Why Coronavirus Outbreak Is Piling Pressure On India’s Biomedical Waste Disposal System

A stray dog fools around with a blue plastic coverall in a video shot in Coimbatore—endearing footage for those who know how playful dogs are, happily making a game out of anything. The image reflects a sinister side, too. Not of the dog, but of the creaking waste disposal system in a country struggling to contain an out-of-control contagion: the new coronavirus. Was the PPE suit flayed around by the dog contaminated, used in the fight against the COVID-19 outbreak? How did the dog get it? Did it fall from a passing ambulance? Or, was it discarded recklessly? The reason is not known, but it’s the second instance of a PPE kit found on a Coimbatore road. Similar cases abound across India. “Masks and sanitiser bottles have become a common sight on roads,” says Joginder Kumar, a garbage collector with the Municipal Corporation of Ludhiana. He empties out bins onto trucks and clears roads of this new kind of litter—worn masks, empty hand sanitiser bottles and, sometimes, discarded PPE kits too. “That spiky rascal could be hanging on to anyone of these,” he says with a heavy sigh, making no pretense to hide the fear of catching an infection from such waste.

The Covid outbreak has put India’s unsophisticated garbage treatment system—especially its inadequate handling capacity for biomedical waste—to a massive test. The nation of 1.3 billion people produced nearly 1,700 tonnes of biomedical waste a day between 2016 and 2018, according to Parliament data. That adds up to more than 600,000 tonnes a year—equivalent of a million full-size, adult African elephants stacked together on a weighing scale. In 2018, an Assocham-Velocity joint study predicted that India will generate about 775.5 tonnes of medical waste a day by 2022, growing at a rate of about seven per cent. Data for 2019 and this year—a global pandemic year—are trickling in, but not quite adequate and comprehensive for publication. “No ground estimate on how much additional waste has been generated during the pandemic is done,” says Dinesh Raj Bandela of the Centre for Science and Environment.

The situation is grim and the government has taken note of it. The Prime Minister’s Science, Technology and Innovation Advisory Council (PM-STIAC) invited individuals, startups, corporate houses, entrepreneurs, and research institutions to a “COVID-19 Biomedical Waste Treatment: An Innovation Challenge”. They were asked to come up with solutions for collection, disposal/treatment of waste—for instance, masks, gloves, and PPEs used in hospitals, airports, railway stations, households, shops et al—generated during this pandemic. The government promised monetary support to the innovators. “We are looking for standalone units that could be installed in housing complexes, markets, etc,” an official says.

There is even a bigger challenge: the lack of waste etiquette among the people. So, what is medical waste? Broadly, any waste generated during diagnosis and treatment, which includes contaminated items such as human tissues, blood, body fluids, equipment (beddings, syringes, sharp objects, dressings, faeces, etc). In these Covid times, the definition has been broadened. The Central Pollution Control Board (CPCB) explains that waste that can infect people with coronavirus fall in Red and Yellow categories. RED bin—used PPE such as goggles, face shield, splash-proof apron, plastic coverall, hazmat suit, gloves, lab equipment like plastic vials, tubes, pipette tips etc. YELLOW bin—masks (the N95 included), head cover/cap, shoe cover, disposable linen, gown, non-plastic or semi-plastic coveralls, faeces from COVID-19 patient using bed pans or disposable diapers. The pollution watchdog recommends fast disposal of such waste.

That brings to the fore the question of segregating waste. Is it done? “No comments,” is the CPCB official’s answer. There is lack of awareness among the people as well as ground-level garbage collectors. There have been instances of waste from “containment zones” or inf­ection hotspots getting mixed with those from “safe localities” despite express dir­ections to sanitation staff to separate the two. Besides, people hardly follow the rules, the standard operating procedure. So much so that, in Noida for ins­tance, residents were asked to not throw used masks and gloves into dustbins; they should cut those into pieces, put them in a paper bag for three days before discarding them with regular garbage. Also, they are advised not to put biomedical waste such as disposable syringes, faeces or urine diapers, in the trash. “Society’s perception and practice of ind­iscriminate disposal of items can be a potential source of infection to municipal workers. People should dispose of used napkins, tissues, empty sanitiser bottles in a separate bag, to ensure the safety of municipal workers and ragpickers. It will ensure garbage collection and plastic recycling don’t get affected,” says Deepak Saxena, professor, Indian Institute of Public Health.

But how much of it is recycled? How much of it reaches landfills? How much of it is incinerated to stop the spread of contagious diseases? The pollution board official says waste management is a state subject. Does that mean there’s no uniform or collective responsibility? The country has, according to the CPCB, more than 3,000 dump sites. But that’s not where hazardous medical waste should go. The protocol says used disposable masks, gloves, aprons, head covers and so on should be incinerated or given a burial—at least 100 feet deep. India has over 1,200 registered plastic recyclers. But the PPE suits manufactured in India cannot be recycled. A company owner says: “Polypropylene is being used for these kits that are available and cheap.” Recycling of poly materials is high and India has no facility for this. Since coveralls are widely used now—from beauty parlours and salons to weddings and hospitals—the question is where will the waste go?

No doubt, Kiran Kumar of Ahmedabad looks skyward and says a little prayer before leaving home to work—that self-assuring, empyrean safety shield against a pathogen invisible to the naked eye now ravaging the world. Kumar has a job as hazardous as, say, defusing an improvised explosive device with the timer ticking. The only difference is that this bomb is hidden, comes in clusters: the new coronavirus, or SARS-CoV-2. He is a public sanitation worker assigned to collect, segregate and dispose of biohazardous waste from hospitals treating COVID-19 pat­ients. He and around 15,000 more like him risk contracting secondary infection every day from the plastic bags filled with used syringes, sharps, catheters, face masks, hazmat suits, and all conceivable clinical garbage. They cover up in overalls, but the risk they take is not covered—no insurance, poor pay, and no acknowledgement either from the government or people. Kumar works for a private biomedical waste management company. Fear stalks him at every step, every litter he picks up. But he can’t quit. In a shuttered economy, jobs are hard to come by.

The CPCB protocol mandates companies handling biomedical waste to ensure maximum safety to their workers—regular sanitisation plus PPE, including three-layer masks, splash-proof aprons/gowns, gloves, gumboots and safety goggles. Well, that means the expenditure shoots up. “The operators are providing equipment and the measures have raised biomedical waste disposal costs from Rs 25-40 a kg to Rs 60-100 a kg. In some cases, even more,” says Vinod Kachhadia, president, Common Biomedical Waste Treatment and Disposal Facility Association of India. Workers are paid more, too, because “nobody wants to risk their lives”. The association is upset over the government’s attitude. The workers of biomedical waste plants are not part of the insurance scheme for those fighting COVID-19. The association wrote to the PM and several ministers. As Kachhadia waits for a response, he asks if  the government will take responsibility of the family of a worker in case he catches Covid and dies? For the answer, the government and the people may have to de-clutter some of the litter fogging their perception about biomedical waste—the risk a contaminated coverall in a dog’s mouth poses to the masses.     

***

• 260,889 Number of healthcare facilities in India

• 12,326 Number of healthcare centres having captive treatment facilities

• 120 Number of healthcare centres having captive incinerators

• 517 tonnes Volume of biomedical waste generated in a day in 2016

• 559 tonnes Volume of biomedical waste generated in a day in 2017

• 608 tonnes Volume of biomedical waste generated in a day in 2018

Sources CPCB, Rajya Sabha and Lok Sabha