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Protective gear stocks: are medics exposed?

The Government must urgently release the details of exactly what essential medical protective equipment it has in stock, a pandemic researcher says.

Without a detailed stocktake, it’s impossible for medical professionals, manufacturers and officials to know where the gaps are - and crucially start to fill them - before a full-blown pandemic hits.

This is the view of top pandemic preparedness expert Wendy McGuinness, head of the McGuinness Institute, a Wellington-based think tank which focuses on New Zealand’s preparedness for future risks like pandemics or climate change.

McGuinness isn't a natural whistleblower. She'd rather be keeping her head down, getting involved in research. But this isn't the time for keeping quiet, she says. 

This morning the World Health Organisation warned of possible global shortages of personal protective equipment (PPE) and called on industry and governments to increase manufacturing by 40 per cent to meet rising world demand.
The WHO warned: "severe and mounting disruption to the global supply of PPE - caused by rising demand, panic buying, hoarding and misuse - is putting lives at risk from the new coronavirus and other infectious diseases."

After raising the red flag on shortages of critical hospital ventilators last week, McGuinness turned her attention to whether we had enough of other medical supplies - gowns, masks, goggles and gloves, even disinfectants. The sort of things that are needed to keep medical teams safe - and working - during a pandemic.

What she found out frightened her. Her spreadsheet, shared with Newsroom, is full of holes and question marks.

Protective masks and goggles must fit well otherwise they don't work. Photo: Francisco Àvia Clínic

We know, for example, that the DHBs hold stocks of gowns, goggles and gloves, but we don’t know how many or what quality they are.

We know the Ministry of Health holds 17 million masks, but we don’t know when it bought them and therefore whether they are still useable. 

What is frightening is when we don’t have the information

“We need the Government to make public what medical resources we have and what we are short of. This information will buy us a window, firstly to not use up what we have only a little of - for example PPE equipment. And secondly, to allow us to gear up to manufacture products in New Zealand, to order or swap with Australia, or to buy from China.

McGuinness says not knowing whether there are enough of these critical products is creating huge uncertainty for doctors, health services and other medical staff in an already uncertain situation.

“Say we knew bleach was in short supply. We don’t know, because we don’t have the numbers. But say we did know. Then we could gear up to manufacture it, or we could try to buy it from overseas, or we could tell people to be careful with using bleach; maybe dilute it.”

What is frightening is when we don’t have the information.

Or enough information.

Are mask stockpiles adequate?

Take P2 respirator/masks. 

In normal times you’d buy a P2 mask in a hardware store and use it if you had some sanding to do. Australians bought a lot during the recent bushfires because they can keep even small particles out of your nose and mouth. 

P2 respirator/masks protect doctors from Covid-19. The looser-fitting surgical masks don’t. 

We know how many P2 masks we have stockpiled in New Zealand because Prime Minister Jacinda Ardern told us. It’s 9 million. Which sounds like a lot, except that they are disposable. You throw them away and put another on after, say, stopping work for lunch. Well, hopefully you do.

The other problem is that we just don’t know how old our masks are. We know that the most recent batch added to the stockpile was 527,000 masks. The year before “nearly four million were purchased”.

But we don’t know when that was.

And that matters, because surgical masks last only 10 years in storage. After that they expire. 

We know the US last stocked up on heaps of masks in 2009 - the year of the H1N1 flu pandemic.

If the same thing happened in New Zealand, a lot of our masks will be past their 10-year use-by date.

All may not be lost. The Americans have started testing expired masks to see if they can still be used. Sometimes they can. But if the seals are old or damaged, the masks won’t work.

“I want to know, have they looked at the masks in storage and checked their expiry date,” McGuinness says.

“We’re running out of time”

She says GPs and hospital staff are getting drip-fed PPE gear. But not knowing what the situation is, is worrying.

“I’m sitting here looking at the supply chain information and I've been getting phone calls from GPs and I can’t tell them, because the Government isn’t being transparent.

She says three weeks of Official Information Act requests to the Ministry of Health have not produced a single reply.

“We’re running out of time. I’m a researcher and I say this window is going to save lives.

“I’m making estimations about what’s in short supply, but I’ll be wrong.

She says the difference between having enough protective medical gear and not having enough will be whether medical professionals catch the virus from their patients - or not. Decent masks, gowns, gloves and goggles keep doctors healthy, so they can continue to treat more people.

It’s about the numbers.

In Italy, at least 2,629 health workers have been infected by coronavirus since the onset of the outbreak in February, representing 8.3 percent of total cases, according to recent research.

On the other hand, infected medical staff in China made up 3.8 percent of the total cases, with only five deaths. 

Each time the medical side lose one of their team, it puts more pressure on them.

Think of it as a rugby game, McGuinness says. On one team are the sick people, on the other side the medical staff.

“Imagine that 40 minutes in the medical team has lost one of their players. This doesn’t simply get us to 14 versus 15. We are now 14 versus 16, with the doctor we had on our side now being a patient on the other.

“This has very serious implications.”

“We need to change the odds and protect the medical people so they deliver the very best care they can. Each time they lose one of their team, it puts more pressure on them.”

Treating people like children

McGuinness says there are philanthropists and business people that want to help - but they can’t if they don’t know where the problem areas are.

“If people aren’t informed, they won’t make the right decisions.”

After Newsroom wrote a story about the critical shortage of respirators last week it was approached by half a dozen companies with possible solutions. Newsroom connected them with the business-government team which had sprung into action coordinating the response.

With protective equipment, that coordinated response isn’t possible, because no one knows where any shortage is.

McGuinness says there are two types of Government-to-country narratives: adult to child, and adult to adult.  

“There’s a danger with the adult-child response. When you are simply told you don’t need to worry, that’s a bad sign. The Government needs to be saying: ‘This is the information; this is what we need to do.”

Credible information is crucial in a crisis.

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