Exploring and Understanding Indian Market (Covid-19 Supplies) in Pandemic

Purakala
ISSN:0971-2143
Vol-31-Issue-59-June -2020
(UGC Care Journal)
Exploring and Understanding Indian Market (Covid-19

supplies) in Pandemic
1. Mrs. Deepti Kalra (Asst. Professor)
Govt. College, Tigaon, Faridabad
Email: deeptikalra_16@yahoo.com
2. Mr. Amit K Arora (Professor)
Max Institute of Medical Excellence (MIME)
Email: amitkarora@maxhealthcare.com
Purpose of study: Exploring and understanding Indian Market in COVID 2020 pandemic and
then balancing the demand supply gap of given unit as a sample.
Sample Study: Exhaustive and practical study done on the usages of essential covid supplies
i.e. Personal protective equipments (PPE) at COVID Unit, 250 bedded Hospital, Delhi NCR
from the month of April and May 2020.
Study Period: 2 months period and also data forecasted for entire year provided Corona
virus stays for that long. However, we wish that this pandemic ends or eradicate soon as
possible.
Type of Study: Visits to covid storage supplies areas (2nd line). No patient interaction been
done in this study due to safety reasons. However, exhaustive and interactive feedback from
Doctors and nurses are taken and captured.
Concept used: TTR (Time taken to recovery) concept applied from reference books and links
used and given below. External guide support of Dr S. P. Reddy, Indian School of Business is
taken for this study.
Introduction and brief explanation of covid supplies market: As the corona virus disease
2019 (COVID-19) pandemic accelerates, global health care systems have become
overwhelmed with potentially infectious patients seeking testing and care. Preventing
spread of infection to and from health care workers (HCWs) and patients relies on effective
use of personal protective equipment (PPE)—gloves face masks, air-purifying respirators,
P a g e | 32 Copyright ⓒ 2020Author
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ISSN:0971-2143
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goggles, face shields, respirators, and gowns. A critical shortage of all of these is projected
to develop or has already developed in areas of high demand. PPE, formerly ubiquitous and
disposable in the hospital environment, is now a scarce and precious commodity in many
locations when it is needed most to care for highly infectious patients. An increase in PPE
supply in response to this new demand will require a large increase in PPE manufacturing, a
process that will take time many health care systems do not have, given the rapid increase
in ill COVID-19 patients
In its current guidance to optimize use of face masks during the pandemic, the Centres for
Disease Control and Prevention (CDC) identify 3 levels of operational status: conventional,
contingency, and crisis. During normal times, face masks are used in conventional ways to
protect HCWs from splashes and sprays. When health care systems become stressed and
enter the contingency mode, CDC recommends conserving resources by selectively
cancelling nonemergency procedures, deferring non urgent outpatient encounters that
might require face masks, removing face masks from public areas, and using face masks for
extended periods if feasible.
When health systems enter crisis mode, the CDC recommends cancellation of all elective
and non urgent procedures and outpatient appointments for which face masks are typically
used, use of face masks beyond the manufacturer-designated shelf life during patient care
activities, limited reuse, and prioritization of use for activities or procedures in which
splashes, sprays, or aerosolization are likely. When face masks are altogether unavailable,
the CDC recommends use of face shields without masks, taking clinicians at high risk for
COVID-19 complications out of clinical service, staffing services with convalescent HCWs
presumably immune to SARS-CoV-2 (severe acute respiratory syndrome corona virus 2), and
use of homemade masks, perhaps from bandanas or scarves if necessary.
A frequent proposal was to acquire PPE from existing supplies in non–health care industries
and settings such as construction, research laboratories, nail salons, dentists, veterinarians,
and farms, and redirect them to the health care system via charitable appeals, community
organizing, financial incentives, or government mandate. One endeavour is Project N95, a
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ISSN:0971-2143
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national COVID-19 medical equipment clearinghouse to identify high-need regions and to

