 Apr 2020 13:47

Well explained Dr Ratnadip. Thank you for all your informative and balanced posts.

Cyrano · Post by **Cyrano** » 07 Apr 2020 13:50

Dr, after reading the above, I'm wondering if asymptomic patients and those who have shown symptoms will have the same levels of acquired immunity after getting cured? Are we in a position to know this currently? Thank you.

DrRatnadip · Post by **DrRatnadip** » 07 Apr 2020 13:53

amar_p wrote:Dr, after reading the above, I'm wondering if asymptomic patients and those who have shown symptoms will have the same levels of acquired immunity after getting cured? Are we in a position to know this currently? Thank you.

Level of protection does not depend on symptomatic status of patient.. So even asymptomatic individuals should have same level of protection..

yensoy · Post by **yensoy** » 07 Apr 2020 14:26

amar_p wrote:Why this heart burn on exporting medicines ? We manufacture them. Since the day lockdown has been announced in India, continuous process industries have been exempt. So our Pharma industry has been producing normally, one can even assume it has ramped up the production of HCQ, Azithomycin and others relevant to treat COVID19 .

...good logic... unless we depend on foreign sources (read: China) for APIs or Active Pharmaceutical Ingredients which are used in these formulations. If the entire product chain of HCQ/Azithromycin is localized or quickly localizable, then we should absolutely ramp up and export.

kit · Post by **kit** » 07 Apr 2020 14:40

amar_p wrote:Why this heart burn on exporting medicines ? We manufacture them. Since the day lockdown has been announced in India, continuous process industries have been exempt. So our Pharma industry has been producing normally, one can even assume it has ramped up the production of HCQ, Azithomycin and others relevant to treat COVID19 .

Given our current case counts are still quite low by global standards, I would trust the govt to make an informed decision to export the quantities medicines we can, to nations that need them.

If anything we should prioritise what we are able to export, to SAARC countries and poor countries in Africa for instance, since they can't afford to provide the protective equipment, uber hospital care with TFTA ventilators, and maintain "strategic stockpiles" that Europe & US can. Their only hope is to treat their limited health care staff prophylactically and treat infected patients with appropriate combination of medicines.

If the reports of Trump threatening India are true, Modi & the whole Indian Govt should go silent on this matter until Trump calls and apologises.

There is not, unfortunately enough raw material (API) to make HCQs for the entire world. 70%still has to come from china unless domestic API manufacturers ramp up production. It will take time. Take away message is right now only a certain quantity can be exported but with some time we can supply almost 70 % of world requirements

Rahul M · Post by **Rahul M** » 07 Apr 2020 14:52

We should export token amounts to all those who requested, for a start. Fulfilling orders would happen after our own requirements are met.

KLNMurthy · Post by **KLNMurthy** » 07 Apr 2020 14:57

Arun.prabhu wrote:I saw that chart and I'm happy that our government is trying to take care of us, but the disease isn't as deadly as we believe it to be... Do we close our roads to save the 150000 annual dead? Or ban all industries to reduce the incidence of heavy metal poisoning and the shortening of life expectancy that causes? Have we banned sugar to fight the diabetes epidemic that will claim so many millions decades before they would otherwise have died?

Not trying to be insulting or anything, but these kinds of analogies only serve to make one appear clever and insightful, but are really quite superficial.

A pandemic due to a brand new, unknown disease has an impact that is beyond simple death counts and airily philosophizing that, after all, everyone dies of something or the other anyway, so why the fuss. It’s not as though people aren’t familiar with the “road accident” analogy, after all, it gets trotted out every time there some concern about some hazard or the other.

Governments can’t afford to ignore pandemics like this one because of the primary reason that, for mankind, they have the effect of magnifying and focusing the fear of *untimely* death, of themselves and near-dear ones, and the resulting loss and isolation. We live civilized lives because, for the most part, in the steady state, we have a shared assumption that death is a timely and orderly thing. We expect the apparatus of civilization—governments and so on—to keep it that way, or at least, not give up on trying to keep it that way. If we see said apparatus giving up, or just declaring that it is not worthwhile to try (because, the clever ones have clued us into the hitherto unsuspected fact that everyone dies anyway), then there will be a general loss of belief in civilization, and without that belief, there is no civilization. This is why, even the most repressive and cynical governments either fight pandemics in some fashion, or (because they are cynical) at least demand credit for seeing to be fighting pandemics.

