In 2020, COVID-19 has spread around the world. Hundreds of cities were locked down and millions of people have been infected with Global healthcare systems under unprecedented burdens. Some countries, such as China, have experienced a substantial increase in medical waste, while other countries such as the United States have undergone a reduction of medical waste instead. This contrast indicates different scopes of medical waste and waste management systems in each country. In this article, we aim to point out the increase in medical waste during a pandemic is reasonable and foreseeable, and under this situation, an effective solution of medical waste disposal will be recommended.
Changes in Medical Waste during the COVID-19 Pandemic
Changes in Medical Waste Production
In China’s most infected city Wuhan, there were about 90,000 patient beds before the Pandemic. Only approximately 10,000 negative pressure beds were available for COVID-19 infected patients. China’s government quickly established new shelter hospitals and the total beds for COVID-19 patients reached around 30,000 in Wuhan at its peak. Usually, the daily waste production was 45 tons, while the number soared to 247 tons per day at the pandemic peak, which was around 6 times higher.
Some European countries such as France, the Netherlands, and Italy have experienced growth of medical waste as well. According to SUEZ, a 40-50% increase was seen in most of the affected areas in France, and quantities have increased by 30 to 50% in their plant in the Netherlands during COVID-19.1
It gives rise to attention that the United States has even experienced a reduction of medical waste production in general, due to the cancellation or delay of the elective surgeries and reduction in hospitalization. In addition, according to industry sources, a large amount of personal protective equipment (PPE) in medical institutions was not managed as medical waste during the pandemic in the United States.
What Makes the Sharp Increase of Medical Waste in China?
Scope of Medical Waste
During the COVID-19 Pandemic, in addition to the ordinary medical waste generated, more waste is managed and treated as medical waste in China, which include: 1) PPE used in healthcare institutions; 2) general waste from hospitals with COVID-19 patients, such as food and dining boxes thrown by patients; 3) general waste of suspected COVID-19 patients in quarantined areas; 4) Infusion bottles and bags (usually disposed by nurses for recycling).
Large Usage of PPE
China used large quantities of PPE during the COVID-19 outbreak. PPE used by both healthcare personnel and patients has increased exponentially. Under normal circumstances, patients do not wear facial masks and healthcare personnel do not wear protective suits, whereas each healthcare personnel was required to wear at least one protective clothing every day, and all hospital staff must wear protective suits during COVID-19 outbreak. With the rich demand and supply, the usage of PPE in China could be also wider and more frequently.
More Healthcare Personnel
To provide the patient timely and adequate treatment, China mobilized more than 40,000 healthcare personnel from other provinces to Wuhan. Hence the number of healthcare personnel per patient was multiplied, so was the usage of PPE.
These reasons above explained why China had much more increase than Europe and the United States.
Hidden Risks of Medical Waste Management under COVID-19 Pandemic
Differences in the Scope of Medical Waste
As per the WHO, infectious waste is defined as waste contaminated with blood and other bodily fluids, cultures and stocks of infectious agents from laboratory work, or waste from patients with infections2. But WHO interim guidelines suggest, all healthcare waste produced during patient care, including those with confirmed COVID-19 infection, is considered as infectious medical waste, but the waste generated in waiting areas of healthcare facilities can be classified as non-hazardous and disposed of by municipal waste services3.
The CDC of the United States claims medical waste coming from healthcare facilities treating COVID-19 patients, is no different than waste coming from facilities without COVID-19 patients, management of medical waste should be performed in accordance with routine procedures4.
On the contrary, in addition to the scope of medical waste mentioned above, the European Commission published Waste Management guidelines in the context of the coronavirus crisis5 and states waste from cleaning healthcare facilities should be treated as infectious clinical waste. Similarly, China officially stipulates general waste produced by patients with infectious diseases as medical waste, and not only that, the general wastes produced by suspected patients with infection disease are also stipulated as medical waste6.
The Necessity to Expand the Scope
According to recent research, viruses can spread nearly half of the clinical area within a mere 10 hours. 86 percent of people in all clinical areas tested positive within 3 days. The rooms closest to the original infection were the most contaminated7. Furthermore, an article signed by 239 scientists over 32 countries displayed that the potential for airborne spread of COVID-19 has been underestimated8. Coronavirus can live in the air and on various surfaces between several hours and several days. In fact, the waste from those hospitals with COVID-19 patients has a high probability of contamination.
