PPE shortage throws doctors out of gear

Desperate times call for desperate measures. Faced with a shortage of personal protection equipment (PPE), India’s healthcare workers — the front-line fighters against Covid-19 — have been reduced to using raincoats and garbage bags instead. The World Health Organization (WHO)-recommended standard protection equipment such as N95 masks, PPE kits and surgical masks are in short supply, even as the number of infected people grows exponentially. Healthcare workers have been drawing attention to the shortage on social media and through professional bodies.

The healthcare workers are tending to infected persons at immense personal risk. In the Capital alone, 108 of them were quarantined after exposure to patients who initially complained of other ailments but tested Covid-19 positive. Wockhardt Hospitals in Mumbai was cordoned off last week after 40 nurses who came in contact with a patient admitted for a heart surgery tested positive for Covid-19.

Such lapses aren’t merely a health risk, they severely deplete the staff strength at hospitals. The Union health ministry has issued guidelines on the grades of protection that need to be made available to healthcare workers. Those attending to a Covid-19 infected patient require a PPE kit, which includes goggles, face-shields, masks, gloves, coveralls or gowns (with or without aprons), head and shoe covers. It also issued guidelines to hospitals and medical staff to use the protection equipment judiciously.

Dr Srinivas Rajkumar, general secretary of the Resident Doctors’ Association at the All India Institute of Medical Sciences (AIIMS), Delhi, draws attention to the shortage at the premier hospital. “We have been protesting the non-availability of PPEs and masks at AIIMS ever since infected patients began coming in,” he says. Dr Rajkumar explains the complexity of the situation: “The issue is that while isolation wards may have been equipped with masks and PPEs, the emergency department has to make do with whatever is at hand. Yesterday, a patient with a bleed in the brain came to the hospital only for us to find out that he was Covid-19 positive. Whoever was on duty had to be quarantined for 14 days. This puts additional stress on our front-line healthcare workers. It is akin to sending soldiers to war armed with lathis instead of proper ammunition.”

The association has written to the prime minister for adequate supply of PPEs and masks, but is yet to receive a response. The AIIMS administration has issued a circular stating that everyone involved in direct patient care would be provided with an N95 mask. Healthcare workers were, though, instructed to reuse the masks after disinfecting them. Resident doctors point to another circular that advises against the reuse of PPEs.

Meanwhile, doctors in Andhra Pradesh report the enactment of ESMA (Essential Services Maintenance Act), which empowers the police to issue a warrant against doctors who refuse duty citing shortage of PPEs.

Pawan (name changed), a Hyderabad-based doctor, says, “While every hospital administration says they’re prepared, the truth is that no one had stockpiled for this emergency and we are facing an acute shortage. A week ago, Telangana had less than 20 Covid-19 patients and now we have over 400. While the chief minister announced that 1.5 lakh PPEs were being made available, the ground reality is that we don’t have the supply yet. As a result, doctors are exposed and working 14-day shifts followed by 14-day quarantine.”

Healthcare workers who highlight the risks do not have it easy. Dr Indranil Khan, an oncologist based in Kolkata, who had drawn attention to the PPE shortage in government medical colleges on Twitter, was questioned by the police and slapped with an FIR. “I had to go through the ordeal of petitioning the High Court for reporting the sorry state of my colleagues. No one is criticising the government, everyone wants the best in this situation. If we don’t protect our front-line workers, how are we going to be able to battle the pandemic?”

Even as government hospitals struggle to get protection equipment, partly due to the price-capset on procurement, the black market continues to thrive. Says Dr Rajkumar, “Private hospitals have been successful in acquiring kits for their staff since they don’t have to comply with price capping. Government hospitals face the brunt of the shortage, but most patients come here as these are the centres designated for Covid-19 patients.”

Last week, doctors of Safdarjung Hospital in Delhi put up a notice asking for donations of PPE kits, masks and sanitisers.

Dr Sunil Chugh, cardiologist and private practitioner in Udaipur, Rajasthan, says that in these difficult times, medical equipment such as ventilators and protection kits have to be acquired at sky-high rates to protect staff. “The products are being sold at triple to 10 times the cost in the black market. As we struggle to bear the cost at a time when earnings are low, members of the general public have begun acquiring these items, adding to the shortage.”

During a press conference, Lav Agarwal, joint secretary in the health ministry, addressed the shortage of protective equipment and claimed that supplies were easing up. “We’ve discussed this with all health secretaries, chief secretaries and DMs as this is one of the major issues. We’ve explained to them that PPEs available with us have already been dispatched to states based on case-load, ” he held. The country had enthusiastically responded to the prime minister’s call to applaud the brave work done by front-line healthcare workers. The ground reality is far from ideal though.

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