About 5% of Confirmed COVID19 Cases Currently Hospitalized in Pakistan

Pakistan has so far had just over 100,000 confirmed cases of COVID19. About 5,000 are currently in hospitals, including 1,000 in critical condition and 278 on ventilators, according to the World Heath Organization representative in Pakistan. Over 32,000 have recovered and 2,000 have died. Data from multiple countries shows that only a few of those who go on the ventilators survive. It takes highly skilled pulmonologists to insert the ventilator, a skill that is not widely available. Meanwhile, antibodies testing in Karachi indicates millions in Pakistan may have already been infected with COVID19 without any symptoms or sickness. More testing is uncovering more of those already infected but only have mild symptoms and unlikely to get sick or die.

Pakistan Hospitalization Data. Source: WHO
Hospitalizations in Pakistan:

About 5,000 Pakistanis are currently in hospitals, including 1,000 in critical condition and 278 on ventilators, according to World Heath Organization representative in Pakistan. Over 32,000 have recovered and 2,000 have died. Data from multiple countries shows that only a few of those who go on the ventilators survive. It takes highly skilled pulmonologists to insert the ventilator, a skill that is not widely available.

Nearly 2,000 of the 100,000 confirmed coronavirus cases have died, bringing Pakistan's fatality rate to about 2%, among the lowest in the world. The number of deaths are now doubling every 18 days, a period three times longer than at the start of the pandemic.


COVID19 Testing and Cases:

Media headlines tend to highlight record single day spikes in confirmed cases. What they don't tell you is the record spike in tests almost every single day in Pakistan. It is very simple: The more you test the more cases you will confirm as long as the virus is in the community.  More testing is uncovering more of those already infected but only have mild symptoms and unlikely to get sick or die.


COVID19 Tests and Cases. Source: Pakistan Ministry of Health

Antibodies testing in Pakistan's largest city Karachi has revealed that 15% of the citizens are asymptomatic carriers of the coronavirus, a figure close to WHO's estimate of 16% for the global population.

Coronavirus Antibodies
Serological Testing:

Antibodies testing of 7,000 adults in Karachi reveals that as many as 15% of them have already been exposed to COVID19 without experiencing symptoms, according to a study by Dr. Wajiha Javed, an epidemiologist and head of public health and research at Getz Pharma in Pakistan. This data raises the possibility that millions of Pakistanis may have already been exposed to coronavirus. It takes at least 40% of the population to be exposed to build herd immunity. This may be the only way to normalcy unless there is a vaccine available sooner.

Human Immune Response:

Human body naturally produces antibodies to fight viruses of various kinds, including the coronavirus. Presence of antibodies in a person confirms that he or she has been exposed to a virus regardless of symptoms. Serology tests can detect body's immune response to even a low-level viral load. Such an immune response also occurs to a vaccine which does not make you sick but helps build immunity. More low level exposure to viruses in large numbers of people is in fact a good thing because it helps build herd immunity. However, the most vulnerable population such as the elderly must be isolated until herd immunity is achieved. It takes at least 40% of the population to be exposed to build herd immunity.


Getz Study:

Getz Pharma's Dr. Wajiha Javed told me in the latest update on her ongoing work that serology tests have so far been administered to 7,000 adults aged 18-65 over the last 6 weeks in Karachi. 15% of them have tested positive for COVID19 antibodies. People tested included those working for banks, restaurants, textile mills, factories, media and health care workers.

Antibody testing kits detect the response of the body rather than the virus or antigen itself. These tests do not have the issue of low viral load. Antibody tests can detect exposure to Covid-19 even in asymptomatic cases. Generally, antibody testing kits have a high level of accuracy, especially on sequential testing. The kit Getz Pharma has been using has a sensitivity (the ability to correctly detect positive cases) of 95.3% and specificity (the ability to correctly detect negative cases) of 98.7% for IgG, and the sensitivity is 86.48% and specificity is 95.18% for IgM, according to Dr. Wajiha Javed.

