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      COVID-19 in five neighbouring limited resources countries: A financial and health threats

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          Abstract

          A pandemic coronavirus infectious disease-2019 (COVID-19) was first originated in December 2019 in Wuhan, China. The entire world was locked down along with China to prevent the local transmission and wide geographical spread [1]. On the 30th of January, 2020, the World Health Organization (WHO) declared the COVID-19 as public health emergency due to the increasing number of cases around the world [2]. The WHO data on 7 May 2020 showed more than 3588700 confirmed and 247500 death cases of COVID-19 around the world [3]. Taking into account the transmission, morbidity, and mortality of COVID-19, it is observed that most of the developed countries having advanced healthcare systems along with using their innovative research have been failed to cope with COVID-19. On the other hand, developing countries with their struggling and compromised healthcare system are even failed to record the prevalence of the COVID-19. It is due to the lack of basic health facilities, unavailability of medical equipment, and the absence of diagnostic kits [4, 5]. Moreover, infection prevention and control (IPC) programs are also weak and compromised in developing countries [5]. In the near future, the total number of confirmed cases is expected to increase significantly in limited resources or developing countries. The weakness of these health-care systems will lead to major direct and indirect mortality rates [6]. The pandemic outbreaks are major threats to the economy of countries especially to those countries that are already bankrupt. This blow to their economy will take many years to recover to the normal conditions [7]. The COVID-19 was found as a mounting threat to the economy of the entire world, including the neighbouring developing countries of China i.e. Pakistan, India, Iran, Afghanistan, and Bangladesh. According to WHO, until 7th May 2020, more than 186040 confirmed and 9000 deaths cases are recorded due to the COVID-19 in these countries [3]. The main objective of the current article is to explore the ill-equipped health care system and economy of the mentioned five neighbouring countries. Additionally, we also highlight the expected consequences of COVID-19 on them. Pakistan: Pakistan is very sensitive to such pandemics and health emergencies because it lacks, basic health facilities, recommended policies and proper medical equipment to cope with such outbreaks. The health care system of Pakistan is still in the developing stage and needs further maintenance and strength [8]. Pakistan is among the top ten recipients of global remittances in 2019 and received 21.8 billion Pakistani rupees (136,548,699.24 United States Dollar: US$) foreign remittances, which contributed to almost 8% of its total gross domestic product (GDP). This flow of remittance helped the developing countries to reduce poverty, overcome food insecurity, support the balance of payments, and contribute to national economic growth [9]. It is reported that up till now more than 1.5 billion people are suffered from the crisis, with an economic loss of 1.3 trillion US$ [10]. While the natural hazards affected almost 50 million peoples with 80,000 deaths that also lead to another economic loss of 25.5 billion US$ [8]. Global terrorism, political up-downs, and the financial crisis have also shrunken and de-stabled the economy of the country. Considering, the current pandemic situation, Pakistan is ill-prepared to cope with it. Furthermore, the poverty line during this period of crisis is expected to be increased from 60 to 125 million due to lockdown and unavailability of jobs. According to the international monetary fund (IMF) and the federal board of revenue (FBR) of Pakistan, a revenue loss of 300 billion Pakistani rupees is expected due to the COVID-19. The exports of textile and foodstuff are decreased by 55% and 18%, respectively due to the cancellation of orders, decrease demands, and continuous locked down. Similarly, the import of machinery, petroleum, textile, and foodstuff is decreased by 13%, 27%, 7%, and 9%, respectively. The value of Pakistani currency has decreased in the market against foreign currencies. According to the World Bank report, 33% of the population has an income of less than 3.32 US$/day, and 75% of the population has an income of less than 5.50 US$/day to live [11]. Therefore, Pakistan is expecting a major blow to his economy and health from this pandemic COVID-19 [12]. India: The Indian health care system is also facing challenges due to its high population, low investment in the health sector, and privatization. Because of the asymmetric privatized health care system in comparison to its GDP, it is unable to tackle and cope with outbreaks like the current pandemic COVID-19 [13]. India is a poor country with a compromised health care system, it boosts its economy by tourism, as it earns US$30 billion income per year from the tourism industry which declined when a ban on traveling took place. Overall economic growth is expected to be decreased due to the bane on transport, completely locked down, closing of shops and other business malls, and shutdown of many