*Dr. K. Balachandra Kurup[1]
*Dr. Balan is a Governance and institutional development expert with more than four decades of working experience in Policy, Governance, Social development, Water resources, WASH, Solid waste management sector (35 years in South Asia and 15 years in Middle East and North Africa Region). He was with the International Civil Service Commission and held several senior management positions with UN and Bilateral agencies. He was Team leader and member of several planning, evaluation and capacity assessment missions at national and international level supported by United Nations, World Bank, ADB, Bilateral agencies.
- Introduction
Waste management is becoming increasingly challenging and complicated due to diverse categories of materials coming in the waste stream, especially due to COVID- 19. This situation is evident in all urban, peri-urban and rural areas due to improper sanitation and drainage problems and degraded environmental issues. Waste generation varies from 200-600 kg/capita/day and collection efficiency ranges from 50-90%. As per the central pollution control board (CPCB) of India, the per capita waste generation has increased at an exponential rate (0.26 kg/day to 0.85 kg/day)[2]. It is estimated that approximately 80% of the municipal waste is disposed-off in landfills without proper management practices and open burning, leading to air, water, soil pollution. As per MoEF&CC around 62 million tonnes of waste is generated annually in the country at present, out of which 5.6 million tonnes is plastic waste, 0.17 million tonnes is biomedical waste, hazardous waste generation is 7.90 million tonnes per annum and 15 lakh tonnes is e-waste. He added that only about 75-80 per cent of the municipal waste gets collected and only 22-28 per cent of this waste is processed and treated[3].
The outbreak of COVID-19 has created health crisis across the nation along with diverse impacts on economy, society and environment. COVID waste has emerged as a critical component in the waste stream and severally affected the hospitals, nursing homes, quarantine centres, the environment and humanity. Covid waste generation and disposal is a significant factor, especially in countries with poor infrastructure, hygiene and high population growth. Medical centres including hospitals, clinics, and places where diagnosis and treatment are conducted generate wastes that are highly hazardous and put people under risk of fatal diseases. Efforts to combat this pandemic have also significantly increased the quantity of bio-medical waste (BMW) and allied solid waste generation. Safe disposal of large quantity of such waste has been gradually posing a major challenge and threat to the solid waste management program and the humanity. Appropriate measures on the management of medical waste was followed based on the existing environmental, financial, and technical feasibility of treatment and disposal technologies at different levels. This paper is trying to present the historical review and status of Covid waste generation, regulation measures, management and how it affected the overall waste management program.
- Evolution of COVID-19 pandemic
The first case of COVID-19 was reported in India were reported in the towns of Thrissur, Alapuzha and Kasargod (Kerala) among three Indian medical students who had returned from Wuhan in January/February 2020. Little information was provided regarding the initial COVID-19 cases, and thus, it is unknown whether they were contacts of the first case or whether they had travel history. On 30 January 2020, government of India initiated awareness of proper hygiene and sanitation steps to protect from the spread of diseases. A major focus was put on proper handwashing, covering oneself, while coughing and sneezes, social distancing, thorough cooking of meat and dairy, and avoiding contact from wild or farm animals. According to the Ministry of Health and Family Welfare, the transmission of COVID-19 is mainly related to travel and local transmission of imported cases in the beginning. Subsequently the momentum has changed drastically. Lockdowns were announced in Kerala on 23 March, and in the rest of the country on 25 March. By mid-May 2020, five cities accounted for around half of all reported cases in the country: Mumbai, Delhi, Ahmedabad, Chennai and Thane.
After the imposition of the first lockdown at the end of March, the government released several guidelines on protection methods, such as making face masks compulsory in public places, but preferably using reusable masks, leaving medical masks for health professionals. Public guidelines, such as social distancing, avoiding spitting in public places, and avoiding mass gathering was enforced. The pandemic has shown increased use of sanitary goods, PPE, and other healthcare products which has triggered to an increase of the generation of different hazardous and contagious wastes. With social distancing and mandatory quarantines in order to avoid the spread of the novel COVID-19 coronavirus and, consequently, relieve the burden of the healthcare system to save lives, the population has been falsely convinced that there have been environmental benefits with decreased environmental pollution. This has resulted in the production of excessive solid/plastic wastes and Covid wastes.
