In the heat of the COVID 19 pandemic
the main management focus of the world is frantic efforts of containment and
search for vaccine, hence measures like lockdown, social distancing, wearing of
face mask, intensive research etc. All that is done to prevent people from
contracting the disease in the first place, boost the immune system of those
who have contracted the disease to prevent fatalities therefrom, reduce fatalities,
and timeously find a vaccine.
The efforts of management come with
the use of medical equipment and materials, some of which are to be used once
and disposed of. Given the scale of this pandemic (over 6 million cases now),
the short term use of equipment and single- use applications and their immediate
disposal, particularly from the hospitals, one could imagine the pile of waste
the pandemic is generating. I have listed below some disposable items being used in
the management of the pandemic:
- Face mask
- Virus detection kit
- Sanitizer
- Test kit
- Thermometer
- Tissue
- Personal protective equipment (PPE)-
Surgical mask
Protective suits
Goggles
Gown
Glove
The foregoing equipments turned waste,
after usage, must be disposed of. In our homes we put our household waste into
dustbins to be collected by waste management companies for disposal. Waste is,
normally, either dumped in landfill or incinerated.
In this post I am going to look at the
COVID 19 medical waste disposal, and how it may compromise the natural environment.
PHENOMENAL INCREASE
Medical waste has always been
generated. The COVID 19 medical waste merely adds to the volume of waste in a
big way.
From the link https://www.scmp.com/news/china/society/article/3074722/coronavirus-leaves-china-mountains-medical-waste
let us get an idea about how the increase has been captured in China, and indeed
Wuhan, the original epicenter of the pandemic:
“More than 20 cities across mainland
China have been overloaded with medical waste, with Wuhan, the centre of the
Covid-19 outbreak, producing up to six times more medical waste than usual,
authorities said.
Medical waste treatment facilities in
28 other cities are working at full load, the Ministry of Ecology and
Environment told a press conference on Wednesday, without specifying what the
other cities were.
Hospitals in Wuhan, home to 11 million
people and 80 per cent of those who died from Covid-19, produced more than 240
tonnes of medical waste daily during the peak of the outbreak, compared with 40
tonnes before the epidemic occurred, said Zhao Qunying, head of the ministry’s
emergency office.”
The link https://gulfnews.com/world/europe/covid-19-medical-waste-piles-up-in-italys-virus-epicentre-1.1588086371890
gives a hint of the additional medical waste occasioned by the COVID- 19
pandemic in Italy as follows:
Contaminated hospital waste is
piling up in the Italian epicentre of the coronavirus crisis.
Medics at the Cremona hospital in
the Mediterranean country's north say the surge in patients since March has
made the issue of its safe disposal particularly sensitive.
Staff must be trained to properly
handle everything from sheets and masks to syringes - standard hospital items
now laced with added danger in a pandemic caused by a new and still unexplored
disease.
"Compared to the time before
the pandemic, the amount of potentially infectious waste has doubled or nearly
tripled," the hospital's waste management director Maria Rosaria Vino told
AFP.
Since the pandemic has touched every part of the world, the rest of the world must be telling the same story as China and Italy, substantially speaking.
COPING WITH THE INCREASE
The COVID 19 pandemic as indicated
brings in more waste. Some of the waste brings with it contamination-SARS- CoV-
2 contamination. The extra waste baggage, compounded by its contamination by a
virus that spreads fast requires careful management measures.
The World Health Organization, with a
global outreach, through file:///C:/Users/user/Downloads/WHO-2019-nCoV-IPC_WASH-2020.3-eng.pdf
gives interim guidance on page 4 under point 4 on how to handle COVID 19 waste.
It has been rearranged in form as follows:
- All health-care waste produced during patient care, including those with confirmed COVID-19 infection, is considered to be infectious (infectious, sharps and pathological waste) and should be collected safely in clearly marked lined containers and sharpsafe boxes.
- This waste should be treated, preferably on-site, and then safely disposed.
- If waste is moved off-site, it is critical to understand where and how it will be treated and disposed.
- Waste generated in waiting areas of health-care facilities can be classified as non-hazardous and should be disposed in strong black bags and closed completely before collection and disposal by municipal waste services.
- All those who handle health-care waste should wear appropriate PPE (boots, long-sleeved gown, heavy-duty gloves, mask, and goggles or a face shield) and perform hand hygiene after removing it.
- The volume of infectious waste during the COVID 19 outbreak is expected to increase, especially through the use of PPE. Therefore, it is important to increase capacity to handle and treat this health-care waste. Additional waste treatment capacity, preferably through alternative treatment technologies, such as autoclaving or high temperature burn incinerators, may need to be procured and systems may need to be put in place to ensure their sustained operation.
In India the Central Pollution Control
Board of the Ministry of Environment, Forrest and Climate Change has in a
letter referenced F. No. B- 31011/BMW (94)/2020/WM-1 and dated March 18, 2020
released guidelines in connection with the disposal of COVID 19 waste to
ministries, departments, state pollution control boards and pollution control
committees. I give below some of the guidelines.
