PM Said 2 Lakh PPEs a Day, But Quality Remains a Problem: Docs
We are producing enough PPE kits, but is this enough to protect our healthcare workers? No, say doctors and experts.
Doctors, nurses, technicians and allied workers have long complained about a lack of personal protective equipment or PPEs.
At 8 pm, on Tuesday, 12 March, Prime Minister Modi announced that India was finally indigenously manufacturing about 2 lakh PPE kits and 2 lakh N-95 masks every day.
FIT spoke to manufacturers, healthcare workers and NGOs working on the ground to find out what’s really going on.
More than 2 Lakh PPEs and Masks Per Day Say Manufacturers - But Issues Persist
We reported early last month, during Lockdown 2.0, that PPE deliveries got off to a rocky start.
Sanjiiiv, the Chairman of the Preventive Wear Manufacturers Association of India (PWMAI), told us that the 2 lakh figure is conservative, adding,
“Production of PPE coverall is more than 2 lakh pieces per day from 15 days. But the issue is that everyone in market is making PPE kits ”Sanjiiiv, Chairman of the Preventive Wear Manufacturer Association of India
He adds that the PM’s statement that India was not manufacturing a single PPE kit in the beginning of the lockdown is not true in the right sense as “India was not producing PPE Coveralls with Seam Tapes, but more than 50 companies were engaged into manufacturing of Medical gowns (which is also A PPE).”
Talking about manufacturing capacity, Paras Anttim Maheshvwari of Paras Trading Corporation, a PPE manufacturer in Kolhapur, says that he can see this number go up to 10 lakh PPEs per day easily.
“Maharashtra’s BMC issued a tender and got 60 manufacturing applicants. I can see the state producing at least 20 to 30,000 kits per day.”
“Initially, the first month of the lockdown was tough. But now orders are happening, systems are in place, transport issues have been sorted out, materials and manufacturers are in place and it is much smoother. Currently, yes, we are definitely producing at least 2 lakh kits per day if not more, and at least 10 lakh masks per day in India. ”Paras from Paras Trading Corporation, a PPE manufacturer from Kolhapur
But the numbers alone do not indicate that all is well.
“There is a lack of knowledge on how to produce PPEs which provide a protective barrier as well as comfort.. If HCWs are uncomfortable then it is supposed to be non-compliance to Safe Infection Control Practices. One of the major issue is that the guidelines issued by the MOHFW don’t clarify what HCWs at low risk need and hence, every procurement demand of PPE is for the entire workforce of the hospital as per the highest specifications cited by the MOHFW,” says Sanjiiv.
He adds, that the NCDC should come forward to start awareness campaigns on “How to choose the right PPE, safe removal practices, due diligence of quality for HCWs.”
“BIS - the Bureau of Indian Standards - is responsible for creating standards at par with international standards. They should come up with national standards for various risk levels, so that manufacturers have complete technical documents to manufacture PPEs atpar with global quality. ”Sanjiiiv, Chairman of the Preventive Wear Manufacturer Association of India
For now, India just has the Health ministry’s guidelines on the rational use of PPEs, no other body has provided anything else.
Abhilash Nair, a project manager and volunteer fo Covidindia.org where his team authenticates PPE suppliers, said that the volumes were much higher but issues of packaging and standardisation persist.
“Getting these specifications initially was also an issue. Another thing is that India has many manufacturers but not all have expertise in protective gear, and the PPE kits need to be quality assured.”Abhilash Nair, covidindia volunteer
There was an immediate demand, and many manufacturers rushed in to fill the glut in the market. But not everyone had the right specifications, and a PPE kit needs to be precise and contain all 6 items. “Many manufacturers were mixing and matching items to cut cost,” says Abhilash.
According to the Health Ministry guidelines, PPE kits consist of 6 items:
- Face-shield and head cover
- Coverall/gowns (with or without aprons)
- Shoe cover
“We need one independent body that ensures quality control and standarization of PPE kits.”Abhilash Nair, COVID-19 India volunteer
There needs to be more knowledge on how to authenticate certifications and suppliers, how to gauge demand efficiently and how to wear the kits too.
In the US with systems in place, healthcare workers need to undergo ‘sealability tests’ for N-95 respirators to test their efficiency and fit. “If you have not undergone this, you cannot attend to any patient,” says Sanjeev.
“HCWs are not aware about the difference between an N-95 mask and an N-95 respirator.”
