Impact of COVID-19 on Parenteral Nutrition in Healthcare Industry
The COVID-19 pandemic has influenced the whole planet with its major impacts on the economy and businesses across the globe. The COVID-19 spread worldwide in unprecedented ways due to its high infectious and contagious nature and lack of availability of its vaccine. As a result, the greatest medical challenge in the 21st century is yet to be faced by physicians worldwide. Though the emergence of the virus can be traced back to Asia, many European countries along with the U.S. have been struck massively by the pandemic. The virus has spread across all regions ranging from North America, Europe, Asia-Pacific, Middle East, and Africa up to South America. The COVID-19 has been declared as a pandemic by World Health Organization (WHO) due to its increased spread across the globe. After the declaration of the pandemic, various countries announced the complete lockdown such as India, China, and other Asian countries to decrease its spread. According to the latest situation report by World Health Organization (WHO) stated 175 million cases of Corona have been reported globally and 4 million patients are dead due to the coronavirus. On a slightly positive note, a total of 158 million people have recovered and a total of 2 million vaccine doses have been administered as well.
Parenteral nutrition is the medical term used for infusing a specialized form of food through a vein, intravenously. The objective of the treatment is to correct or prevent malnutrition by providing liquid nutrients, including carbohydrates, proteins, fats, vitamins, minerals, and electrolytes. Parenteral nutrition is used when the patient's gut cannot be used to absorb nutrients, the nutrition then must be delivered into the patient’s bloodstream, bypassing the gut. The reason for this type of feeding includes blockage of the gut, Perforations of the gut, parts of the bowel are diseased, or when a large part of the gut has been removed. COVID-19 has negatively impacted the market as trained professionals are required for the administration of such nutrition. But owing to the imposition of lockdown by the government, such administrations can’t be done that impacted negatively.
The pandemic has affected the parenteral nutrition market in three ways: by directly affecting production and demand, by creating supply chain and market disruption, and by its financial impact on firms and financial markets.
For instance,
• In October 2020, the American Society for Parenteral and Eternal Nutrition issued the guidelines to update the use of filters for parenteral nutrition. The guidelines aim at reducing exposure to particulate matter during parenteral nutrition (PN) therapy by updating In-line intravenous filters.

STRATEGIC INITIATIVES BY KEY PLAYERS
As the reality of COVID-19 dawned upon the world, manufacturing and production unit of companies involved in parenteral nutrition key players formed strategies to mitigate with the limitations occurred due to the virus and keep their business running.
At the individual company level, companies are now more focused on operational resilience and accelerating initiatives that enable more agility, and transparency through the greater deployment of analytical tools and automation. Companies are considering re-evaluating their strategies, risk tolerance, and overall footprint. The market players have adopted various strategies including mergers, acquisitions, partnerships, and new product developments, among other strategies, to stay ahead of the competition and expand the market footprint.
For instance,
• In May 2021, Otsuka Pharmaceutical Co. Ltd announces that its affiliated company, Egypt Otsuka Pharmaceutical Co., S.A.E. (Egypt Otsuka), has agreed to jointly participate with a local pharmaceutical company Gypto Pharma for Trading and Pharmaceutical Manufacturing S.A.E. (Gypto) to establish a new company, Otsuka Gypto Pharmaceutical Egypt S.A.E. (Otsuka Gypto), which will sell ethical drugs such as IV solutions locally.
However, to address the crisis all companies in this market are revisiting their financial trajectories and framing new strategies that will lead to bringing out solutions in the market resulting in increased business efficiency.
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IMPACT ON DEMAND
With the lockdown, all hospital admissions were stopped except the COVID-19 patients. Since the pandemic, lockdown situation the economic growth of the country is declining. And the manufacturing units for various items that are considered non-essential are shut down due to the non-availability of manpower.
The pandemic has caused major destruction in the delivery of healthcare products across the world. It has posed limitations on many patients to access standard health services such as visits to healthcare professionals, medications, and diagnosis. It has adversely impacted the ability of patients and practitioners to adhere to treatment guidelines. Moreover, the demand for parenteral nutrition and growing awareness about current and new products is also fueling the market.
For instance,
• Otsuka Pharmaceutical Co. Ltd stated that in the pharmaceutical business, official requests to stay at home and urban lockdowns have led to a decrease in outpatient numbers in hospitals but there is an upward trend for long-term prescriptions for patients with chronic diseases. If the current situation were to be prolonged or become more serious, there may be a further decline in the number of new prescriptions and decline in prescriptions such as injections as part of hospital treatment due to restrictions on visits to health care facilities and the voluntary restraint on efforts to raise awareness of diseases, which may affect revenue.
However, the negative impact of the pandemic on the parenteral nutrition market will be soon mitigated as different states/ countries allow medical clinics to reopen, services and once again being offered.

