Doctors and other healthcare workers have been fighting the battle often without the essential Personal Protective Equipment (PPE). Worse, until a few weeks ago and long after the world started seeing the onset of the pandemic, there was no ban on the export of masks, sanitizers, etc.
While India continues with its 21-day lockdown to combat the Coronavirus pandemic, one issue that has emerged is the woeful lack of preparedness of the country in facing up to such a crisis. Unprecedented in the last 100 years this may be, but the SARS-CoV-2 virus pandemic risks exposing the rot in India's public health infrastructure.
Doctors and other healthcare workers have been fighting the battle often without even the basic Personal Protective Equipment (PPE) that is deemed essential. Worse, until a few weeks ago and long after the world started seeing the onset of the pandemic, the Union government was permitting the export of masks, sanitizers and other protective equipment such as gloves.
In India there is a problem with both the quantity and the quality of PPE available. While the government has floated a tender asking for urgent supplies, the quantities are nowhere near to likely being enough in case of a spread like in some of the worst-affected countries. Also in many cases staff are having to make do with single-layer protection against the stipulated double-layer protection recommended. N95 masks are in short supply, leading to the surgical masks or the 3 ply masks being widely used.
To be fair to the government, the shortage of PPE is a global problem that countries with far better health infrastructure, such as the United Kingdom and the United States, have also been facing. The Centre for Disease Control (CDC) in the US went as far as to suggest that as a last resort staff could use scarves or bandanas if they were out of masks. The COVID-19 crisis could scarcely have been anticipated on this scale, but for sure the central government could have acted sooner.
What is intriguing is that the government tightened the export norms on PPE on January 31 and then relaxed them eight days later to permit the export of surgical masks and gloves, and again eased them even further in late February to also allow export of some other items such as non-woven shoe covers etc.
The World Health Organization (WHO) sent a guidance note to countries on February 27, warning them of a disruption to the global supply chain for PPE and giving recommendations for optimising the availability of PPE. This seems to have been largely ignored. Lav Agarwal, the Joint Secretary in the Ministry of Health, said that they had not received any such advisory and went as far as calling it “fake news”. Only on March 19, a good 20 days after the WHO guidance note, did the government ban the export of all PPE. Until then India was exporting surgical masks and gloves even as coronavirus cases increased steadily and hospitals faced a shortage. It will be interesting to see which companies were exporting these until the day exports were banned, and it also needs to be probed if these companies lobbied to ease the restrictions imposed on January 31.
Prime Minister Narendra Modi in his address to the nation mentioned that the government was making efforts to provide PPE to healthcare staff, perhaps a tacit admission that there was a short supply. The Resident Doctors Associations (RDAs) of various hospitals across India have raised the issue repeatedly. With the incidence of COVID-19 infections among healthcare workers being reported to be 6-10 percent in some of the affected countries, they have every reason to be worried.
Right now every available source has been put to work to manufacture PPE in India. Companies such as 3M have promised to help by increasing production. However, in many cases the unorganised sector is being used to stitch masks and body suits. Recently, a television channel carried a story on how these ‘masks’ were being manufactured in the most abysmal conditions without following any protocols raising serious questions about their efficacy.
Over the next few weeks we shall know to what extent our healthcare system can cope. The countrywide 21-day lockdown itself was necessitated in part because of the present condition of public health infrastructure in India, which is pretty much on the verge of collapse in many states. The only hope is that thanks to the lockdown and other measures we can flatten the curve sufficiently to ensure that the already tottering system is not overwhelmed.
Meanwhile, spare a thought for those brave healthcare workers putting their lives on the line with the barest minimum of protection. They are operating on a wing and a prayer. Hopefully their prayers will work.Sumanth Raman is a doctor (internal medicine), a Chennai-based television anchor and political analyst. Views are personal.