Pakistan COVID19 Death Rate Among The World's Lowest. Source: Our World in Data 

Asymptomatic Carriers: 

Over 90% of those who tested positive in Karachi did not have any symptoms or had only mild symptoms, Dr. Wajiha Javed recently wrote in Dawn newspaper.  But some were infectious and they were spreading the virus to others. Because of their non-existent or mild symptoms, they had not reached out to a PCR testing facility to get tested for Covid-19, and were only incidentally picked out for the antibody test during Getz's study. This data raises the possibility that millions of Pakistanis may have already been exposed to coronavirus.

Summary:

About 5% of the 100,000 confirmed COVID19 in Pakistan are currently hospitalized. About 2,000 of the 100,000 confirmed coronavirus cases have died, bringing Pakistan's fatality rate to about 2%, among the lowest in the world. The number of deaths are now doubling every 18 days, a much longer period than at the start of the pandemic.  As many as 15% of Karachi adults have been exposed to COVID19 with over 90% of them showing no symptoms, according to a Getz Pharma study in Pakistan. This is close to WHO's 16% of the global asymptomatic carrier population. Presence of antibodies in a person confirms that he or she has been exposed to a virus regardless of symptoms. It can even detect body's immune response to a low-level viral load. Getz Pharma's antibodies test data suggests the possibility that millions of Pakistanis may have already been exposed to coronavirus.  Such an immune response also occurs to a vaccine which does not make you sick but helps build immunity. More low level exposure to viruses in large numbers of people is in fact a good thing because it helps build herd immunity. This may be the only way to normalcy unless there is a vaccine available sooner.

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Comments

Riaz Haq said…
New York City Covid 19 Cases 205,011
Hospitalizations 53,369
Confirmed deaths*
Deaths following a positive COVID-19 laboratory test 17,255
Probable deaths
Cause of death reported as "COVID-19" or equivalent, but no positive laboratory test 4,705

https://www1.nyc.gov/site/doh/covid/covid-19-data.page
Riaz Haq said…
Wall Street Journal on COVID19 New York City: ”You can magically make an ICU appear, but you can’t make staff appear immediately.”

https://www.wsj.com/articles/how-new-yorks-coronavirus-response-made-the-pandemic-worse-11591908426

How New York’s Coronavirus Response Made the Pandemic Worse
The hasty expansion of medical facilities by state, city and hospital leaders led to grave mistakes, a Wall Street Journal investigation found; ‘wartime conditions’
Elmhurst Hospital in Queens, N.Y., in April. NATALIE KEYSSAR FOR THE WALL STREET JOURNAL
By Shalini Ramachandran, Laura Kusisto and Katie Honan
June 11, 2020 4:47 pm ET

New York leaders faced an unanticipated crisis as the new coronavirus overwhelmed the nation’s largest city. Their response was marred by missed warning signs and policies that many health-care workers say put residents at greater risk and led to unnecessary deaths.

In the first few days of March, Gov. Andrew Cuomo and Mayor Bill de Blasio assured New Yorkers things were under control. On March 2, Mr. de Blasio tweeted that people should go see a movie.
Riaz Haq said…
Widely available low-cost dexamethasone (low-dose steroid) treatment reduces death by up to one third in hospitalized patients with severe respiratory complications of #COVID19. It could have saved up to 5,000 lives of #coronavirus patients on #ventilators https://www.recoverytrial.net/files/recovery_dexamethasone_statement_160620_v2final.pdf

---------

A cheap and widely available drug can help save the lives of patients seriously ill with coronavirus.

The low-dose steroid treatment dexamethasone is a major breakthrough in the fight against the deadly virus, UK experts say.

The drug is part of the world's biggest trial testing existing treatments to see if they also work for coronavirus.

It cut the risk of death by a third for patients on ventilators. For those on oxygen, it cut deaths by a fifth.

Had the drug had been used to treat patients in the UK from the start of the pandemic, up to 5,000 lives could have been saved, researchers say.

