The COVID-19 pandemic crisis has brought attention to the inadequacy of infrastructure for the medical staff resulting in high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS CoV2). The shortage of Personal protective equipment (PPE Kit) which includes N95 respirators (N95s) is a subject of friction between the medical workers and the lax government in India and many parts of the world. While the Centers for Disease Control and Prevention recommends disposal of N95 masks after a single patient encounter, the inadequate availability of these masks forces medical workers to reuse them.
In India, the government departments have implemented various PPE Kit reuse and extended use rules (under ‘rational use of PPE’) but without studying empirical evidence of their effectiveness. In addition, the Ministry of Health and Family Welfare (MoHFW) has told the Supreme Court in June 2020 that it is ‘ultimately a doctor’s own responsibility to protect himself from COVID-19’. The ministry also blamed a petitioner doctor of not having ‘empirical evidence’ suggesting doctors were testing positive for COVID-19 in spite of wearing PPE and that the conclusions drawn were merely a ‘hypothesis’. This was in response to a plea filed by a doctor questioning the Modi governments new Standard Operating Procedure for front line COVID-19 healthcare workers, by which it has ended the 14-day mandatory quarantine for them. What is more alarming is that the reply also suggests that with the use of PPE a medical worker stands protected against any “potential exposure” and “subsequent infection”. Hence, the ones who are wearing PPE bears no risk to their families, children or others.
Now a study at the University of California, San Francisco (UCSF) emergency department goes against the Indian government argument. “N95 failure may contribute to SARS-CoV-2 transmission despite PPE use and deserves further study. Based on these preliminary data, health systems should closely evaluate N95 fit during extended use or reuse and limit duckbill mask use if alternatives are available,” says the study. The study points out that Dome-shaped N95 Mask has a higher failure rate than duckbill shaped N95’s. The failure of dome-shaped masks was due to increased use.
The study was designed to detect mask failure based on qualitative fit testing. A Respirator Mask Fit Test is done to ensure the mask is properly fitted to an individual’s face type to provide the safest protection. Generally, there are 2 types of tests undertaken, known as a Qualitative test and a Quantitative test. The Qualitative Respirator Mask Fit Test is a commonly used test and covers most of the regularly used workplace masks such as N95, half-face and full-face respirators. The test involves the taste sensitivity of the user being tested and can be applied to any type of mask that does not have its own separate air supply. A tight-fitting respirator should seal to the wearer’s face in order to provide expected protection.
Modi government claims that there was no PPE kit production in India before COVID-19 and it has created a new industry in India. However, the quality problems have surfaced due to lack of specifications from the government agencies initially. In addition, there are PPE kit procurement scams reported from Gujarat, Punjab and Himachal Pradesh. Some firms have been obtaining fake certifications as the testing labs authorized by the Ministry of Textiles are not certification bodies.