source and distribute PPE and other equipment where it is needed most.
Numerous proposals suggested sterilization of used PPE with agents ranging from ethylene
oxide, UV or gamma irradiation, ozone, and alcohol. There were also novel proposals such
as mask-fiber impregnation with copper or sodium chloride. These are not new ideas; work
was performed after prior viral epidemics to determine the feasibility of sterilizing
PPE. Most commenter’s acknowledged uncertainty about the effects of these sterilizing
agents on the structural integrity of PPE, and there is some evidence the fibers in masks and
respirators that filter viral particles can degrade and lose their efficacy with PPE
reprocessing.
A few people advocated for use of positive pressure airflow helmets; proposals ranged from
creating devices from plastic bags insufflate using compressed air and nasal cannula tubing
to adoption of commercially available devices used in the welding industry. An advantage of
this approach is that by not relying on filters, positive airflow devices can be cleaned and
reused indefinitely.
Many proposals reflect an era when PPE was made of cloth and laundered. Health care
might be made greener if reusable PPE was employed where feasible. Cloth gowns and
masks are easily created and stored, and laundry capacity could easily be expanded by
recruiting commercial launderers that service hotels and other large organizations who
currently sit idle. Many contributors wrote of sewing masks, creating them out of clothing,
using novel materials to make them, and using cloth sleeves to extend the use of N95
respirators. As with re-sourced material, most commenter’s acknowledged uncertainty
about the ability of these handmade solutions to filter infectious agents and weather
repeated cleaning, although common sense suggests they are better than no PPE at all.
Conservation of existing PPE is important, as recommended by the CDC. Some commenter’s

called for suspending practices that consume large amounts of PPE and are of uncertain
effectiveness, such as contact precautions for some infectious diseases, to free up
supplies. The idea of using HCWs who have recovered from clinical illness or who have
stayed healthy but test positive and are presumed immune and are no longer infectious is
Purakala
ISSN:0971-2143
(UGC Care Journal)
an age-old and appealing solution. Hoarding of PPE and other supplies has occurred during
the current COVID-19 pandemic, and some proposals suggested rationing or controlling the
supply chain through limited, controlled allocation of supplies.
Sample survey key notes after (TTR) Time taken to recovery applied:
The first step in assessing the risk associated with a particular supplier is to calculate time to
recovery (TTR) for each of its sites under various disruption scenarios. We, from sample case
taken at Saket, developed a simple Survey to collect key data, including:
Sample case of PPE (Personal Protective Equipment) for COVID SCM planning for a 250
bedded hospital.
1 Supplier:
 11 Site Locations
(City, region, country)
09 – Delhi, NCR, India
01 – Mumbai, MH, India
01 – Germany, GbH.
2 Parts from this site:
 Part number and description – Known.

 Part cost – VEPR known and defined part wise in HIS
 Annual volume for this part – 2 months data known with volume
 Inventory information - Known
(days of supply) for this part
 Total spend (per year) – Extrapolated and known. 50-60 lakhs per
month for 150-250 bedded COVID unit.
3 End products:
 OEM’s end product (s) PPE Coverall, Fluid Shield mask, Sterile
Gloves, Goggles, and surgical masks 3 ply, 1
N95 mask.
Purakala
ISSN:0971-2143
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That uses this part.

 Profit margin for the end product(s) 25%
4 Lead Times form supplier site to OEM Site:

 Days – Local 5 days, National 10 days, International
– 15 days.
 (Days of supply) for this part. M, T, W, T, F – 5 days a week.
5 TIMES TO RECOVERY (TTR):
The time it would take for the site to be restored to full functionality
 if the tooling is lost – The TTR would be 2 days if unit level to be restored and this
would be from CMS (Central medical store).
6 COST OF LOSS:
Is expediting components form other locations possible? If so, what is the cost? PRICE
VARIATION impact by more than 15% if in urgency purchased from other sources.
 Can additional resources (Overtime, more shifts, and alternate capacity) be