And it could be of huge benefit in poorer countries with high numbers of Covid-19 patients.

https://www.bbc.com/news/health-53061281
Riaz Haq said…
#Pakistan #lockdown in 20 cities as #coronavirus ‘hotspots’: #Karachi, #Lahore, #Quetta, #Peshawar, Rawalpindi, #Islamabad, #Faisalabad, Multan, Gujranawala, Swat, Hyderabad, Sukkar, Sialkot, Gujarat, Ghotki, Larakana, Khairpur, DGKhan, Malakand & Mardan. https://tribune.com.pk/story/2242926/1-live-pakistan-start-commercial-manufacturing-covid-19-diagnostic-kits-national-tally-hits-144478/


The novel coronavirus emerged in the central China city of Wuhan towards the end of last year and proliferated to almost the whole world within a couple of months. It’s not the virulence or fatality, but the infectivity of the new virus – also known as SARS-CoV-2 – that has set off a global frenzy.

The Covid-19 respiratory illness caused by this mysterious contagion has so far infected more than 7.7 million people in 202 countries and territories of the world – and over 428,000 of them have died and counting.

Pakistan, despite its close proximity with China, remained coronavirus-free until February 26 when a young man from Karachi tested positive after returning from Iran – one of the worst-hit countries. After a brief hiatus following the first case, Covid-19 cases spiked as more pilgrims returning from Iran tested positive for the virus.

Nearly one-and-a-half months after imposing the lockdown across the country, Prime Minister Imran Khan announced to ease the lockdown in phases.

The nationwide tally of Covid-19 patients stands at 146,879 with 54,138 cases in Punjab, 55,581 in Sindh, 18,472 in Khyber-Pakhtunkhwa, 8,327 in Balochistan, 1,143 in Gilgit-Baltistan, 8,569 in Islamabad and 663 in Azad Jammu and Kashmir.

The virus has claimed at least 2,784 lives while around 53,721 coronavirus patients have recovered.

The situation remains fluid and we’re updating stats as soon as new figures are officially released.

Riaz Haq said…
COVID19 drug Dexamathsone has been found to be effective. It is widely available under various brandnames in Pakistan at very low cost.


http://www.druginfosys.com/AvailableBrands.aspx?query=4%20mg/ml&form=Inj&drugCode=222&drugName=Dexamethasone&Ing==1


