Manufacturing of personal protective equipment (PPE) for the COVID-19 pandemic response should be scaled up by 80 to 100 times to meet the projected needs of the healthcare workforce, the World Health Organization said on Friday.

Amid a growing PPE shortage crisis in hotspots like Italy, the United States, and Iran, some 26 million healthcare workers around the world who may have to engage with COVID-19 patients could be in need of personal protective equipment, WHO projected.

“The greatest tragedy is the prospect of losing a great part of our healthcare workforce that may lose their lives [to care for those who are sick],” WHO’s Executive Director of health emergencies, Mike Ryan, told reporters Friday.

Ryan added that WHO was working on directing medical supplies into a “protected supply chain for health workers,” but at the moment the organization was also facing issues with transporting existing stock to countries in need.

“We’re having issues with flights, issues with moving material around” due to some international travel restrictions, said Ryan. “We’re going to need to set up air bridges to bring staff and stuff to countries to help assist them.”

WHO’s Director-General Dr Tedros Adhanom Ghebreyesus additionally added that the shortage of PPE could not be addressed “without political commitment of our leaders.”

According to Dr Tedros countries should be taking three key steps:

1. Increase production of protective equipment;
2. Support cross-border mobility and lift export restrictions on protective equipment;
3. Focus on equitable distribution, as all countries may not have access based on needs.

Down at the community level, Maria Van Kerkhove, WHO’s technical lead on the COVID-19 crisis, said individuals who are not caring for a sick COVID-19 patient or sick themselves should not use masks in order to keep the supply available for healthcare workers.

“There’s very serious discussions about use of masks – if you do not need to wear a mask, don’t hoard those masks. Make sure they are available for healthcare workers,” she said.

“They’re making very difficult decisions about extended use or repeated use.”

US Healthcare Workers Plead For More Government Support As PPE Stocks Run Low

Amidst the global PPE shortage, healthcare staff around the United States are pleading with the federal government for assistance procuring personal protective equipment. 

Additionally, in some hospitals in the epicentres of US outbreaks, resident doctors are being refused COVID-19 tests unless they themselves show severe symptoms.

One resident at a large hospital in New York City posted on social media that the new hospital policy is that a resident should continue working, even if they have mild upper respiratory infection symptoms.

“We are being refused COVID tests as doctors. We are only deemed eligible if we develop [further] respiratory symptoms,” added the resident in their post.

Another resident in New York City confirmed that this was a new policy at a different hospital, as New York City shifted from testing and tracing all suspect cases, to reserving COVID-19 tests for severe cases on Wednesday as cases surged. On Tuesday, a federal official told the Washington Post that there were reports of more than 60 health workers infected with COVID-19 in the US. 

However, US President Donald Trump told reporters in a press briefing Thursday that the federal government has yet to take action under the “Defense Production Act” invoked on Tuesday to direct American manufacturing towards producing supplies for the COVID-19 response. Vice President Mike Pence insisted that “35 million masks” manufactured by 3M, a major respirator production company “were immediately available” for hospitals to purchase, although social media reports from healthcare providers indicated a severe shortage on the ground.

Desperate healthcare workers are calling on the US government to step up. Said the NYC resident, “there has been no government-issued PPE provided to any hospital as of yet… we also need help from the government.”

The US CDC loosened PPE guidance to recommend “facemasks as an acceptable alternative when the supply chain of respirators cannot meet the demand.” Respirators, masks which filter inspired air rather than just protecting against splashes and sprays, offer a higher level of protection against droplet and aerosol transmission than surgical masks. 

A widely circulated petition submitted by three physicians on Change.com, which has gathered more than 700,000 signatures in 48 hours, pleaded “Recommendations to protect healthcare workers should not be based on what’s available; availability should be based on what is necessary.”

According to the petition, some hospitals have taken the CDC’s advice to mean that surgical facemasks are the preferred PPE, and are thus rationing N95 respirators only for ‘aerosol-generating procedures’ such as intubation procedures required to place patients on ventilators. 

