On Tuesday, weary of the monumental challenges that the novel coronavirus pandemic may create for India’s stretched public health system, Prime Minister Narendra Modi announced a lockdown across the country, in the central government’s latest move to halt the spread of the virus. With the number of reported cases of the infection continuing to grow steadily, amid grave concerns that India may have already reached the ‘community transmission’ stage, it is India’s healthcare workers who are at the very frontline of the pandemic.
Now, in the latest setback, doctors, nurses and health workers in some hospitals have expressed concern over the lack of PPEs required to keep them safe. From private hospitals in Pune to medical centers in Uttar Pradesh, resident doctors are growing increasingly anxious over the level of vulnerability they may face in treating patients. The Resident Doctors’ Association (RDA) of the All India Instiute of Medical Science (AIIMS) in Delhi, earlier this week, wrote a letter to its director stating that some doctors were forced to attend to patients without the requisite personal protective equipment (PPE), also calling for the immediate procurement of PPEs.
PPEs critical for effective care
The news is extremely worrying especially within the context of reports stating that over 3,300 Chinese doctors, nurses and other healthcare staff had become infected while treating patients in Mainland China, primarily due to a lack of equipment. PPEs refer to all equipment required for professionals who come in close proximity to or treat infected patients without risking their own safety. For healthcare workers, this amounts to medical masks, respirator masks (N95), medical gowns, gloves, aprons and eye protection in the form of face shields or goggles. For cleaners, this also includes heavy duty gloves, boots and advanced eye protection.
The World Health Organisation provides detailed guidance on the procurement and use of PPEs, and the need to use ‘PPE forecasts that are based on quantification models to ensure the rationalisation of requested supplies.’ A single PPE kit cannot be washed, and must be disposed off once it has come into proximity with an infected patient. The WHO published its guidelines on 27 February, yet, according to some reports, the central government only issued a notification banning the export of indigenously produced PPEs on 19 March.
Underprepared and vulnerable?
Just one day after India recorded its first case of the novel coronavirus (30 January), the directorate general of foreign trade issued a notice prohibiting the export of all PPE. However, that order was bizarrely amended on 8 February, to allow for the export of gloves and surgical masks. These sanctions were further relaxed on 25 February to include 8 other items. Now, with India looking at, perhaps, one of its largest healthcare crises in its history, it appears India seems underprepared to shield its healthcare workers from the virus itself.
The situation seems compounded by reports that HLL Lifecare Limited, the public sector enterprise tasked with procurement of all PPEs for central and state hospitals, had delayed placing orders for the requisite PPEs. HLL,itself, does not manufacture any PPEs, but has been assigned to assemble equipment into kits that can then be distributed to hospitals.
It goes without saying that if India’s brave healthcare workers – the ones that country is relying on to carry it out of the crisis – are not adequately supported with the resources required, the threat of an “avalanche,” as described by some health experts, may be far greater than first imagined.-Times Nownews