Coronavirus disease-19 pandemic and health-care waste: Strategies to ensure environmentally sustainable management

Saurabh RamBihariLal Shrivastava; Prateek Saurabh Shrivastava

doi:10.4103/ed.ed_6_22

SHORT COMMUNICATION

Year : 2022 | Volume : 7 | Issue : 1 | Page : 29-32

Coronavirus disease-19 pandemic and health-care waste: Strategies to ensure environmentally sustainable management

Saurabh RamBihariLal Shrivastava¹, Prateek Saurabh Shrivastava²
¹ Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
² Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission	06-Feb-2022
Date of Decision	21-Feb-2022
Date of Acceptance	01-Mar-2022
Date of Web Publication	28-Mar-2022

Correspondence Address:
Saurabh RamBihariLal Shrivastava
MD, FAIMER, PGDHHM, DHRM, FCS, ACME. Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu
India

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/ed.ed_6_22

Abstract

In the global mission to prevent climate deterioration and ensure environmental sustainability, the appropriate management of health-care waste carries immense importance. The available global estimates suggest that 30% of the healthcare establishments do not have the desired systems and mechanisms required for the segregation of waste. The ongoing coronavirus disease-2019 (COVID-19) pandemic proved to be a double-edged sword in this case, wherein not only it accounts for a massive increase in the health-care waste that has been generated, but also significantly decreased the capacity of the workers to efficiently deal with the waste, owing to rising caseload and other consequences of the infection. Acknowledging the magnitude of the problem, it is the need of the hour to come out with potential solutions to reduce the impact of health-care waste on the environment. To conclude, the containment of the ongoing COVID-19 pandemic necessitated an unprecedented global response. There are no doubts that we have improved ourselves in that regard, but in the process, it has resulted in the generation of significant amounts of health-care waste. It is high time that all the stakeholders should join their hands together and take appropriate steps to ensure reduction and appropriate management of health-care waste.

Keywords: Coronavirus disease-2019 pandemic, health-care waste, personal protective equipment

How to cite this article:
Shrivastava SR, Shrivastava PS. Coronavirus disease-19 pandemic and health-care waste: Strategies to ensure environmentally sustainable management. Environ Dis 2022;7:29-32

How to cite this URL:
Shrivastava SR, Shrivastava PS. Coronavirus disease-19 pandemic and health-care waste: Strategies to ensure environmentally sustainable management. Environ Dis [serial online] 2022 [cited 2023 Mar 30];7:29-32. Available from: http://www.environmentmed.org/text.asp?2022/7/1/29/341192

Introduction

Health-Care Waste Generation in Early Stages of Coronavirus Disease-2019 Pandemic

The emergence of the coronavirus disease-2019 (COVID-19) pandemic was an important milestone in the health-care sector, as the infection spread rapidly across the different nations in various parts of the world.^[1] In the initial stages of the outbreak, not much was known about the disease, and at the same time, health-care workers also acquired and succumbed to the infection. As it was known that the infection spreads by close contact and through airborne droplets, soon the demand for personal protective equipment (PPE) increased enormously.^[1],[2],[5] As a matter of fact, incidents of panic buying, extra storage of PPE, and misuse of the same were reported in the health sector, amongst patients, as well as in communities. On one hand, though a shortage in PPE supply was reported, on the other hand, a significant rise in the amount of health-care waste that was generated was simultaneously reported.^[3],[4] A wide range of health-care waste such as masks, gloves, gowns, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapid antigen test, polymerase chain reaction testing cartridge, vaccine vial, vaccine needle, plastic packing, and containers, etc., have been associated with the ongoing COVID-19 pandemic.

Impact of COVID-19 Pandemic on Health-Care Waste

The shortage of PPE compelled the international agencies and the donor agencies to augment the production and streamline the supply of them in different parts of the world.^[2] During those times, our priority was to just ensure an adequate supply of quality-assured PPE that keeps people safe, while not much attention was given toward their safe management upon usage.^[1] Eventually, the use of PPE continued to rise with cases of the disease being reported in every part of the world. At this stage, we wish to reiterate that all this happened, though we were aware that a significant number of health-care establishments lack facilities for the disposal of health-care waste.^[1],[2],[4]