If you consider yourself one of the select few that are purely driven by rationality and are not susceptible to silly fears afflicting the common run of humanity, well then, more power to you, I suppose. However, you are, due to that exact fact, completely irrelevant to the civilized mainstream, as civilization is, by definition, a construct that only applies to masses of humanity.

Any individual setting themselves outside this ambit of civilization is a Republic of One, i.e., Arundhati Roy.

In the event that several such individuals manage to gather
together to have any degree of power or influence, they become nihilistic collectives like Tablighi Jamaat.

milindc · Post by **milindc** » 07 Apr 2020 14:58

yensoy wrote:
amar_p wrote:Why this heart burn on exporting medicines ? We manufacture them. Since the day lockdown has been announced in India, continuous process industries have been exempt. So our Pharma industry has been producing normally, one can even assume it has ramped up the production of HCQ, Azithomycin and others relevant to treat COVID19 .
...good logic... unless we depend on foreign sources (read: China) for APIs or Active Pharmaceutical Ingredients which are used in these formulations. If the entire product chain of HCQ/Azithromycin is localized or quickly localizable, then we should absolutely ramp up and export.

Most Pharma have stopped manufacturing currently due to lack of APIs. Apparently Chinese have captured the market with ridiculous prices, and then bought out the people who were manufacturing here. They later proceeded to jack up the prices.

One friend of mine who is C&F business asked to stock on essential medicines stating that unless import from China start on APIs there will be shortages in India as well.

Cyrano · Post by **Cyrano** » 07 Apr 2020 14:59

kit, you're right. I would trust GoI to determine what that "certain quantity" should be now and in the future; and to whom it must be exported to :
1. Respect already signed export contracts
2. Satisfy the world's need to the extent we can and as *we* see fit and not based on some countries' greed. The last thing the world needs is for tonnes of medicines rotting away to expiry in some "stockpile".
3. Charge a fair market price and avoid the temptation to respond to greed with greed.

We are a country of Dharma led by Sthithaprajnas, not some Orangeutan.

India must seize the opportunity to reduce dependence on China for APIs. Make in India must go well beyond defence supplies to cover every item that can become a strategic Achilles heel.

yensoy · Post by **yensoy** » 07 Apr 2020 15:16

milindc wrote:
yensoy wrote:
...good logic... unless we depend on foreign sources (read: China) for APIs or Active Pharmaceutical Ingredients which are used in these formulations. If the entire product chain of HCQ/Azithromycin is localized or quickly localizable, then we should absolutely ramp up and export.
Most Pharma have stopped manufacturing currently due to lack of APIs. Apparently Chinese have captured the market with ridiculous prices, and then bought out the people who were manufacturing here. They later proceeded to jack up the prices.

Looks like we make our own HCQ API. See https://www.fiercepharma.com/manufactur ... hloroquine

The story is different in India, perhaps the biggest producer of the chloroquine phosphate API. India last week added it to a list of more than two dozen APIs that it no longer is allowing to be exported while officials get a handle on how much will be needed for India’s COVID-19 outbreak.

and just above this quote, the article says

Xin said production is stable at the two primary producers of chloroquine phosphate, and efforts are being focused on meeting international demand. One of those producers, Chongqing Kangle Pharmaceuticals, was able to export 4.9 tons of the API within five days, Xin said.
“We can further increase the supply in accordance with international market demand,” Xin said.

Another article, this time from Business Today https://www.businesstoday.in/latest/tre ... 00208.html indicates that we have a few API makers but the vast majority (order of 100) pharma formulators are dependent on Chinese HCQ API. Now it all makes sense.

pankajs · Post by **pankajs** » 07 Apr 2020 15:33

Folks on SM and BRF are either "We must stand with friends like America" or "We must extract the maximum price".

Both of them miss the nuance in foreign policy.
1. There are no permanent friends or enemies amongst nations.
2. Bulls make money bear makes money but pigs get slaughtered.