organized to satisfy demand? If so, what is the cost?
a) Cost of overtime – Rs 1.5 Lakhs per month.
b) Cost of stock holdings – 20% of ICC of Rs 50 Lakhs = Rs 10 lakhs per unit
7 SUPPLER’S RISK ASSESSMENT:
 Does the supplier produce only from a single source? No – Varied sources
 Could alternate Vendor4s Supply the part? Yes – Various sources
 Is the supplier financially stable? Yes but stressing on advance
policy.
 Is there variability in performance (lead time, fill rate, quality)?
Yes 2/11 vendors reported
variability in performance.
Purakala
ISSN:0971-2143
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8 MITIGATION STRATEGIES FOR THIS SUPPLIER PART COMBINATION:
 Alternate Suppliers – <11 diff sources.

 Excess Inventory – <10 days inventory.
 Other – 01 Central Warehousing provision kept despite inventories at Unit level.
These scores and all comments are insightful, many have references, provide links to
websites and videos with illustration and instructions, and readers should spend time
determining which, if any, might best fit their needs and situations. But the ingenuity
displayed in the contributions needs to be placed in context. First, few of the ideas can be
successful independent of the broader health care enterprise and its vulnerabilities. The
commonly suggested process of cohorting low-risk patients for PPE preservation, for
example, requires rapid testing to be accurate and efficient; a requirement regrettably not
yet met in most US health systems. More important, PPE shortages are a problem for HCWs,
but not a problem HCWs are trained to address or should be expected to solve; it’s become
cliché to point out that fire-fighters are not asked to source their own equipment before
entering burning buildings. Hospital administrators, health system media relations
departments, university leadership, elected officials and government agencies have a role to
play in reaching out to suppliers and organizing a response and develop a reliable supply
system. Hospitals successful at procuring supplies should employ rational use of PPE. Better-
resourced institutions and some clinician advocates have considered policies requiring all
staff to wear face masks in public spaces regardless of high-risk exposures, despite little
evidence that this is a judicious use of resources.
Actions taken to expand the service levels and also monitoring the trends during COVID
times ensuring motive of being VOCAL ABOUT LOCAL is as follows:
1. Make or buy decisions: In these tough times, wherein many companies are re-thinking
on their strategic plans, make or buy decision to be carefully crafted again. E.g. taking
the basic action on commonly-used 3-ply, 2-layer surgical masks where the impact on
financial can be enormous for us.
Purakala
ISSN:0971-2143
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The surgical masks during COV’19 increased

from Rs 0.67/- to whopping Rs 5.25/- per
mask. However, this in-house decision to
make masks from HP WRAP SMMMS
having AN EN ISO 13485:2016 certified
company costs around Rs 3.5/- per mask.
The production in house started from 100
masks per day to 1000 qty from just 2 manpower only.
Impact:
a. Reduced cost against volume.
b. Savings to Unit Hospital as well as entire PAN-MAX units.
c. Assurance of uninterrupted supply chain by having more 1 option.
d. Boost for internal employees for showing INTRAPRENEURIAL skills and
innovations.
2. Product consumption control: During the scarcity of COVID supplies wherein everything
majorly is outsourced and seldom MAKE IN INDIA;
the companies to start adopting control
techniques as well. For e.g. we did experiment
using sanitizer dispensing spray technology in
Handrub bottles by replacing the caps by nozzle.
The new nozzle is being used.
Impact:
1. Reduced consumption and better control.
2. Savings by 60% i.e. tune of Rs 5 lakhs per
month per unit.
3. Longer usages and less logistical
movements.
4. Organizational benefits in this tough time of cost and expenses.
Purakala
ISSN:0971-2143
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3. Optimizing Quality: The current PPE used comprising of 6 components which was
suddenly stopped by vendors due to non-availabilities issue. This gave us the
opportunity to source these 6 components separately from different vendors. The new
process now is:
Step 1: Insertion of coverall suit.

