Covid-19 update: India orders PPE kits as frontline health workers face shortage

On March 28, the Indian Pilots’ Guild, a union of pilots at the state-owned airline Air India, wrote to the civil aviation minister and the company’s chairman complaining about the quality and quantity of personal protective equipment (PPE) on “recent rescue flights” aimed at bringing back home Indians stuck overseas on account of the Covid-19 pandemic.

The union specifically mentioned shoe covers that failed in “minutes”, gloves in hours, and “ill-fitting” hazmat suits, of which there weren’t enough, in the letter to chairman Rajiv Bansal, and “flimsy PPE that tear” in that to minister Hardeep Singh Puri.

While the quality issues are worrying, what’s equally worrying is the shortage of PPE. Reuters reported last week, citing documents from India Invest, that the country needs 6.2 million units of PPE and has “approached hundreds of companies to secure supplies quickly”.

In a statement issued on Monday, the Press Information Bureau of the government said that “in order to meet the requirement of PPEs, masks and ventilators, factories producing essential items are working around the clock and ordnance factories are trying to produce PPE for medical personnel”. The statement added that the state-owned Bharat Electronics would also soon start manufacturing ventilators.

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The Reuters report also said India needs 38 million masks.

In its release, PIB said India has “3.34 lakh PPEs” in “various hospitals”, and pointed out that another “3 lakh donated PPEs” would arrive by April 4, and orders for 2.9 million PPEs have been placed (300,000 with ordnance factories and 2.6 million with 12 other manufacturers). In addition, the release added, orders for another 3 million PPEs have been placed with “a Singapore based online platform” and a “supplier based in Korea”. That works out to 6.2 million PPEs.

“There was a shortage of PPEs initially but we worked on a war footing and managed to test the cloth, identify manufacturers and place orders in a matter of weeks. The government is taking all necessary measures to ensure there is no shortfall of necessary equipment,” said Lav Aggarwal, joint secretary in the health ministry.

PIB’s statement also gave an update on availability of N95 masks. A million “would be part of the PPE kits being sourced from Singapore”, it said, adding that two domestic manufacturers are in the process of increasing their daily capacity to 100,000 masks from the current 50,000 within a week. The Defence Research and Development Organisation has worked with local producers to “produce about 20,000 N99 masks,” with “this supply also expected” within a week.

Hospitals in the country already have 1.195 million N95 masks, the statement said.

Health experts have pointed to the shortage of ventilators in the country . “What we have, and what we are trying to procure, is not going to be enough if the curve does not flatten out, and the situation explodes,” said Dr Yatin Mehta, chairman of critical care at Medanta Hospital, Gurugram.

Only around 20 people (out of the at least 1,100 being treated for Covid-19) right now are on ventilators, the PIB statement said, adding that 14,000 ventilators have been set apart in public and private hospitals for Covid-19 patients.

The disease attacks people’s lungs, in some cases compromising their ability to breathe as they develop pneumonia. Ventilators, which deliver air to the lungs through a tube placed in the windpipe, are crucial to keep these patients alive.

India on March 22 banned the export of ventilators and placed an order for 10,000 ventilators with Agva Healthcare, a domestic manufacturer based in Noida, which is expected to deliver the units by April 2. An order for 30,000 ventilators has been placed with Bharat Electronics Limited, which will collaborate with other domestic manufacturers, PIB said. Auto manufacturers, such as Mahindra & Mahindra and Maruti Suzuki, have also said they are preparing to manufacture ventilators.

On Monday, M&M’s managing director Pawan K Goenka tweeted that “Mahindra’s in-house effort for affordable respiratory device is near fruition. Video shows a working model. Packaging yet to be done. Testing started. Looking for ideas on what to call it? Will go for approvals soon”. The tweet was accompanied by a video of a product-demo.

“Global data shows between 3% and 5% of Covid-19 affected people develop severe illness and may require oxygen support or mechanical ventilation, and the data is the same for India,” said Aggarwal.

He added: “We must keep in mind that not all severely ill patients would need ventilators. The number of positive cases that we have currently, we have enough ventilators. Placing orders for more ventilators is to prepare in case numbers increase. Apart from the Centre, even states are procuring at their level. The government has taken several measures to ensure there is no shortage of any critical equipment needed to manage the disease, including ventilators.”

It is possible that the successful implementation of social distancing measures could help India flatten the curve — reducing the number of ventilators needed.

“Though the number of positive cases is rising, the number of people needing ventilators may not suddenly shoot up. And if required we can always tweak the ventilator settings to accommodate two patients on one ventilator,” said Dr MS Kanwar, senior consultant, department of pulmonary, critical care and sleep medicine at Indraprastha Apollo Hospital, New Delhi.