Health-Care Waste Linked With COVID-19

The ongoing COVID-19 pandemic proved to be a double-edged sword in this case, wherein not only it accounts for a massive increase in the health-care waste that has been generated, but also significantly decreased the capacity of the workers to efficiently deal with the waste, owing to rising caseload and other consequences of the infection.^[2],[6] The global estimates depict that since the emergence of the novel viral infection, in excess of 360 million cases has been reported, and this makes it very obvious that in most of the above cases PPE has been used by the caregivers, and subsequently disposed of. In fact, it was reported that more than 85,000 tonnes of PPE and 140 million diagnostic kits were procured between March 2020 and November 2021.^[6] These health sector activities have accounted for the generation of a remarkable amount of health-care waste, a significant percentage of which is infectious.^[1],[2],[5]

COVID-19 Vaccine Waste

There are no doubt that the introduction of COVID-19 vaccines played a major role in minimizing the sufferings and reducing mortality rates. In fact, since the introduction of COVID-19 vaccines in 2021, 9 billion doses of vaccines have been administered, and billions are planned in the near future as well.^[6] However, this resulted in the generation of an excessive amounts of health-care wastes, which can be broadly classified as nonbiodegradable plastic waste (like disinfectant bottles, one-time-use plastic equipment, and vaccine packaging materials); and consumable waste (viz. syringes, needles, and empty vials).^[7],[8] The vaccine wastage can be further divided into opened, unopened, and partially used vials, of which the opened and partially used ones remain the source of pathogenic vaccine waste.^[6],[7],[8] The disposal of these wastes has accounted for a massive impact on wild animals and marine life.^{[9],[10],[11]} Moreover, owing to the immense load of packaging, storage, and deep-freezing of the COVID-19 vaccines, a significant rise in the production of greenhouse gas (carbon-dioxide) has also been reported.^[7],[8]

Impact of COVID-19 Waste on Wild and Marine Life

The presence of face masks has already been reported in various oceans, beaches, and freshwater systems, reflecting that we have not been disposing the health-care waste appropriately.^[9] It has been estimated that even inadequate management of 1% of face masks may account toward the production of 30–40,000 kg of health-care waste daily, which is an alarming fact.^[9],[10] It has been found that the discarded vaccine vials contain thiomersal-mercury-based preservative, which is highly toxic if they are released in water bodies to both aqueous ecology and humans.^[10] Even the PPE contains microplastics, which are again hazardous to the environment. In fact, due to the indiscriminate littering of face masks and plastic gear, a significant rise in the levels of plastic pollution has been reported.^[9],[10] At the same time, a significant risk of acquisition of COVID-19 infection among wild (Siberian tigers and African lions) and domestic animals (such as dogs) has also been reported due to the indiscriminate disposal of health-care waste.^[11] All these things have to be noted and urgent steps should be taken to minimize the damage on the ecosystem.^{[8],[9],[10],[11]}

Potential Strategies

Acknowledging the magnitude of the problem, it is the need of the hour to come out with potential solutions to reduce the impact of health-care waste on the environment.^[2],[3] This has to begin with ensuring reduction in the amount of PPE that has been used by promoting rational usage. This predominantly applies to the use of gloves and the times when they should be used, replacing them with other measures such as hand hygiene, training of health workers, role modeling, and providing feedback to them about the areas that can be improved.^[9],[12] In addition, we should encourage the use of small amounts of packaging materials that are more sustainable (such as using cornstarch-based foam instead of polystyrene), and thus have minimal impact on the environment.^[12],[13]

Further, we have to also focus our attention on the development and use of those kinds of PPE that can be reused and easily disinfected. Even though reuse has not been recommended, with an intention to reduce the generated health-care waste, we can definitely look forward to promoting their re-usage, especially in low-resource settings.^[14],[15] Moreover, the PPE should be made up of those materials that have a greater percentage of items that are renewable, bio-based, and can be recycled. In addition, there is a definite need to adopt reverse logistics (viz. using the same system that delivers medical equipment to hospitals for safe disposal) and centralized treatment of waste that does not include burning.^{[14],[15],[16]}