The containment of the spread of COVID-19 pandemic and limitations on commercial activities, mobility and manufacturing sector have significantly affected waste management scenario. The invaluable service provided by the waste management sector ensures that the unusual heaps of waste that poses health risks and escalate the spread of COVID-19 is avoided. It was reported that the quantity of waste increased across countries observing the social distancing measure of staying at home. The intensification of single-use products and panic buying have increased production, storage and consumption, hence thwarting efforts towards reducing plastic pollution. However, the central and state government instituted policies to ensure sustainable management of waste while protecting the safety of waste handlers. Due to the stockpiling of gloves, gowns, masks and other protective clothing and equipment, there appears to be a waste emergency due to the unusual production of waste from both households, quarantine centres and health facilities.
The second wave beginning in March 2021 was much larger than the first, with shortages of vaccines, hospital beds, oxygen cylinders and other medicines in parts of the country.[15] By late April, India led the world in new and active cases. On 30 April 2021, it became the first country to report over 400,000 new cases in a 24-hour period. Health experts believe that India’s figures have been underreported due to several factors. The bigger capital such as Mumbai, Delhi, Kolkata, Chennai, Hyderabad, Bangalore caters a huge share of the solid waste generation in India. Highly dense population stays in these regions generates a heterogeneous type of solid waste daily which consist about 70% to 80% of the total waste generated per day in India[1]. As per the MNRE report 2018, overcrowded states such as Maharashtra, Tamil Nadu, Uttar Pradesh, National capital Region, Gujarat, Karnataka & West Bengal generates a tremendous amount of waste in the country.
The second wave cast a dangerous spell with more than 3.5 lakhs lives lost in this period alone. About 88% of deaths comprised of people in the age group 45 and above. The e-governance played into a central role in visualising effective communication system, leadership and coordination between policy makers and administration and society. Digital technologies established through e-governance initiatives became an important source for sharing knowledge and disseminating information to all target groups associated with the management, health care and monitoring of Covid -19 pandemic including the people at large. The online data base of Covid-19 cases, lockdown guidelines, travel restrictions, locating vacant bed in hospitals, oxygen cylinders, financial assistance etc were carried out through e-governance.
The waste burden correlates with spread of diseases and infections. In one year, India generated 56,898 tonnes of COVID-19 bio-medical wastebetween June 2020 to June 2021,data from the Union Ministry of Environment, Forest and Climate Change[1].
Maharashtra contributing the maximum (8,317 tonnes) followed by Kerala 6,442 tonnes, Gujarat 5,004 tonnes, Tamil Nadu 4,835 tonnes, Delhi 3,995 tonnes, Uttar Pradesh 3,881 tonnes and Karnataka 3,133 tonnes (see table below). The composition of Covid waste consists of PPE kits, masks, shoe covers, gloves, human tissues, items contaminated with blood, body fluids like dressings, plaster casts, cotton swabs, beddings contaminated with blood or body fluid, blood bags, needles, syringes etc.
In India we have around 198 Biomedical Waste Treatment Centers (BMWTC) along with around 225 medical centers with well-developed waste management facilities. Simple arithmetic revealed that such infrastructure is very poor to handle such large amount of COVID wastes. Therefore, development of several mobile incinerators, several campaigning regarding awareness of waste segregation may be an alternative to address this crisis. The chart given below give an Overview of COVID waste management, the information of which collected from different health care institutes practiced in India (Hindustan Times 2020[2]).
Maharashtra is the worst affected state due to the current pandemic, and in non-COVID-19 situation, it is among the top BMW generating states in India and with comparatively better management facilities. The state has 60,414 healthcare facilities, where 50, 440 kg/day of BMW is generated from bedded hospitals, 11,793 kg/day is generated from non-bedded hospitals and 185 kg/day is generated from other sources[1]. states that the state has 60,414 healthcare facilities, where 50,440 kg/day of BMW is generated from bedded hospitals, 11,793 kg/day is generated from non-bedded hospitals and 185 kg/day is generated from other sources. Of the total hospital waste generated, approximately 10% is hazardous, 85% is general (non-risk) waste while a small percentage (5%) is labelled as highly hazardous. Pollution Control Boards of specific states have also formulated and issued guidelines for Management of BMW with specific instructions for implementation. The current practice of waste management has serious implications on aesthetics, health, water quality and air quality. Therefore, considerable effort required by way of evolving appropriate environmental management plan and its implementation to upgrade the current practices to the environmental regulatory standards.
The tremendous increase in the use of PPE — like gloves, face masks, and gowns, by healthcare workers, fuelled by the outbreak are disposable after single use generating an enormous amount of plastic waste (WHO, 2016). Besides, the protective equipment used by the healthcare staff and infected patients inside an ambulance including hoods, masks, gloves, gowns, during their transfer to healthcare facilities, are generally disposed of post transport. Moreover, the increased biomedical waste generation from laboratory studies and testing which includes a considerable proportion of plastics also contributes to the problem. It is understood that the infectious plastic waste generated from hospitals and at homecare facilities are not being fully collected, treated, and disposed of as per the biomedical waste management rules.
