Protective gear shortage makes Indian health workers vulnerable to coronavirus

Medical staff with protective clothing are seen inside a ward specialised in receiving any person who may have been infected with coronavirus, at the Rajiv Ghandhi Government General hospital in Chennai, India, on Jan 29, 2020.
Medical staff with protective clothing are seen inside a ward specialised in receiving any person who may have been infected with coronavirus, at the Rajiv Ghandhi Government General hospital in Chennai, India, on Jan 29, 2020.PHOTO: REUTERS

BANGALORE - The 32-year-old doctor coughed through his sentences during our phone call.

"For eight days, five of us screened over 250 patients a day for coronavirus, but we were not given any protective gear. Now I have developed symptoms, and am in quarantine," he said.

In India, and according to World Health Organisation (WHO) guidelines, protective gear for medical professionals and health workers include coveralls, three-layer or N95 masks, gloves, and goggles.

The senior resident in a government hospital that is one of the Covid-19 centres in New Delhi, said his team wore only surgical masks and latex gloves.

According to the United States' Centres for Disease Control and Prevention, surgical masks do not provide as much respiratory protection as an N95 respirator.

As the number of patients grew, the doctor's team requested "at least proper masks because we were under constant threat of being infected one day".

"But the medical superintendent at our hospital told us that people will panic if doctors are in full suits or wearing masks. When we argued, he said he didn't want to waste the kits on us.

"He said 'What if we run out of N95 masks? What will we do in the isolation wards in the future?'" said the doctor, who declined to be identified.

"This is true of all (19 government) hospitals across Delhi (screening suspected Covid-19 patients). Either they have run out of it or they are not giving it to doctors because they have a shortage," said the doctor.

On Sunday, he and another doctor on the team developed a fever, cough and cold - symptoms of a possible coronavirus infection. "I was to report back to work on Monday, but I decided to go on a self-imposed quarantine for 14 days," the doctor said.

He has not been tested. Due to capacity shortages, India tests only people with a travel history, as well as high-risk contacts of Covid-19 positive cases.

 
 

Any health workers showing symptoms are only quarantined.

The nurse and orderlies on the team did not show symptoms, but the hospital asked them to go on leave for a week.

Even as thousands of Indians responded on Sunday to Prime Minister Narendra Modi's appeal to clap and clang metal plates to thank medical workers in the "front line of the coronavirus crisis", medical staff across the country are working without basic gear to protect them from the virus.

The resident doctors' association at the premier All India Institute of Medical Sciences, New Delhi, wrote to the Ministry of Health and the Delhi government, highlighting shortages of protective gear and masks.

India now has more than 600 positive Covid-19 cases and at least 14 deaths.

On Tuesday, the Indian government imposed a 21-day nationwide lockdown, ordering people to stay home and shutting down all public transport, markets and private businesses.

Facing a crisis like no other, and with no international help, the Indian government is trying to address the shortages that were unexpected and unplanned for.

 
 

A central agency procuring protective gear has placed an order for 725,000 body-coveralls, six million N95 masks and 10 million three or two-ply face masks for the entire country, but experts estimate the requirement might soon be many times that.

There is no official estimate of the total ventilators in India, but Brookings Institution calculates it is no more than 57,000, and estimates India needs 110,000 to 220,000 by May, for the 5 per cent of positive cases expected to be in intensive care.

India might rally car manufacturers like Mahindra and Tata Sons to make the ventilators with local manufacturers. As India is in Stage 2 of transmission, the widening gap, however, is in protective gear.

All the doctors this reporter spoke to requested anonymity. "One resident nearly got suspended for tweeting to the Health Minister about protective gear shortages," said a doctor in Chennai, Tamil Nadu.

At the renowned Stanley Medical Hospital in Chennai, he said postgraduates and interns were given nothing but surgical cloth masks.

"These young people are facing the brunt of it, but are not given protective gear. They're sent into the ward without being told if patients are positive, or have been tested," said the Chennai doctor.

Health experts say that India is acutely short of protective gear because the Indian government did not stockpile them even though WHO guidelines on Feb 27 advised all countries to do so.

 
 

At a press briefing on Monday (March 23), the Health Ministry's joint secretary Mr Lav Agarwal said that he was not aware of any such guidelines. "Where is this WHO report where India was advised to take these steps?" he said.

While India's Ministry of Textiles blocked the export of N95 masks and coveralls on Jan 31, it lifted the ban from Feb 8.

It was only on March 19 that India banned the export of protective gear and all the raw materials that go into making the gear.

Protective gear manufacturers in India have been e-mailing the government since February about "a flood of queries" for masks and coveralls, and requesting officials to quickly issue standards.

The government subsequently appointed the state-owned HLL Lifecare to centrally coordinate procurement of gear and assemble them into full kits before sending them to hospitals.

HLL first said it had ordered the required equipment, but when the country's leading manufacturers' body said that only a few of them had been approached, HLL floated a tender.


A paramedic staff member enters a newly setup isolation ward for the people who suffer symptoms of coronavirus, at a hospital in Kolkata, India, on March 25, 2020. PHOTO: REUTERS

Protective gear manufacturers will not have to apply through the tender.

Mr Rajiv Nath, founder of the Association of Indian Medical Device Industry who has been in meetings with the Prime Ministers Office and Health Ministry, told the press: "Some companies got orders through e-mails, some have to apply through a tender.

"It's too confusing. And during an emergency, all this is too time consuming."

"Without stockpiling protective gear, and blocking exports, it is already too late, but even now, this long drawn out tendering process has prevented production from beginning at the scale we need," said Ms Malini Aisola, co-convenor of the All India Drug Action Network (Aidan).

"The specifications announced for coveralls are also unnecessarily stringent, and only two or three manufacturers will qualify to make them," added Ms Aisola.

The Ministry of Health says coveralls must have "taped seams", which the relaxed WHO guidelines of Feb 27 do not insist on, because Covid-19 is not an airborne disease.

Another source of delay - the textile ministry also requires fabric makers for masks and coveralls to test their samples in a lab before selling.

There are about 100 local manufacturers of protective gear in India, but few have the inventory to scale up at short notice. Unless demand and the standard specifications are clearer, manufacturers say they will not be able to buy raw materials and produce quickly.

What bureaucracy delays, the lockdown is bringing to a halt.

Mr Sanjiiv Kumar, the chairman of the Preventive Wear Manufacturer Association of India said the ban on interstate travel, transport and private factory operations were huge roadblocks.

While masks and coveralls are part of essential goods, their raw materials are not; the police stopped trucks carrying fabric and elastic to the factories.

"This is a 100 percent manual sector, and only a handful of workers are able to reach factories because there are no buses and trains, and police also sends them home," said Mr Kumar. Without courier services, fabric makers have not been able to send their samples for testing either.

Manufacturers want the government to relax specifications, and replace the centralised tendering process with rate contracts for emergency production and supply.

"If not, the small and medium-sized enterprises will start bypassing the central agency, make non-standard garments and supply to the state hospitals directly to meet the rising demand.

"More people could get infected!" said Mr Kumar.

Aidan and other public health groups have requested the Prime Minister's Office to stop centralised acquisition, and start testing all symptomatic healthcare workers.

On Wednesday, the Finance Minister announced a 1.7 trillion rupee ($32.5 billion) economic package promising, among other things, rations and cash transfers for the poor, and for over 2.2 million medical workers, an insurance cover of five million rupees if they "meet with an accident".

"First, care enough to give us gear to protect ourselves, that's all I ask," the doctor said.