Coronavirus delays: Why India’s health workers are still facing shortages of safety gear

Key to fighting the coronavirus pandemic is a country’s ability to create strong supply chains of crucial materials like testing kits and safety gear. This report is part of a series that takes a closer look at how India has fared on this front.

On April 16, the Bureau of Indian Standards issued specifications for the manufacture of “bio-protective coveralls” for frontline workers at risk of exposure to the novel coronavirus.

The bureau is the sole government agency responsible for laying down standards and specifications for all goods made in India. But it had not made any move to issue standards for coronavirus safety gear through February or March. The first coronavirus case in India was diagnosed on January 30.

Even the health ministry had not laid down any specifications, despite the manufacturers repeatedly asking for them, as Scroll.in reported, until as late as March 24, the day when India began a 21-day lockdown. India had 536 cases that day.

Earlier, several manufacturers had told Scroll.in they were hesitant to start production without the standards. After March 24, even though they had the standards, production was slow and painful as workers were unable to travel to the factories because of the lockdown.

In the midst of this logjam, when the bureau released its specifications on April 16, there was more confusion: would the bureau’s standards override those issued by the health ministry?

On April 17, the bureau clarified: “As of now, standards specified by the Ministry of Health and Family are applicable.”

The lockdown has since been extended to May 3. India has 17,656 cases of Covid-19, the disease caused by the coronavirus, as of April 20. Every day brings more accounts of health workers complaining of safety gear shortages.

Here is a timeline of how India mismanaged crucial safety gear production.

Export ban – revoked and reinstated

Soon after the first coronavirus case was detected in India, the government moved to ban the export of all Personal Protective Equipment on January 31.

But this ban was partially revoked on February 8 for surgical masks and all gloves. Later, on February 25, the government also allowed the export of eight types of PPE items.

On March 19, by the time India had 194 Covid-19 cases, the government reinstated the ban on the export of masks, ventilators and raw materials needed to manufacture PPE.

Central government orders – opaque and delayed

On March 8, the cabinet secretary assigned the task of ensuring India had adequate protective equipment to the ministry of textiles.

The ministry organised a meeting on March 18 with key manufacturing associations and the health ministry. Scroll.in accessed minutes of the meeting which stated that a public sector company under the health ministry, HLL Lifecare Limited, had been appointed the “sole procurement agency” for PPE for “central and state government hospitals”.

In the meeting, the health ministry said HLL had placed orders for 20 lakh masks and 7.25 lakh coveralls – also called hazmat suits – with the ministry estimating that public hospitals would need 60 lakh N-95 masks, one crore three-ply masks and 7.25 lakh coveralls up to May.

This was an obvious underestimation, given that health workers who screen, test and treat Covid-19 patients need to change their safety gear several times a day.

Worse, two associations of the manufacturers, representing a large section of the industry, said that almost none of their member-firms had received the orders.

After the Times of India reported their grievances, HLL sent emails to 14 firms soliciting orders. It simultaneously uploaded tender documents seeking bids, as an investigation in Scroll.in reported.

The lack of transparency added to the delays, since firms debated whether to respond to the emails or apply for the tender.

Eventually, HLL placed orders to procure PPE from 39 manufacturers for supply to central government hospitals and to state governments who have placed orders with the public sector company. Officials at HLL and the health ministry did not respond to Scroll.in’s queries about the total number of PPE kits ordered from these Indian companies, or how many kits have already been supplied.

At the end of March, according to an NDTV report, the health ministry had procured only 60,000 out of 60 lakh PPE ordered, half from domestic companies and half from abroad. On April 14, the Centre claimed that it has ordered 15 million PPE from China. Apart from that, China also donated 1.7 lakh kits to India, but a report in the Economic Times on April 16 claimed that more than 50,000 of them have failed tests for quality.

Centre-state confusion

The minutes of the March 18 meeting said HLL was the “sole procurement agency” for PPE for “central and state government hospitals”. However, health is a state subject in India. This means the Centre does not ordinarily have the powers to procure for states. In a press briefing on March 22, when asked about the March 18 meeting, joint secretary health Lav Agarwal denied protective equipment procurement had been centralised.

Yet, on April 2, a letter was sent by the health ministry to all states, saying that states should procure safety gear and ventilators centrally, through the ministry.

When Scroll.in contacted the health ministry, the spokesperson said the letter was just an “advisory”.

State governments continue to place orders directly with companies.