IMPACT ON SUPPLY CHAIN
As the world came to halt in the last few months due to the emergence of the pandemic, the supply chain couldn’t escape the impact. The government throughout the globe imposed total lockdown which led to supply chain disruptions. Consequently, the supply chain came to standstill due to the closure of borders. Even though the demand for parenteral nutrition remained untouched up to an extent, the availability was affected due to disruption in the supply chain, trade, and travel restrictions. Supply of raw material was also affected, due to which the product was affected.
The outsourcing services which are providing warehousing, storage, and other services face challenges too. They are dependent on the logistic and transportation of chemical compound raw material from the outsourced service to the researchers' desk. However, with the sudden shut down globally with a ban in travel this process gets disrupted. Still, the companies managed to overcome the challenges and saw high growth.
For instance,
• According to the Annual report 2020 of Otsuka Pharmaceuticals Co. Ltd stated that concerning the procurement of raw materials, the purchasing channels overall are secure, although delays are occurring for some important items. Manufacturing had been temporarily suspended for some line items due to employees staying at home, but all manufacturing has been restored. The manufacturing operations are adequately staffed and proceeding smoothly. If the spread of COVID-19 were to be prolonged or become more serious causing stoppages in the procurement of raw materials, or if a cluster of infections or other similar cases occurred at a manufacturing plant, the supply of certain products may stop.
However, the companies have been faced with substantial business and operational disruptions, which have included everything from mitigating the effects of reduced supply to managing disruptions to logistics suppliers, and indeed hurdle in meeting their contractual obligations to customers.
The pandemic has forced the companies to rethink their supply chains and their stability and reliability for an uncertain future, including other externalities and government actions throughout the world, which have begun impacting supply chains, such as issues of sustainability.

IMPACT ON PRICE
Due to the pandemic, the market is disturbed to a greater level. The several establishments have to remain shut while others scale down or put on hold expansion plans as they tried to survive the unprecedented crisis.
Due to the impact of the coronavirus, many large pharmaceutical companies have placed new trials on hold and numerous small, mid-size, and large enterprises have suspended ongoing ones, thereby demonstrating the magnitude of the disruption.
There have been uncertain past months due to the emergence of COVID-19. The sale of some company’s products experienced a downfall while others managed to stay afloat.
For instance,
• According to the annual report of Vifor Pharma Management Ltd., the sale of its products increased from USD 1794 million in 2019 to USD 1944.4 million in 2020
• According to the annual report of Otsuka Pharmaceutical Co. Ltd the nutraceuticals segment had a sale of USD 3,340.88 million with a business profit of 2.1 %. The total revenue in 2019 was USD 13,962.4 million which increased to USD 14,228.26 in 2020.

CONCLUSION
COVID-19 has impacted every sector with no exception global parenteral nutrition market has been affected the same. Different companies dealing in parenteral nutrition were finding out their way to deal with this pandemic situation. The government and companies around the globe are working together and have issued advice for those undergoing treatment for severe conditions during these unprecedented times during COVID-19 lockdown around the world.
However, healthcare industries and government bodies are exclusively concentrating on how they can make the effective and best contribution to control the spread of the virus and save lives. They are also ramping up the production of essential medicines to new levels and ensure that the speed doesn’t affect or destroy the quality of products.
However, in the crisis call pharmaceuticals, key players, government bodies and healthcare organizations are working closely with healthcare professionals, customers, and patients for the betterment of public health. Thus, it is reasonable to assume that constraints on gathering and movement have disproportionally impacted people who use parenteral nutrition.