HCFI Dr KK Aggarwal Research Fund

COVID -19 Bio-Medical Waste (COVID - BMW) is increasing in India since January 2020 (Peak observed in May 2021) and its management needs improvement. A similar picture has emerged in other countries too. For proper management and disposal of COVID-19 bio-medical waste, HCFI Round Table on Environment decided to understand the problems being faced and also to come up with suggestions for curbing these problems. 

Accordingly, HCFI Round Table on Environment held its online meetings on 30^th May, 6^th June, and 13^th June, 2021 via ZOOM at 12 noon to 1 PM. In all its meetings, detailed discussions were held on COVID Bio-Medical Waste (including PPE kits, Masks etc.) - Recycling and Management Issues. 

Key points from the discussion are

1. A massive surge in generation of COVID - BMW has been observed during the second wave of COVID-19. There is an exponential increase in quantity of COVID - BWM generation since February, 2021.
2. India is facing several challenges regarding COVID - BMW management particularly with regard to collection, segregation, handling and disposal apart from safety and hygiene of workers involved in waste collection.
3. CPCB has issued guidelines for handling the waste generated during quarantine/isolation of COVID patients in July 2020. These guidelines have defined the responsibility of every sector/stake holder involved in BMWgeneration /collection/management etc.
4. As per CPCB, around 198 CBWTFs are involved in treatment and disposal of biomedical waste across India.
5. CPCB has also launched COVID-19 Biomedical Waste Tracking App to regulate the COVID waste. Every COVID-19 biomedical waste generator, common facility operator and SPCBs are required to report data on daily basis on said app.
6. But, COVID-19 BMW management is still in nascent stage.The waste types should be identified and how each can be treated should be defined. Different categories of COVID -19 BMW cannot be treated in the same manner. Some may be incinerated; some can be recycled. Different strategies need to be formulated for Government Hospitals, Nursing Homes, Clinics & Primary Health Centres (PHCs). This is because of the fact that each of them has different levels of manpower, infrastructure, training and awareness and disposal infrastructure. 
7. For example, PHCs often conduct vaccination drives in their Centres or nearby Schools. PHCs, particularly in rural areas, have a system for needle disposal after vaccination but not for the disposal of cotton and vaccine vials. Hence, a separate strategy is required for vaccination centres in Rural Areas. 
8. Unless an inventory of waste handled by the Common Bio-Medical Waste Treatment Facilities (CBMWTFs) / individual Health Care Facilities (HCFs) is maintained, there would be a gap in data and figures. We must know the total amount of COVID - BMW handled by all the CBMWTFs / Health Care Facilities.
9. The number of discarded PPE kits, masks, gloves has increased many folds. Ways and means are to be explored as to how this plastic can be utilised after proper disinfection instead of disposing them in the garbage or incinerating them. For instance, recycled polyester yarns can be made out of these, which can be used for clothing, carpets etc. Other products can also be made after proper disinfection. Government of India should draft a policy in this regard.
10. Incineration of chlorinated plastic waste may be avoided since it has side effects such as generation of dioxins and furans. 
11. There are challenges w.r.t. the limitations in capacities of existing facilities and incinerators, manpower (getting them to work, protecting them from the infection), recycling, training, precautions.
12. There are other challenges including logistics, handling, decontamination and selling decontaminated waste to authorised recyclers.
13. Clarity and public awareness are required about this i.e., how to dispose and recycle them.

After great in-depth discussions, HCFI Round Table on Environment gave consensus for following recommendations which are to be proposed to the relevant Authorities, Governments both Central and State for effective COVID Bio-Medical Waste (including PPE kits, Masks etc.) recycling, disposal and Management. 

Proposed recommendations/suggestions

1. Inventory of COVID-19 BMW handled by the CBMWTFs/Individual Health Care Facilities is very important for preparedness. A target may be fixed by CPCB/ SPCB.
2. End to end encryption is missing. This is a loop hole in COVID-19 BMW management, which needs to be addressed. The present practice is that the liability ends, once the COVID-19 BMW waste as part of BMW is given to the Authorised Recyclers. This should change. The unauthorised recyclers should be identified and be integrated in the system after due verification process.
3. Segregation and collection of COVID - BMW is still a big challenge. Role of citizens and Municipal Corporations is very important in this respect.
4. COVID- BMW should be collected separately; it should not be mixed with other waste. Separate strategies need to be formed for PHCs and Vaccination Centres.
5. CPCB Guidelines for handling waste generation during quarantine/isolation of COVID patients are not very clear on collection and management of domestic hazardous waste. Though, it is a part of Solid Waste Management Rules 2016. But it needs to be mentioned in the guidelines.
6. Guidelines are not very clear on waste coming from crematoriums. As per guidelines, PPE kits used by persons handling the dead body will be treated as BMW. But PPE kits used by visitors to the crematorium should be stored for at least 72 hours and it should be treated as dry solid waste.
7. There is a requirement of capacity build-up of incinerators, improvement of technology.This needs to be done after due assessment of the gap by CPCB. The experiences of Municipalities, waste handlers, recyclers, facilities incinerating the waste can be clubbed together. 
8. Awareness is required regarding COVID plastic waste; there should be a clear message from Regulators to Recyclers and to the Municipalities. The process should be made easier and more transparent.
9. Proper communication between Regulators and Stakeholders is essential for appropriate implementation of said CPCB guidelines.
10. For home quarantine in COVID Waste Management guidelines, Dos and Don’ts of home quarantine waste need to be published, in all vernacular languages and circulated widely. 
11. A celebrity may be requested by the Government/ Regulators to spread the message of how to dispose of such infectious waste. It can also be published in newspapers and in electronic &social media. 
12. The workers need to be vaccinated on priority and protected from the infection. All COVID waste handlers should be provided PPE kits – long gloves, masks and bath after, to prevent spread of infection.
13. Peoples’ participation is very important for waste management program to be successful.  Regular training and awareness programmes need to be conducted by Municipalities, HCFs, CBMWTFs, State Health Departments, SPCBs/ CPCB in association with NGOs.
14. Recycling should be thought of first. Incineration should be the last option. Infectious part of waste may not be negated.
15. It is suggested that CPCB may organise a review meeting on Guidelines with all stake holders. Heart Care Foundation of India (HCFI) may also be a special invitee to discuss this issue in a larger perspective.

Members of the Round Table