Covid-19, like every 'black swan' event, was discovered and designated on hindsight. Only when we are singed by catastrophic damage do we start to see what precisely may have happened when and why. Investigation and diagnosis are indeed important, but the need to contain and minimise the loss in real time must always take precedence. And how we should future proof ourselves against a fresh occurrence needs fresh capacity building.
These are in short supply all over the world and India is no exception. While several good-meaning business units have responded swiftly by repurposing their factories to fabricate and supply PPE, the scarcity persists. Covid-19 is here to stay and there must be a long-term plan for the supply of quality PPE for future use. Even if the Covid-19 threat somehow attenuates, we know that general protection of our healthcare workforce against infections at not just medical services establishments but other workplaces; sanitation workers, among others, would require appropriate PPE and gear. And then, as experts warn us there is the threat of future pandemics. Let us not wait to be ambushed by another Black Swan event to act.
Let me share the grim situation currently on the ground. There is acute supply scarcity and sharp demand surge. Every hospital is facing difficulties to procure quality PPE on time. Prices have risen sharply and much of the supply is of indifferent quality, varying from border line acceptable to down-right dysfunctional. Some of these are due to new and inexperienced suppliers jumping into the fray, some existing suppliers unable to ramp up production or meet sharp delivery lead times.
Add to this wilful neglect, sheer opportunistic and commercial exploitation and host of other inadvertent mistakes linked to supply chain disruptions. Medical establishments are already overwhelmed with core duties of patient care and have no time or the bandwidth to apply the stringent quality checks. The challenges are more severe in smaller hospitals or those operating in Tier-II and III towns. There are news reports that under shortage or severe commercial pressure some medical staff end up wearing garbage bags, raincoats, bike helmets and ordinary eyewear and cotton handkerchief as PPE. This gives them no protection against infections. This is not the way to equip our frontline warriors.
There are a few things that we must do urgently. The regulators must develop and notify material, design, fabrication standards and specifications for all PPE items. What are the approved or designated fabrics, what is their GSM, air porosity, water repulsion or resistance among other parameters for hospital-grade PPE gear? There are N-95 masks, Eye protection, head gear, face shields, protective gowns, gloves, foot covers etc. Do you know that an average healthcare worker takes around 35 minutes to put on a full PPE suit? Do you also know that they could stay in that gear for up to 12-13 hours at a stretch? The global best practice is 4-5 hours.
Medical teams are unable to eat or take a comfort break while in a PPE suit; some wear adult diapers while working long hours. This causes a rising incidence of skin injuries. There are device-related pressure injuries, moisture associated skin damage and skin tear. Remember, a vast majority does not have the luxury of working in air conditioned environment.
Current PPE is not made of breathable fabric. Nor do they have seam sealing, making them insufficient against infection. With the onset of torrid summer conditions, all these can only be expected to aggravate further. The scenario in case of N95 masks is somewhat peculiar—there is a huge shortage of high-quality masks and extended use is being promoted by using the same mask after 4-5 days. However, this strategy, which is largely unproven on eliminating the viral load, also presents a risk of transmission via contact. The situation needs urgent attention and intervention from the regulatory bodies at the national and state level for introducing rational set of guidelines and standards.
On average, a large Covid-designated hospital could be using up to 300 PPE suits in a day. No one has the resources to accommodate the budgets to consistently procure PPE in such large numbers. This would approximate to a minimum expenditure of Rs 8-10 crore for one large hospital in a year. What was traditionally a relatively minor expense item is now set to rise exponentially for the foreseeable future, if not forever. Clearly, we need to innovate here. We should seriously examine how we could reuse select PPE items. This could bring down the expenditure to less than 1/10th of a single use regime that currently prevails. Further it would improve the functional role they are required to play in the first place: Safety and comfort of the medical teams.
We should invite innovators, engineers, problem solvers and entrepreneurs to step in and help. Can we reuse PPE? The answer is yes. This is under serious consideration not just in India but also in other leading medical jurisdictions around the world. As we speak, N95 masks are currently sanitised and reused twenty times over in large hospitals in the US under a programme funded by the Federal Govt.
The global med-tech industry is furiously working to develop technology to sanitise other elements of PPE for reuse. The best talent in leading centres of excellence across the world have jumped into this, quite like they have to develop a vaccine. It is a race for an enormous global prize. First-movers would have the opportunity to target world-wide demand, not just for Covid, but for many other infection control use cases. Just like 9/11 permanently changed the airport security protocols all over the world, Covid-19 would alter the need for using PPE in many public and private services.
The apex regulatory and development bodies such as ICMR, AIIMS, IIT, NITI Aayog and others need to proactively help entrepreneurs fast track notification of national level standards, protocols, certifications for PPE and its reuse. We need to galvanise the start-up ecosystem to participate. Although there are dozens who already have, they need funding, CSR disbursements, govt and private grants, mentors, subject matter experts. Why should we wait for Silicon Valley or Israel to come up with a solution?
We are the global ground zero for frugal innovation. It is heartening to see the intense effort currently on within IIT Delhi and other leading tech start up incubators encouraging and supporting ventures to focus on this problem. This is an available opportunity. Let us all come together and help our engineers, med-tech entrepreneurs and health care workers.
The writer is a member of the Indian Angel Network
The thoughts and opinions shared here are of the author.
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