Before COVID-19 crept into our world of normal, the use of personal protective equipment (PPE) was largely reserved for surgeons to maintain a sterile field during operations or avoid respiratory droplets and spray of body fluids on the face. In other cases, it was used occasionally by sick patients to prevent the spread of pathogens to others – referred to as “source control”.
But as the invisible enemy sparked in the style of pandemics, application of PPE has sharply moved from the shadows of critical clinical procedures to the stage of common use by all and sundry, ill or not.
The unrelenting spread of the disease in Nigeria has left healthcare facilities nationwide struggling to care for the fast increasing number of patients and especially worried about the tools needed to protect their workers.
Doctors, nurses and other medical staff need masks, gowns, gloves, and other personal protective equipment (PPE) to reduce the risk of coronavirus infection as they manage the frontline war to curtail the outbreak.
However, the steep rise in the price, hoarding, and scarcity that earlier accompanied the prevalence of the virus has refused to disappear, implying that Nigeria’s fighters face shortage of PPE weapons in a war that seems overwhelming. Medical production and distribution chains were crushed by the pandemic disruption on international manufacturing capacity.
Packs of gloves, surgical or N95 face masks, respirators, and protective gowns have barely changed from about 300 percent increase seen since the pandemic started. Whereas three pieces of the common surgical face mask, for instance, was N50 during the pre-coronavirus period, the pandemic has stabilised it at N200 each. High-end versions of face masks capable of filtering 95 percent of air particles ranged between N3,000 and N5,000 per piece when BusinessDay visited some wholesalers and retailers.
Recently, about 812 frontline healthcare workers were infected with COVID-19 as the country recorded the third-highest number of confirmed cases in Africa. Nigeria’s cases of COVID-19 have risen to over 13,000.
Chioma Nwakanma, a public health expert, said the situation not only threatens healthcare workers’ well-being but equally limits Nigeria’s capacity to care.
“They are a core part of the health workers’ protection outfit. We’re seeing the consequences of that now. It now seems like it is most talked-about because we are currently dealing with a contagious outbreak and if there was ever a time we needed PPEs as workers, it is now,” said Nwakanma.
The consequence of PPE shortage is huge for everyone, not just healthcare workers, experts say. In hospitals, the lack of preparedness explains a shortage of masks, gowns, and other PPE, among other problems. As numbers of cases are increasing, isolation centres expect beds to overflow amid the pandemic and the shortage threatens to undermine how many doctors and nurses will be there to treat patients.
According to Nwakanma, in the case of Nigeria, healthcare workers have always had to deal with the shortage of basic protective equipment in government hospitals.
“The consequences will be an explosion of disease spread. If the workers are not protected, the patients are not, the community is not and it affects everyone. Also, it will lead to reluctance to work, on the part of our workers, plus strike actions in advanced cases. This will ultimately affect us all,” Nwakanma said.
“PPEs shouldn’t be at the heart of our advocacy right now, it shouldn’t even be something our leaders need to be reminded of. It is a necessary and complementary part of the healthcare workers’ jobs. It shouldn’t be begged for; it is the LEAST our leaders can provide to protect the citizens they govern,” she said.
According to UNICEF, the need for PPE may reach 2.2 billion surgical masks, 13 million goggles, 1.1 billion gloves, and 8.8 million face shields through the end of the year 2020. In addition, as the lockdown is relaxed across Africa, there is a hike in the number of cases, thereby increasing the exposure of healthcare workers, without PPE, to the infection.
Nigeria had just started responding to the pandemic with barely 100 cases of COVID-19 in March when the global community started experiencing severe disruptions in the supply chain of PPEs majorly caused by rising demand, panic buying, hoarding, and misuse, according to WHO.
Looking inwards
Fashion designers in Aba, the commercial hub of Abia State, whose businesses had been badly hit by the pandemic, seized the opportunity and ventured into manufacturing of PPEs using local fabric, cotton, and polypropylene.
Currently, scores of manufacturers churn out thousands of facemasks, laboratory coats and full-body covers needed by healthcare workers on the frontline of the COVID-19 battle. The Inter-ministerial Committee on COVID-19 had since evaluated the PPEs produced in Aba.
Abia State government reportedly released a N12 million (about $31,000) grant to support tailors to make the protective gear. The grant was disbursed to 100 selected tailors at the start of April.
Sam Hart, director-general, Abia State Marketing and Quality Management Agency (ASMQMA), disclosed in a televised programme that the state produced over 1 million face masks in April. He said with more support, the state can produce more PPEs even after the pandemic.
As Nigeria entered community transmission, thousands of tailors across the country began production of facemasks for public use using local fabric.
The Nigerian military also swung into action. The Defence Industries Corporation of Nigeria (DICON) began mass production of PPEs and ventilators. By mid-April, thousands were ready for supply to states at affordable rates and Kaduna was the first state to take delivery.
Support through donations
Chinwe Ochu, head of Prevention Programmes and Knowledge Management, told BusinessDay that Nigeria was also able to meet demand through the strategic stockpile, donations and support from various partners including United Nations family, Coalition Against COVID-19 (CACOVID) and Jack Ma Foundation.
Ochu added that initiatives like ‘Partnership to Accelerate COVID-19 Testing (PACT)’ led by the African Union and Africa CDC which coordinates pooled procurement of medical commodities for distribution across the member states have also been instrumental in accessing PPEs for use in Nigeria.
In March, Nigeria took delivery of 100,000 facemasks, 1,000 protective gowns and 20,000 test kits from Chinese billionaire, Jack Ma. The country received another tranche of donations in April.
Lessons from India – zero to hero in 60 days
India has been able to maximise the outbreak of the coronavirus as a tool for its economic development, product independence and sustainability having moved to become the second-largest producer of PPE in 60 days. It reached a cumulative production of approximately 1 million coverall units and is making moves to become an exporter as well if domestic demand can be met.
The government took the bull by the horn to begin and eventually ramp up production to over 100,000 per day after the short supply of imported kits due to the glut in stocks and ban of exports by the source countries, according to the country’s “Personal Protective Equipment in India, A ₹ 7000 crore industry in the making ” report.
“The virus also overwhelmed the global production capacity of PPE which is the most critical product to protect the front-line health workers and other responders. Surging demand for PPE kits along with disrupted global supply chain amid the Covid-19 pandemic was putting lives at risk,” the report stated.
“India realised the critical role of PPE in combating this pandemic as early as March. What followed this is a remarkable journey of collaboration between governments at the central and state levels, industries and workers to revamp existing production lines to manufacture a completely unknown product, from scratch,” it said.
Smriti Z Irani, Union Cabinet Minister for Textiles and Women & Child Development, in a public statement on her Twitter handle revealed that prior to the outbreak, India could not boast of producing even a single unit of the COVID-19 PPE. However, as of May 18, over 600 companies were duly certified to manufacture PPE which consist of a mask, eye shield, shoe cover, gown, and gloves.
The feat was achieved through the full capacity utilisation of its textile and manufacturing industries as well as the engagement of local entrepreneurs supported with the aid of its government’s strategic policies and activities which include working with various industry bodies and manufacturers to streamline the supply chain, remove bottlenecks, and maintain a steady supply.
For Nigeria, local production is the first challenge to beat. The critical other is availability at the point of need for frontline health workers.
