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Face mask and medical waste disposal during the novel COVID-19 pandemic in Asia

 

The origin of the novel human coronavirus (SARS-CoV-2) and its potential for harm increased face masks and medical waste in the environment, thereby necessitating the urgent prevention and control of the pandemic. The article estimates the face mask and medical waste generation in Asia during the pandemic to convince the waste management and scientific communities to find ways to address the negative impact that waste disposal has on the environment. Standardisation, procedures, guidelines and strict implementation of medical waste management related to COVID-19, community habitats and public areas should be carefully considered to reduce pandemic risks in hospitals, as proper medical waste disposal effectively controls infection sources.

1. Introduction

The emergence of the novel coronavirus (COVID-19) disease has attracted global attention since December 2019. The first outbreak of coronavirus disease 2019 (COVID-19), which is caused by a novel severe acute respiratory syndrome, namely, coronavirus 2 (SARS-CoV-2), occurred in Wuhan, Hubei Province, China. Although most countries have closed their borders to prevent unnecessary travel and immigration, the possibility of confirmed cases and deaths is still increasing due to increased community transmission and increased capacity for testing. World Health Organisation (WHO) and the US Centres for Disease Control and Prevention, the National Centres for Disease Control and local governments have announced various guidelines, including frequent handwashing, social distancing and quarantine (home, local and state quarantine), to reduce the spread and health risks associated with COVID-19. These institutions have also recommended medical personnel and the general population to use personal protective equipment (PPE) such as surgical or medical masks, non-medical face masks (including various forms of self-made or commercial masks of cloth, cotton or other textiles), face shields, aprons and gloves. More and more countries have recommended wearing masks when going out in public places. The press conference study of the Joint Prevention and Control Mechanism of the State Council of China found that approximately 468.9 tons of medical waste are generated every day in association with COVID-19.

 

On the other hand, it was found in Indonesia (Jakarta) that the medical waste scale had reached 12,740 tons approximately 60 days after people were first infected by a coronavirus in the area. Infectious waste is characterised as any material that is suspected to contain pathogens (bacteria, viruses, parasites or fungi) in sufficient concentration or quantity to cause disease in susceptible hosts. It also comprises waste contaminated with blood, bodily fluids, tissues, organs and sharp objects from treatment and, therefore, also includes diagnosis, swabs, medical devices and so on. Therefore, it is harmful to health. In particular, infectious waste generated by the COVID-19 outbreak has posed a major environmental and health concern in many countries. In particular, inadequate solid waste management may increase the spread of coronavirus, especially in developing countries.

 

Currently, millions of contaminated face masks, gloves and materials for diagnosing, detecting and treating SARS-CoV-2 and other human pathogens are undergoing the irreversible process of becoming infectious waste. This, in turn, will cause environmental and health problems if they are stored, transported and handled improperly. Moreover, due to the increased healthcare waste owing to the COVID-19 pandemic, the threat that unsafe disposal of medical waste will spill over into environmental pollution is palpable and immediate. A recent study by Kampf et al. found that human coronaviruses can remain active on inanimate hard surfaces (such as metal, glass or plastic) for up to nine days. Although some Asian countries still do not follow proper management strategies and insufficient solid waste containers are one of the major problems that lead to the contamination of infectious waste in solid waste containers in the general community, the threat will be greater in developing countries that do not have sufficient resources for solid waste management. In particular, most developing countries, such as Cambodia, the Philippines, Thailand, India, Malaysia, Indonesia, Bangladesh, Vietnam and Palestine are widely perceived to be dump solid waste in poorly managed and open landfills. This is another example where improper management of contaminated PPEs and healthcare waste may increase the spread of viral disease in the environment 

 

Consequently, one of the many problems that will inevitably occur is contagious waste, which, if not managed properly, maybe the root cause of severe diseases and environmental problems. Hence, the purpose of this work is to estimate face mask use and medical waste during the COVID-19 pandemic, thereby calling on the waste management and scientific communities to express their concerns and take the requisite actions for the formulation of appropriate solid waste management policies and strategies to governments at all levels.