To expedite the above actions, at the global level, we have to strengthen the collaboration between all the stakeholders, encourage investment toward the production of eco-friendly PPE and waste systems, and promote the behavior of rational use of PPE amongst healthcare workers and the community.^[2],[3] At the national level, it is high time that the existing waste management guidelines are updated, and that policy makers not only increase the investment towards better management of waste, but also regularly monitor health-care waste practices, and envisage the use of sustainable PPE in all settings.^{[13],[14],[15]} One thing that cannot be ignored is the training component that has to be given to people who are involved in the generation or management of health-care waste, and the importance of hand hygiene and appropriate use of PPE.^[12],[13] Finally, we cannot ignore the fact that all these actions will require financial investment, and the welfare agencies and the national leaders should advocate and support the implementation of all the above measures.^[2],[12]

Conclusion

To conclude, the containment of the ongoing COVID-19 pandemic necessitated an unprecedented global response. There are no doubts that we have improved ourselves in that regard, but in the process, it has resulted in the generation of significant amounts of health-care waste. It is high time that all the stakeholders should join their hands together and take appropriate steps to ensure reduction and appropriate management of health-care waste.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Nguyen TD, Kawai K, Nakakubo T. Estimation of COVID-19 waste generation and composition in Vietnam for pandemic management. Waste Manag Res 2021;39:1356-64.
2.	World Health Organization. Global Analysis of Healthcare Waste in the Context of COVID-19: Status, Impacts and Recommendations. Geneva: WHO Press; 2022. p. 2-31.
3.	Urban RC, Nakada LY. COVID-19 pandemic: Solid waste and environmental impacts in Brazil. Sci Total Environ 2021;755:142471.
4.	Benson NU, Bassey DE, Palanisami T. COVID pollution: Impact of COVID-19 pandemic on global plastic waste footprint. Heliyon 2021;7:e06343.
5.	Ouigmane A, Boudouch O, Hasib A, Ouhsine O, Layati E, Isaifan RJ, et al. Effect of COVID-19 on the generation of waste in Marrakech, Morocco. J Health Pollut 2021;11:210606.
6.	World Health Organization. Tonnes of COVID-19 Health Care Waste Expose Urgent Need to Improve Waste Management Systems; 2022. Available form: https://www.who.int/news/item/01-02-2022-tonnes-of-covid-19-health-care-waste-expose-urgent-need-to-improve-waste-management-systems. [Last accessed on 2022 Feb 06].
7.	Hasija V, Patial S, Raizada P, Thakur S, Singh P, Hussain CM. The environmental impact of mass coronavirus vaccinations: A point of view on huge COVID-19 vaccine waste across the globe during ongoing vaccine campaigns. Sci Total Environ 2022;813:151881.
8.	Ovens W, Tomescu S, Harrison E, Crampton T, De Nooy A, Jassat W, et al. Guiding equitable prioritisation of COVID-19 vaccine distribution and strategic deployment in South Africa to enhance effectiveness and access to vulnerable communities and prevent waste. S Afr Med J 2022;112:13501.
9.	Dharmaraj S, Ashokkumar V, Hariharan S, Manibharathi A, Show PL, Chong CT, et al. The COVID-19 pandemic face mask waste: A blooming threat to the marine environment. Chemosphere 2021;272:129601.
10.	Chowdhury H, Chowdhury T, Sait SM. Estimating marine plastic pollution from COVID-19 face masks in coastal regions. Mar Pollut Bull 2021;168:112419.
11.	Leroy EM, Ar Gouilh M, Brugère-Picoux J. The risk of SARS-CoV-2 transmission to pets and other wild and domestic animals strongly mandates a one-health strategy to control the COVID-19 pandemic. One Health 2020;10:100133.
12.	Ilyas S, Srivastava RR, Kim H. Disinfection technology and strategies for COVID-19 hospital and bio-medical waste management. Sci Total Environ 2020;749:141652.
13.	Das AK, Islam MN, Billah MM, Sarker A. COVID-19 and municipal solid waste (MSW) management: A review. Environ Sci Pollut Res Int 2021;28:28993-9008.
14.	Dehal A, Vaidya AN, Kumar AR. Biomedical waste generation and management during COVID-19 pandemic in India: Challenges and possible management strategies. Environ Sci Pollut Res Int 2022;29:14830-45.
15.	Singh E, Kumar A, Mishra R, Kumar S. Solid waste management during COVID-19 pandemic: Recovery techniques and responses. Chemosphere 2022;288:132451.
16.	Vanapalli KR, Sharma HB, Ranjan VP, Samal B, Bhattacharya J, Dubey BK, et al. Challenges and strategies for effective plastic waste management during and post COVID-19 pandemic. Sci Total Environ 2021;750:141514.