Step 2: Insertion of Goggles.
Step 3: Insertion of sterile gloves.
Step 4: Insertion of fluid shield masks.
Step 5: Insertion of long shoe covers.
Step 6: Testing and quality re-check with
sanitization of kit.
Impact:
a) Sourcing best quality.
b) Reduced cost of PPE from Rs 950/- to
Rs 550 to Rs 650/- per kit. Savings of Rs 8 lakhs p.m. per unit.
c) Organizational benefits in this tough time of cost and expenses.
4. Forecasting tool: We started using forecasting tool based on the LIVE data collected and
number of COVID patients admitted plus suspected. It is based on the linear
programming and probability of upward growing trend.
Purakala
ISSN:0971-2143
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Summary: Total of Sr 1-4 financial savings tabulation (taking sample PPE & others
initiative):
Sr Nomenclature Existing Volume New Volume Savings per annum

Rs
1 Make or buy 120000 qty x 5.25/- 120000 qty x 3.5/- 25.20 Lakhs per
decision = 630000 per = 420000 per annum
month month
2 Product control 11 lakhs per month 06 lakhs per month 60.00 Lakhs per
annum
3 Cost optimization 950 x 8000 per 650 x 8000 per 288.00 Lakhs per
and bargain savings month month annum
4 Forecasting ICC cost 950 x 8000 per 650 x 8000 per 57.60 Lakhs per
month month annum
Total Savings p.a. Rs. 430.80 Lakhs p.a.
The savings is calculated on 2 months actuals (April and May 2020) and 10 months
extrapolated if COVID remains. However, we pray that this doesn’t remain so far with us 
NATURE INITIATIVES: Not only the financial savings, we did a lot of work involving
environment and nature impact of going back to basics. EARTHING BASICS were applied
here. Watch this movie when free
https://www.youtube.com/watch?v=44ddtR0XDVU
The movies talk about that human beings are and must always connected to mother earth.
If any person, talks for around ½ to 1 hour BAREFOOT daily connecting him or herself with
mother earth; then the NEURONs get charged and healing takes place by its own.
We did personally experiment this on my hospital colleagues who got COVID +ve and found
enormous difference in their healing. For e.g. Mr Sandeep (full name not disclosed) got +ve
10 days back and after daily walking barefoot early morning at sharp 6 am; now today he
got his result as –ve and fit to work. Of course, he did adhere to his medications, diet, and
exercise regularly and on time.
Purakala
ISSN:0971-2143
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This brings a different dimension altogether in saving human life via connecting and sourcing
back to nature.
Novel Coronavirus Disease 2019 (COVID-19): Additional guidelines on rational use of

Personal
Protective Equipment (setting approach for Health functionaries working in non-COVID
areas)
1. About this guideline:
This guideline is for health care workers and others working in Non COVID hospitals and
Non-COVID treatment areas of a hospital which has a COVID block. These guidelines are in
continuation of guidelines issued previously on ‘Rational use of Personal Protective
Equipment’
(https://www.mohfw.gov.in/pdf/GuidelinesonrationaluseofPersonalProtectiveEquipment.p
df). This guideline uses “settings” approach to guide on the type of personal protective
equipment to be used in different settings.
2. Rational use of PPE for Non COVID hospitals and Non-COVID treatment areas of a
hospital which has a COVID block.
The PPEs are to be used based on the risk profile of the health care worker. The document
describes the PPEs to be used in different settings.
Purakala
ISSN:0971-2143
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2.1. Out Patient Department :
S.No. Setting Activity Risk Recommended Remarks

PPE
1 Help desk/ Provide Mild risk Triple layer Physical distancing

Registration information to medical mask to be followed at
counter patients Latex all times
examination
gloves
2 Doctors Clinical Mild risk Triple layer No aerosol

chamber management medical mask generating
Latex procedures should
examination be allowed.
gloves
3 Chamber of Clinical Moderate N-95 mask Aerosol generating

