Generate an explanation for the given claim using the provided supporting material from the paragraph. Please consider the following points while generating an output. 1) The claim will always have supporting proof in the paragraph, and the paragraph will have a clear point of view supporting the claim. 2) There can be instances where direct correlation to the claim is not available. Make use of the sentences in the paragraph to provide a corresponding output supporting the claim. 3) The explanation should be at least one and at most twelve sentences long.

Ex Input:
Paragraph: In its latest “report card,” the American College of Emergency Physicians said such reduced access earned the nation a “D+” — that’s down from the overall “C-“ grade from the group’s last report in 2009. Shortages and reduced hospital capacity make it more difficult to access emergency care, the group said. It also warned about the impact on disaster preparedness. While the report does not measure the actual quality of care provided, it does offer a snapshot of national and state policies affecting emergency medicine as seen by providers. Washington, D.C., was ranked the highest in the report, earning a “B-“ grade, while Wyoming ranked last and was the only state to earn an overall failing grade of “F.”  The group’s task force looked at scores of measure in five major categories — access to care, quality and patient safety, liability, injury prevention and disaster preparedness — and relied on data from the Centers for Disease Control and the Centers for Medicare and Medicaid Services, among others. The report comes just as the Affordable Care Act, known as Obamacare, comes into full effect this year. The 2010 law aims to expand access to health insurance and reduce the nation’s healthcare costs, but it has become a political flashpoint amid a troubled rollout of the federal insurance exchange website. While the physician’s report does not factor in all of the effects of the law — its grades are based on data from early 2013 — emergency rooms could be used even more as more Americans gain insurance coverage under Obamacare, it said. Some health experts have predicted that increasing the number of insured patients should reduce pressure on hospital emergency rooms because access to regular doctor care will improve, something that is hoped would prevent chronic conditions from spiraling out of control or help catch other problems before they worsen. But insurance coverage could also lead those who might have held off going to the emergency room to seek care, said Jon Mark Hirshon, an emergency medicine doctor and researcher at the University of Maryland who oversaw the group’s report card. Newly insured people also may have a hard time finding a regular doctor who accepts their plan, he said. “On top of that, emergency departments are open 24 hours a day, seven days a week. If I have a primary care provider but it’s 9 o’clock at night on a Friday and they’re closed, then people come to the emergency department,” Hirshon told Reuters. The group is asking for congressional hearings to probe whether the law puts “additional strains” on emergency rooms. Already, beds for patients have fallen from a rate of 358 per 100,000 people four years ago to about 330 beds per 100,000 people now, the report said. Wait times have increased to a median of 4.5 hours compared to four hours in 2009. Despite the dismal U.S. grade given by the group, it noted that policies and infrastructure varied widely by state. States with the best emergency care include Massachusetts, Maine, Nebraska and Colorado, while Kentucky, Montana, New Mexico and Arizona rounded out the bottom, just above Wyoming. States are also still grappling with the uninsured. By law, hospitals must provide emergency care regardless of patients’ ability to pay. Under Obamacare, states can expand access to Medicaid, the federal-state health insurance plan for the poor. Data shows that Medicaid patients use emergency rooms as much as other insured patients, but several recent studies have shown that Medicaid patients utilize them more than the uninsured. One study this month showed Oregon patients given Medicaid through a lottery increased their emergency room use by 40 percent compared to those not offered Medicaid. “We have to be leaner and more efficient, but it just becomes more and more challenging,” Hirshon said. Claim: Doctors say pressure on ERs may rise, give U.S. failing grade.

Ex Output:
People seeking urgent medical could face longer wait times and other challenges as demand increases under Obamacare, U.S. emergency doctors said in a report on Thursday that gives the nation’s emergency infrastructure a near failing grade.


Ex Input:
Paragraph: “The woman had experienced symptoms and was later hospitalised” before succumbing to the illness, said Ibrahim Melhem, a spokesman for the Palestinian Authority, which has limited self-rule in the West Bank. The woman was from Bidu, a Palestinian village north of Jerusalem and southwest of Ramallah, Melhem added. There are 62 confirmed coronavirus cases among Palestinians in the West Bank, and two in the Gaza Strip. Claim: Palestinians report first death from coronavirus.

Ex Output:
The Palestinians reported their first death from the coronavirus on Wednesday, a woman in her 60s who lived in the Israeli-occupied West Bank.


