Waste

COVID-19 will place India’s biomedical waste management under terrible strain

Under-reporting, poor segregation and lack of awareness ail India’s COVID-19 waste management. The pressure is set to further increase with the nationwide vaccination drive

 
By Siddharth Ghanshyam Singh
Published: Wednesday 30 June 2021

Representative PhotoWith the novel coronavirus disease (COVID-19) prolonging its stay and spread, the face of litter is fast changing in the country.

One can easily spot surgical masks, face shields, gloves, shoe covers and personal protective equipment, or PPE, being disposed of as part of household waste or lying discarded by the roadside, behind hospitals, on beaches, in parking lots, in landfills and even in crematoriums, occasionally burning alongside the pyres.

This waste could harbour the novel coronavirus and other infectious pathogens and be as hazardous to humans and the environment as any hospital waste such as bloody bandages, biological material, syringes and scalpels would be.

Due to this inherent potential risk of COVID-19 litter, the Central Pollution Control Board (CPCB) categorised it as hazardous biomedical waste as soon as the pandemic tightened its grip over the country.

Since March 2020, CPCB has issued guidelines from time to time under the Bio-medical Waste (BMW) Management Rules, 2016, and reviewed them to ensure that COVID-19 waste is collected with utmost caution and transported to “biomedical waste treatment and disposal facilities”, specifically designed to handle biohazardous waste from hospitals, health camps, morgues, pathological and clinical laboratories, and other medical establishments and activities.

In May 2020, CPCB also launched a mobile application, COVID-19 Biomedical Waste Management (BWM) App, to keep a tab on this fastgrowing waste stream in real time.

A back-of-the-envelope calculation of the data collected by CPCB using the BWM App shows that the country has generated some 45,954 tonnes of COVID-19 waste in the past one year till May 10, 2021. Meaning, since the pandemic’s first wave, it has generated 126 tonnes of COVID-19 waste a day — this is about 20 per cent of the 614 tonnes of biomedical waste that the country generates on any given day.

On the face of it, the country seems to be well equipped to handle this additional load. In a report submitted to the National Green Tribunal (NGT) on January 14, 2021, CPCB says the country’s 198 common biomedical waste treatment and disposal facilities and the several such captive facilities in hospitals together have a capacity to treat 826 tonnes of biomedical waste a day.

By comparison, in May 2021, when CPCB reported maximum COVID-19 waste generation, the total biomedical waste generated reached 800 tonnes a day — well under the national treatment capacity. Then why are the country’s landfills changing their hues?

Data defies data

Consider this. In its January 2021 report submitted to NGT, CPCB mentions that Lakshadweep has a treatment capacity of 72 tonnes a day, even though the board itself has stated that the archipelago does not have a single common biomedical waste treatment facility.

While CPCB has not come out with a clarification about this erroneous data, it indicates that the actual treatment capacity of the country is 754 tonnes a day, and not 826 tonnes. This simple correction brings down the biomedical waste processing capacity of the country closer to its actual generation of COVID-19 waste.

Moreover, at 754 tonnes per day, the treatment facilities are highly insufficient to handle any surge in COVID-19 waste, like that witnessed in September 2020 or in May 2021. The picture appears grim when one compares the waste generated by individual states with their treatment capacity.

A careful analysis of CPCB’s January and May 2021 reports suggests that 22 of the 35 states and Union Territories generate more biomedical waste than they can handle. The capacity of facilities to treat biomedical waste is nearly saturated in Maharashtra, Goa, Manipur, Andhra Pradesh, Meghalaya, Rajasthan and others.

In May 2021, when India recorded the maximum number of new cases, COVID-19 accounted for 33 per cent of the biomedical waste generated across the country. This seems to have particularly overwhelmed an already-strained biomedical waste treatment infrastructure.

The volume that month was massive at places. In Haryana, COVID-19 waste was responsible for 47 per cent of the biomedical waste, followed by Chhattisgarh (42 per cent), Himachal Pradesh (40 per cent), Andhra Pradesh (40 per cent) and Delhi (39 per cent).

All these are just the tip of the iceberg. There is a clear indication that the 45,954 tonnes of COVID-19 waste collected by CPCB is a gross underestimation of the actual volume of waste generated so far.

Failing in catching up

Last year, in September, the country generated 183 tonnes of COVID-19 waste in a day, the highest at the time. This year, the peak was in May with 203 tonnes a day, according to the CPCB. While this increase of 11 per cent suits the narrative of the pandemic’s second wave being more infectious than the first wave, it has not kept pace with the COVID-19 caseload that rose by an astounding 234 per cent during the period.

Strangely, the data, when disaggregated, suggests that India’s per capita COVID-19 waste generation (waste generated by one infected person) during the second wave has reduced by one-fourth from the first wave. On an average, a COVID-19 patient generated 0.49 kg in May 2021 as compared to 2.09 kg in September 2020.

CPCB in its COVID-19 waste management status, released on May 11, 2021, offers an explanation. “Despite the increase in the number of patients, there is nonproportional growth in the quantity of COVID-19 biomedical waste generated. This is mainly due to the proper segregation of waste,” it notes.

While CPCB’s logic sounds plausible, many fear that such reduced generation could also be due to under-reporting of data. “The number of used vials, syringes and other COVID-19 waste we are receiving is nowhere close to what is being generated by the pandemic,” says the owner of a biomedical waste treatment facility in north India, who does not wish to be named.

Missing waste

A major challenge in monitoring the flow of COVID-19 waste is its innumerable sources that vary from individual households to isolation centres and makeshift quarantine camps. This is the reason CPCB requires COVID-19 waste generators such as health centres and quarantine homes, biomedical waste treatment facility operators, urban local bodies and pollution control authorities in states and Union Territories to regularly feed in data related to generation and treatment in its BWM App.

