INTRODUCTION
On January 30th the World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC), followed by an official announcement on February 11th that the outbreak was caused by a novel coronavirus (CoV) named COVID-19, the acronym for “corona virus disease 2019”. 1 COVID-19 is the latest in the series of global viral pandemics in the past 20 years including the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 and 2003, the H1N1 influenza in 2009, and the Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia in 2012.1 However, the COVID-19 pandemic emerged in a modern world that is both the most diverse and most deeply interconnected in terms of global healthcare economy and supply chain of pharmaceuticals in history. Many of the major pharmaceutical companies in the United States rely primarily on the active medical ingredients and medications that are manufactured overseas.2 We looked at the 15 most commonly prescribed generic topical dermatology medications, and the locations of the major pharmaceutical factories producing generic forms of these medications (Table 1).3,4 Of the top 15 most commonly prescribed topical dermatology generics, 13 were found to at least partially be manufactured in China in addition to the local and/or other international locations (Table 1). China was the emergence point of COVID-19 and the first country to undergo an alarming epidemic. Primary efforts are targeted at curbing further spread and rate at which the population is getting infected by employing strict isolation measures.2 These measures including refraining from coming to work, so far proved successful in decelerating and stabilizing the disease in China.1 However, the same measures have a negative impact on economy, pharmaceutical manufacturing, and exporting to other countries that are dependent on these pharmaceutical means. In other words, the COVID-19 epidemic that originated in China and has now evolved into a global pandemic across the world may have significant ramifications on the pharmaceutical supply chain of the commonly prescribed medications in dermatology. The concern exists for the possible deficits of the final manufacturing drug products from China, as well as the vast number of active drug ingredients that are exported for use and further modifications locally in the United States.2 Moreover, should the pandemic expand, the possibility of factories
