EXPLAINER: The PPE keeping our healthcare workers safe
MANILA, Philippines (UPDATED) – Our health workers are fighting COVID-19 on the frontlines, but what’s keeping them from contracting the disease themselves?
The world is experiencing a shortage of personal protective equipment (PPE) amid the pandemic and its effects can be felt in the Philippines, where at least 17 doctors have died of the new disease due to lack of protection.
The worldwide shortage was caused by rising demand, panic buying, hoarding, and misuse, according to a World Health Organization (WHO) statement on March 3. WHO asked governments to increase production of PPE by 40% to meet the demand.
Meanwhile, officials like Vice President Leni Robredo and public figures like volleyball star Jia Morado have raised funds to procure PPE supplies. Some resourceful Filipinos have even found ways to improvise safety equipment, while fashion designers and brands have begun sewing protective gear for donation.
Below, we go over what our healthcare workers need to stay protected from COVID-19.
The PPE that hospital workers wear depends on the work they intend to do and the area where they work.
At the University of the Philippines-Philippine General Hospital (PGH), one of the country’s referral hospitals for coronavirus patients, there are 4 levels of PPE protection.
1) LEVEL 4 – the COVID-19 wards and operating rooms require the most protection for personnel. This level of PPE protection consists of the following:
- Surgical cap
- N-95 mask
- Scrub suits
- Goggles/face shield
- Double gloves
- Dedicated shoes
- Shoe covers
This applies to all personnel in the areas where confirmed cases of COVID-19 are admitted. They include healthcare workers who have to stay in these areas for at least 4 hours and anesthesiologists who intubate patients and stay for an entire operation.
2) LEVEL 3 – for the triage and areas where patients under investigation (PUIs) are admitted. PPE protection consists of:
- Cap and goggles or face shield
- N-95 mask
- Gown or coveralls
3) LEVEL 2 – for areas with bathrooms where healthcare workers can bathe after duty. They require the same amount of protection, as Level 3, but do not need face shields.
4) LEVEL 1 – for low-risk areas like the outpatient clinic and non-COVID-19 wards that require staff to wear surgical masks and goggles or face shields. Those working in administrative offices and the pharmacy, which are the lowest risk areas, are required to wear surgical masks at all times inside the hospital.
How many needed?
Healthcare workers – doctors, nurses, and medical technicians – use hundreds of PPE a day. Some of the gear like caps, goggles, and gowns, can be changed after a shift, but gloves need to be changed after each patient handled and masks should also be changed as needed.
Doctor Norberto Francisco, chief of Clinical Trials and Research at The Lung Center, said that their hospital can use from 200 to 500 PPE in one day. The Lung Center is also a referral hospital for coronavirus patients in the Philippines.
Ideally, said Francisco, PPE are disposed of after one exposure, but when they’re low on gear like now, a healthcare worker will use the same PPE for all the confirmed COVID-positive patients just to extend its wear. Once done, they remove their equipment and leave the room and then don a new set if a patient has special needs like a clogged ventilator tube.
PGH Spokesperson Jonas del Rosario, on the other hand, said that they’ve estimated that they use 600 to 800 PPE a day for a 130-bed COVID-19 referral center facility. There are about 200 to 300 healthcare workers at PGH in a day, he said, now that they’re on a skeleton workforce due to the pandemic.
Some suppliers sell individual equipment, while others offer full kits of protective gear that can cost anywhere from less than P400 to P1,800.
Del Rosario said that a full kit nowadays costs P1,000 each but because of the demand, a full PPE set can also cost up to P1,200 to P1,500. Before the coronavirus pandemic, he said, these would cost only P800.
On April 1, Senator Grace Poe said that a PPE set is normally priced at P400 to P1,000 and questioned why the Department of Health procured PPE sets for P1,800 each.
Robredo, through a partner-organization called Kaya Natin! Movement, raises funds for PPE sets that cost P378.37 each.
Overpriced medical items became a problem when the outbreak began. On March 26, the Bureau of Customs seized P5 million-worth of overpriced alcohol and PPE at a store in Binondo. The items were said to be sold online at 4 times the suggested retail price.
The Department of Trade and Industry, on March 12, imposed a nationwide price freeze on basic necessities amid the COVID-19 pandemic.
Most PPE in the Philippines are manufactured in China, said former health secretary Manuel Dayrit, which makes them less easy to get hold of.
To speed up the process of receiving PPE from abroad, the Food and Drug Administration (FDA) on March 20 said that local suppliers only need to show an importer’s license to operate, and proof of application for notification in order for the equipment to be released from the Bureau of Customs. FDA clearance is not needed for foreign donations.
When asked if the Philippines has the capacity to manufacture these, Dayrit said in a mix of English and Filipino, “Well, apparently not. And that’s one of the things we have to ask ourselves. You have to develop that type of capacity, right? That’s the issue now of trade, business, entrepreneurs, et cetera.“
On March 29, Robredo said that a prototype for protective suits made by Joey Socco's team at Kidstyle Fashion Inc using taffeta silver back lining was approved by local and international experts.
(Editor's Note: An earlier version of this story previously said that Socco designed the protective suits that were approved by local and international experts. The protective suits were designed by a team led by Mich Dulce. We apologize for the error.)
PPE need to be made of material that is impermeable to liquid, lightweight, and durable, said Del Rosario.
Wearing PPE can be taxing
Because it’s so hard to get them, healthcare workers at PGH who need to don a whole PPE set must wear them for a minimum of 8 hours.
“You’re not allowed to go to the toilet to pee, to drink, to wash your hands…because once you contaminate yourself you have to change the whole thing, you know, it’s so expensive,” said Del Rosario.
"Some are being asked to wear diapers… Yeah, if you cannot control yourself. Or you just wasted a P1,000 suit," he added.
Wearing a PPE can be especially taxing in the Philippines because of the heat. Some healthcare workers have to wear their coveralls over their scrubs, and gloves need to be tucked into their sleeves so as not to expose any part of the skin.
“That’s why you hear stories about health workers getting sick, because they have been wearing this [PPE], because they get dehydrated. It gets so tiring,” Del Rosario said. – Rappler.com