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The year 2020 started with a bang due to pandemic Covid-19. At present, the number of people infected worldwide has crossed 17.5 million with 0.67 million deaths1 and still counting. This novel virus caught the world unprepared resulting in huge social and economic impact due to movement restrictions and healthcare crisis. So far, there is no specific treatment barring some assumptions and hypotheses in providing symptomatic treatment and palliative care. So, maintaining social distance, observing personal hygiene and donning mask are prescribed which would help in bringing down infection spreading via aerosolised droplets containing virus including other respiratory pathogens. The use of personal protective equipments (PPEs) becomes a compulsion for the personnel in health care facilities and frontline workers who are involved in managing the containment of Covid-19. This situation has generated huge amount of biomedical waste across the world since most of the PPEs (coverall suits, gowns, gloves, aprons, shoe covers, head covers, masks etc) and other solid waste (packaging materials, bandages, wipes, infusion kits etc) are meant for one time use only. Therefore proper and effective disposal of these wastes as per the biosafety norms has becomes an imperative issue and poses a challenge for its management to all the countries. Every country has got regulatory bodies to monitor these activities. For instance, the Environmental Protection Act 1990 (Part II), Waste Management Licensing Regulations 1994, and the Hazardous Waste Regulations (England & Wales) 2005, as well as the Special Waste Regulations in Scotland in United Kingdom, The Medical Waste Tracking Act and its allied Medical Waste Management Program (Program) in every state in the USA, The Bio-medical Waste (Management and Handling) Rules, 1998, amended 2016 in India are some of the regulating act that deals with the nuances and compliance of biowaste management. In India, each State’s Pollution Control Board or Pollution Control Committee is given the responsibility for implementing this legislation.
Improper management of health care waste can have both direct and indirect health consequences for community and on the environment. With the pandemic spreading to every corner of the world, besides the hospitals designated for treating Covid-19 cases, other points in the local environment which may account for generation of equal volume of waste include primary health care centres, quarantine set-up, administrative institutions, banks, law enforcement personnel, scanning centres in districts, State borders, shops and market places dealing with essential and individual households. Therefore, the proper management of waste from such points should also be given emphasis to avoid physical littering on the surrounding and contaminating the same. And this could also become a potential source for community spread of virus through sanitary workers, waste collectors, rag pickers and menace to stray animals if left unattended. In a country like India having 1.38 billion population with 1.34 doctor per 1000 person2 and other health care workers at 20 per 10000 person3, assuming that 10% of doctors and 30% of other health care workers attend the Covid-19 duty, the calculated amount of disposable PPE waste generated per day will be 303.87 tonnes (average weight of PPE @ 300 gm per kit). The disposable waste generated from masks and gloves by other frontline workers like police, sanitation workers and general public would add more volume to the bulk. Disposal of massive amount of waste by incineration or burning will emit tonnes of harmful gases into the environment. There is also a concern for increasing carbon footprint due to the requirement for huge numbers of PPEs in the current scenario. It has been reported that carbon footprint emission of 100 pairs of gloves produced 42 kg CO2 equivalent4; so in our country alone, even if 50% of the 5 million sanitation workers and 14.2 lakhs police forces on duty in a day along with doctors and other health care workers will account for use of more than 4.2 million pairs of gloves per day. So, producing these amounts of gloves waste alone will release an equivalent of 1773.62 tonnes of CO2. Hence, effective guidelines for safe and environment friendly disposal of waste advocating proper decontamination and recycling is the need of the hour.
In this context, few measurements that could considered are: (1) Small scale sterilisation of used PPEs using low cost techniques like autoclaving in pressure cooker to contain infectious waste generated at individual household level. (2) Use of reusable face mask and other protective clothing which can be washed and reused multiple times making it more affordable and also lessening the quantity of waste generation into the environment. (3) Small scale waste treatments at community level in the villages/towns rendering it harmless before disposing into the surrounding environment. (4) Community participation to come up with innovative ideas to recycle the waste generated etc, could help reduce the risk of infection and waste generation. It would also ease the burden of the implementing agency e.g., the municipal board in disposing overwhelming mounts of waste. As per the WHO updates and other health experts, the virus is not going away anytime soon. Therefore, the new normal in donning mask and other protective clothes in dealing with the virus is unavoidable. So, having sustainable and environment friendly ways of waste disposal and developing alternatives to the use of disposable PPEs is much required. Another important dimension would be to create extensive awareness programme to educate the mass about the impact of waste to the public and environment and encourage everyone to bring in innovative ideas of recycling the waste. Together we have to do our bit in fighting this war till effective therapeutic or prophylactic control measures are put in place.
Khanmi Kasomva and Kekungu-u Puro
Khanmi Kasomva is a Ph.D., research scholar in Biotechnology and Molecular Biology Unit, ERI, Loyola College, Chennai. His research focuses on the development and metastasis of cancer cells in cancer. Email id: kasomva@gmail.com.
K. Puro is an IFBA certified professional working as Senior Scientist in the Animal Health division of ICAR-RC for NEHR, Umiam. Her research focuses primarily on viral infections, including influenza virus and coronary virus in poultry and other livestock.
Email id: akulepuro@rediffmail.com.