- Keep separate color coded bags/bins/containers in wards and maintain proper segregation of waste as per BMWM rules, 2016 as amended and CPCB guidelines for implementation BMW management rules.
- As a precaution double layered bags (using 2 bags) should be used for collection of waste from COVID 19 isolation wards so as to ensure strength and no leaks.
- Collect and store biomedical waste separately prior to handing over same to CBWTF. Use a dedicated collection bin labelled as “COVID- 19 Waste” to store COVID- 19 waste and keep separately in temporary storage room prior to handing over to authorized staff of CBWTF. Biomedical waste collected in such isolation wards can also be lifted directly from wards into CBWTF collection vans.
- In addition to mandatory labelling, bags/containers used for collecting biomedical waste COVID- 19 wards should be labelled as COVID- 19 waste. This marking would enable CBWTFs to identify the waste easily for priority treatment and disposal immediately upon receipt.
- In case it is required to treat and dispose more quantity of biomedical waste generated from COVID- 19 treatment, CBWTF may operate their facilities for extra hours, by giving information to SPCBs/PCCs.
(https://www.cpcb.nic.in/uploads/Projects/Bio-Medical-Waste/BMW-GUIDELINES-COVID.pdf)
The World Health Organization, a component of the United Nations Organization, is the spearhead in the fight against COVID- 19. It generates guidelines and strategies for member states to follow in the fight against the pandemic. The organization serves as authority of reference for public health matters, more so the COVID- 19 pandemic. So measures a country like India, for example, takes in the fight against COVID- 19 is related to directions from the World Health Organization.
DISPOSAL AND THE NATURAL ENVIRONMENT
The natural environment, is fully
packed with living and nonliving things, both that which can be seen and that
which cannot be seen with the naked eye. The living and nonliving things, the
visible and invisible, are designed to live harmoniously in a required balance.
Obviously that balance is lost. That a
virus, SARS- CoV- 2, was able to move from one species (animal) to another species
(man) is in itself breach of balance!
What man has been doing all this while
is to try and regain that required balance. So in disposing COVID- 19 waste,
within that frame of mind, man ensures that the natural environment is not
compromised further, as evidenced in guidelines etc. regarding waste disposal.
When it comes to management of waste,
that is, the application of guidelines etc., generally there is a problem all
over the world. If that was not the case there should not be, for example, so
much plastic waste in the natural environment.
One cannot speak of the natural
environment without bringing in the body of the United Nations Organization
that man has raised to oversee the sanity of the natural environment, more so
when we are neck deep in the COVID- 19 pandemic. That body is the United
Nations Environment Programme. The United Nations Organization was put in place
to prevent, avoid and therefore safeguard the world from another world war
(World War III), and degradations therefrom, of course including environmental
degradation.
Therefore, in this warlike, critically
important pandemic, the mind of United Nations Environment Programme ought to
be picked. Tapping from https://www.unenvironment.org/covid-19-updates
United Nations Environment Programme is of the view that:
“The transmission of diseases,
like the
Novel Coronavirus COVID-19, between animals and humans (zoonoses)
threatens economic development, animal and human well-being, and ecosystem
integrity. The United Nations Environment Programme supports global efforts to
protect biodiversity, to put an end to the illegal trade in wildlife, to
safeguard the handling of chemicals and waste and to promote economic recovery
plans that take nature and the climate emergency into account.”
Given the rate at which SARS- CoV- 2
spreads, and is infectious, COVID- 19 waste requires a particularly effective
and efficient disposal so as not to compromise the natural environment.
From https://www.euractiv.com/section/coronavirus/news/coronavirus-waste-burn-it-or-dump-it/
I give you a story of how Spain is grappling with environmentally-friendly
disposal of COVID- 19 waste:
Catalonia has three autoclave sanitary
waste processing plants (which kill microorganisms using saturated steam under
pressure), which were able to absorb an average of 275 tons each month before
the outbreak.
Between the middle of March and the
middle of April, at the height of the pandemic in Spain, waste from COVID-19
rose to 1,200 tons in the region, according to the Catalan Waste Agency (ACR).
“The plants that are authorised to
treat the waste are overwhelmed, they cannot cope with such volumes coming from
hospitals and hotels converted into clinics. In Catalonia, we discarded storage
and have agreed to incinerate the waste at three urban garbage plants,” ACR
director Josep María Tost told Efe.
In the same story Greenpeace gives its
remarks thus- In Spain, “waste management was already an important pending
matter” before COVID-19: 82% of the garbage was collected mixed up “and very
little was recovered,” Julio Barea, expert in waste management at
Greenpeace-Spain, told Efe.
“More than 60% of the garbage was
dumped in a landfill.”
“Since the outbreak, that amount has
increased significantly because there is no manual sorting of the mixed waste,
so it is not recovered. There is no data on how many masks, gowns and gloves
are being generated each day.”
“Because of the evidence, we fear that
most of this COVID-contaminated waste is being poorly managed and ending up
buried in landfills. There is no capacity to do anything else, we are not
prepared,” Barea said.
