A case study
In the eastern city of Kolkata, junior doctors at Beleghata Infectious Disease Hospital – were given plastic raincoats to examine patients last week. In Haryana state near New Delhi, Dr. Sandeep Garg of ESI Hospital said he had been using a motorbike helmet because he didn’t have any N95 masks. Shortages of PPEs are forcing some doctors to use raincoats and motorbike helmets while fighting the coronavirus. Doctors told Reuters they were concerned that without proper masks and coveralls, they could become carriers. Apart from India, Indonesia is the only country that allocated raincoats to doctors and healthcare workers to treat coronavirus patients.
Fighting COVID19 with raincoats
In Bangladesh, a doctor posted a photo on his Facebook page in which he is on emergency duty wearing a raincoat adding that the PPE given by the government was of the worst quality. He said: “I bought a PPE for BDT 1, 600 for personal use. I wear a raincoat over it so that I can keep this PPE clean and can reuse it since there are not enough PPE in the country.” Masud Hasan, a medical officer, said: “I started duty with a raincoat. We are not in good condition. I bought one PPE but one piece is not enough for regular duty, because every day I have to change or disinfect after seeing one COVID-19 patient. Since we do not have enough PPE, we have to reuse these, which is risky.” Abul Kalam, a raincoat seller, said: “Nowadays doctors are coming to buy raincoats. The crowd is growing every day.”
COVID-19 is a respiratory illness, and coronavirus spreads through vaporized droplets. N95 respirator masks are the only type that can protect you perfectly from acquiring SARS-CoV-2. Any other variety, including surgical masks and homemade, is not proven to be effective at blocking the virus. So why do some people continue to wear surgical masks? And what about the trend of homemade face masks? Wearing any type of mask could supply mental satisfaction others might feel ill. And still, others may not be fully informed about the limitations of surgical or homemade masks.
How safe these PPEs are
According to some virologists, conventional raincoats do not provide protection and the virologists suggest that if used while treating a COVID-19 patient, the raincoats should be discarded after 4-5 hours of usage. A microbiologist at Peerless hospital stated that PPEs were also made of plastic material but were thicker and tough compared to a layman’s raincoat. Hence, a basic raincoat can also provide protection but it needs to be made from a thicker plastic. However, many medics stated that it violates WHO guidelines and raincoats should not be a substitute for PPEs. A prominent doctor Professor AKM Akhtaruzzaman from BSMMU, Bangladesh said, “Raincoats never protect from viruses. Using raincoats is risky for both doctors and patients.” There are also available a type of PPE which is for one-time use only. One-time use of a PPE is okay for treating COVID-19 patients and for the ICU. But after using it once it should not be reused. There are some disposal rules so that no one can touch it.
In Bangladesh, some organizations are making PPEs locally. This PPE is made of parachute clothe which can protect from air and water. Doctors and concerned people have observed that these PPEs are not suitable for doctors dealing with ICU and Covid-19 patients. It cannot protect from viruses perfectly.
Disruptions in the global supply chain of PPE
The current global stockpile of PPE is insufficient, particularly for medical masks and respirators. The supply of gowns and goggles is also insufficient. Surging global demand−driven not only by the number of COVID-19 cases but also by misinformation, panic buying, and stockpiling − will result in further shortages of PPE globally. The capacity to expand PPE production is limited, and the current demand for respirators and masks cannot be met, especially if widespread inappropriate use of PPE continues. The Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus had said that “The chronic global shortage of personal protective equipment is now one of the most urgent threats to our collective ability to save lives.”
What should we do before buying PPE?
Anyone can sell safety but you wouldn’t buy safety from anyone. A lot of processing is involved in making suitable PPE for ICU doctors. A PPE should be made in a scientific way including testing and other options. It should be a package comprising goggles, hand gloves, cap, and face mask. Care must be taken in selecting PPE as certain types give reasonably high levels of protection while others that may appear almost the same, give relatively low levels of protection. Insourcing PPE, the employer must select appropriate PPE which is user-friendly & proper fit. Special care should be taken where persons suffer from certain medical conditions, e.g. certain types of respiratory protective equipment (RPE) may not be suitable for employees with asthma, bronchitis or heart disease.
It would be best if you can ensure any PPE you buy is ‘CE’ marked and complies with the requirements of the European Union (Personal Protective Equipment) Regulations 2018, which require PPE to have the appropriate CE mark. The CE marking signifies that the PPE satisfies certain essential health and safety requirements. U.S. health officials have updated guidance on personal protective equipment for health care personnel amid the spread of SARS-CoV-2. The Centers for Disease Control and Prevention (CDC) of U.S. guidance includes new recommendations on face masks, gowns, and airborne infection isolation rooms.
Please watch out for fake product certification. Professionals relying on protective equipment depend on actually SAFE equipment, not the equipment which has wrongly been labeled as “safe”. The general populace did not need to use PPE. Hand-washing, social distancing, and self-quarantine are considered more effective measures for ordinary citizens. All personnel should avoid touching their face while working.
[Aggregated and written by Touhid Rahman]