- Waste management Policies and regulations
In our country, waste management is governed by Ministry of Environment, Forest and Climate Change (MoEF) at national level and state level by the Pollution Control Boards. Certain laws are also present in the legal setup which helps in regulation of waste in India. The National Environment Policy, 2006 laid emphasis not only on disposal of waste but also recycling and treating waste. The Union Ministry of Environment, Forests and Climate Change (MoEF&CC) recently notified the new Solid Waste Management Rules (SWM), 2016. These will replace the Municipal Solid Wastes (Management and Handling) Rules, 2000, which have been in place for the past 16 years.The new rules are now applicable beyond municipal areas and have included urban agglomerations, census towns, notified industrial townships, areas under the control of Indian Railways, airports, special economic zones, places of pilgrimage, religious and historical importance, and State and Central Government organisations in their ambit.
Besides, there are six other regulatory instruments for solid waste management under the Environment Protection act. (1) Bio-medical management rules (1998 subsequently revised in 206, Plastic waste management rules, 2016, (2) Batteries management and handling rules, 2011, (3) Hazardous and Other Wastes (Management and Transboundary Movement) Rules, 2008 subsequently revised in 2016, (4) Plastic waste management rules, 2011 subsequently revised in 2016 and 2021, (5) E-waste management rules, 2011, subsequently revised in 2016, (6) Construction and Demolition Waste Management Rules, 2016. All these regulatory frameworks have implications on COVID-19 pandemic. However, the bio-medical wastes generated from health care facilities depend upon a number of factors such as classification of wastes, type of health care units, occupancy, specialization of healthcare units, ratio of reusable items in use, availability of infrastructure and resources etc.Efforts to combat this pandemic have also significantly increased the quantity of bio-medical waste (BMW) and allied solid waste generation. Safe disposal of large quantity of such waste has been gradually posing a major challenge and threat to the solid waste management program and the humanity. This paper is trying to present the historical review and status of Covid waste generation, regulation measures, management and how it affected the overall waste management program.
The other regulatory framework for waste management is related to Indian government initiatives for waste management under Jawaharlal Nehru National Urban Renewal Mission (JNNURM), Urban Infrastructure Development Scheme for Small & Medium Towns (UIDSSMT), “Recycled Plastics Manufacture and Usage Rules (1999) amended and now known as The Plastics Manufacture and Usage (Amendment) Rules (2003), “Draft Guidelines for Sanitation in Slaughter Houses (1998)” by Central Pollution Control Board (CPCB), Non-biodegradable Garbage (Control) Ordinance, 2006, Municipal Solid Wastes (Management and Handling) Rules, 2000, etc. At the national policy level, the ministry of environment and forests has legislated the Municipal Waste Management and Handling Rules 2000.
The first standard on the subject to be brought out in India was by the Bureau of Indian Standards (BIS), IS 12625: 1989, entitled ‘Solid Wastes- Hospitals-Guidelines for Management’ (Annexure 7.1) but it was unable to bring any improvement in the situation. In this scenario, the notification of the ‘Biomedical waste (Management & Handling) Rules, 1998’ assumes great significance. The Ministry of Environment and Forests of the Government of India has enacted the Biomedical Waste (Management and Handling) Rules, which came into effect on 20th July, 1998[1].These rules are applicable to every hospital and nursing home, veterinary institution, animal house or slaughterhouse that generates biomedical waste. According to Biomedical Waste (Management and Handling) Rules, 1998 of India “Any waste which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals”.
The World Health Organization (WHO) reports revealed that 85% of hospital wastes are actually non-hazardous, whereas 10% are infectious and 5% are non-infectious. Studies have shown that about three fourth of the total hospital waste is not hazardous / infected (provided strict segregation is practiced) and can even be taken care of by the municipal waste management system, e.g., waste generated at the hospital kitchen or garden, the office or packaging material from the store etc. The indiscriminate disposal of hospital waste and exposure to such waste possess serious threat to environment and to human health that requires specific treatment and management prior to its final disposal. Now it is a well-established fact that there are many adverse and harmful effects to the environment including human beings which are caused by the “Hospital waste” generated during the patient care. Hospital waste is a potential health hazard to the health care workers, public and flora and fauna of the area. The problems of the waste disposal in the hospitals and other health-care institutions have become issues of increasing concern.