Estimation of daily face mask usage of the general population

The quantity of daily face masks is estimated using an equation adapted from Nzediegwu and Chang as follows:

DFM=P×Up×FMAR×FMGP10,000where.

D_FM ​= ​Daily face mask use (pieces)

P = Population (persons)

U_P = Urban population (percentage)

F_MAR = Face masks acceptance rate – 80% [3].

F_MGP = Assumption that each person in the general population uses one face mask each day

 

The amount of medical waste generated at different hospitals is proportional to the number of infected persons and the average waste generation per bed. An early study reveals that the daily generation of medical waste in Jordan is 2.69 ​kg/bed/day. Meanwhile, estimated values and analysis of medical waste in the city of Istanbul showcased that the yearly average values of daily unit medical waste per hospital bed have increased from 0.43 ​kg/bed/day in 2000 to 1.68 ​kg/bed/day in 2017. In April 2020, the highest rate of medical waste was estimated at around 14,500 tons during the COVID-19 pandemic. This has undoubtedly increased since then due to the increasing infection rate. For instance, the amount of medical waste peaked at 240 tons per day in Wuhan City. At the same time, the medical waste amounted to an average value of 206 tons per day in Dhaka, Bangladesh. Recently, in Jordan, the study conducted by Abu-Qdais et al. found that the average medical waste generated in King Abdullah University Hospital as a result of COVID-19 treatment was 3.95 ​kg/bed/day. In general, in the context of the COVID-19 pandemic, medical waste related to diagnoses and patients’ treatment is expected to be higher than the general average of infectious disease and the detected upper limit. Therefore, the estimation of medical waste provided by previous studies in Jordan (3.95 ​kg/bed/day) has been further considered in the medical waste analysis as follows:

M_W ​= ​Medical waste (tons/day)

N_CC = Number of COVID-19 cases (infected persons)

M_WGR ​= ​Medical waste generation rate, that is, 3.95 ​kg/bed/day

 

The number of face masks used in self-defence and medical waste generated by the total COVID-19 cases in developed and developing countries in Asia during the crisis. The result showed that more than one hundred thousand people were infected in Asian countries, such as India, Iran, Pakistan, Saudi Arabia, Turkey, Bangladesh, Qatar and Indonesia. The number of masks used in 49 Asian countries was estimated from the COVID-19 pandemic database on July 31, 2020. Subsequently, it was found that 2,228,170,832 face masks were used in Asia in total. In particular, the selected countries that use the most daily face masks are China (989,103,299 pieces), followed by India, Indonesia, Bangladesh, Japan, Pakistan, Iran, Philippines and Vietnam with 381,179,657, 159,214,791, 99,155,739, 92,758,754, 61,762,860, 50,648,022, 48,967,769 and 46,288,632 pieces, respectively

 

It was found while conducting this study that the total medical waste generated in Asia is around 16,659.48 tons/day. The countries with the highest medical waste are India (6,491.49 tons/day), followed by Iran (1,191.04 tons/day), Pakistan (1,099.30 tons/day), Saudi Arabia (1,083.17 tons/day), Bangladesh (927.81 tons/day) and Turkey (908.07 tons/day). Information about the medical waste of other countries has been included in Table 1. Indeed, due to the rapid increase in the number of confirmed cases, the amount of medical waste related to COVID-19 has also significantly increased. The use of medical gloves, surgical face masks and aprons has been recommended for essential healthcare service staff such as physicians, nurses, medical technologists and nurses’ aides. Moreover, face mask use has been mandated for citizens.

 

 

Disposal Most countries that generate excessive waste should evaluate their management systems to properly incorporate medical waste disposal during the COVID-19 pandemic. Therefore, waste management through its different phases (that is, pre-treatment, segregation, storage, delivery, collection, transportation and disposal) can represent another way forSARS-CoV-2 to spread, mainly through contact with contaminated surfaces and objects. Hence, all necessary precautions must be taken to prevent the potential spread of infectious viruses and feasible guidelines should be put forward. The guidelines should also consider socio-economic conditions and technologies available in specific environments. However, healthcare waste must be treated by incineration and secure landfill. Thus, priority is given to high-temperature incineration to dispose of medical waste related to COVID-19.