Our study demonstrates that the availability of PPE in both Gaza and the West Bank is insufficient to support the COVID-19 response needs of the oPt. Alcohol-based hand sanitizers, gloves, face masks, eye protection, isolation gowns, N95 respirators and face shields were reported to be inconsistently available, despite being internationally recommended as critical equipment needed for protecting health care workers from infection.(13) Governmental hospitals, as opposed to non-governmental settings, appear to be particularly lacking in equipment. Lessons from prior outbreaks have underlined the importance of PPE in infection control.(14) Recommendations from the WHO suggest the inadequate supply of infection prevention and control measures must be addressed immediately, with assistance from international partners if necessary.(15) The WHO outlines supplies needed to implement recommended protocols, such as PPE, and denotes them as a key resource for all national authorities currently not producing sufficient volumes themselves. Suggestions for other methods of procurement, conservation and management of PPE have been extensively covered in the literature during the pandemic.(16) Many of these suggestions may not be viable in the geopolitical and economic context in which oPt operates. However, methods such as governmental coordination of all PPE supply, extending or creating new supply through 3D printing all provide viable means of blunting the dearth of PPE in oPt currently.(17, 18)
Our study showed that most HCWs surveyed did not receive adequate training on local protocols or measures to address COVID-19 spread. Comparing the preparedness of HCWs in oPt to those around the world will be a vital element of the debrief from this pandemic and important in developing strategies to ensure the oPt can face future public health crises. A lack of data and the ongoing nature of the crisis makes this comparison difficult, at present. In previous pandemics, clinicians in other countries have been substantially more confident in their clinical ability to manage infected patients than those we surveyed. For example, Chinese ICU HCWs during the 2009 H1N1 pandemic were substantially more confident in their preparedness.(19) This may partly be due to a far greater provision of PPE amongst these workers, permitting greater clinical confidence.
Our study has some important strengths. To our knowledge, this study represents the first attempt to assess the availability of PPE in oPt and the preparedness of HCWs to face the COVID-19 pandemic. We provided a comprehensive evaluation of most PPE described in the literature and used clinically. Participants were well-represented across gender, geographic region, department/specialty, level of training, profession, and type of health care facility.
Potential limitations of this study include a small sample size, which may impact generalizability of our results. Another weakness of our study was the failure to elicit whether the lack of appropriate PPE was one of the driving factors in reducing HCW confidence in their preparedness. Making this link would allow us to assert that attempts to target increasing PPE provision could both protect HCW and improve clinical confidence in managing COVID-19 patients. Potential selection bias arose due to the sampling method. Most study participants were recruited from social media posts and emails to the networks of the researchers involved, which may limit the study’s generalisability. However, other studies have demonstrated the viability of social media recruitment and snowball sampling to access difficult to reach populations.(20) Additionally, participants were asked to report on their individual experiences and thus may not be wholly representative of the institutions in which they are employed. The cross-sectional nature of this study is, by definition, unable to take into account any changes in equipment or training preparedness over time and is only representative of the point-in-time data were collected. These limitations were acknowledged by the authors during study enrolment - as information was required in a timely manner. This study design allowed the authors to rapidly address the gap in the literature regarding COVID-19’s unique impact on the population in the oPt.