The Government of India was quick to recognize the threat of COVID-19 and introduced a series of steps expeditiously to contain the transmission. Protective measures such as thermal screening, travel history, securing symptoms of the disease, and airport screening began at the end of January. The Government also started dedicated and aggressive public awareness campaigns through multiple media channels. The innovative messages and mode of communication were effective in convincing the public to react enthusiastically and in a spirited manner to the Government’s directive, including a countrywide lockdown, which began on 24 March. Physical distancing, personal hygiene, and use of face masks were emphasized and are widely practised, with remarkable compliance. After the completion of 3 weeks of the first lockdown, it was further extended by an additional 5 weeks. The Government has introduced and implemented a series of innovations including a novel smartphone application called AarogyaSetu for contact tracing and aiding in quarantine and related containment measures.
Considering the magnitude of problem associated with BMW management during pandemic, Central Pollution Control Board (CPCB) has initially formulated guidelines (Guidelines for Handling, Treatment and Disposal of Waste Generated during Treatment/Diagnosis/Quarantine of COVID-19 Patients) based on current knowledge on COVID-19 and from other contagious diseases. CPCB has been issuing specific guidelines on segregation, collection, storage, transportation and disposal of COVID-19 wastes generating from the treatment facilities. It is encouraging to note that the Central Pollution Control Board (CPCB) has been in the forefront to come up with timely guidelines towards BMW-COVID-19.
There are apparent challenges and gaps in implementing the guidelines due to inadequate infrastructure across the states and inconsistent operational efficiency of implementing agencies. Though there have been many revisions in regulatory guidelines for better management of BMW during this pandemic, the inadequate management efficiency has been observed in several localities. This is mainly due to weak monitoring system and low accountability. In spite of regulations in place for segregation of health care waste mixing with municipal solid waste and other plastic waste is a major challenge in BMW-COVID-19 management in India[1]. The gap between policy and implementation, more specifically pertaining to infrastructure, capacity and monitoring to be bridged. Considering the quantity of waste generated, technology for recycling and resource recovery should be given priority.
The guidelines further stipulated that the Common Bio-Medical Waste Treatment Facilities (CBWTF) operators “shall ensure regular sanitisation of workers involved in handling and collection of biomedical waste and that they should be provided with adequate personal protective equipment”. PPE has been suggested as mandatory for all medical personnel with probable exposure to the virus including staff, persons involved in handling of any material exposed to COVID-19 care facilities. The National Green Tribunal, India, expressed the need for further revision of the guidelines so that all aspects of scientific disposal of liquid and solid waste management are taken care of not only at institution level but also at individual levels, such as manner of disposal of used Personal Protection Equipment (PPE), without the same getting mixed with other municipal solid waste causing contamination. Administrations and the management of the service providers are required to provide adequate PPEs for the human resources handling BMW as prescribed in the guidelines.
- Plastics and Covid wastes
Plastics are one of the significant components of medical equipment and allied products. However, mixed plastics like that of single use masks with layers of plastics combined with other materials also pose a great threat to the environment due to their low recyclability The inadequacies and discrepancies in the existing waste management systems like shortage of staff, capacity constraints, capability of handling of treatment facilities, disruptions in recycling facilities due to the pandemic, could lead to improper disposal of wastes polluting the environment. Furthermore, several infectious waste plastics like masks, gloves and face shields could also cause greater havoc of viral transmission without proper sterilization. As the country starts to move ahead of this pandemic, we might realize that our increased dependence on plastics at the expense of our environment has resulted in a new plague of plastic waste which we were struggling to come in terms with.
The waste collection and transportation workers in the hospital segregate the recyclable material for sale. In a similar way, all disposable plastic items are segregated by the waste pickers, from where the waste is deposited either inside the hospital grounds, or outside in the community bin for further transportation and disposal along with municipal solid waste. Since the infectious waste gets mixed with municipal solid waste, it has potential to make the whole lot infectious in adverse environmental conditions. It is reported that in some places/localities biomedical waste generated from health care facilities are collected without segregation into infectious and non-infectious categories and are disposed in municipal bins located either inside or outside the facility premises.
Despite the progress made in plastic sustainability and waste management, there have been widespread drawbacks in the use and management of plastics during COVID-19 pandemic. Alarming cases of infection have exerted personal protective equipment (PPE) (containing a substantial proportion of plastic) as the most reliable and affordable defense system against infection and transmission of the virus. The increased demand for single-use PPE by doctors and other health care workers and mandated usage of masks for the public has transformed the dynamics of plastic waste generation. Moreover, national lockdowns and home quarantine orders have stimulated an upward trend on online delivery of food and other essential groceries which has increased use of plastic packaging and further waste generation.