Single Ingredient
Inj :20 mg2 mg/ml4 mg/ml
Eye Drops:0.1 %w/v
Oint:0.1 %w/w
Tabs:0.5 mg0.5 mg/ml
Multi Ingredient
Drops:0.1 %w/v
Eye Drops:0.1 %w/v0.2 %w/v
Ear Drops :0.1 %w/v
Eye Oint:0.1 %w/w
E and E Drops:0.1 %w/v
Oint:0.1 gm
Cream:0.1 gm0.1 %w/w0.4 %w/w0.04 %w/w3500 IU/g
Dexamethasone [Inj 4 mg/ml]
Brand Name Manufacturer/Mnf. Representative Trade Price Retail Price
ADRENAAL CIRIN PHARMACEUTICALS (PVT) LTD. 0.00 250.00
ALDRON HARMANN PHARMACEUTICAL LABORATORIES (PVT) LTD. 132.60 156.00
ATNESON ENGLISH PHARMACEUTICALS INDUSTRIES 212.50 250.00
CECIDRON CEICIL LABORATORIES LTD. 221.00 260.00
D CORT BROOKES PHARMACEUTICAL LABORATORIES (PAK.) LTD. 203.23 239.09
D SONE MEDIATE PHARMACEUTICALS (PVT) LTD 250.00 250.00
D.DRON EPHARM LABORATORIES 107.95 127.00
DANADEX DANAS PHARMACEUTICALS (PVT) LTD 0.00 250.00
DANADEX DANAS PHARMACEUTICALS (PVT) LTD 0.00 10.00
DECADRON OBS 349.35 411.00
DECADRON OBS 55.25 65.00
DELTASALONE TRIGON PHARMACEUTICALS PAKISTAN (PVT) LTD. 9.50 0.00
DEXADRIN STAR LABORATORIES (PVT) LTD. 154.70 182.00
DEXADRIN STAR LABORATORIES (PVT) LTD. 24.43 28.75
DEXAMED MUNAWAR PHARMA (PVT) LTD. 82.02 96.50
DEXAMEDRON GEOFMAN PHARMACEUTICALS 48.06 56.54
DEXAMEDRON GEOFMAN PHARMACEUTICALS 212.91 250.48
DEXAMEK KARACHI PHARMACEUTICAL LABORATORY 79.56 93.60
DEXAMETHASONE VENUS PHARMA 59.65 70.18
DEXAMETHASONE AMROS PHARMACEUTICALS. 82.28 96.80
DEXAMETHASONE IBL HEALTH CARE (PVT) LTD 0.00 0.00
DEXAMETHASONE ELKO ORGANIZATION (PVT) LTD. 0.00 0.00
DEXAMETHASONE ORIENT LABORATORIES 49.50 54.00
DEXAMETHASONE AMROS PHARMACEUTICALS. 0.00 0.00
DEXAMETHASONE DOSACO LABORATORIES 0.00 0.00
DEXAMETHASONE LAWRENCE PHARMA 54.40 64.00
DEXAMETHASONE ORIENT LABORATORIES 53.08 96.50
DEXAMETHASONE ORIENT LABORATORIES 14.45 17.00
DEXAMETHASONE VENUS PHARMA 65.66 77.25
DEXAMETHASONE VENUS PHARMA 22.95 27.00
DEXAMEX BOSCH PHARMACEUTICALS (PVT) LTD. 265.62 312.50
DEXAROID MEDICAIDS PAKISTAN (PVT) LTD. 199.38 234.57
MERRYSONE HYGEIA PHARMACEUTICALS 40.80 48.00
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METHOX MACQUINS INTERNATIONAL 89.25 105.00
NEUDEX NEUTRO PHARMA (PVT) LTD. 212.50 250.00
ORADEXON OBS 252.70 297.29
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Z-DEX Z-JANS PHARMACEUTICAL (PVT) LTD. 0.00 160.00
Riaz Haq said…
Has #Coronavirus peaked in #Pakistan? Cases fall for 5th straight day from peak of 6,895 last week to 3,892 in last 24 hours. Fatalities have also decreased significantly over recent days, falling to 60 on Wednesday from the record high of 153 on June 19. http://v.aa.com.tr/1888337

New coronavirus cases in Pakistan continued to decline for a fifth consecutive day on Wednesday, official data showed.

According to the Health Ministry, 3,892 cases were confirmed across the country over the past 24 hours, raising the overall count to 188,926.

The figure marked a fall of almost 3,000 from the record high of 6,895 reached slightly over a week ago on June 13.

It was also the fifth day of declining cases -- 6,604 on June 19, 4,951 on June 20, 4,471 on June 21, and 3,946 on June 22.

Fatalities have also decreased significantly over recent days, falling to 60 on Wednesday from the record high of 153 on June 19.

The death toll in the country now stands at 3,755, while recoveries increased by 4,283 to 77,75, raising the overall recovery ratio from 37% to 41.2%, according to the ministry's data.

Health experts also confirmed the improving numbers in the South Asian country of over 220 million, which has conducted over 1.15 million tests so far.

"Despite increased testing capacity, the numbers are slowly reducing and we at Khyber Medical University have also observed the declining trend," Arshad Javaid, the university's vice chancellor, told Anadolu Agency.

Asad Umar, a federal minister leading Pakistan's COVID-19 response, last week warned that infections could exceed one million by the end of July, if daily numbers continued to rise at the same rate.

However, on June 15, authorities identified hotspots in 20 big cities and enforced locality-based lockdowns -- which the government has dubbed "smart lockdowns" -- in the high-risk areas.

