India's biomedical waste management, and surge during COVID-19

As per the Central Pollution and Control Board, biomedical waste means,

"any waste which is generated during the diagnosis, treatment or immunisation of human beings or animals or research activities pertaining thereto or in the production or testing of biological or in health camps."

Biomedical covers a diverse range of materials such as:

• Infectious waste: contaminated with blood and other bodily fluids, cultures, infectious agents, waste from patients in isolation wards, and equipment
• Pathological waste: human tissues, organs or fluids, body parts, and animal carcasses
• Sharps: syringes, needles, disposable scalpels, blades
• Chemicals: solvents for laboratory preparations, disinfectants, and heavy metals contained in medical devices 
• Pharmaceuticals: expired, unused and contaminated drugs and vaccines
• Genotoxic waste: highly hazardous, mutagenic, carcinogenic, or teratogenic such as cytotoxic drugs
• Radioactive waste: waste contaminated by radionuclides including radioactive diagnostic material or radiotherapeutic materials
• Non-hazardous or general waste: waste that does not pose any particular hazards

Categorization

1. Human anatomical waste
2. Animal waste
3. Microbiological and biotechnology waste
4. Waste sharps
5. Discarded medicines and cytotoxic drugs
6. Soiled wastes 
7. Solid waste
8. Liquid waste
9. Incineration ash
10. Chemical waste

Biomedical Waste Management Rules, 2016 provides medical institutions and health camps with a framework or rules as to how to safely dispose the biomedical waste and recycle equipment that can be used again. The rules were amended in 2018, and then in 2019.

Read more: PICTORIAL GUIDE ON BIOMEDICAL WASTE MANAGEMENT RULES 2016

These rules categorize the biomedical waste generated from these facilities into four categories based on the segregation pathway and color code. 

The biomedical waste is handed to a Common Bio-medical Waste Treatment and Disposal Facility (CBWTF) in designated colored bags for proper treatment and disposal.

Read more: Guidelines for Management of Healthcare Waste as per Biomedical Waste Management Rules, 2016

Hazards of biomedical waste

As per the National Library of Medicine, between 75% and 90% of the waste produced by healthcare providers is comparable to domestic waste. And, can be categorized as non-hazardous or general healthcare waste. It is mostly produced by the administrative, kitchen, and cleaning tasks at healthcare facilities. Although, it may also comprise packaging trash and garbage produced during building maintenance. On the other side, the remaining 10%–25% of medical waste is classified as "hazardous" and could have negative effects on the environment and human health.

Read more: Health Hazards of Medical Waste and its Disposal - PMC

Infectious waste may contain a great variety of pathogenic microorganisms. Pathogens in infectious waste may enter the human body by a number of routes: through a puncture, abrasion, or cut in the skin; through the mucous membranes; by inhalation; by ingestion. The body fluids are the usual vehicle of transmission.

According to the World Health Organisation (WHO), adverse health outcomes associated with healthcare waste and by-products include:

• sharp-inflicted injuries
• Toxic exposure to pharmaceuticals products, in particular antibiotics and cytotoxic drugs released into the surrounding environment and to substances such as mercury or dioxins during the handling or incineration of health care wastes
• Chemical burns arising in the context of disinfection, sterilization, or waste treatment activities
• Air pollution arising as a result of the release of particulate matter during medical waste incinerators
• Radiation burns

Read more: Health-care waste

A person who experiences one needle stick injury from a needle used on an infected source patient has risks of 30%, 1.8%, and 0.3% respectively of becoming infected with HBV, HCV, and HIV. Additional hazards occur from scavenging at waste disposal sites. And, this can happen during the handling and manual sorting of hazardous waste from healthcare facilities. These practices are common in many regions of the world, especially in low- and middle-income countries. The waste handlers are at immediate risk of needle-stick injuries and exposure to toxic or infectious materials.

WHO also states that the disposal of untreated healthcare wastes or waste treated with chemicals can lead to contamination of groundwater. And, can also result in the release of chemical substances into the environment if those substances are not handled, stored, and disposed of in an environmentally sound manner.

Read more: AN INTRODUCTION TO ESSENTIALS OF BIO-MEDICAL WASTE MANAGEMENT - PMC

COVID-19, and biomedical waste

The pandemic brought a huge upsurge in biomedical waste that the country was absolutely not ready for. A study published by Frontiers in Environmental Science reveals that Maharashtra, Karnataka, and Kerala generated the highest biomedical waste in 2019. India did not have sufficient infrastructure and Human Resources to handle this huge amount of waste. By the end of May 2020, India became the second largest manufacturer of PPE kits producing nearly 4.5 lakh PPE kits and more than 104 lakh N-95 masks.

Read more: Upsurge in biomedical waste due to COVID-19 in India: A statistical correlation, challenges and recommendations

According to a paper published on Clinical Epidemiology and Global Health, as of 2020, out of 35 states and union territories in India, 8 states/UTs did not have any (CBWTFs) while 6 states/UTs only had one (CBWTF) in the whole state. Although, the calculation of the exact amount of bio-medical waste generated during that period is challenging. Yet, it was estimated that it was six times more than the pre-pandemic situation.     

