Coronavirus: why is it so hard to get adequate PPE?

Doctors in the UK are being forced to decide whether to treat coronavirus patients or protect themselves because of a shortage of personal protective equipment (PPE).

With supplies running critically low, Dr Alison Pittard, the dean of the faculty of intensive care medicine, said her members were “concerned about having to make those sorts of decisions”.

She told Today on BBC Radio 4 that her organisation was “very concerned about the update to the PPE guidance” that said health workers could reuse equipment where there were shortages, says The Guardian.

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“People have to make their decisions based on whether they’re in a risky situation or not,” said Angela McLean, the government’s deputy chief scientific adviser, in The Telegraph when asked whether doctors and nurses should be allowed to refuse to work if they don’t have the right PPE.

What has caused the shortage in the UK?

The government can’t claim it didn’t have enough warning. In 2016, an operation to test the UK’s readiness for a pandemic, codenamed Cygnus, “flagged up the strain on supplies of personal protective equipment. The issues were not only the vast quantities needed but getting items to where they were needed,” reports The Times.

Despite the current dangerous shortage of PPE, a government spokesperson said at the weekend that it had been “extremely proactive in implementing lessons learnt around pandemic preparedness, including from Exercise Cygnus”.

The government claims it began ordering some PPE “in January, before the first confirmed UK case” and in February asked suppliers about their stockpiles in relation to the possibility of a no-deal Brexit.

But the global outbreak led to some foreign governments banning the export of face masks, gowns and visors, so some orders that were placed were not fulfilled.

There have been criticisms the PPE shortage is a result of a dereliction of duty at the top, after The Sunday Times revealed over the weekend that Boris Johnson had not attended five emergency Cobra meetings at the start of the coronavirus crisis, and was instead holidaying with his pregnant girlfriend.

Health Secretary Matt Hancock angered clinicians earlier this month after suggesting health workers should be “making sure PPE is only used when clinically necessary and isn’t wasted or stockpiled”. Staff were bewildered by the suggestion they might waste crucial PPE.

What will happen next?

Ministers claimed that an order of PPE from Turkey was set to arrive in the UK last week, announcing that a “very significant additional shipment” was heading to the UK on Sunday.

But multiple Turkish sources have told Sky News that the UK only made a formal request to Turkey over the consignment of PPE on Sunday, the day after a cabinet minister announced the protective gear was on its way.

The sources also revealed that the PPE manufacturer only submitted a request to the Turkish ministry of health on Monday for permission to export the gear.

With a series of deadlines set by UK ministers missed, the British government has blamed its Turkish counterpart for causing the delays, reports The Guardian.

But “the Turkish state is not responsible for any delay. We are ready to help in any way we can,” said one Turkish source. “There was never a problem from the Turkish authorities. On the contrary, all permissions have been issued very swiftly.”

The Turkish government gifted 250,000 pieces of PPE – 14 tonnes – to the UK over the Easter weekend.

RAF planes are waiting in Turkey to be loaded with PPE, with the hope of returning to the UK on Tuesday.

Chris Hopson, chief executive of NHS Providers, said the 400,000 gowns from Turkey would be welcome, but the NHS was using 150,000 gowns a day, The Mirror reports.

Hancock has called on British manufacturers to approach the government with offers of help, but many companies who have done so say they have yet to hear back.–––––––––––––––––––––––––––––––For a round-up of the most important stories from around the world - and a concise, refreshing and balanced take on the week’s news agenda - try The Week magazine. Start your trial subscription today –––––––––––––––––––––––––––––––

How are other countries faring?

The UK might have looked to countries other than Turkey for its supplies, after European neighbours faced similar struggles ordering PPE from the country.

An Italian order of 200,000 Turkish-made masks was held up for 17 days in March until Italy’s prime minister, Giuseppe Conte, raised the matter directly with the Turkish president, Recep Tayyip Erdogan.

In early April, the Spanish government said Turkey was holding a Spanish shipment containing dozens of respirators. It was released the day after Spain’s complaints, when the Turkish government agreed to exempt the shipment from its export ban.

And five million masks sold by Turkish companies to Belgium before the ban were delayed, prompting Belgium’s health ministry to “file a criminal complaint”, reports the Guardian.

Another reason for the shortage in the UK is that millions of pieces of PPE are being exported from British warehouses to Germany, Spain and Italy despite the severe shortages, The Telegraph revealed.

“Lorries are being packed with masks, respirators and other PPE kit before heading back to supply hospitals in the EU,” said the paper.

The UK firms said they had “no choice” but to keep selling the PPE abroad, because the UK government had not responded to their offers for help.

UK wholesalers told the Telegraph that they have warehouses full of millions of pieces of PPE bought from China, but are now delivering these daily to EU countries for use by their health workers.

But European neighbours are still struggling with a lack of PPE. An Italian study found that “the outbreak-related global PPE shortage has forced the use of lower-protection PPEs”, including masks for infection control procedures on hospital patients.

In Spain, a severe PPE shortage has contributed to at least 12,000 healthcare professionals contracting the virus, around 14% of total infections, says Forbes.

Further afield, in the US, healthcare workers are being forced to reuse existing supplies more times than the Centers for Disease Control and Prevention (CDC) recommends in order to stretch supply.

In India, doctors are using raincoats and motorbike helmets in place of N95 masks while desperately calling for adequate PPE, reports Reuters.

“We won’t risk our lives unless our demand is met,” said Hanuman Pandey, president of the Indian ambulance workers’ association.