Dental/ENT management risk Goggles procedures
doctors/ Latex anticipated.
Ophthalmology examination
doctors gloves
Face shield, when a
+ face shield splash of body fluid
is expected
4 Pre- anesthetic Pre-anesthetic Moderate N-95 mask * Only

check-up clinic check-up risk Goggles* recommended
Latex when close
examination examination of oral
gloves cavity/dentures is
to be done
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5 Pharmacy Distribution of Mild risk Triple layer Frequent use of

counter drugs medical mask hand sanitizer is
Latex advised over
examination gloves.
gloves
6 Sanitary staff Cleaning Mild risk Triple layer

frequently medical mask
touched Latex
surfaces/ Floor examination
gloves
#All hospitals should identify a separate triage and holding area for patients with Influenza
like illness so that suspect COVID cases are triaged and managed away from the main out-
patient department.
2.2. In-patient Department (Non-COVID Hospital &Non-COVID treatment areas of a

hospital which has a COVID block) :

PPE
1 Ward/individual Clinical Mild risk Triple layer Patients stable.

rooms management medical mask No aerosol
Latex generating
examination activity.
gloves
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ISSN:0971-2143
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2 ICU/ Critical Critical care Moderate N-95 mask Aerosol generating

care management risk Goggles activities
Nitrile performed.
examination
gloves
+Face shield
Face shield, when
a splash of body
fluid is expected
3 Ward/ICU Dead body Low Risk Triple Layer

/critical care packing medical mask
Latex
examination
gloves
4 Ward/ICU/ Dead body Low Risk Triple Layer

Critical care transport to medical mask
(Non-COVID) mortuary Latex
examination
gloves
5 Labor room Intra-partum Moderate Triple Layer Patient to be

care Risk medical mask masked
Face shield in the Labor room
Sterile latex
gloves
N-95 mask*
*If the pregnant
woman is a
resident of
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containment zone
6 Operation Performing Moderate Triple Layer Already OT staff

Theater surgery, Risk medical mask shall be wearing
administering Face shield
general (wherever
anaesthesia feasible)
Sterile latex
gloves
For personnel
+ Goggles involved in
aerosol
generating
procedures
N-95 mask* *If the person

being operated
upon is a resident
of containment
zone
7 Sanitation Cleaning Low Risk Triple Layer

frequently medical mask
touched Latex
surfaces/ floor/ examination
changing gloves
linen
Purakala
ISSN:0971-2143
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2.3. Emergency Department (Non-COVID)

PPE
1 Emergency Attending Mild risk Triple Layer No aerosol

emergency cases medical mask generating
Latex procedures are
examination allowed
gloves
2 Attending to High risk  Full

severely ill complement of
patients while PPE (N-95
performing mask, coverall,
aerosol goggle, Nitrile
generating examination
procedure gloves, shoe
cover)
2.4. Other Supportive/ Ancillary Services

PPE
1. Routine Sample collection Mild risk Triple layer

Laboratory and medical mask
transportation Latex
and testing of examination
routine gloves
(nonrespiratory)
samples
Respiratory Moderate N-95 mask

samples risk Latex
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examination
gloves
2 Radiodiagnosis Imaging services, Mild risk Triple layer

, Blood bank, blood bank medical mask
etc. services etc. Latex
examination
gloves
3 CSSD/Laundry Handling linen Mild risk Triple layer

medical mask
Latex
examination
gloves
4 Other Administrative Low risk  Face cover ** Engineering and

supportive Financial dietary service
services incl. Engineering** personnel visiting
Kitchen and treatment areas
dietary** will wear personal
services,etc. protective gears
appropriate to that
area
Purakala
ISSN:0971-2143
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2.5. Pre-hospital (Ambulance) Services

PPE
1 Ambulance Transporting Low risk Triple layer

Transfer to patients not medical mask
designated on any Latex
hospital assisted examination
ventilation gloves
Management of High risk  Full While performing