industries. The agricultural industry is affected more because of the Chinese import cessation [14]. The export industry is fully paralyzed due to the stoppage of shipping, cargos, and flights. Export business is crippled due to moderate collapse in the world supply chain especially in those destinations interlinked with India such as United States (US), United Arab Emirates (UAE), United Kingdom (UK), Germany, and China. The warehouses are full due to the stoppage of export to other countries. The market shares and nifty-fifty index of the petroleum industry have fallen by 27% and 20%, respectively that has produced a global panic in the business market [15, 16]. COVID-19 pandemic contributes to disrupting the economy of India by enlisting it in the top 15 affected economies of the world [17]. India is unable to cope with such pandemic due to the higher unemployment ratio and limited health and financial resources. Iran: Iran is the poorest country among the top ten affected countries with the maximum number of COVID-19 cases to date. Iran is mostly affected by the pandemic COVID-19 and at the same time, it faces the United States economic sanctions. Its healthcare system is already compromised and now the sanctions have made it more severe because of the unavailability of funds. Although, basic medical equipment and medicines are exempted from the economic bans, the effect of sanctions on trade, manufacturing sector and also outbreak has restricted the provision of these kinds of stuff [18]. The stock exchange is fallen by 30% [19]. Lack of basic diagnostic kits and all other means of treatment and prevention has increased the chances of crisis. Recently, Iran is suffering from a very troublesome state of economic growth rate. The economic growth rate is -9.5% and the inflation rate 35.7%, which is the lowest and highest recorded values respectively in the history of the country. The economic growth rate is expected to be further reduced by 1.4% due to the COVID-19 outbreak which can probably lead to economic crumbling and collapse. All these circumstances have made it unable to properly cope with the COVID-19 [18]. It is clear from the situation that Iran is more exposed to threatening consequences of the current pandemic among all the mentioned five neighbouring countries. Afghanistan: Afghanistan is another neighbouring country of China with an ill-prepared health care system and structure. Moreover, the number of health care professionals is very low compared to international recommended standards. He got infected from COVID-19 due to its neighbor country Iran. It lacks basic health and quarantine facilities to manage with the current pandemic. According to the global health security index, it is ill-prepared to cope with the current pandemic outbreak. The poverty line in Afghanistan is below 55% and it contains one of the weakest economies in the world. Almost 45,800 and 24,500 people were already suffered from conflicts and disasters respectively and the economy is in the state of war for decades [20]. The entry of Afghan citizens from Iran will further increase the economic crisis. Afghanistan has suspended its flights with different countries, which also affected the aviation industry [21]. According to a report on the Afghanistan economy, the economic growth rate is expected to collapse further by 10% in the coming future. The trade and business are more vulnerable at this juncture [22]. The COVID-19 pandemic seems to be more threatening to Afghanistan due to its weak economy and poor health care system. Bangladesh: Bangladesh is a South Asian developing country that suffered a lot due to COVID-19. The ratio of preexisting disease loads on its weak healthcare system posing the country to a thrilling challenge in the current pandemic situation. Bangladeshi garments are accounting for 80% of exports, due to bane on flights, sea ships, cargos and the locked-down have confined their business to warehouses. An exclusive crash of 1.8% is expected in exports. Bangladesh is the keen trade partner of China, so the import of raw materials for manufacturing, machinery, electrical and chemical equipment is ceased due to the COVID-19 outbreak. The effect of these consequences will be critical to the Bangladesh economy [23]. Recently due to the COVID-19 outbreak, the stock exchange has plunged by 5.8% that has induced an ultimate effect on the country’s economy. The telecom and banking industry faced a loss of 6.2 and 5.8% respectively, owing to the terrible destruction of Bangladesh's economy with altering magnitude [24]. Hence, in this terrible situation, Bangladesh will also face risky financial and health threats. Conclusion In a nutshell, the international organizations and developed countries should collaborate with national agencies of the respective and other lower- and middle-income countries. The inimical impacts of COVID-19 on health, treatment strategies, welfare, and economics are likely to be considered in limited-resource countries. Governments in the respective countries also need to increase amounts allocated to health care for better management. It is the right time for economic giants both at the global and community level to address the issue of COVID-19 among the poor population because the world may not be safe for the rich in the presence of poor carriers.

