With input from Dr Monica Vasudev

1324: Round Table - Expert Group on Environment Zoom Meeting on “COVID waste management"

10^th January, 2020, 12 noon-1pm

Participants: Dr KK Aggarwal, Dr TK Joshi, Mr Dipankar Saha, Dr SK Tyagi, Ms Ajeeta Aggarwal, Sr. Environmental Engineer, Delhi Pollution Control Committee (DPCC), Dr BG Venkatesh, CMO EDMC, Mr Pradeep Khandelwal, Mr Neeraj Tyagi, Dr Suresh Mittal, Dr Anil Kumar, Ms Ira Gupta, Dr S Sharma

The meeting was chaired by Ms Ajeeta Aggarwal

Key points from the discussion 

• The CPCB has issued guidelines for COVID waste management. This guideline has undergone four revisions; the latest revision was in July 2020. These are very specific guidelines that are required to be followed by all stakeholders.
• The situation in Delhi initially (around May-June) was very bad as the entire waste was sent to Common Bio-medical Waste Treatment Facilities (CBWTFs). The amount of COVID waste generated then was around 25 tonnes per day. The yellow waste was very high, which overstretched the entire capacity to handle waste. The situation has improved now and the amount of medical waste has reduced to 7.5 tonnes per day. Out of this, 4 tonnes is COVID waste. CBWTFs are well-equipped to handle this.
• Most patients in Delhi are now in home care and the waste generated is collected by urban local bodies (ULBs) and handed over to CBWTFs.
• In Delhi, there are 86 hospitals; there are isolation wards in 17 hospitals, 164 sample testing centers, 19 quarantine camps, 15 designated COVID testing labs. Most of these are on CPCB App and their data is fed daily by CBWTFs.
• Biomedical waste management was a challenge as we did not know how to handle it.
• The first suggestion made was to start double bagging, especially for yellow bags.
• It was also decided that the guidelines should not be so strenuous to make the waste management process go haywire.
• CDC classifies medical waste into two categories. Category A is considered the most hazardous as it contains class 4 dangerous viruses like Ebola, Marburg. A study of various authentic sources revealed that nothing extra was required except use of personal protective equipment (PPE) should be rigorously monitored. Face shields were added to avoid inadvertent transmission of virus from inanimate surfaces by touching face.
• There were dedicated vehicles to carry COVID waste; dedicated vehicles are now discontinued.
• Reports from states do not suggest that any of the waste workers contracted coronavirus by handling such waste.
• Meticulous maintenance of records, adherence to standard precautions, e.g. staying at home if ill, provision of all protective equipment (including puncture proof gloves), if symptoms suspected then immediate testing, full wages to be paid if somebody became sick, were some measures adopted to keep the workers safe.
• Waste water was also an issue. But, there is no reported case of coronavirus from sewage water in sewage workers.
• In East Delhi Municipal zone, early in April, dedicated teams were created to collect COVID waste such as gloves, masks, medicine, etc., from home quarantine/isolation/ care patients, which included two public health workers and two safai karamcharis. Patients were educated to dispose only the COVID waste in yellow bags. COVID waste collection from EDMC was around 5-10 kgs only. A list of home care patients is received from CDMOs by DHOs, who sent the list to the teams. There is a dedicated collection center in Swami Dayanand Hospital.
• Guidelines are there but their implementation is inadequate.
• Masks should be kept for 3 days and then cut and disposed as general waste and not as biomedical waste.
• At the time of SARS 1, there was no awareness about N95 masks.
• Bleach is best cleaning and disinfecting solution for households. It is much safer to use. Lysol is hazardous. Both WHO and CDC recommend bleach; peracetic acid can also be used.
• Hypochlorite and hydrogen peroxide (3%, 6%) are used to sanitize public places, market areas and other areas such as schools.
• COVID vaccination has started in the country. Disposal of leftover vaccine, vials, syringes, etc., is a concern. All the suppliers/manufacturers should be prepared to take over the leftover stock (extended producer responsibility). Adequate number of sharp boxes should be provided.
• Any liquid waste has to be pretreated.
• There has to be a policy about how manufacturers will dispose of the left over vaccine, vials and syringes. These are to be treated at the point of origin with hypochlorite solution.
• Any problem can be resolved once all stakeholders are on board.  Public have to be taken into confidence.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA