'Women health workers in ill-fitting PPEs at greater risk of exposure'

The WHO says they are wearing equipment designed for men; estimates that one in 10 health care workers worldwide is infected by COVID-19

The COVID-19 pandemic has claimed the lives of many a frontline warrior, especially health workers, world over, raising concerns among scientists. India and Mexico have reported disproportionately higher death rates as compared to the rest of the world. The WHO claims health workers are more at risk of exposure to COVID because 75 percent of frontline warriors worldwide are women, who are wearing masks and other PPE equipment designed for men.

A leading PPE manufacturer in Bengaluru agrees. He said, "The craze for having PPE kits has come down in the past couple of weeks, as compared to the initial days of the pandemic. Earlier, hospitals were very cautious about the quality, approval system, and adherence to guidelines for the PPE kits, and more over, the number of manufacturers was less. This would lead to a high cost for the kit (varying from R450 to R800). Now in the past few months suddenly there has been a PPE manufacturer has come up in every nook and corner, and is selling the product at a low price (R300 – R400) with no quality assurance."

He added that the number of front line warriors getting exposed to the infection, can come down, provided the government emphasises that hospitals follow the guidelines set by the ministry of health while procuring PPE kits. The manufacturer claimed that every hospital today is concerned about pricing, and since the PPE kit is for one-time use, pricing is given priority over quality of material.

He also admitted that at present they are coming up with isolation gowns, which are not gender specific. Therefore many women front liners may be facing discomfort wearing the oversized gowns. He said, "It is a must to have gender specific gowns, but no one has bothered to look into this."

"The problem in health care workers worsens because 75 percent of frontline warriors worldwide, are women that include female doctors, nurses, class four servants etc; and masks and other PPE equipment designed for men are being used by woman, resulting in women at greater risk of exposure to COVID-19," said Dr Wiqar Shaikh, senior allergy and asthma specialist.

Dr Shaikh said, "Globally, there are approximately 70 million health workers, India has 4.7 million health workers, the USA has got 18 million, the UK has 1.2 million. Health workers are more vulnerable to the infection due to frequent contact with the infected individuals. Front line health workers are also vulnerable due to work intensity and lack of adequate rests."

Also Read: Government allows export of COVID-19 PPE medical coveralls

Dr Shaikh added, "In several underdeveloped and developing countries such as India, health care workers are required to work without proper safety gear, particularly, personal protective equipment. Moreover, the PPE kits available today do not have any standard specification approval such as from ISI that ensure the safety parameters are in place. Also, it is important that frontline health workers don't use PPE kits for hours together. It only gives a psychological sense of relief of wearing a PPE kit, which actually may not be of any use exposing the frontline workers further."

"WHO estimates that one in 10 health care workers worldwide is infected with COVID-19. A study by the Harvard University published on September 1, 2020 in The Lancet, reveals that in the USA and UK, the risk of infection with COVID-19 in front line health workers, was five-fold when compared to the general community. They will also suffer from psychological problems," he said.

Dr Shaikh added, "Two studies, from Singapore and China reported that health care workers suffered from anxiety, depression, stress, and insomnia. The problem in health care workers, worsens because 70 percent of front line warriors worldwide, are women. Masks and other PPE equipment, designed for men are being used by women. The PPE kits they use are not as per their physique, and it is important that this equipment should be specially designed for females."

Since the onset of the COVID-19 pandemic in November 2019, several monitoring indicators have been designed by health scientists. "In India, for example, the general population death number of 72,800-plus, giving the death rate of 53 per million has been the subject of discussion, primarily as an important success indicator in managing the pandemic," said Dr Subhash Hira, professor of Global Health at the University of Washington-Seattle and health advisor to several Indian and African health agencies.

"This indicator has been compared for several countries that have reported general population death rates ranging between 53/m for India to 612/m for UK," said Dr Hira.

India and Mexico have reported disproportionately higher death rates of 122/m and 3,300/m respectively among their health workforce. By comparison, some countries such as the USA, UK, Brazil, and South Africa severely affected by the pandemic, have reported death rates among health workers that are only 1/10th to one-half of the death rates seen among their general populations. The disproportionately high death rates among health workforce in Mexico and India appear directly related to weak health systems.

With health workforce found to be 2.5 times more vulnerable to COVID-19 related deaths in India, the likely weaknesses in its health systems responsible for this situation are: delayed provision of appropriate and adequate personal PPE, low density of 47 lakh workforce i.e 3,615/m leading to over-burdened workers, overwhelmed healthcare facilities, fewer testing facilities that were rapidly expanded to over 1,000 PCR laboratories (they have now completed over 50 million COVID tests in six months,), slow community participation in preventive measures due to scarce public health experts across the country, and government health expenditure of less than 2% of the GDP (total health expenditure, including private spenders at 8% of GDP). The lack of scientific and operations research has also made it difficult for policy implementers to improve performance and efficiency of systems, and save more lives.

Dr Ketan Vagholkar, professor of Surgery, DY Patil Medical College said, "Five percent of health care workers, are testing positive as per a WHO report. The incident amongst health care workers is increasing due to various factors: a) Mental health issues related to direct contact with patients, b) long working hours, c) COVID fatigue leading to improper use of PPE kit, inadequate precautionary measures such as hand washing and inadequate social distancing from patients."

"Proper use of N95 masks, use of protective gear depending on the level of risk exposure, and repeated hand washing, are the most important factors which can prevent transmission of infection to health care workers," said Dr Vagholkar.

He added, "Periodic self-assessment of infection risk and meticulous precautionary measures are the only ways to prevent infection amongst health care workers. In a country like ours, where the population is over 1.30 billion, and the doctor to population ratio is 0.76 doctors per 1,000, over working for health care workers is inevitable. Therefore, the onus lies on the individual health care workers to update themselves about newer precautionary measures and to ensure that they take adequate care of themselves."

COVID-19 death rate in general population versus health workforce, September, 2020

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