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巴克莱-美股-医疗用品与设备行业-COVID19影响下的美国医疗用品与设备行业-317-30页.pdf
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Equity Research
17 March 2020
CORE
Barclays Capital Inc. and/or one of its affiliates does and seeks to do business with
companies covered in its research reports. As a result, investors should be aware that the
firm may have a conflict of interest that could affect the objectivity of this report. Investors
should consider this report as only a single factor in making their investment decision.
PLEASE SEE ANALYST CERTIFICATION(S) AND IMPORTANT DISCLOSURES BEGINNING ON PAGE 23.
Restricted
- Internal
U.S. Medical Supplies & Devices
COVID-19: Puts & Takes; ISRG-Get
Ready for Some More ‘Warning Flags’
The novel coronavirus (COVID-19) global pandemic is now rapidly spreading through
Europe and the U.S. Efforts are underway to “delay and flatten the curve.” The federal,
state, and local governments are taking actions to address COVID-19, some of which
include canceling/postponing elective procedures – which we highlighted in past
research reports (and discuss below in greater detail).
ISRG-Last night: A ‘warning flag’: Last night after market close, Intuitive Surgical (ISRG;
not covered) issued an 8K commenting on the impact of COVID-19. ISRG has seen an
impact but the regions do not represent a material portion of procedure volumes.
HOWEVER, management noted the spread of COVID-19 to the larger EU and US
regions, and when combined with the recent recommendations by the American
College of Surgeons (Friday) the Surgeon General (Saturday) and advising the
deferral of elective procedures, there could be a material impact ahead. Moreover,
restrictions on travel, access to customers, temporary closures of its facilities or of its
suppliers or contract manufacturers could also materially impact results.
Unfortunately, we believe this is just the start: We expect more companies to possibly
preannounce or warn, referencing the new recommendations, and/or “pull” their
guidance for the balance of the year in light of the unprecedented uncertainty.
What’s inside this report…
MedTech COVID-19 takeaways from the Barclays Global Healthcare Conference.
We discuss the American College of Surgeons and U.S. Surgeon General’s
Recommendation to cancel elective procedures.
We review State, Health System, and Hospitals that have taken actions to limit
elective procedures (and other actions that are relevant to Medical Devices
including their commentary regarding building out of new beds).
We review what are elective procedures and discuss product mix of each company.
We review what products could be used in the COVID-19 efforts and the companies
that manufacture such products.
Stock views
We upgraded HRC to Overweight on March 17. We estimate at least 40% of sales
(e.g. the rental beds and legacy Welch Allyn products such as thermometry, patient
monitoring, blood pressure, physical examination) could benefit from COVID-19. In
addition, Hillrom’s acute care frame’s business (20%-25%) could benefit to the
extent there are additional beds added to systems.
We view JNJ and ABT (Overweight) as “beacons of safety” in these turbulent
markets given their diversified businesses, balance sheet strength, and cash flows.
We continue to rate MDT and BSX Overweight as we believe that when the market
returns to fundaments, product cycles should matter again. In the case of MDT, the
company also has a strong balance sheet, cash flows, and a dividend.
INDUSTRY UPDATE
U.S. Medical Supplies & Devices
NEUTRAL
Unchanged
U.S. Medical Supplies & Devices
Kristen Stewart, CFA
+1 212 526 6965
kristen.stewart@barclays.com
BCI, US
Benjamin Weaver
+1 212 526-1961
ben.weaver@barclays.com
BCI, US
Josiah Hannon
+1 212 526 4155
josiah.hannon@barclays.com
BCI, US
Barclays | U.S. Medical Supplies & Devices
17 March 2020 2
CONTENTS
COVID-19: A Pandemic ................................................................................................................................ 3
COVID-19 Takeaways from Last Week’s Barclays Global Healthcare Conference ...................... 3
Since Friday, A Lot Has Changed: American College of Surgeons and Surgeon General .......... 5
A Number of States and Institutions Are Now Following the Recommendation of the
Surgeon General and ACS… ....................................................................................................................... 6
Intuitive Surgical’s 8K “Warning”: Beginning of a Trend? Unfortunately, We Think So… ......... 8
How long could the postponements last? ............................................................................................... 9
What procedures are considered “elective”? .......................................................................................... 9
Our View on Each Company’s Elective Procedure Exposure ........................................................... 11
What About Products Used in the COVID-19 Efforts? ...................................................................... 17
Barclays | U.S. Medical Supplies & Devices
17 March 2020 3
COVID-19: A Pandemic
Coronavirus is a type of virus that has caused an outbreak of respiratory illness that is now
called COVID-19. The virus started in Wuhan, China and is thought to have been linked to a
seafood and live animal market.
