Personal protective equipment, or PPE, include masks, goggles, gloves and face shields, is a mandatory requirement for all health workers screening, testing or treating people for the virus. Both doctors and manufacturers have flagged the issue of dwindling PPE supplies.
“We cannot afford to have our doctors and nurses contracting the virus at this juncture as there is a shortage of medical personnel to treat the infected,” said Dr U.S. Vishal Rao, chief of head and neck oncology at Bengaluru’s HCG Cancer Centre and member of the consultative group to principal scientific advisor, government of India. “We need to ramp up supply of PPE on a war footing. They must be changed daily, and therefore numbers matter.”
Manufacturers said the challenges to ramping up production include export and import restrictions because of the pandemic, the ongoing lockdown, and the centralized procurement process through a single government agency.
“The delay in procurement of PPE has already irreversibly jeopardized the public health response to Covid-19,” said Malini Aisola, co-convenor, All India Drug Action Network. “While some positive measures are being initiated, there is still no concerted effort on the part of the government to address the PPE shortages.”
State-run HLL Lifecare has been designated as the government’s sole procurement agency for PPE kits. It has floated a global tender for procuring PPE kits, including coveralls, goggles, N95 masks, gloves, face shields, triple- layer surgical masks, digital infrared thermometers and thermal scanners.
“Having alienated several domestic manufacturers, HLL has now put out a global tender for procuring PPE components,” Aisola said.
HLL Lifecare declined to comment, directing the queries to the health ministry.
However, worldwide, governments are looking to procure more PPE, and imports will be hard to pull off. WHO has so far shipped nearly half a million sets of personal protective equipment to 47 countries but supplies are rapidly running out everywhere. Based on WHO estimates, the world needs about 89 million medical masks and 76 million examination gloves for Covid-19 response every month.
“The government has divided the country into four zones for procurement of PPE but a single zone itself is so large that supply from one place to another by road or rail will take a long time. As of now, the PPE procured will only be supplied to central government hospitals,” said Sanjiv Relhan, chairman of Preventive Wear Manufacturers Association of India. “The manufacturer bodies have been asking the government to allow retail sale of face masks only on prescription or only to those who have been in contact with the infected. In this way, we can save a lot of face masks for healthcare workers. They didn’t do it,” said Relhan.
Doctors say the government banned the export of PPE three weeks too late. A notification was issued only on 19 March, despite the WHO guidelines on 27 February advising all countries to stockpile medical equipment. “By then, the virus had already entered India and huge supplies of PPE continued to leave the country. It is imperative that deadlines are set for manufacturers to ready required stock so that our doctors and frontline health workers are protected,” said the chairman of a prominent hospital chain.
NATHEALTH Healthcare Federation of India, a forum that liaisons between government and private hospitals, in its meeting with NITI Aayog last week submitted a list of 50 essential PPE to tackle the mounting cases. “Of all the challenges we are facing, supplies of PPE is the most difficult to solve as the global supply chain is heavily disrupted. If testing should be ramped up during the 21-day lockdown to prevent a surge, we must have adequate PPE to restrict infection rate. We have conveyed this to the government,” said Siddhartha Bhattacharya, secretary general, NATHEALTH.
Amid growing concerns of PPE stocks running out fast, NITI Aayog has launched a 100-day emergency plan. It will analyze data on available resources, from manpower to PPE, and projections on the increasing requirement, and prepare for the next three months. “We are trying to talk to people from across the spectrum, including retailers and manufacturers, to gauge the challenges they are facing, and the issues that might need escalation at the central level,” said a NITI Aayog official.
Raising concerns about the quality of PPE, Dr Nandakumar Jairam, chairman and group managing director of Columbia Asia Hospitals, said: “Poor quality PPE will defeat the purpose of wearing them. The best brands come from abroad, which could be a challenge in these times. While we are comfortable now, we must be proactive and prepare to meet demand in the coming weeks.”