Read more: COVID-19 and waste management in Indian scenario: challenges and possible solutions - PMC 

A report titled State of India’s Environment in Figures 2021 by the Centre for Science and Environment reveals that in April 2021 India produced 139 tonnes per day of COVID-19-related biomedical waste which escalated by 46% to 203 tonnes per day in May 2021. Out of the 1,613.54 tonnes of biomedical waste generated daily during this period, about 60% was Covid related.

According to reports by CPCB, in May 2021, India had the greatest number of new instances of COVID-19.  In these months, in states like Haryana, COVID-19 waste accounted for 47% of the biomedical waste, 42% for Chattisgarh, 40% for Himachal Pradesh, 40% for Andhra Pradesh, and 39% for Delhi. In some states like Assam, Uttarakhand, Himachal Pradesh, and Arunachal Pradesh CBWTFs capacity was not adequate and one facility could not cater to the entire state. Hence, it needed to depend on captive facilities, burial pits, and incineration, another study stated. 

Read more: Generation of COVID19 related Biomedical Waste in States/UTs

Biomedical Waste Management (BMW) App

The Central Pollution Control Board (CPCB) and the All India Institute of Medical Sciences (AIIMS) issued new guidelines for the safe handling and disposal of biomedical waste. The state and the central pollution control boards also suggested strict adherence to all the guidelines laid and adopted additional precautionary measures. CPCB also launched a mobile application, COVID-19 Biomedical Waste Management (BMW) App in May 2021. The app was supposed to monitor the waste generated but only a few states/UTs registered and fewer reported through the app. 

Read more: Updates on biomedical waste management during COVID-19: The Indian scenario

Down to Earth, which is published under the Centre for Environment and Science (CSE), claims that even after the Supreme Court passed an order that makes reporting through BMW apps mandatory, very few waste generators register. The most shared information on the BMW app was during November 2020 when 100,000 generators shared their waste-generated information. Even in May 2021, when India accounted for almost half of the world’s cases only 5,084 generators shared their data on the BMW app. This generated a huge gap in information regarding waste generated due to COVID-19.

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

Another reason for the gap was that guidelines and protocols have been provided for healthcare facilities for proper segregation and disposal of waste. But, there were no such rules or systems in place for home quarantine centers. This also created alarmingly high plastic waste such as PPE kits, masks, and goggles which were disposed of with unsegregated food and other household wastes. According to reports by CPCB, till the month of June 2021, 193 out of 198 CBWTFs started using the tracking app. Furthermore, around 13,000 generators of COVID-19 waste have registered on the said app.

Read more: COVID-19 and the changing nature of waste

Vaccination and bio-waste

After the decrease in COVID-19 cases since 2021, as per the August report by CPCB, the total Covid-19-related biomedical waste generated during the month was 5.08 TPD and 45 out of 202 CBWTFs were engaged. The epidemic has significantly altered the kind and quantity of garbage that is produced. And, it is expected to do so for the foreseeable future.

Read more: Redefining bio medical waste management during COVID- 19 in India: A way forward - ScienceDirect

The waste produced during the mass vaccination drives to curb COVID-19 transmission could have huge environmental effects, a report in The Science of the Total Environmental in November 2021 claims. With 3,000 vaccination clinics spread across the nation, India launched one of the largest vaccination campaigns in the world in January 2021. And as a result, a significant amount of bio-waste from used vials was produced. Additionally, the production and use of surgical masks, gloves, syringes, and disinfectants in large quantities, as well as the preparation and storage of vaccinations, all add to the global greenhouse gas emissions associated with the vaccination process. Toxic plastic trash is produced by improperly discarding waste, such as masks.

Read more: The environmental impact of mass coronavirus vaccinations: A point of view on huge COVID-19 vaccine waste across the globe during ongoing vaccine campaigns - ScienceDirect

With the increasing production of PPE kits reaching 450,000 thousand PPE kits/day between March and May 2020, a lot of these masks and PPEs are ending up in India’s water bodies now. A huge number of discarded plastic masks and gloves have been washing up on beaches and are being stopped out from ocean beds. Used PPE kits, blood pouches, and other hospital waste that had been openly disposed of were spotted floating in floodwaters in Assam. Furthermore, raising concerns about the spread of COVID-19, a report states.

Read more: Coronavirus | Used PPEs wash up in Assam floods, raise concern over COVID-19 spread - The Hindu

Conclusion

A report released by Partnerships in Environment Management for the Seas of East Asia (PEMSEA), revealed that India is among the most affected countries with a significant portion of the recycling industry either closed or operating at low capacity, due to COVID-19 lockdowns and lack of essential service status. According to the report less than 10% of plastic recyclers were operating during lockdowns, and although 20-70% of these recyclers are functional post-lockdown, they are operating at only 25-50% of their full capacity. 

Read more: Safeguarding the Plastic Recycling Value Chain: Insights from COVID-19 impact in South and Southeast Asia

On March 2022, the Ministry of Environment, Forest and Climate Change implemented a scheme called ‘Creation of Management Structure for hazardous Substances’ wherein central assistance to the tune of Rs. 1 crore is provided for setting up those CBWTF projects which are duly recommended by State/UT government. In the case of North-Eastern states, the central assistance is Rs. 2 crores.

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