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          SARS-CoV-2: an Emerging Coronavirus that Causes a Global Threat

          Jun Zheng (2020)
          An ongoing outbreak of pneumonia caused by a novel coronavirus, currently designated as the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), was reported recently. However, as SARS-CoV-2 is an emerging virus, we know little about it. In this review, we summarize the key events occurred during the early stage of SARS-CoV-2 outbreak, the basic characteristics of the pathogen, the signs and symptoms of the infected patients as well as the possible transmission pathways of the virus. Furthermore, we also review the current knowledge on the origin and evolution of the SARS-CoV-2. We highlight bats as the potential natural reservoir and pangolins as the possible intermediate host of the virus, but their roles are waiting for further investigation. Finally, the advances in the development of chemotherapeutic options are also briefly summarized.
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            COVID-19: A promising cure for the global panic

            The novel Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2, which is the causative agent of a potentially fatal disease that is of great global public health concern. The outbreak of COVID-19 is wreaking havoc worldwide due to inadequate risk assessment regarding the urgency of the situation. The COVID-19 pandemic has entered a dangerous new phase. When compared with SARS and MERS, COVID-19 has spread more rapidly, due to increased globalization and adaptation of the virus in every environment. Slowing the spread of the COVID-19 cases will significantly reduce the strain on the healthcare system of the country by limiting the number of people who are severely sick by COVID-19 and need hospital care. Hence, the recent outburst of COVID-19 highlights an urgent need for therapeutics targeting SARS-CoV-2. Here, we have discussed the structure of virus; varying symptoms among COVID-19, SARS, MERS and common flu; the probable mechanism behind the infection and its immune response. Further, the current treatment options, drugs available, ongoing trials and recent diagnostics for COVID-19 have been discussed. We suggest traditional Indian medicinal plants as possible novel therapeutic approaches, exclusively targeting SARS-CoV-2 and its pathways.
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              Managing COVID-19 in Low- and Middle-Income Countries

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                Author and article information

                Contributors
                Journal
                Value Health Reg Issues
                Value Health Reg Issues
                Value in Health Regional Issues
                ISPOR--The professional society for health economics and outcomes research. Published by Elsevier Inc.
                2212-1099
                2212-1102
                30 June 2020
                30 June 2020
                Affiliations
                [1 ]College of Pharmaceutical Sciences, Soochow University, Suzhou, 215123, China
                [2 ]Department of Pharmacy, Comsat University (Abbottabad campus), Islamabad, Pakistan
                [3 ]Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
                [4 ]Faculty of Economics and Administrative Sciences, Department of Business Administration, Cukurova University, Adana, Turkey
                [5 ]Wahdat High school, 17th district of Kabul, Afghanistan
                [6 ]Department of Pharmacology (Pharmacovigilance), Cukurova University, Adana, Turkey
                Author notes
                []Corresponding author: Zakir Khan* Present affiliation: Department of Pharmacology (Pharmacovigilance), Cukurova University, Adana, Turkey, Previous affiliation: Department of Pharmacy, Quaid I Azam university Islamabad PakistanTel: 0090-5315921109 zakirkhan300@ 123456gmail.com
                Article
                S2212-1099(20)30042-X
                10.1016/j.vhri.2020.06.001
                7324313
                33545492
                1c2abee0-2f22-42c9-b26a-73968ecee15f
                © 2020 ISPOR--The professional society for health economics and outcomes research. Published by Elsevier Inc.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 11 May 2020
                : 1 June 2020
                Categories
                Article

                coronavirus disease (covid-19),limited resources countries,economics,health,pandemic

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