The Chhattisgarh government floated a tender for 2.5 lakh PPE kits for its state hospitals on April 7, and floated a re-tender when none of the bidders’ samples passed its quality tests.

In Haryana, state government hospitals have floated a tender for 2.2 lakh PPE kits, in addition to nearly 20 lakh separate masks, 40,000 face shields and 9.75 lakh gloves.

Supply shock

But states have found it hard to get assured supplies.

Take the example of Chhattisgarh. In March, the state had ordered 14,000 kits for its hospitals from HLL, but the public sector firm was only able to deliver 3,000. Fortunately, the state has a central government-run hospital – the All India Institute of Medical Sciences in Raipur – which received 5,000 kits from HLL.

States have ended up placing orders with small and medium sized firms within their borders. But these firms are struggling to meet the targets.

Take the case of Harsh, a small PPE manufacturer in Kolkata who has not yet been able to supply a single coverall to his clients despite starting production three weeks ago.

“I have been left with just 5% of my factory staff since the lockdown began – the rest are too scared to leave their villages,” said Harsh, who did not wish to reveal his last name. “Some are afraid of catching the virus, some are afraid of the police, and some have been told by their panchayat leaders that they will not be allowed to return if they leave the village.”

Several media reports have highlighted police violence towards working class people during the lockdown, and workers at most PPE manufacturing units have been at the receiving end of it. “Local police routinely stop workers, humiliate them and don’t recognise permission slips given to vehicles carrying our raw materials or testing samples,” said one manufacturer in Delhi who did not wish to be identified. “Without workers, what can we do?”

Even the 39 companies manufacturing PPE for HLL have been facing lockdown hurdles. At the end of March, HLL admitted that it would take 25 to 30 days to deliver PPE supplies to its clients because of the “curfew situations” caused by the lockdown. The textile ministry has appointed nodal officers to each of these companies to help smoothen out any logistical difficulties during PPE production, but at least two of the nodal officers told Scroll.in that the lockdown continues to impact production and supply.

Regulatory problems

Manufacturers have also been facing another lockdown-related hurdle.

Before full-fledged production, they must send samples of their PPE for testing at a government-approved laboratory. At the start of the lockdown, the Centre had appointed just one agency – the South India Textile Research Association in Coimbatore – for testing Covid-19 PPE. By April 11, three more laboratories were added to the list to cater to decentralise and speed up the testing process, including the Defence Research and Development Organisation in Delhi.

But that has not solved the problem so far.

“It took me four days just to look for a courier company willing to take my coverall samples to a laboratory,” said Harsh, who claims his company can attempt to make up to 3,000 coveralls a day once samples are approved. “Most courier services claimed they could fly the samples from one airport to another, but were unwilling to make door-to-door deliveries. I finally sent my samples to DRDO by speed post through the General Post Office.” Since the test results are yet to come, Harsh cannot start supplying the stock he has made so far.

In Himachal Pradesh’s Barotiwala town, Manish Sabharwal’s factory has been operating with a third of its regular workforce, and has been unable to send any samples for testing at all. Sabharwal’s company makes hand sanitisers as well as crucial tapes to ensure that a coverall’s seams are completely sealed.

Although some manufacturers have argued that seam-taping is not required for Covid-19 coveralls, the health ministry’s specifications have made it mandatory. This makes Sabharwal’s product critical for coverall manufacturers, and he has a stock of 10,000 tapes ready to be tested, approved and supplied.

“But no courier or speed post service is working here, and now we have been forced to shut down because a containment zone has come up within 3 km of our plant,” said Sabharwal.

Besides the tapes needed as raw material, the process of seam-taping requires special machinery that is not accessible to all PPE manufacturers in India. Since one machine can tape the seams of just 120 coveralls a day, the Centre plans to import 60 hot-air seam-sealing machines from China to enable manufacturers to ramp up production. Meanwhile, many manufacturers are adapting other kinds of machines to serve as seam-tapers. In Kolkata, for instance, Harsh and other manufacturers use the machines used for seam-taping in the raincoat industry.

Some manufacturers claim there is also still some confusion over specifications. Even though the health ministry publicly released a set of specifications for the design, quality and testing of all components of PPE kits on March 24, manufacturers claim that some state governments have tweaked them and added some of their own details to the specifications.

“The government specifications simply state that the fabric for coveralls should be non-woven and should pass the synthetic blood penetration test, but some states like West Bengal and Haryana have additionally asked for fabric to be 90 or 95 GSM [grams per square metre], which should not be a criteria at all,” said the manufacturer who did not wish to be identified.