The novel coronavirus disease (COVID19) is the fifth documented pandemic since the 1918 flu. The contagious respiratory and vascular disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), had surfaced from Wuhan seafood wholesale market of China in December. However, it was reported only in 30.01.19, when the World Health Organization (WHO) Director General had declared its outbreak as a public health emergency of international concern. Since then handling COVID biomedical waste has posed many serious but new challenges.
By 21.05.2020, COVID 19 had spread to 190 countries and regions with more than 5 million confirmed cases worldwide and more than 300,000 deaths as per WHO data. The spread of COVID 19 might have increased by inadequate waste management. With the rapid rise in the number of confirmed cases, the amount of COVID 19 related medical waste also increased significantly. Life came to a standstill across the world and the WHO had issued standard operating procedures (SOPs) and use of personal protection equipments (PPE) for treatment and transportation of suspect/confirmed cases to check local transmission and community transmission. The ambulance drivers and technicians were trained in transporting infected patients. Donning of PPE was made mandatory for doctors and medical staff. Thus, ensuring disposal of COVID 19 related medical waste timely, efficiently and harmlessly became an important part of the battle against the pandemic.
The WHO and UNICEF (in March last) had issued guidelines for infection prevention and control (IPC) relating to personal hygiene, water, environment and solid waste management and health care facilities (HCF) infectious waste, which included PPEs like gloves, face and nose masks, waterproof protective gowns, rubber boots, rubber aprons and other contaminated materials including paper tissues. Proper collection, storage, transfer, treatment and final disposal of infectious waste from healthcare facilities and patients' treatment were vital to reduce the risk of epidemic.
Interestingly, the COVID 19 outbreak in India had not only exposed the poor healthcare infrastructure and lack of preparedness to battle a pandemic but also loopholes in the waste management process. According to a report filed by Central Pollution Control Board in National Green Tribunal in July, 2020 India generated about 101 metric tonnes of COVID 19 related bio medical waste, per day. This quantity was in addition to regular biomedical waste generation of about 609 MT per day.
The COVID 19 outbreak in India had not only exposed the poor healthcare infrastructure and lack of preparedness to battle a pandemic but also loopholes in the waste management processMaharashtra generating 17.494 TPD of bio medical waste was the biggest generator of such waste, as per data compiled on May 31, followed by Gujarat (11.693 TPD) and Delhi (11.114 TPD). The report clearly stated that the available capacity for incineration of COVID19 biomedical waste in the country is about 840 MT against the total generation of about 710 MT per day.
The patients infected with SARS-CoV-2 that manifest as fever and cough are important source of infection; some recent studies have suggested that COVID 19 may be spread by asymptomatic carriers. The virus is thought to spread mainly from person to person through respiratory droplets and close contact and the aerosol may be a potential transmission channel.
Studies have shown that SARS-CoV-2 can survive on plastic and metal objects for up to three days and there was extensive environmental contamination by confirmed patient. Thus, the management of medical waste could be an important way to control the source of infection. The Asian Development Bank on 04.05.20 had warned that COVID 19 could leave major Southeast Asian cities with 1,000 extra tonnes of medical waste per day with Manila at the top and suggested incineration.
The Union Ministry of Housing and Urban Affairs in its guidelines had said that incineration has an advantage because it results in converting infectious waste into biologically sterile products. The ashes produced are roughly 5-10% in volume and can be managed appropriately as byproducts/aggregates if toxins or hazardous materials are below the threshold limits.
The disadvantages of incineration are associated with high treatment costs and resulting air pollution in forms of black carbon, dioxins and others; but this is only if they are not properly handled. Though most experts believe that another influenza pandemic will occur, they fail to predict when or where it will appear or how severe it would be. Meanwhile there is no agreement about the subtype of the next pandemic influenza virus.
Thus, strict adherence to management and disposal of medical/biomedical waste, including PPE, in a hygienic manner with an appropriate monitoring, review and verification mechanism alone could prevent the killer virus, even in future.