SARI patient complement of aerosol generating
PPE (N-95 procedure
mask, coverall,
goggle, latex
examination
gloves, shoe
cover)
Driving the Low risk Triple layer Driver helps in

ambulance medical mask shifting patients to
Latex the emergency
examination
gloves
Points to remember while using PPE:
1. Standard precaution to be followed at all times
2. PPEs are not alternative to basic preventive public health measures such as
hand hygiene, respiratory etiquettes which must be followed at all times.
3. Always follow the laid down protocol for disposing off PPEs as detailed in
infection prevention and control guideline available on website of MoHFW.
Purakala
ISSN:0971-2143
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In addition, patients and their attendants to be encouraged to put on face cover.
In case a COVID-19 patient is detected in such Non-COVID Health facility, the MoHFW
guidelines for the same has to be followed (Available at:
https://www.mohfw.gov.in/pdf/Guidelinestobefollowedondetectionofsuspectorconfirmed
COVID19ca se.pdf)
Concluding remarks: When health systems pass this stress test, the operations,
organizations, and profession will have learned a thing or two, and be stronger for it.
References:
 Guidelines from Ministry of Health and Family Welfare:
 Ministry of Health and Family Welfare
 Directorate General of Health Services
 [Emergency Medical Relief]

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Purakala

Exploring and Understanding Indian Market (Covid-19

national COVID-19 medical equipment clearinghouse to identify high-need regions and to

Conservation of existing PPE is important, as recommended by the CDC. Some commenter’s

 Part number and description – Known.

That uses this part.

4 Lead Times form supplier site to OEM Site:

5 TIMES TO RECOVERY (TTR):

 Can additional resources (Overtime, more shifts, and alternate capacity) be

7 SUPPLER’S RISK ASSESSMENT:

8 MITIGATION STRATEGIES FOR THIS SUPPLIER PART COMBINATION:

 Alternate Suppliers – <11 diff sources.

The surgical masks during COV’19 increased

Step 1: Insertion of coverall suit.

Sr Nomenclature Existing Volume New Volume Savings per annum

Novel Coronavirus Disease 2019 (COVID-19): Additional guidelines on rational use of

1. About this guideline:

2.1. Out Patient Department :

S.No. Setting Activity Risk Recommended Remarks

1 Help desk/ Provide Mild risk Triple layer Physical distancing

2 Doctors Clinical Mild risk Triple layer No aerosol

3 Chamber of Clinical Moderate N-95 mask Aerosol generating

4 Pre- anesthetic Pre-anesthetic Moderate N-95 mask * Only

5 Pharmacy Distribution of Mild risk Triple layer Frequent use of

6 Sanitary staff Cleaning Mild risk Triple layer

2.2. In-patient Department (Non-COVID Hospital &Non-COVID treatment areas of a

S.No. Setting Activity Risk Recommended Remarks

1 Ward/individual Clinical Mild risk Triple layer Patients stable.

2 ICU/ Critical Critical care Moderate N-95 mask Aerosol generating

3 Ward/ICU Dead body Low Risk Triple Layer

4 Ward/ICU/ Dead body Low Risk Triple Layer

5 Labor room Intra-partum Moderate Triple Layer Patient to be

6 Operation Performing Moderate Triple Layer Already OT staff

N-95 mask* *If the person

7 Sanitation Cleaning Low Risk Triple Layer

2.3. Emergency Department (Non-COVID)

S.No. Setting Activity Risk Recommended Remarks

1 Emergency Attending Mild risk Triple Layer No aerosol

2 Attending to High risk  Full

S.No. Setting Activity Risk Recommended Remarks

1. Routine Sample collection Mild risk Triple layer

Respiratory Moderate N-95 mask

2 Radiodiagnosis Imaging services, Mild risk Triple layer

3 CSSD/Laundry Handling linen Mild risk Triple layer

4 Other Administrative Low risk  Face cover ** Engineering and

2.5. Pre-hospital (Ambulance) Services

S.No. Setting Activity Risk Recommended Remarks

1 Ambulance Transporting Low risk Triple layer

Management of High risk  Full While performing

Driving the Low risk Triple layer Driver helps in

1. Standard precaution to be followed at all times

In addition, patients and their attendants to be encouraged to put on face cover.

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