Impact of COVID-19 on Dexamethasone in Healthcare Industry
OVERVIEW
A novel coronavirus, SARS-CoV-2, appeared in December 2019 in Wuhan, China, spreading much faster than its predecessors and has already infected millions of patients worldwide as of April 19, 2020. As the scope of the current COVID-19 outbreak has reached the proportion of pandemics, major international efforts in public health are underway to control the outbreak. Although the favorable vaccine was discovered to save the patient life, not everyone gets the dose, so there is considerable interest in repeating existing corticosteroid-based drugs against COVID-19. Several many clinical interpretations of the Randomized Evaluation of COVID-19 Therapy were performed to evaluate useful tool whether dexamethasone is useful for the severe hospitalized patients.
Dexamethasone is a corticosteroid widely used or known for its anti-inflammatory and immunosuppressant activity. Dexamethasone exerts its action in decreasing inflammation by suppressing the migration of cells known as polymorph nuclear leukocytes of PMN and reducing capillary permeability. Through this phenomenon, it stabilizes the cell and lysosomal membrane. In premature infants, dexamethasone also stimulates increased surfactant production in the lungs. It also can inhibit pro-inflammatory cytokines and prostaglandin synthesis. Moreover, dexamethasone also suppresses the proliferation of lymphocytes through direct cytolysis and can inhibit mitosis process of cell division.

IMPACT ON DEMAND
The Coronavirus zone is the result of various markets around the world. This is the cause of the widespread closures and isolation that are affecting world economic activity. As the cases increase in April, the sudden surge in demand has seen, and the drug went out of stock.
In June 2020, as the University of Oxford releases the clinical results, they demand dexamethasone increases and the orders for dexamethasone surpassed 2.8 million compared to the 397,500 in the month of May 2020. According to Vizient Inc. one of the largest groups for drug purchasing organizations in U.S. hospitals said that as the Oxford clinical studies results on dexamethasone releases, the demand rose by 167%. Vizient Inc. spoke person also said that after the rising demand drug’s makers have been able to fill only about half of hospital orders on time.
The impact of COVID -19 has created an opportunity for the number of clinical research to cure the diseases or related symptoms. The impact of COVID-19 created a positive impact on the dexamethasone market because a number of regulatory bodies approved the emergency use of the drug, and the strong clinical evidence also supports the usage.
Patient’s families are in a panic situation due to the limited stock of the injection and the higher price of the drug. The injection being sold at a higher price in the black market. In that particular situation, the government takes over the allocation and supply of injection in the different states of India.
Moreover, as the cases increase, the WHO chief pointed out the need for equitable supplies of dexamethasone for possible use in critical patients worldwide as the demand is rising to save the patients. As the India and U.K. regulatory grant, the emergency use of dexamethasone for severe patients the demand is continuously rising after the second wave of Coronavirus hits different countries. WHO also stated that to meet the rising demand for dexamethasone the production facility or capacity must be increased to meet the global demand.

IMPACT ON PRICE
Various market players face many challenges due to the coming of the novel Coronavirus and different strains. One such issue is the uncertainty surrounding the impact of COVID-19 on dexamethasone demands. Due to the increased demand for life-saving drugs such as Tocilizumab, Remdesivir, Favipiravir, Dexamethasone, and several more for coronavirus treatment and stiff competition between the market players.
According to the reports, the drug cost in U.K. only costs 5 pounds which are needed for ten days, and for the U.S. the cost of this drug is USD 50. Moreover, according to the Health-e News, the regulated price for the injection in South Africa is between R149. 03, and R176.44.
According to the reports, countries such as India, the U.K., Spain, and many more face second and third waves of Coronavirus due to a sudden surge in demand, and India already grant the use of dexamethasone for severe patients. It looks like as the severity of the COVID infection increases, the dexamethasone usage is also increasing.
The impact of COVID-19 does not create any major impact on the price of dexamethasone, although some small or developing countries are facing the issue of pricing.

IMPACT ON SUPPLY
As the pandemic intensifies, supply chains can be at significant risk due to over-located locations that can potentially be disrupted. The supply chain of drugs has been disrupted. The spread of COVID-19 makes it difficult for governments to use these drugs; the availability of these systems faces constant challenges due to their components of use and limited initial needs.
The impact of COVID-19 on dexamethasone supply chain was positively affected because it creates an opportunity for researchers and drug manufacturers.
The trade restrictions have chosen nothing more than to produce the necessary medicines domestically during the pandemic, when the increase, counterfeiting, and price increases of imported goods increase. This signifies that even during the COVID-19 pandemic, the market players are able to maintain the supply chain.
Due to the sudden surge in cases and rise in demand for the drug, the supply is also increasing. After the U.K. report on dexamethasone usage in COVID-19 patients, a massive surge in demand due to this drug supply also increases. As the WHO stated, the drug is inexpensive, and there are many dexamethasone manufacturers worldwide, who we are confident can accelerate production, so there is no supply chain disruption. One more reason is dexamethasone is only used for critically ill patients or in severe patients. The usage is limited for the patients.

STRATEGIC DECISIONS OF GOVERNMENT AND MANUFACTURERS
As the Coronavirus continues to spread to various countries, concerns are growing about drug production and distribution disruptions. Collaborations, agreements, initiatives of market participants such as Fresenius Kabi expand their business to overcome the growing demand for dexamethasone, especially in Indian, U.S., U.K., and highly affected countries. This will help increase the demand for the product among the consumers and thus increase the company's future sales.
• German drug manufacturer “Fresenius Kabi” spoke person also stated that we are confident to meet customers’ needs with COVID-related medicines such as dexamethasone. Moreover, the company also stated that they have a good inventory on hand of the steroid and is ramping up production in three of its U.S. factories to meet the surging demand
• U.K.-based Oxford University started a clinical trial (Recovery Trial), which is funded by U.K. government showed beneficial results. The results showed that dexamethasone reduces the risk of death by approximately one-third in patients on ventilators and one-fifth in patients receiving oxygen. Moreover, U.K. government also ensures that the lifesaving drugs will be available in NHS healthcare settings with immediate effect
• World Health Organization (WHO) also closely monitored the supply and demand of dexamethasone across the globe. Moreover, WHO advises the scale-up production of dexamethasone for the continuous supply of drugs
• In Boston, Massachusetts General Hospital, infectious disease specialist “Arthur Kim”, stated that we revised our treatment protocol for the recommendation of dexamethasone for patients with severe COVID-19 who require supplemental oxygen
The increasing demand and increasing sale of dexamethasone drugs are fueling the growth of dexamethasone drug market in the near future.
Market participants are involved in the production of dexamethasone drugs, expanding their business through various programs, including collaboration, contracts, pipeline development, collaboration, and market expansion. It is expected that the strategic decisions of these companies will provide significant opportunities for market participants operating in the dexamethasone market.

CONCLUSION
The available clinical evidence suggests that dexamethasone is relatively safe with minimum side effects. Moreover, studies showed that when dexamethasone is administered, it reduces one-third of the risk for patients on ventilators and one-fifth risk for patients on oxygen supply and reduces 35% mortality benefit in certain patients with COVID-19 who are severely ill. However, the FDA still does not approve dexamethasone's use on severe patients, but doctors recommend the usage to save the patient life.
Moreover, ongoing trials are evaluating the use of dexamethasone for the treatment of COVID-19. Government and pharmaceutical market players have also taken strategic initiatives to overcome the pandemic.
Read more COVID-19 Impacts on different types of Market