The story refers to a World Health Organization (WHO) warning thus:
In its
2018 report “Safe Management of Waste from Health Care Activities,” the WHO
warned of the health risks of incorrect management of medical waste “through
the release of pathogens and toxic pollutants into the environment.”
“Landfills can contaminate
drinking-water if they are not properly built. If waste is incinerated
inadequately, this can cause the release of pollutants into the air, such as
human carcinogens that have been associated with a range of adverse health
effects,” the organisation said.
To allay the fears of
environmentalists, Tost specified that the garbage processed in the incinerators for
urban waste in Catalonia is made up essentially of protective personal
equipment.
“PPE is made of cellulose or
polypropylene in the case of gowns, caps and masks and latex in the case of
gloves. They do not carry chlorinated elements, which is what environmentalists
are concerned about,” Tost said.
CLASSIFICATION OF WASTE
Medical waste is made up of different
types of waste. Thus far, through the post you may have had a hint to that end.
Some of the wastes are treated as hazardous, while others are treated as
ordinary waste. The World Health Organization has their standards of branding
health care waste. From and through a WHO link https://www.who.int/news-room/fact-sheets/detail/health-care-waste
I share with you by WHO standard how health care waste is classified:
Of the total amount of waste generated
by health-care activities, about 85% is general, non-hazardous waste comparable
to domestic waste. The remaining 15% is considered hazardous material that may
be infectious, chemical or radioactive.
Waste and by-products cover a diverse
range of materials, as the following list illustrates:
- Infectious waste: waste
contaminated with blood and other bodily fluids (e.g. from discarded
diagnostic samples),cultures and stocks of infectious agents from
laboratory work (e.g. waste from autopsies and infected animals from
laboratories), or waste from patients with infections (e.g. swabs,
bandages and disposable medical devices);
- Pathological waste: human
tissues, organs or fluids, body parts and contaminated animal carcasses;
- Sharps waste: syringes,
needles, disposable scalpels and blades, etc.;
- Chemical waste: for
example solvents and reagents used for laboratory preparations,
disinfectants, sterilants and heavy metals contained in medical devices
(e.g. mercury in broken thermometers) and batteries;
- Pharmaceutical waste: expired,
unused and contaminated drugs and vaccines;
- Cytotoxic waste: waste
containing substances with genotoxic properties (i.e. highly hazardous
substances that are, mutagenic, teratogenic or carcinogenic), such as
cytotoxic drugs used in cancer treatment and their metabolites;
- Radioactive waste: such
as products contaminated by radionuclides including radioactive diagnostic
material or radio-therapeutic materials; and
- Non-hazardous or general waste: waste
that does not pose any particular biological, chemical, radioactive or
physical hazard.
The major sources of health-care waste
are:
- hospitals and other health facilities
- laboratories and research centres
- mortuary and autopsy centres
- animal research and testing laboratories
- blood banks and collection services
- nursing homes for the elderly
High-income countries generate on
average up to 0.5 kg of hazardous waste per hospital bed per day; while
low-income countries generate on average 0.2 kg. However, health-care waste is
often not separated into hazardous or non-hazardous wastes in low-income
countries making the real quantity of hazardous waste much higher.
The foregoing paragraph shows that even though low-income countries generate lesser hazardous waste than high-income countries, disposal of hazardous waste in low-income countries is dangerous because the differentiation in the waste is often not done!
CONCLUSION
This post sought to find out how
COVID- 19 medical waste will be disposed of without compromising the natural
environment. Generally, the disposal of medical waste is done through
incineration or burial in landfill. Even before COVID- 19 there were environmental
problems with waste disposal.
Countries have guidelines which
municipal authorities apply in the disposal of waste, and indeed medical waste
(particularly COVID- 19 waste) within coordinated frameworks, support and
directives of the World Health Organization and the United Nations Environment
Programme.
The facilities for waste disposal are
overwhelmed particularly because of the COVID- 19 pandemic. In some countries facilities
for waste disposal are being expanded to contain the extra trash the pandemic
is generating. In other countries, under the circumstance, waste materials that
should not have been burned or incinerated are being burned.
To my mind, the remarkable challenges
with COVID- 19 medical waste disposal are:
- The sheer volume of the waste, and fast rate of build-up
- Capacity to cope with volume of waste so generated
- The adherence to disposal guidelines in the disposal chain for effective and efficient disposal
It can also be said that technology,
expertise and methodology are critical in the matter. The guidelines feeding
into, and underpinning the methodology.
As to whether the disposal of COVID-
19 waste will compromise the natural environment or not is couched in the WHO
2018 report quoted in the section of this post headed “DISPOSAL AND THE NATURAL
ENVIRONMENT”, and I requote in part:
….WHO warned of the health risks of
incorrect management of medical waste “through the release of pathogens and
toxic pollutants into the environment.”
“Landfills can contaminate
drinking-water if they are not properly built. If waste is incinerated
inadequately, this can cause the release of pollutants into the air, such as
human carcinogens that have been associated with a range of adverse health
effects”…
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