Tuesday, June 9, 2020

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.

Related Links:

Haq's Musings

South Asia Investor Review

Antibodies Testing Results in Karachi

Vast Majority of Pakistanis Support Imran Khan's Handling of Covid19 Crisis

Pakistani-American Woman Featured in Netflix Documentary "Pandemic"

Coronavirus Lockdown, Lives and Livelihoods

Can Pakistan Effectively Respond to Coronavirus Outbreak? 

How Grim is Pakistan's Social Sector Progress?

Pakistan Fares Marginally Better Than India On Disease Burdens

Can Imran Khan Lead Pakistan to the Next Level?

Democracy vs Dictatorship in Pakistan

Pakistan Child Health Indicators

Pakistan's Balance of Payments Crisis

Panama Leaks in Pakistan

Conspiracy Theories About Pakistan Elections"

PTI Triumphs Over Corrupt Dynastic Political Parties

Strikingly Similar Narratives of Donald Trump and Nawaz Sharif

Nawaz Sharif's Report Card

Riaz Haq's Youtube Channel

12 comments:

nayyer ali said...

The use of antibody tests has a number of limitations. First is significant false positive rates, as high as 2-3%, which inflates the estimate of the population exposed. Secondly is whether the sample is truly random cross section of the entire population, or is concentrated in groups most likely to have been exposed. This appears to be what occurred in Karachi study. I highly doubt 15% of the population has been infected. Additionally, the WHO data did not state that 16% of the global population are asymptomatic carriers. Carriers are people who continue to have infection but no symptoms. With this virus, the infection clears in 2-3 weeks, often with minimal symptoms, but there are no true long term carriers of the virus. WHO stated that about 16% of infections result in no symptoms, and that is still an area under study.
To get a reasonable estimate of total infected, the best number to use is actual deaths. As the virus has a .5-1% fatality rate, the infected number can be estimated at 100-200x the number of deaths. This needs to adjust for the fact that deaths can lag and occur weeks after infection, and that death rates can vary based on health care system and demographics of the population. The relatively low number of deaths in Pakistan is good news but remains a puzzle. Are some deaths occurring at home or without testing and missing from the stats? A good way to figure that out is to count total excess deaths over expected for the relevant time frame and assume those represent Corona virus mortality.
Finally, at least in the US, going on a ventilator usually but not always results in survival, though you may need to be on the ventilator for 10 days to 6 weeks. I've treated and saved many patients with this who needed a ventilator.

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...

NA: "Are some deaths occurring at home or without testing and missing from the stats? A good way to figure that out is to count total excess deaths over expected for the relevant time frame and assume those represent Corona virus mortality"

There were about 4,000 deaths daily in Pakistan before the current coronavirus pandemic. There's no evidence of significant change in the number of daily burials in recent months.

Here's an Express Tribune story on the subject:


"As many as 3,265 bodies were brought for burial to 30 graveyards in the metropolis in the 49 days between February 20 and April 9, official statistics from the city’s top administrative body revealed on Thursday.

Interestingly, however, the data shared by Karachi Municipal Corporation (KMC) senior municipal director Masood Alam showed that the number of burials in the city had declined by 25 per cent in the first 15 days of April, while the most burials so far this year – a total of 2,849 – were carried out in January.

As many as 13,993 people had been buried in 31 different graveyards operated by KMC during the last six months. April, with 766 burials, has seen the lowest number so far. Around 2,013 burials were done in these graveyards in October 2019, 1,807 in November 2019, 2,303 in December 2019, 2,278 in February and 1,978 in March"

-------------

"According to data obtained from government hospitals in Karachi, 10,791 patients were brought to the emergency department during the first three months of 2020. Of this, 121 of those were dead on arrival while the fatality rate was 1.12 per cent."


https://tribune.com.pk/story/2200655/1-3265-bodies-brought-burial-49-days/

Riaz Haq said...

NA: "Finally, at least in the US, going on a ventilator usually but not always results in survival, though you may need to be on the ventilator for 10 days to 6 weeks. I've treated and saved many patients with this who needed a ventilator."

Elderly covid-19 patients on ventilators usually do not survive, New York hospitals report...... No critically ill patients under the age of 30 died at the two hospitals, O’Donnell said, and only a small number of them had to be put on ventilators. But more than 80 percent of people over 80 who went on a ventilator did not survive.

https://www.washingtonpost.com/health/elderly-covid-19-patients-on-ventilators-usually-do-not-survive-new-york-hospitals-report/2020/05/19/ba20e822-99f8-11ea-89fd-28fb313d1886_story.html

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31189-2/fulltext

samir sardana said...

People say that the COVID death rate is 0.40% ! This was circulated in several news channels also !

Me Thinks the death rate is beyond 10%,on aggregate count,and for some nations it is way beyond.

As per - https://www.worldometers.info/coronavirus/#countries = there are 7.5 million cases and 420000 dead.Simple numerics place it at proximating 6%.

Wrong me says ! dindooohindoo

India,Brazil,Russia have seen a sharp rise in cases,in the last 30 days.40% of their cases came in the last 30 days,and for India,it will worsen exponentially.If you see the kill data of the RIB in the BRICS - it has increased sharply,in the last 30 days (which proves my thesis)

People dying today,were in the quasi morgue (hospitals) 30-60 days ago.Let us take it,at 30 days.

