While the total quantity of waste being generated in the country due to Covid is not known, several states in order to meet the increased load have started outsourcing the collection of these items while also roping in spare incineration units in the cities to dispose of such material.
Biomedical waste in hospitals per bed daily has gone up from 500 gms in normal times to 2.5 to 4 kgs per bed per day during Covid pandemic. The number of treatment units for such waste in the country has stayed at around 200.
“We are disposing around 1,500 PPE kits a day across our group’s hospitals. In normal times, we had one fifth the amount of present medical waste...We have to start thinking of reusability of these items or it will become a huge problem,” said Alok Roy, Ficci health services committee and chairman, Medica Group.
The Central Pollution Control Board (CPCB), which had issued guidelines for Covid-19
waste management for hospitals, care and isolation centres has also started an app to record all biomedical waste being generated from hospitals.
“It is certainly a concern...We were among the very first ones who brought out the guidelines for medical waste disposal. We have proactively revised and improved our guidelines...Now implementation is the focus,” said, Prashant Gargava, member secretary, CPCB.
While the CPCB app, being used in 27 states, has recorded generation of 60 tonnes of Covid waste everyday, the mayor of Municipal Corporation of Delhi-North, Jai Prakash said that 40-45 tonnes is getting added daily from his area itself which includes the Lok Nayak hospital, one of capital’s largest Covid facilities.
He said that the medical waste collection has been outsourced to a private company since government capacity might fall short. “Now since home isolation, containment zones have increased, we also have to ramp up our capacity...We also mark the houses where people are quarantined to ensure proper waste collection,” Prakash added.
CPCB too, taking note of the limited capacity available to handle biomedical waste of unprecedented volumes has allowed “other bio-hazardous waste facilities” to be roped in and also permitted disposal of waste in industrial incinerators wherever available.
“In rural areas, where common disposal facilities may not be available in the vicinity or transportation issues may not be adequate, we are suggesting deep burial,” Gargava added.
CPCB has also suggested that medical waste such as masks and gloves at homes be stored in a paper bag for 72 hours before being disposed of in a separate bag.
Ramesh Kumar S, COO of Aster CMI Hospital, which started handling Covid-19
patients recently, has started following a strict protocol to manage Covid waste - they are packed in double-layered bags that are bar-coded and then picked up in a separate vehicle. From the hospital to the incinerator the waste can be tracked due to barcoding.
While detailed guidelines are in place, the bigger challenge is lack of awareness which has led to the problem of segregating waste at source putting garbage collectors at a risk.
“We have just finished an inspection. The systems are very well laid down and properly managed when the waste comes from a registered health care facility. However, since many people are in home isolation, that’s where the problem is,” said Sunita Narain, director general, Centre for Science and Environment.
Environmental experts are also concerned about the temporary health facilities that accommodate symptomatic patients. “The focus at these facilities is, from all accounts, more on infrastructure and on health care staff. Little or no attention is paid to the availability of trained staff, or the systems in place, to ensure safe disposal of contaminated waste,” said Leena Srivastava, deputy director general–Science, International Institute for Applied Systems Analysis.
Not just care centres, crematoriums too are in the line of fire. CPCB for instance received complaints of PPEs being thrown around without any precaution in a south delhi crematorium.
The pollution control body is of the view that PPEs which are made entirely of plastic can be disinfected instead of getting incinerated in order to minimise the environmental impact.
Hospitals are trying to minimise the financial impact too by encouraging reuse of items wherever possible and avoid disposable sheets, patient robes among others.
Not surprisingly so, since in Mumbai, on an average a hospital bill to manage this waste has gone up more than five times to nearly Rs 400,000-450,000 a month from the pre-covid days.
Anoop Lawrence, Operations Head at Global Hospitals, Mumbai, said BMC has outsourced the job to manage Covid waste, and is charging an additional Rs 100 per kg of waste. “From food containers, to bed linen to patient dress, all are soaked in hypo solution first and then sent through the laundry cycle...As the patient load has kept on growing, these items are getting reused, but with care," Lawrence said.
Hospitals in Mumbai have requested the municipal authority to allow them to pass on a part of the cost to the patient, given that treatment charges are capped. Soon such a notification is expected where the patient may bear a part of the cost of the Covid 19 waste to the tune of Rs 300-325 per day.
It has been an uphill task for the waste management firms too - finding manpower to do this dreaded job and managing the growing load.
Experts feel that while the government has recognised the role of urban local bodies in handling medical waste, whether they are being adequately trained and provided with protective gear will determine the success of such efforts.
“We now need to move our messaging one step further to create a mass sensitivity to practices of waste disposal...We also need to provide both guidance and PPE to rag-pickers and the sanitation workers across the country -- which while necessary will add to the waste being generated,” Srivastava added.