COVID-19 Impact on the Global Cholangitis Market in Pharma Industry
The COVID-19 pandemic has posed a complex challenge in front of several healthcare companies and proved to be an unprecedented global health threat. This global pandemic has emerged in December 2019 which has been proved as a global pandemic by WHO in March 2020. With the development and introduction of novel coronavirus vaccine, COVID cases have been declined but with the development of mutant coronavirus strain, the overall COVID cases have been surged and are increasing at a rapid rate in India, U.K, and other European countries.
The most common symptoms associated with this include cough, fever, diarrhea, sore throat, and loss of smell or taste. Patients affected with COVID-19 are at increased risk of developing hepatic manifestations and also experiences damage to liver tissues.
As per the studies conducted this has been reported that the prevalence of chronic liver disease in COVID-19 patients ranges from 2% to 11%. The hepatic involvement in COVID-19 infection can be related to the direct cytopathic effect of the virus, sepsis or drug-induced liver injury, and an uncontrolled immune response. This has been proved that cholangiocytes express the high level of ACE2 receptors which are the target receptor of SARS-CoV2 that in turn worsen the hepatic decompensation and increases the overall mortality rates.

Cholangitis is indicated as an infection of the common bile duct of the individual. This is caused due to bacterial infection and chronic infection leads to mortality and mortality. The most common symptom associated with it includes low blood pressure, jaundice, abdominal pain and fever among others. Cholangitis can be treated using antibiotics including ceftriaxone, penicillin, metronidazole, ciprofloxacin among others. Moreover, intravenous fluid and bile duct drainage are other alternative treatments indicated for cholangitis treatment. This has also been projected that ursodeoxycholic acid which allows liver protection can also be used for cholangitis management.
As the hepatic manifestations are more common with COVID 19 infections, the increasing COVID-19 cases have posed complex challenges in front of patients suffering from cholangitis among others.
IMPACT ON PRICE
As cholangitis is a bacterial infection the most commonly prescribed drug indicated for its treatment includes antibiotics. With the sudden increase in COVID 19 cases, the people's concerns for their better health have also increased. Majorly patients suffering from respiratory illness infections including pneumonia among others are at higher risk of developing COVID-19 infections hence have started to take proper precautions to lead a healthy life.
As India relies on China for 70% of drug intermediates and bulk drugs, COVID -19 is expected to hike the price of the medicines used for Cholangitis.
For instance,
• Penicillin, an antibiotic indicated for cholangitis treatment has become 40 percent costlier within a month due to an increase in the cost of penicillin API to USD 8.69 per unit during the year 2020.
• As per the report of September 2020, this has been projected that as India is largely dependent upon China for APIs used for drug production, the country has raised the overall drug prices. The prices of common antibiotics including paracetamol, ciprofloxacin among others have been shot up.
Table 1: Price Hike of Antibiotics indicated for Cholangitis Treatment during the COVID-19 Pandemic Across U.K
This thus signifies that the COVID-19 pandemic has led to increased demand for few antibiotics which has enhanced the overall cost of antibiotics.

IMPACT ON DEMAND
The coronavirus has affected the various regions of the world and caused the widespread closure of companies and local manufacturing plants. This lockdown and isolation have adversely impacted global economic activity.
COVID-19 is expected to be an opportunity for the cholangitis market, as the rising COVID-19 cases are responsible for inducing cholangitis cases.
THE IMPACT OF COVID-19 INFECTION ON CHOLANGITIS PATIENTS
As per the several studies conducted till now, liver injury is a more common problem associated with COVID-19.
For instance,
• According to a report published in May 2020, this has been reported that COVID-19 patients usually have a high level of ACE2 receptor expression which complicates the cholangitis case and results in an increased level of cholestasis.
• As per the publication of December 2020, COVID-19 has resulted in increased hospitalization rates with the rising demand for medications to treat the most complicated infectious disease including cholangitis among others. Moreover, as India relies heavily on China for the supply of main APIs, a slow-down production of these finished pharmaceutical products has also impacted the manufacturing of antibiotics.
Moreover, antibiotics are the major treatment options indicated for cholangitis treatment and antibiotics use has been increased during the COVID-19 pandemic.
For instance,
• As per the report published in August 2020, this has been reported that antibiotic usage has been increased by 84% in some hospitals. Moreover, the news suggested that 56.6% of patients receiving antibiotic therapy during the pandemic of COVID-19.
• In May 2020, Sandoz International GmbH had expanded its manufacturing capabilities to manage the dependable supply of medicines. The company has opened this manufacturing facility to boost up the production of antibiotics and respiratory medicines to fulfill the rising patient’s demands. Moreover, the company is boosting up the production of key antibiotics at a site in Kundli, Austria, and Romania to respond to the COVID-19 crisis.
• Recipharm AB has published a blog according to which the rising prevalence of COVID-19 has resulted in an increased demand for antibiotics which has led to a surge in the production of key antibiotics. Moreover, the company stated that they have recently reported an increased demand for potent antibiotics including ampicillin, sulbactam, ceftriaxone among others, which shows that ceftriaxone is widely used for managing cholangitis is in higher demand.
This suggests that the increasing prevalence of COVID-19 poses a life-threatening challenge and hence enhances the demand for cholangitis treatment options. This thus signifies that COVID-19 is accelerating the demand of the cholangitis market.

