Long-term solutions needed for protective gear shortage, say health pressure groups

Soo Wern Jun
A complete set of PPE consists of a face shield, gown, boot covers, head cover and apron. — Picture by Yusof Mat Isa

KUALA LUMPUR, April 1 — It is vital for the government and private sectors to find long-term solutions to the shortage of personal protective equipment (PPE) specifically for healthcare workers in contact with novel coronavirus (Covid-19) patients, health pressure groups said.

The pressure groups suggested the government and private sectors increase PPE production capacity locally.  

According to Dr Khor Swee Kheng, who is part of a support group Malaysian Health Coalition, a lasting answer was needed even if there were no immediate solutions to the shortage of PPE supplies.

“A long term solution would be to ramp up our capacity in Malaysia to produce [PPE] ourselves. When I say long term, I mean in two weeks.

“The situation is such now, that even with infinite amounts of money, it cannot buy PPE supplies as there is a global supply shortage.

“In the short term, the Malaysian civil society, private sectors (including factories) as well as the government must establish purchasing lines to China in order to secure supplies from China especially when their factories are back in production,” he said.

This would mean that the Federal of Manufacturing Malaysia, small-medium enterprises, and the private sector need to consider measures to retool factories to produce PPE.

“We may need 3D printers, we may need very innovative solutions, because an unprecedented crisis is calling for unprecedented solutions,” he added.

Dr Khor — who specialises in health systems, health policies and global health — pointed out that the current shortage of PPE for frontliners and healthcare staff was due to a large demand in a very short period of time, causing a crunch.

A complete set of PPE consists of a face shield, gown, boot covers, head cover and apron.

He also said it was unfortunate that frontline healthcare workers have had to improvise their PPE from other items due to the shortage.

“It’s not safe compared to those which have been approved by the Department of Safety and Health and certainly not according to World Health Organisation guidelines,  however, during crisis situations, the entire world has to improvise.

“This situation of improvisation is not just present in Malaysia but also present in other countries because of the global shortage,” he said.

Agreeing that long-term solutions needed to be laid out, Galen Centre for Health and Social Policy chief executive Azrul Mohd Khalib the government must strengthen the supply chain, increase manufacturing capacity, and ensure good and rapid distribution of PPE units.

“If we can’t protect our healthcare workers, they won’t be able to protect the public,” said Azrul when contacted.

“Therefore, in light of the government’s announcement of a RM500 million allocation to the Health Ministry, they have to make it their priority to ensure that frontliner and healthcare workers are provided with sufficient PPE units.

“It must plan for at least two months of this level of response,” he added.

When referring to several local initiatives that have jumped in to help address shortage of PPE units, Azrul said it should not be the burden of civil society to mobilise to procure PPE but Malaysians and the private sector have come forward to help through donations, sourcing of PPEs and event production of face shields using 3D printing.

“This should be encouraged, and be seen as complimenting the government’s efforts.

“The problem is now the government’s bureaucracy, which has been seen as hindering supplies donated or sourced by non-governmental organisations, companies and private individuals.

“It must make it easier for these supplies to get to the designated hospitals and clinics. It must also eliminate the use of middlemen,” said Azrul.

It was reported earlier that one of the reasons for PPE unit shortage was due to ‘redistribution’ of supplies to designated health facilities.

Health workers test members of the public for Covid-19 at the Section 7 Mosque in Shah Alam March 26, 2020. — Picture by Yusof Mat Isa

Health Director-General Datuk Dr Noor Hisham Abdullah has assured healthcare workers that his ministry has managed to secure 33 million units of PPE stock, with three million units arriving at designated health facilities within this week.

“PPEs, these are all necessary when attending to high-risk patients and need to be changed frequently.

“Even with selective use, one healthcare worker can be expected to go through several complete sets a day,” said Azrul.  

While he agreed that jury-rigged PPE should not be an option, Azrul said the reality was that they are confronted with difficult situations that pit their desire to remain safe against their duty to help patients.

“We owe it to them to ensure that they are provided with adequate protection. Their safety should be non-negotiable as it translates into benefits for society as a whole,” he said.

Apart from PPE units, Azrul disputed the government’s decision to give out face masks imported from China to the public for free.

“The 10 million masks from China should not be distributed to the public but instead be given to the public and private healthcare workers who need it more than anyone else.

“The government healthcare system alone goes through an estimated 250,000 each week. The general practitioners in private clinics and private hospitals who are also at the frontlines, should be included in this prioritisation. There will be no surplus,” he added.

As for Malaysian Public Health Physicians’ Association president Datuk Dr Zainal Ariffin Omar, he also stressed the need for the government to prepare for a worst-case scenario where PPE units could be the only equipment that can protect frontliners who are not healthcare workers.

“We are talking about overcrowding at quarantine facilities. Should Covid-19 cases increase, they may have to station frontliners such as the police, RELA or other non-healthcare workers.

“Because these people do not have medical knowledge, the only protection from the risk of being exposed could be the PPE units. At least without medical knowledge, these PPE units can offer some form of protection from risk of infection,” said Dr Zainal.

He also called for the government to directly assess the severity of the shortage rather than waiting for information to come back to them.

“When we found out about the masks shortage, I managed to mobilise 300 volunteers to help source for masks.

“But we cannot help if we don’t know the exact extent of a problem,” he said referring to the current shortage of PPE units.

Meanwhile, the Malaysian Medical Association (MMA) said the sourcing of PPE should be a top priority now and overseen by the Ministry of Domestic Trade and Consumer Affairs given its urgency.

MMA president Dr N. Ganabaskran questioned what the ministry has done to alleviate the problem.

“The issue of shortage of facemasks has been highlighted since the outbreak in early Feb 2020. It has made national news and every citizen is aware about this.

“It is disappointing to even have to go to the press to highlight this,” he said.

Malay Mail earlier reported that doctors, nurses and other medical staff at Malaysian hospitals are treating Covid-19 (novel coronavirus) patients in PPE improvised from everyday items like dustbin liners because there is a shortage of PPEs.

Videos of medical staff making protective suits from dustbin liners, cling wrap and plastic bags made the rounds on social media earlier.

A video of medical staff making protective suits from dustbin liners, cling wrap and plastic bags have been shared on social media, which has shocked healthcare workers.  

Mentioned in Malay Mail report earlier, two senior doctors have since written an open letter appealing to the authorities to speed up their supplies.

Datuk Dr Musa Mohd Nordin and Datuk Dr Zulkifli Ismail, both paediatricians at private hospitals, revealed that larger hospitals like Sungai Buloh Hospital may have a sufficient supply of PPEs, but the same cannot be said of the many other hospitals, including private ones.

They urged the National Security Council to immediately mitigate the PPE shortage.

At present, 19 medical frontliners have come down with Covid-19, 11 of whom are now in intensive care.

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