On March 11, the World Health Organization declared the novel coronavirus (COVID-19)
outbreak a global pandemic. The last pandemic was the H1N1 flu pandemic in 2009 which
killed hundreds of thousands globally. The most severe pandemic in recent history was
known as the “Spanish Flu” in 1918 which is estimated to have infected approximately 500
million (a third of the world’s population) and killed 50 million.
As of March 16, according to the John Hopkins University Center for Systems Science and
Engineering (JHU CSSE) (link), Coronavirus COVID-19 Global Cases total 182,400 with the
greatest number of cases continuing to be in China, followed by Italy, Iran, Spain, South
Korea, Germany, France, and the United States. As the number of cases continue to grow
globally, efforts are underway to “delay and flatten the curve,” that is to slow the
progression of transmission to allow doctors the time and resources to treat more people
and save more lives.
COVID-19 Takeaways from Last Week’s Barclays Global
Healthcare Conference
Last week, COVID-19 was a key topic discussed at the Barclays Global Healthcare
Conference. (Takeaways: https://live.barcap.com/go/keyword/GlobalHealthcareConf)
Most companies indicated that a slowdown in procedures has been seen in China and other
COVID-19 “hot spots” like Italy, but were just starting to see some postponements in “hot
spot” areas in the US. Below we summarize some of the comments from companies
attending our conference, specific to COVID-19:
Varian (VAR; Not Covered): Varian negatively preannounced on March 9 heading into
our Conference citing that COVID-19 would negatively impact the company’s operating
results, noting that healthcare resources were being prioritized for treatment and
management of the outbreak. Unlike other geographies, management noted that China
radiation treatments were performed inpatient, not outpatient, and it was also seeing
delays in hardware and software installations as well as acceptance and delivery of
interventional oncology procedures. It was starting to see some trends improving in
China though was starting to see some trends weakening in other regions where
COVID-19 was starting to become more of a “hot spot” and it noted if things worsened
in Europe, it could represent incremental risk.
CONMED (CNMD): Preannounced lower 1Q results on March 10 citing COVID-19
noting weaker trends in China, broader APAC, Western Europe, and anticipating
softness in the United States. Management did not update the 2020 guidance, but
planned to do so when it released its 1Q results in April. Management noted that its
Buffalo Filter and AirSeal business was still seeing positive underlying momentum.
Zimmer Biomet (ZBH): Management reiterated its commentary previously made.
Specifically, it noted that China was a little less than 5% of its overall business and that it
was seeing a significant reduction (85%-90%) reduction in elective procedures through
February. It had not seen any significant or material improvement through February and
it expected that at a minimum to continue through March. It noted that it was beginning
to see in Asia Pacific some early signs in some markets, such as Korea, that there
continues to be some headwinds but not to the same scale as China. It was continuing
to monitor trends in EMEA, particularly Europe and some Middle Easter countries.
Management noted that it was starting to see a little impact in the United States but that
it was too early to call what the trends look like.
Coronavirus (COV-19)
Barclays | U.S. Medical Supplies & Devices
17 March 2020 4
Boston Scientific (BSX): Management did not reiterate or update its guidance, which
was in-line with the company’s general intra-quarter policy. That said, management
emphasized that its ability to forecast the impact was challenged at the present time.
Management had earmarked a $10-$40 million headwind at the time of the 4Q earnings
call (Feb 5). It was seeing some glimmers of hope in China and expected delayed
procedure volumes to ultimately return, but noted that the landscape had obviously
changed since February as the virus continued to spread into other geographies.
Medtronic (MDT): Management felt it was still too early to quantify the COVID-19
impact, but planned to provide an update via an 8K close to the end of the quarter.
Management noted the situation remained very fluid. It has seen an impact insofar as
some elective procedures being delayed in regions affected by COVID-19. Specifically,
Medtronic has seen disruption in “virus hotbeds” such as in China (7% of sales), Korea,
Japan, Italy, and Iran. Management noted the evolving situations in Europe and North
America. That said, it is also seeing some recovery take place in China where procedures
are starting to be rescheduled. From a supply chain perspective, Medtronic has worked
with suppliers to minimize disruption, as well as provide related products including
ventilators, pulse oximeters, intubation products, and ECMO machines.