There are different requirements for different healthcare workers in different departments.
Issues in Verifying Suppliers
Paras tells me another hiccup initially was the need to get quality certified. The government currently has 8 approved laboratories for testing the kits. Most hospitals prefer South India Textiles Research Association (SITRA) certification.
Manufacturers need to provide an affidavit declaring they are legitimate textile manufacturers within their Unique Certification Code (UCC) Certificate. This UCG will then be on all their kits, on each item.
However, Sanjiiiv adds that there have been many complaints of fake certifications provided to the customers. “Testing labs authorized by the Ministry of Textiles are not certification bodies. They only issue the test reports for the prototype sample of PPE Coveralls. The buyer has to do their own due diligence before purchasing and this is also declared on all UCCs issued. But fly by night operators are flaunting these test reports as Certificates and mentioning SITRA/ DRDO Certified PPE KITS.
Due diligence and standardisation is what we keep circling back to.
Another point to note: not everyone needs to supply medical grade equipment. Paras adds that there will be a need for masks for everyone in the coming months - police forces, for labourers, railways, regular people - and these non-expert manufacturers can cater to that demand.
Paras and Abhilash both estimate that there is enough supply to ride out the predicted surge of COVID-19 cases, at least from the manufacturer's side.
But that is just one part of the story. Issues with delivery and demand are another battle.
“We just arranged an order to be delivered to a remote part of Odisha but it took quite long, around 5 days. Finally however it was the state governmen helped after we connected them to a supplier ,” says Abhilash.
“The solution lies in creating a national standard and defining the equipment needed for various levels of protection. Then a regulator like CDSO should regulate it,” says Sanjiiv.
Raising Demand a Problem
Across India, healthcare workers have reached out informally or on social media to appeal for help in procuring PPEs. Many instances of those speaking out and getting into trouble have been reported.
“The real situation is hazy, we are not sure if doctors are getting PPE kits too late, or not at all, or not in the right quantities,” says Seema B, director of the NGO Manjhi Skilling Foundation, who is working with Give India to distribute PPE kits to hospitals in Mumbai. “Either way doctors are at risk and so we stepped in.”
A senior doctor at Mumbai’s Bhabha Hospital who spoke to us on the condition of anonymity said that while they had adequate number of PPEs, the quality is not always good and often have even packaging issues. They added that BMC supplied kits were often too short and did not fit properly while others were extremely uncomfortable.
“The BMC says they are giving enough but they do not look into quality assurance,” they add.
In an earlier video, nurses spoke about the discomfort of wearing PPEs.
Different healthcare providers need different kits, and those going to isolation wards or to operation theatres need sterilised kits. “But this comes at an additional cost, so we are making do for now. The BMC also does not supply sterilised kits.”
Manufacturers are often not equipped to provide kits for different uses.
Hospitals get different vendors through their central purchasing partners, through hospital staff reaching out and through donations.
A source in a private hospital in Mumbai said that departments are rationing kits, and often sterilising and re-using their N-95 masks.
But ICU and isolation doctors cannot reuse their masks, and the doctor from Bhabha Hospital says they need 300-400 daily.
“We also will be facing a shortage of oxygen and ventilators,” says the doctor. “We also require body bags, we got 10 from the BMC for two weeks but we need 7-10 daily.” For now, their need has been met through donations although they need ventilator maintenance. “We had 10, but now just 5 are working - this will become an issue.”
Healthcare workers in Maharasthra especially worry about the predicted surge in cases and the looming monsoon seasons. “There are already leakages in some kits, and in the monsoons, this will be more difficult to manage.”
Dr Sangeeta Pikale, a gynaecologist at S L Raheja Fortis Hospital in Mumbai, also warns of additional staff shortages and transport issues as floods often leave the roads ravaged.
But Dr Pikale offers a ray of hope. She tells me that hoarding is a natural human reaction to a shortage and pandemic situation but she sees this reducing. “The fear of the virus in some places is going down, as many people have recovered, some doctors and nurses have bounced back, so the fears are reducing.”
She adds, however, that this current issues are expected as the healthcare sector was not prioritised and going forward we need long-term, sustainable solutions.
“The government just spends 1.4 per cent of its GDP on healthcare. So demand will be there for a while as governments are patching up deficits. The government and public health sector will be overburdened and overworked for a while. We are going to need more long-term solutions.”Dr Sangeeta Pikale, gynaecologist at S L Raheja Fortis Hospital
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