The demand for plastic in other sectors (automobiles, aviation, construction) has, however, drastically reduced during the economic crisis. The public perception and fear about hygiene and health safety has altered their mind set of reusable cups, bags, etc. has reduced the plastic waste generation. The loss of people’s faith in products without packaging could risk the return of the throw-away culture and cause the resurgence of usage of single-use plastics. Also, the consumer behavioral changes also affected the increased use and disposal of single-use plastics contributing to the plastic waste problem.
- Covid 19 and environmental monitoring
The amount of waste generated due to COVID-19 threatens the existing waste management streams, meaning that plastic leakage/pollution may impose severe risks to both environmental and human health. Thus, it is imperative to increase monitoring of the use of plastic waste under post-COVID-19, around the hospitals, covid centres and other places. COVID-19 pandemic has been causing major drawbacks in terms of environmental protection policies around the globe. For example, the United States Environmental Protection Agency (USEPA) has stopped enforcements concerning monitoring and reporting requirements of environmental protection for an undefined period of time, China has temporarily suspended environmental regulations etc. At the same time, the fear associated with COVID-19 transmission has resulted in increased use of single-use plastics, disinfecting products and related chemicals, therefore causing increased environmental water pollution concerns. Single-use plastics are now more popular than ever as, amid the COVID-19 fear, people will preferentially buy disposable items like water bottles and other products housed in plastic containers and bags, such as hand sanitizers, sanitizing wipes, toilet papers etc.
With limited available solutions, there is a substantial need for innovations which should address key challenges in covid waste/plastic waste collection and integrating new technologies in segregation and treatment into the existing waste management system. Scientific sterilization of infectious waste at on-site treatment facilities of healthcare centers like steam-sterilization (autoclaving), energy-based treatments (microwave, radiowave), incineration, chemical disinfection would guarantee the reduced risk of viral transmission from contaminated PPE and other plastic waste
- Conclusion
The COVID-19 pandemic has developed an increased awareness and usage of sanitary goods, PPE, and other healthcare products which has resulted into generation of different hazardous and contagious wastes. The isolation wards/hospitals/quarantine centers/home-quarantines should follow careful collection of all used and non-used health related items in double-sealed bags/bins for their disposal based on Government guidelines. The roles of local civil bodies are also very significant for the timely collection and disposal, although many waste management facilities face the manpower shortage during the lockdown period. The health workers as well as sanitization workers should use sanitizer after proper removal of PPE and facemasks.
The challenge before us is to scientifically manage growing quantities of biomedical/Covid waste that go beyond past practices. If we want to protect our environment and health of community, we must sensitize ourselves to this important issue not only in the interest of health managers but also in the interest of community. To deal with the current situation, there is a need to prepare infrastructure and operation modalities for fastest disposal and aggressive disinfestation during the holding period. This calls for setting up additional incineration facilities in short time frame near Covid-19 hotspots.
Higher degree of protection should be rendered to waste handlers as they may be prone to infection in view of their health security and to contain further possibilities of secondary infection. The central government and the state governments need to be stricter and more attentive while considering government and none should go without treatment following these procedures and guidelines issued by the government. Public awareness for the segregation of waste should also be promoted that might help to segregate the waste like masks and gloves which are used in homes as well to be treated before it can harm any other human beings.
Many studies have emphasised that these vulnerabilities are further characterised by their ignorance, low educational levels, lower incomes and limited support from the agencies. According to the Solid Waste Management (SWM) Rules 2016, the municipal corporation is required to develop a system to recognise organisations of informal waste pickers in order to promote their involvement in the SWM service chain.The quality of waste segregation at the household level is also critical not only for sustainably managing waste but also from the perspective of workers’ safety.
To overhaul the covid waste management sector we need to induce appropriate personal behavioral and social institutional changes. An integrated approach of environmental processes and governance is required for effective solid waste management. Effective institutional framework needs to be established along with policy-level directions which will facilitate the required change. Specific colored bags might be provided by the local authority to households to dispose of PPE kits (mask, gloves) in sealed bags, which makes them easy for separation and treatment along with biomedical wastes. Besides, appropriate policies should be framed to avoid spread of infections by providing specification for handling waste for generation, segregation, collection, storage, transportation, and treatment. Awareness should be created at all levels of society through various means of communication and education, so that the risks of spreading the health hazards could be minimized.
References
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