Johnson & Johnson (JNJ): Within its Medical Device business, management noted it was
seeing a “meaningful” impact on elective orthopedic procedures, particularly in COVID-
19 “hot spots” such as China, Japan, South Korea, and Italy. It was also starting to see
some impact on elective procedures in some US hotspots. Management also noted that
more diligence is being done around salesforces’ access to US healthcare institutions,
where it has begun to receive requests to limit its sales organization. In areas where
trends have begun to ease, such as China and broader Asia, management has begun to
see some normalization in procedures, though not yet to the level before the outbreak.
From a supply chain perspective, management noted that previously closed facilities in
China have begun to come back online and are helping to provide critical products to its
customers. Within Consumer, J&J was seeing some stocking across some of its
businesses, notably its over-the-counter business. Within Pharmaceuticals, J&J noted it is
working on developing a vaccine and also working on evaluating several medicines to
see if they could help patients survive or reduce the severity of the disease.
Abbott (ABT): Management did not provide any specific impact on COVID-19 but did
provide some color. Management noted China represents about 8% of overall sales,
and sales are across all of its business units. Abbott has some plants located in China
and the plants are operational. With respect to demand, it noted that within the device
business there are some procedures that perhaps could be postponed temporarily. Our
view is that it seems to be a fluid situation that management is monitoring. To the
extent that there is COVID-19 related revenue weakness, there could be some offsets
and/or the potential for a recovery later in the year.
Teleflex (TFX): Management said it was not seeing any impact on its UroLift franchise
and noted it had already included a $5-$10 million headwind in with its guidance that it
provided on February 20. Teleflex noted that China appeared to be returning back
toward normal but that other countries and regions were now being affected by the
virus and it would continue to monitor the situation.
Hillrom (HRC): Management noted there was no material impact from COVID-19.
Management was seeing some puts and takes across the portfolio and was staying
close to it. Management would give more insights on its F2Q. From a revenue
perspective, management noted it had products that could be used to help treat
coronavirus patients including patient monitoring equipment, respiratory health, and a
suite of products in the ICU. It was also watching its capital business (about 30%-35%
Barclays | U.S. Medical Supplies & Devices
17 March 2020 5
of revenues) for any changes in demand, but had not seen any signs of changes. From a
supply chain perspective, management noted it had suppliers in China and was working
to ensure its ability to meet demand with no material disruption to date.
Avanos (AVNS): No impact so far seen, but evaluating the situation going forward.
From a supply chain perspective, management noted that it does not have much
exposure in China other than NeoMed (a recently acquired smaller business) and those
factories are up and running at present. Management is monitoring the situation
elsewhere as the virus spreads. From a demand perspective, management noted some
products within Chronic Care (i.e. respiratory) could be used in acute cases with COVID-
19. However, in our view management seemed to be thinking more about cases that
could be negatively affected like the ON-Q pump business where 50% is related to
orthopedics or the interventional pain/COOLIEF business—where it is a more elective
procedure. Management noted is not seeing any impact or any trends of physicians
pushing off elective procedures in the US but is closely monitoring trends. Management
plans to release 1Q results in the first week of May and provide an update on the
COVID-19 impact for the quarter and year.
Axonics (AXNX): Management noted no impact from COVID-19 and commented that
it has a higher weighting toward ambulatory surgery center procedures. From a supply
chain perspective, it did not foresee any disruptions.
Masimo (MASI; not covered): Management commented that in flu seasons, it
typically sees a positive impact on its pulse oximetry sensors and to the extent
COVID-19 drives up critical care admissions, it would likely see an increase in sensor
utilization. Management is watching trends and would have to see how it plays out in
the coming weeks and months.
BUT since our Conference…
A LOT
HAS
CHANGED…
Since Friday, A Lot Has Changed: American College of
Surgeons and Surgeon General
On March 13, the American College of Surgeons issued updated “Recommendations for
the Management of Elective Surgical Procedures” which recommend that hospitals and
surgeons thoughtfully review all scheduled elective procedures with a plan to minimize,
postpone, or cancel electively scheduled operations, endoscopies, or other invasive
procedures until we have the passed the inflection point in the exposure graph and we can
be confident that the healthcare infrastructure can support a potentially rapid and
overwhelming uptick in critical patient care needs. This was not too dissimilar from the
CDC’s Interim Guidance for Healthcare Facilities in preparing for community transmission of
COVID-19 in the United States. These guidelines include, among other things, rescheduling
non-urgent outpatient visits, rescheduling elective surgeries, shifting elective urgent
inpatient diagnostic and surgical procedures to outpatient settings when feasible.
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