So we rewind to 30 days ago,and exclude the jump in RIB of BRICS,in the last 30 days. So we have say 4.5 million cases and the kill quant is 420,000

Rate proximates 10% ! But that is also wrong,as the infected are NOT solely on RTPCR mode.Many nations cannot afford it and are doing antibody tests.An antibody positive may be RTPCR negative,and the vice versa is less likely. If you exclude these specimens from the infected tally,the % rises further.

Also have to exclude the recovered cases - as those with immunity will recover in 30 days - AS THE VIRUS was DESIGNED THAT WAY.Unlike HIV and Cancer - where patients are NOT likely to recover- on a generic mode.But those who recover from COVID -WILL (in part) come back again,and then die.That will double count the infected cases.Hence,we exclude the recovered cases (which are 4 million,as per site stated above).

These Johnnies who recouped,may have been infected,say 15 days ago - and if you rewind to 15 days ago,and deduct the spike in the RIBs of the BRICS - you will have an infected base of,say 6 million.If you remove the recovered (4 million),and then ratio it,to the dead of 420000 - then you have a
kill ratio of 21% !

Cannot compare the dead to the entire population - as of this instant - as it would include billions of aged,morbid and asymptomatics - who will get infected very soon.

If we take a 1 year horizon - then post the 1 year - you could take the global population - as that by that time,the virus would have had enough time,to spread,evolve and mutate (across the latitudes and seasons).At that stage,a ratio w.r.t the population,would be a meaningful statistic - to benchmark intra and inter se,with other diseases.By that time the death rate will mature and the complete breakdown of the health imfrastructure will be apparent (to explain the future geometric rise)

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
MERRYSONE HYGEIA PHARMACEUTICALS 212.50 250.00
METHOX MACQUINS INTERNATIONAL 89.25 105.00
NEUDEX NEUTRO PHARMA (PVT) LTD. 212.50 250.00
ORADEXON OBS 252.70 297.29
ORADEXON OBS 38.96 45.84
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

Riaz Haq said...

#Pakistan's top 5 #pharma, incl GSK, Abbott, and AGP Pharma, increase profits by 37% in Q1/2020 over same period last year, to Rs2.6 billion while profits of 13 #consumer giants, incl Nestle, Packages, Pakistan Tobacco, Colgate, remained flat amid #COVID19 https://profit.pakistantoday.com.pk/2020/06/14/the-lockdowns-devastated-consumer-spending-but-food-and-pharmaceutical-companies-remain-resilient/


On the flip side, manufacturers of consumer discretionary items such as automobiles did terribly. Kumar had grouped four companies under consumer discretionaries: the three car manufacturers Indus Motors, Honda Atlas, Pak Suzuki Motors, and Thal Ltd, which manufactures jute products. The total profits of all three fell by 39% to Rs2.9 billion.

Meanwhile consumer staples – which includes 13 companies such as Nestle, Packages, Pakistan Tobacco, Colgate, among others – saw profits remain more or less stagnant, with a growth of 1% YoY to Rs8.35 billion.

“Overall slowdown in economic activity and country-wide lockdown starting during the last week of Mar-2020 in the wake of COVID-19, resulted in lower consumers’ purchasing power,” noted Kumar.

The pandemic, it seems, forced consumers to pause and consider exactly what they were opening their wallets for. In the midst of pay cuts, lay-offs, and general job uncertainty, consumers decided this was the worst possible time to buy a car.

Food and cleaning products, or items that are manufactured by Nestle, Unilever or National Foods, are deemed more of a necessity, even though this sector saw an increase in overall prices. The same goes for pharmaceuticals, which are necessities that consumers will often cut back on other spending for in order to be able to continue to afford them. This holds particularly true during a climate of a global pandemic.

This is reflected in the sales numbers as well. Sales for discretionary items (at this point, we will just call it autos), declined by 32% YoY in the first quarter of 2020. But the sales of consumer staples and pharmaceuticals, saw an uptick of 8% YoY and 7% YoY, respectively.

“We believe, due to country wide lockdown amid COVID-19 outbreak, the overall sales of the consumer segment will be affected due to supply chain disruptions, wherein consumer discretionary firms are likely to take the hit most among others,” said Kumar.

So first, let us look at the problem sector: autos. The overall slowdown in economic activity and country wide lockdowns, meant that sales took a hit. Foreseeing this, many such as Indus Motors and Honda Atlas sharply hiked their prices, in order to salvage some semblance of a profit. They should not have bothered: volumes witnessed a contraction of over 50% YoY, leading to a massive overall decline.

Of the three auto companies, Indus fared a little better, with its sales only declined by 20% YoY, compared to Honda Atlas’ 35% YoY fall, and Pak Suzuki’s abysmal 48% decline. According to the report, Indus also helped buoy the overall gross margins of this sector, which increased by 0.11 percentage points to 8.8%.

Now, to consumer staples. Much of the higher revenue in staples was actually driven by an increase in the prices of goods, as the rupee’s devaluation led to costs being passed on to consumers. There was also an increase in volumes compared to last year. Much of this growth in Kumar’s sample size was led by National Foods, which saw a 28% increase in sales compared to last year, and Unilever Pakistan Foods, which saw a 17% increase.