COVID-19: Can we win a war without weapons?

• It is high time to prioritise the protection of Frontline Health Workers to combat COVID-19  

Healthcare workers in the country are facing ‘heat’ while fight novel coronavirus COVID-19. The governments have provided them with insurance cover and expect them to deliver the best for treatment and care of COVID-19 patients. The main challenge before them is to protect them against the infection and take care of patients as well.

It was heard in recent past that doctors were told to treat patients without protective gears because they have been given adequate insurance coverage. This could have been an isolated case but it reflects the state of affairs while dealing with a pandemic. Are we expecting our Warriors to go to war without weapons?  

The COVID-19 pandemic is rapidly spreading across countries and has caused severe disruption to the global supply of personal protective equipment (PPE). We are witnessing rising demand and even panic buying for hygiene, immunity boosters, and antiviral products in the country.

The World Health Organisation (WHO) has recommended standard protection equipment which includes the N95 masks, PPE kits and surgical masks for all the health workers across the globe.

With COVID-19 cases soaring, doctors, nurses and other frontline medical workers across the country are confronting a shortage of masks, surgical gowns and eye gear to protect them from the virus. All the health workers are relying on PPE to protect themselves and their patients from getting infected.

The limited access to supplies such as gloves, medical masks, respirators, goggles, face shields, gowns, and aprons shortages have left all the doctors, nurses and other frontline workers dangerously ill-equipped to care for COVID-19 patients. The risk to healthcare workers around the world is real.

It is a critical situation for everyone but it is also highly important for the Industry and the governments to act quickly and boost supply import and export restrictions should be eased and put corrective measures in place to stop speculation and hoarding.

According to estimates, approximately 89 million medical masks are required for the COVID-19 response each month. For gloves, that figure goes up to 76 million, while international demand for goggles stands at 1.6 million per month. Therefore, the prices for all the healthcare equipment’s or PPE have surged and have seen seven to ten-fold increase. Prices of medical equipment such as ventilators and protection kits have been sky-rocketing.  

Healthcare workers at risks  

The problem which hospitals are facing is the isolation department may have equipped masks and PPE but the emergency department is struggling with the equipment. There have been many cases where a patient with different problems get admitted to the hospitals but were found positive with COVID -19 and in such cases, whoever is on duty has to be quarantined for 14 days which further makes the healthcare workers go into stress or anxiety. Such situation have led to several doctors and nurses tested positive with COVID-19.

Even though every hospital is saying they are prepared to face this situation but the fact is that we are facing an acute shortage of these PPEs. The ground reality is that the hospitals are not getting enough or don’t have supplies at all and as a result doctors and other health workers are exposed and working 14 – day shifts followed by 14-day quarantine.

No doubt, the government has been taking necessary measures to deal with the shortage. But it’s also important to take quick action of boosting the supplies as everyone wants the best in this situation. They need to understand if we don’t protect our frontline health workers than it would difficult to win this battle against pandemic together.

PPE manufacturing has to be taken as an emergency where the entire state machinery has to come together and passes have to be given to factories and their workers so they can move easily. Ensuring supplies to all the remote corners of the country is also one big challenge.

Optimization of supplies

Many hospitals in India made hand sanitizers based on WHO guidelines and plastic face shields as an alternative of PPE while they look after COVID-19 patients due to the shortage of PPE in the hospitals.

It is important for healthcare providers to carefully prioritize PPE use. There should be a defined SOP for the appropriate requirement of PPEs in areas like OPD, A&E, ICU, Wards and OTs. Full set of impermeable PPEs including Cap, Goggles, Impermeable Gown, Gloves and Three ply/N95 respirator should be used in critical care areas and where there is a possibility of generation of aerosols while doing a procedure in A&E, ICU or OT. Other areas could have a  more optimized set.

Healthcare providers should maximize the use of engineering controls, such as barriers and maintained ventilation systems, and administrative controls, such as altering work practices to minimize patient contacts. Use re-usable PPE that can be reprocessed as per defined SOPs approved by the Infection Control Department of the hospital.

In the given circumstances, it is very critical for the country to avoid dependence on other countries for PPE and other protective gears. Our experience with China concerning the import of PPE or testing kits resulted in a fiasco. Initially, India had started looking at importing PPE, N95 masks and ventilators to meet its requirements. Most of the procurement that India was looking at was from China and other South-East Asian countries.

It is time to ramp up our domestic manufacturing capacity of PPE. It is promising to note that several Indian companies have come forward to start manufacturing protective gears.

Several industrial hubs in the country have also geared up to meet the growing demand. Hopefully, we would catch up but for that union Ministries of Health and Family Welfare, Textiles, and the Department of Pharmaceuticals need to work in unison with industry bodies, stakeholders and manufacturers to streamline the supply chain and remove all bottlenecks for enhanced production of PPE. Such measures would also provide a major push to ‘Make in India’ program amid the halted economic activity in the nation in the light of the lockdown imposed to contain the spread of COVID-19.

Growing demand and the shortage also call for urgency and speed. To meet the requirements of PPE, masks and ventilators, manufacturing units producing essential items need to work round the clock to produce PPE for medical personnel. Meanwhile, we also need to train our health workers to take all necessary precaution and be fully prepared for emergencies while dealing with COVID-19.