Nowadays more cases show that people may be infected by non-dangerous objects, such as the new outbreak in Beijing wholesale food market and British meat factory. It reminds the world that Coronavirus could return anytime. Since potential and unknown characteristics in Covid-19 have not been discovered, the best practice and solution is to take it cautiously and carefully, and manage the potential contaminated waste as medical waste.
It is evident that, China dealt with COVID-19 waste with more caution and that is why the production of medical waste has seen an explosive growth in China. These medical waste management measures, taken by China, could be one of the key reasons that helped the effective control of COVID-19. Meanwhile, great danger is hidden in PPE and general waste of hospital with COVID-19 infection if they not considered as medical waste.
Medical Waste Management Optimisation after COVID-19
Expanding Scope of Medical Waste
In view of the continuous emergence of COVID-19 and the unknown and sudden nature of the coronavirus, the infection of waste is likely overlooked. It is suggested that the governments legally stipulate that both general waste, and PPE used in the infectious disease area, be labeled as medical waste. To avoid the possibility of contaminated waste entering the general municipal waste collection and transportation systems, and prevent the virus spreading to people through the medical waste that has not been properly disposed of. It is sustainable and visionary that to treat infectious diseases and medical waste in a more prudent manner, although this would increase the amount of medical waste during a pandemic
China has completed the revision of the new standard draft at the end of April 2020, and officially listed the above waste as medical waste. More rigorous and detailed classification criteria will be officially released in the near future.
Medical Waste Treatment Capacity
In face of the increase of medical waste during the COVID-19 pandemic in February 2020, the existing capacity was insufficient to deal with the large increase of medical waste. It led China Ministry of Ecology and Environment to present 3 emergency solutions at that time: 1) Build temporary storage in every district in Wuhan city to store medical waste that could not be treated in time 2) Call for all mobile medical waste treatment equipment available in China to Wuhan. (round 60 mobile treatment systems were added in total) 3) Most importantly, an emergency medical waste treatment plant was built within 14 days with 30-ton/day-treatment capacity. This emergency plant has treated one-quarter of the total medical waste generated during the pandemic in Wuhan.
We can speculate that, with the extension of the scope of medical waste, the amount of medical waste will sharply increase in a pandemic. Most countries, especially developing countries, have to face the problem of inadequate medical waste treatment facilities that Wuhan once faced.
An Effective Solution for Medical Waste Disposal
Considering that the existing medical waste treatment facilities in most developing countries around the world do not have the necessary capabilities to cope with the substantial increase of the medical waste during a pandemic outbreak, the suggestions are as follows:
First of all, it is suggested to increase the capacity of existing medical waste treatment facilities and make the treatment more environmentally friendly and reliable, and build new treatment facilities. China has been optimising and expanding existing facilities widely and has initiated the construction of a new centralised medical waste treatment plants. By 2022, the treatment capacity of China’s medical waste treatment facilities will have at least double.
Secondly, building many medical waste treatment facilities may be costly and difficult to implement, especially in developing countries, so it is proposed that mobile medical waste treatment facilities as a reserve would be a solution. In the past decade, some regions of China purchased mobile treatment vehicles as preventive measures and have gained extensive experience. So, our advice is each country and central city could to be equipped with some mobile medical waste treatment facilities as a strategic reserve for emergency situations. Those facilities can also help some remote areas and islands with proper medical waste treatment when needed.
Team-Up in Improving the Global Medical Waste Management Capabilities
As the largest professional medical waste treatment equipment manufacturer in China and a global leader in medical waste treatment technology, Gient has undertaken most of the construction projects of medical waste disposal facilities in China and provided equipment globally including in the United States, Mexico, and Peru since COVID-19 outbreak. Meanwhile, they have been actively collaborating with the Chinese Ministry of Ecology and Environment, UNIDO and other institutions or organizations to carry out aid construction projects for medical waste treatment in developing countries. They are well-resourced to facilitate developing countries to build advanced centralized medical waste treatment stations and onsite treatment facilities in hospitals and provide various mobile solutions such as mobile medical waste treatment station and modular units. More importantly, we are willing to share our experience and technologies to help the world fight against the pandemic and jointly improve the capacity of medical waste treatment.
Thanks to our partner Ms. Elsa Brown, President of Bondtech Corporation in the USA, for sharing with me relevant information on the treatment of medical waste and her revision to this article.