IMPACT ON SUPPLY CHAIN
The COVID-19 pandemic has affected and badly disrupted the global drug supply chain due to the continuous shut down of manufacturing facilities and restrictions imposed by the government over import and export activities. Due to a wide shut down of manufacturing facilities, antibiotics manufacturing has been badly affected. This has been reported that as of June 2020 10.5% of all drugs which have been reported with shortage are antibiotics.
As per the FDA, the shortage in antibiotics is majorly due to quality issues associated with manufacturing facilities.
Due to the pertinacious COVID-19 lockdown, sanctions have been imposed by governments of various countries. These restrictions and barriers across countries' borders led to a decrease in the supply of APIs needed for drug manufacturing and raw materials required for the manufacturing of devices including insulin pumps. Lack of updates to routine operations maintaining the antibiotics manufacturing during the COVID-19 led to a shortage of high-quality antibiotics manufacturing and impacted the overall supply of these antibiotics including antibiotics indicated for treatment cholangitis.
However to deal with the current scenario of antibiotics supply shortage FDA and the International Council for Harmonization (ICH) have issued guidelines to improve the quality controls and to boost up the productions.
This, thus signifies that due to continuous lockdown and several restrictions by government authorities the companies and patients are facing disruption of the supply chain for antibiotics including antibiotics indicated for the treatment of cholangitis.

STRATEGIC DECISIONS of MANUFACTURERS
Collaboration, agreements, strategic initiatives by market players such as Pfizer Inc., Bayer AG, Dr. Reddy's Laboratories Ltd among others in the cholangitis market will help them to expand their product portfolio and to provide appropriate antibiotics among others to physicians and patients. This in turn will lead to increased product sales and hence will put a positive impact on the overall company’s revenue.
Cholangitis treatment manufacturing companies are taking so many strategic decisions to cope up with the current scenario of COVID-19. The companies engaged in the manufacturing of cholangitis treatment drugs are adopting several initiatives to accelerate the development of antibiotic medicines and efficiently supply the drugs to different end-users.
Companies have already taken several kinds of strategic initiatives to cope up with the coronavirus situation. For instance,
• In August 2020, Bayer AG collaborated with PSCI and TfS to establish new sustainability standards for maintaining the company’s supply base. Through this initiative, the company has boosted up product manufacturing and enhanced the pharmaceutical supply chain by improving the conditions of workers, and by providing them with a cleaner environment amid COVID-19.
• In June 2020, Dr. Reddy's Laboratories Ltd acquired a division of Wockhardt generic business which comprises a portfolio of 62 brands including gastroenterology, dermatology, pain, vaccines among others. As the company’s sales have been reduced during the COVID-19 pandemic this acquisition boosted the company’s revenue.
With the increasing demand and increasing sales of cholangitis medicines, governmental agencies are also investing in antibiotics development.
For instance,
• In July 2020, WHO announced the launch of the AMR action fund which has been designed for antibiotic medicines development. As per the fund launched new antibiotics are expected to launch by 2030. This action fund is a collaboration of major pharmaceutical companies which together adopted initiatives for the development of new treatments.
• In 2020, the Indian government has launched The Production Linked Incentive (PLI) Scheme for boosting up the production of critical key intermediates used for drug production including antibiotics indicated for cholangitis treatment among others.
Thus, companies operating in the cholangitis market are adopting several strategies, including collaboration, agreements, acquisition, and market expansion to enhance their business. These strategic decisions by the companies are expected to provide significant opportunities for the market players operating in the cholangitis market.

CONCLUSION
As the pandemic of COVID-19 has resulted in several restrictions throughout the borders but still, manufacturers of antibiotics can manage their stocks. Various manufacturers have allowed their manufacturers to work in a clean and safe environment to boost up the production of antibiotics at various manufacturing facilities across several regions of the world helping them to maintain a continuous supply chain. However, the introduction of mutant corona strain has worsened the situation and affecting several industries worldwide which are compensated by raising the price of cholangitis treatment drugs. By raising the prices the companies are gaining extra profit which is helping them to combat the negative effect on overall revenue.