On 22 March, as 1.3 billion Indians imposed a curfew on themselves, at the request of Prime Minister Narendra Modi, health workers continued to struggle with the slow-rising horror that India had failed to create stockpiles of personal protective equipment, or PPE, such as masks, gowns, and gloves in the past two months. Modi had called upon the nation to impose the “janata curfew” on 18 March, urging them to make noise from their balconies to support India’s health workers. But it was only the next day that the Indian government issued a notification prohibiting the export of domestically manufactured PPE, three weeks after the World Health Organisation issued guidelines informing countries to expect a disruption in the supply of PPE.
As early as 27 February, the WHO had issued the guidelines, noting, “The current global stockpile of PPE is insufficient, particularly for medical masks and respirators; the supply of gowns and goggles is soon expected to be insufficient also. Surging global demand − driven not only by the number of COVID-19 cases but also by misinformation, panic buying and stockpiling − will result in further shortages of PPE globally.” As described in the WHO guidelines, PPE includes gloves, medical masks, gowns or coveralls, and respirators, such as the N95 masks. Yet, the Indian government waited till 19 March to issue a notification prohibiting the export of domestically manufactured PPEs and the raw material for the same.
Perhaps the most disturbing aspects of the government’s decision-making process has been the bizarre progression of developments with respect to PPE, as they watched the pandemic approach. On 31 January, one day after India reported its first COVID-19 case, the government’s directorate general of foreign trade issued a notification prohibiting the export of all PPE. But in just over a week, on 8 February, the government amended that order, permitting the export of surgical masks and all gloves. On 25 February, by which point Italy had reported 11 deaths to the virus and over two hundred cases, the government further relaxed the restrictions, allowing eight new items for export. It is inexplicably clear that the Indian government did not make the necessary attempts to forecast the demand for PPE kits, as had been recommended by the WHO. As a result, India’s doctors and nurses have paid the price and will continue to do so, as they walk into this public-health nightmare without adequate gear to keep them safe.