On July 30, 2020, the Supreme Court, based on the report submitted by the Environmental Pollution (Prevention and Control) Authority (EPCA), also passed an order that makes reporting through BWM App mandatory. Yet, very few have registered themselves on the application so far, and even fewer are reporting on a regular basis.

As per CPCB’s January 2021 report to NGT, till December 2020, as many as 184 of the 198 common biomedical waste treatment and disposal facilities were updating their waste handling data on BWM App. The number has reduced to 168 in May this year.

Waste generators have fared even worse on this account. A conservative estimate shows that there are over 106,600 bedded healthcare facilities in the country that must update their COVID-19 waste data daily on the BWM App.

Then there are the COVID-positive households, whose details need to be fed into and updated in the App by municipal corporations or village panchayats. Yet it was only once in November 2020 that 100,000 generators, the most so far, shared their information on the BWM App.

In all other months, their number was between 5,000 and 8,000. The gap is clearly too huge to be an expected variation. Even in May 2021, when India accounted for almost half of the world’s new cases single-handedly, only 5,084 generators had shared their data on the App.

Such gross under-counting and under-reporting of COVID-19 is a matter of worry because of the changing geography of the infection from urban to rural areas, where mechanisms to track patients in real time are almost non-existent. And this is the basis for setting up systems for collection of biomedical waste from individual households.

A gap too deep

At places where COVID-19 waste finds its way to treatment facilities, lax regulation defeats the purpose. Consider this. The BMW Management Rules, 2016, require healthcare facilities to follow a colour-coded segregation system for waste disposal and hand it over to treatment facilities within 48 hours. At treatment facilities, a considerable part of the waste, that comes in red and blue bags or in white containers, is channelised for recycling after sterilisation.

Only a small amount of the litter, particularly pathological and laboratory wastes, that comes packed in yellow bags, is sent for incineration. While healthcare facilities follow the protocol during disposal of COVID-19 waste, no such segregation system is in place for home quarantine centres.

The guidelines do mention discarding of PPE kits, goggles and other paraphernalia in the red bag, but do not mention its distribution in home quarantine centres. As a result, these quarantine centres are provided with only yellow bags. Due to poor awareness and lack of communication, these facilities throw everything from food waste and disposable cutlery to masks, PPE kits and gloves into yellow bags, which are then sent for incineration.

Because of poor segregation, an alarmingly high quantity of plastic waste is now being incinerated. “This results in scaling on the inner lining walls of incinerators, which eventually decreases the efficiency,” says the biomedical waste treatment facility owner.

Burning of plastics also releases noxious gases like dioxins and furans, but there is no way to monitor the pollution. EPCA in a July 2, 2020 report, submitted to the Supreme Court, states that an “online continuous emission monitoring system has been installed in most central biomedical waste treatment facilities, but this is not working to satisfaction.”

Brewing challenge

Biomedical waste is generated not just during the treatment of the disease but even in the attempts to prevent it. India began administration of COVID-19 vaccines on January 16, 2021, and as of June 21, has administered 289 million doses. While this is good news, it is also concerning as every jab generates a waste syringe, and every 10 or 20 vaccinations, depending on the vaccine type, generate one waste glass vial. All these are biomedical wastes.

Due to insufficiency of vaccine vial monitors that display key indicators, especially storage temperature while stocking and transportation, a considerable amount of vials have to be discarded after four hours of opening. This challenge is prevalent in the rural parts of India.

The use of auto disabled syringes ensures safety of vaccine beneficiaries and healthcare staff, as it restricts the use of syringe twice. However it also generates massive quantities of biomedical waste which the country will have to deal with in the coming months.

By the end of the vaccination drive, which the Centre hopes to reach by the end of this year, the country would have generated over 1.3 billion used syringes, needles and more than 100 million discarded glass vials, that would require careful disposal as per the COVID-19 vaccines operational guidelines released on December 28, 2020.

While this sub-stream of biomedical waste need not be incinerated, it does require treatment and sterilisation before being channelised to the authorised recycling facilities. Statewise autoclaving capacity of the country will be of key concern in this context.

Treatment plant operators say a lion’s share of the plastic, metal and glass components from vaccination centres is sold off to local dealers by support staff at vaccination centres, which indicate lack of training and awareness among the support staff.

No stone should be left unturned in the safe handling and disposal of COVID-19 waste to ensure that it does not snowball into the next crisis.

The essential tweaks
Steps to better manage COVID-19 biomedical waste
  • Intensify awareness among citizens and enforce segregation at source
  • Ensure all waste generators and processors are registered on COVID-19
BWM App
  • Limit the use of PPE kits and other single-use paraphernalia only to frontline workers. Promote the use of re-usable/cloth masks among the general public
  • Use washable utensils in quarantine camps/ homes to minimise waste
  • Plug the gaps in the guidelines through regularly updating them
  • The Central Pollution Control Board (CPCB) should provide data that segregated according to generation sources, waste types and treatment facilities. Doing this will help strategise for any outbreaks or pandemic waves
  • CPCB should also reflect on the rural scenario in terms of quantum of generation and the general practices followed to dispose of the COVID-19 biomedical waste
  • Ensure that vaccination camps outside hospitals segregate the waste properly
  • As per Bio-Medical Waste Management Rules, 2016, bar-code the bags used for collecting biomedical waste for tracking the source of the waste once it reaches the treatment facility. Kerala is one of the few states that has been bar-coding its waste bags and this has been a major part of its response towards the pandemic

This was first published in the 1-15 July, 2021 print edition of Down To Earth

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