Sources told Health Policy Watch that some hospitals in the Tri-State area, which encompasses New York, Connecticut, and New Jersey, have begun collecting used N95 respirators to sanitize and reuse. 

But the concerns do not apply to New York City alone. The authors of the petition, who hail from San Diego, California, wrote “We urge the government to access the Strategic National Stockpile, [the federal government’s stock of emergency medical supplies], and to utilize both the public and private sector to immediately increase production of PPE supplies.”

WHO Director-General Tells Young People “You Are Not Invincible” As Data Indicates Severe Disease In Those Under 50

As confirmed COVID-19 cases around the world rose to 246,276, and total deaths surpassed 10,000, Dr Tedros put out an urgent message to young people to treat the virus with greater caution, amidst an ongoing narrative that the virus is mostly serious in those above the age of 65 and with preexisting conditions.

“You are not invincible,” said the WHO Director-General. “This virus could put you in hospital for weeks, or even kill you.

“Even if you don’t get sick, the choices you make about where you go could be the difference between life and death for someone else.”

Approximately two-thirds of cases in intensive care units in Italy, which now has 41,035 confirmed cases and 3,405 deaths, are under the age of 50, said Ryan. Cases across Europe increased to 99,302 cases and 5,174 deaths, increasingly placing health systems under strain.

Swiss authorities warned on Friday that along with a shortage of diagnostic tests, parts of the country including Ticino canton in the south faced a looming shortage of hospital beds, according to the Local. With one of the highest case to population ratios in Europe, Switzerland has reported 4,164 cases and 43 deaths, according to the Swiss Federal Office of Public Health.

Spain was battling the second largest outbreak In Europe with 18,077 cases and 833 deaths; followed by Germany with 16,290 cases and 44 deaths, and France with 10, 891 cases and 371 deaths.

Across the Atlantic in the United States, some 38% of patients hospitalized for COVID-19 are under the age of 55, according to data released by the US CDC on Wednesday. Among 121 patients admitted to the intensive care unit, 48% were under the age of 65. The case count in the US rose to 14,250 confirmed cases and 250 deaths as outbreaks accelerated in New York State, California, and Washington State.

In Iran, where the epidemic bloomed to 18,407 cases and 1,284 total deaths,  Iranian Ministry of Health spokesman Kianush Jahanpur said that the coronavirus disease is currently killing one person every 10 minutes and some 50 people become infected with the virus every hour. The government urged people to stay home on Friday for Nowruz, the Persian New Year.

More than 700 cases have been confirmed across WHO’s Africa region by Friday, when just one week ago the case count stood at 147 confirmed cases. With local transmission settling into twelve countries in the African region including South Africa, which has 202 confirmed cases, South African Health Minister Zweli Mkhize warned the country to scale up preparedness efforts for when the outbreak starts “affecting poor communities where families do not have enough rooms or spaces to quarantine those affected.”

In Latin America, Brazil and Chile have the highest number of reported cases so far, with 428 and 342 cases respectively according to WHO’s Pan-American Regional Office. On Friday, Brazilian officials announced a ban on entry of all foreigners from Europe for a month, starting 23 March. On the same day, Argentina, with 128 cases, began a “preventative and compulsory” lockdown. Peruvian president Martín Vizcarra announced an investment of US $28 million to help ramp up diagnostic capacity in the country, which currently has 234 cases and just reported its first death.

In one bright spot, Wuhan, the Chinese city at the center of the epidemic merely six weeks ago, reported no new cases of COVID-19 for the first time since the beginning of the outbreak.

“Of course, we must exercise caution – the situation can reverse. But the experience of cities and countries that have pushed back this virus give hope and courage to the rest of the world,” said Dr Tedros.

“Wuhan provides hope for the rest of the world, that even the most severe situation can be turned around.”

Svet Lustig and Zixuan Yang contributed to this story.

Image Credits: New York City Nation Guard, Johns Hopkins CSSE.