"The smart lockdown, apparently, has helped stem the spread of the virus to other areas," Dr. Mohammad Akram, a pulmonologist based in the capital Islamabad, said.

Earlier this month, the World Health Organization advised Pakistan to impose a two-week strict lockdown, declaring the country the second-most vulnerable to the pandemic after neighboring Afghanistan.

The recommendation came as infections skyrocketed when the government lifted its lockdown restrictions of varying strictness in late May, ahead of the Muslim festival of Eid al-Fitr.

Prime Minister Imran Khan, however, rejected the UN body's suggestion, saying "smart lockdowns" were the only possible option for Pakistan because it "is a poor country … [with] no choice but to reopen."
Riaz Haq said…
Pakistan #pharma industry growing fast. #Pakistan’s domestic #pharmaceutical firms sales have grown 13.1% CAGR in last 4 years, outperforming multinational companies (MNCs), which saw global growth of 9.34% CAGR, according to global industry group IQVIA. https://www.thenews.com.pk/print/681143-pakistan-s-domestic-pharmaceuticals-growing-faster-than-mncs

Emerging faster than the MNCs, the local pharmaceutical companies’ quarterly revenues surged to Rs320 billion till March 31, 2020 compared with Rs195.75 billion as of March 31, 2016. Similarly, MNCs increased their quarterly market size to Rs143.2 billion by the end of the first quarter of 2020 as against Rs100.2 billion in Q12016.

IQVIA is a global provider of information, innovative technology solutions and contract research services with operations in more than 100 countries.

Due to high rupee depreciation, overall industry growth in dollar terms in the first quarter of 2020 remained negative. In dollar terms, national companies witnessed CAGR of 2.41 percent in last four years compared with MNCs, which grew at a CAGR of negative 1.01 percent in the same period, the report said. The pharmaceuticals have remained functional during the Covid-19 pandemic and in fact registered growth.

Pakistan Economic Survey 2019-20 disclosed that the pace of contraction diminished in the pharmaceutical sector, as it registered 5.38 percent decline during July to March in FY2020 as compared to 8.66 percent decline in the corresponding period the previous year. Also, the pharmaceutical sector recorded the highest sales in March, while it fetched $1.3 million foreign direct investment (FDI) in April 2020. Analysts believe at the present growth rate the market size for pharmaceuticals would double in the next 10 years in Pakistan.

But the impact of the pandemic would be severe in the coming months, as the International Monetary Fund (IMF) has revised down its world GDP projections and now expects a contraction of 4.9 percent in 2020.

“Apart from the last three months, the next twelve months will also be very tough for the Pakistan economy,” said Taha Khan Javed, Head of Equities at Al Meezan Investment. “The outlook for Pakistan GDP is also precarious with growth for next fiscal year expected to be only 1-2 percent, much below the normal growth 3-5 percent we have seen in the past.”

Javed said few industries including the pharmaceuticals of the country could play a vital role in their capacity to help the national economy. He suggested the pharmaceutical industry to ramp up production capacity, and collaborate with international pharmaceutical companies to bring critical medicines in the country and eventually aim for joint venture investment of production facilities.

“The government should ensure that timely price increases are given to companies so that they have incentive to increase their investment instead of relying on only imported medicines,” he added.
------------------

Medicine spending growth in the pharmerging markets
continues to slow compared to the past five years and
is projected to grow at 5–8% through 2023. Although
China, Brazil and India have the greatest medicine
spending within the pharmerging markets, Turkey,
Egypt and Pakistan are forecast to have the greatest
growth between 2019 and 2023 (see Exhibit 4).
Pharmerging market growth continues to derive
primarily from increasing per capita use, but some
markets are seeing wider uptake of newer medicines as
patients’ ability to afford their share of costs improves
with economic growth.

https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/the-global-use-of-medicine-in-2019-and-outlook-to-2023.pdf?_=1593882831247

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