Ex Input:
Paragraph: China’s Zhejiang Huahai Pharmaceutical (600521.SS), which produces bulk ingredients for drugmakers, told its customers in late June it had found NDMA in its valsartan, an off-patent blood pressure drug originally developed by Novartis (NOVN.S). The discovery means that some of the 10 billion pills containing valsartan sold worldwide last year to prevent heart attacks and strokes had traces of N-nitrosodimethylamine (NDMA), classified as a probable human carcinogen. No one has been reported as sickened by the toxin, once used in the production of liquid rocket fuel. Regulators and industry experts say the toxin almost certainly was introduced when Huahai changed the way it produced valsartan in 2012 - a modification that was signed off on by the European body that sets standards. Subsequent inspections by European, U.S. and Chinese regulators also found no problem. “Everyone failed – the company, the inspectors, the FDA (U.S. Food and Drug Administration), the Europeans, the Chinese,” said Philippe André, an independent pharmaceutical auditor who inspected two Huahai facilities last August and found no critical concerns. “It’s a system failure.”  Reuters was unable to determine how Huahai first discovered the problem. In a July 7 statement released through the Shanghai Stock Exchange, it said it detected the toxin during the “optimization and evaluation” of its manufacturing process. A Novartis spokesman told Reuters that its generic drugs arm, Sandoz, spotted the NDMA in the course of intensive testing to prepare for expanding its purchases of valsartan. He declined to comment further, including on the identity of the manufacturer or when the tests took place. Two other smaller bulk suppliers - Zhejiang Tianyu Pharmaceutical 300702.SZ and a unit of India’s Hetero Drugs - have since also discovered traces of NDMA in some of their valsartan. The three companies declined to comment to comment about the case. For a graphic on heart drug widely used, click tmsnrt.rs/2KnaxAx  Huahai said in a document released through the Shanghai Stock Exchange it changed the production process to reduce waste and improve yields. “The NDMA impurity was produced in trace amounts during the normal manufacturing process according to the company’s current registered process,” it said in a statement on July 24. “All changes in the company’s valsartan manufacturing process have been approved by each country’s drug regulator, and the company manufactures in compliance with legal and regulatory standards.”  The European Medicines Agency (EMA) regulator, which first publicly raised the alarm in a statement on July 5, told valsartan suppliers in a subsequent memo dated July 16 that the NDMA may have been connected to the combined use of the solvent dimethylformamide and sodium nitrite. The FDA is also going on that hypothesis, said Janet Woodcock, director of its Center for Drug Evaluation and Research. She stressed the investigation was still going on. “This (NDMA) was not what you look for in an inspection,” Woodcock said in an interview. “If you don’t test for this you’re not going to have an idea that it’s in there, and you’re not going to see it on an inspection.”  The European Directorate for the Quality of Medicines (EDQM), responsible for setting manufacturing standards, told Reuters it was aware the solvent was being used when it approved the changed process, but that NDMA as a by-product was unexpected and not tested for. Detecting NDMA would have required gas chromatography coupled with mass spectrometry, a very sensitive level of testing, an EDQM spokeswoman said. “These techniques are not normally used routinely to test pharmaceutical products,” she said. Built by Novartis into the $6 billion-a-year brand Diovan, valsartan’s European and U.S. patents expired in 2011 and 2012. Global sales totaled 10.4 billion pills last year, including combination products, healthcare data consultancy IQVIA estimates. People with high blood pressure typically take one pill daily and heart failure patients two. More than 50 companies around the world making finished tablets from the tainted valsartan have recalled products in recent weeks, according a Reuters analysis of national medicines agencies’ records. They include major generic drug manufacturers such as Teva Pharmaceutical Industries (TEVA.TA), Ranbaxy Laboratories and Sandoz. Based on the average NDMA impurity detected at Huahai of 60 parts per million (ppm), the EMA says there could be one additional case of cancer in every 5,000 people taking the highest dose for seven years. The contamination puts a spotlight on manufacturers in China and India, which supply more than two-thirds of all active pharmaceutical ingredients used in medicines, industry executives estimate. China accounts for the lion’s share. Huahai, founded in 1989 and listed in Shanghai in 2003, was one of the first Chinese companies to get drugs approved in the U.S. market. The FDA has inspected the site that made the contaminated valsartan three times since 2010, its records show. European inspectors also visited regularly. The provincial branch of the Chinese FDA (CFDA) also inspected Huahai facilities 10 times in connection with new drug applications between January 2016 and June 2018, the national online database shows. U.S. and European regulators have increased scrutiny of  Chinese and Indian drug factories after the adulteration of the blood thinner heparin sickened hundreds and caused the deaths of at least 81 Americans in 2007 and 2008. The CFDA is also on alert. Last month, it revealed that Changsheng Bio-technology 002680.SZ, a vaccine maker, had fabricated data and sold ineffective vaccines for children. It also found that a diphtheria, tetanus and pertussis vaccine sold by the state-owned Wuhan Institute of Biological Products was substandard. The fact that international inspections do not appear to have detected the NDMA contamination alarms Anders Fuglsang, a former European medicines regulator who runs a pharmaceutical consultancy in Denmark. “We need to ask ourselves how it is possible - despite  pharmacopoeias and agency guidelines, inspection programs with coordination across continents, a system of public quality control, and companies complying with all rules - that a nasty carcinogen can find its way into our drugs and be there for years without anyone noticing,” he said. Claim: Toxin at heart of drug recall shows holes in medical safety net.

Ex Output:

A toxin inadvertently produced in the manufacture of a widely prescribed medicine but not spotted for years raises questions about regulators’ ability to detect risks in a sprawling global drug supply chain increasingly reliant on factories in China.