Therefore,
1. We must help out countries that are friendly to the extent possible for multiple reasons.
a. Out destiny is liked to the global destiny and India is unlikely to prosper while the rest of the world goes to the dogs
a. Create goodwill around our neighborhood and the globe with spare supply **to the extent possible**
b. Enhance partnership for future co-operation / Open doors for future opportunities by becoming a reliable provider of goods and services.

2. While we are in no position to "gift" supplies to any great extent we must also not charge black market rates. The supplies should be charged at commercial rates which allows the manufacturers its margins.

Anything more will play foul to the objectives listed under the previous point.

pankajs · Post by **pankajs** » 07 Apr 2020 15:38

My guess is that GOI's initial order to ban exports was to assess the situation (stocks/pipeline/future supplies) and reconcile it with our likely demand.

Now that phase should be over and GOI has started moving to allow (limited) exports. Hopefully, GOI has chalked out plans for the missing API pipeline that was usually served by import from China.

Hopefully, GOI has plans to ramp up production of Chloroquine to meet global demand. I would be disappointed otherwise.

Pratyush · Post by **Pratyush** » 07 Apr 2020 15:47

Guys,

Early on people speculated that increase in temperature may reduce the potency of the virus.

Has this been validated by research till now??

As have not seen any thing on it.

pankajs · Post by **pankajs** » 07 Apr 2020 15:47

yensoy wrote:Another article, this time from Business Today https://www.businesstoday.in/latest/tre ... 00208.html indicates that we have a few API makers but the vast majority (order of 100) pharma formulators are dependent on Chinese HCQ API. Now it all makes sense.

They said apart from Ipca Laboratories and Zydus Cadila which are the major manufacturers of APIs in India for this drug, other main manufacturers of anti-malarial drugs include companies like Intas Pharmaceuticals, McW Healthcare of Indore, Macleods Pharmaceuticals, Cipla and Lupin from Mumbai. Other API suppliers include Abbott India, Unichem Remedies, Laurus Labs, Vijayasri Organics etc.

<snip>

A Zydus Cadila spokesperson said the company is currently the leading supplier to the US market of hydroxychloroquine and has already ramped up its production capacity by about five times to 20 million tonnes (MT) from about 4 MT. Plans are to ramp up production to 30 MT within a month.

Zydus Cadila > from 4 MT to 30 MT in a month. Very Good!
IPCA > Plans unknown

IPCA has been in the eye of the storm for about a decade now for its lax quality control, etc with a ban by FDA. The ban has just been lifted to allow it to supply. Therefore, I am highly doubtful of the ability of a company that allowed itself to be cut off from the most lucrative drugs market in the world.

Rahul M · Post by **Rahul M** » 07 Apr 2020 15:50

https://twitter.com/ShaunakSA/status/12 ... 74944?s=19

IPCA claims regarding HCQ API.

nandakumar · Post by **nandakumar** » 07 Apr 2020 16:19

yensoy wrote:
amar_p wrote:Why this heart burn on exporting medicines ? We manufacture them. Since the day lockdown has been announced in India, continuous process industries have been exempt. So our Pharma industry has been producing normally, one can even assume it has ramped up the production of HCQ, Azithomycin and others relevant to treat COVID19 .
...good logic... unless we depend on foreign sources (read: China) for APIs or Active Pharmaceutical Ingredients which are used in these formulations. If the entire product chain of HCQ/Azithromycin is localized or quickly localizable, then we should absolutely ramp up and export.

Also, many of the big pharmaceutical companies no longer manufacture their formulations. They outsource to smaller contract manufacturing companies. They are shut down as their workers are unable to come for work.

Cyrano · Post by **Cyrano** » 07 Apr 2020 16:27

Aren't Pharma employees not considered as "essential services" workers? In case not (uniformly everywhere), this is any easy thing to fix

schinnas · Post by **schinnas** » 07 Apr 2020 16:51

Imports of 150 Million tonnes of APIs that India had ordered from China earlier have either reached India or expected to reach in next few days. So India pharma industry is back on its feet. Don't worry about exports. We will have ample to export to friends and those with deep pockets.