Global healthcare systems are burdened following the spread of COVID-19 in 2020. As the public health crisis continues, 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.
This contrast indicates the different scopes of medical waste and waste management systems in each country. While the increase in medical waste during a pandemic is reasonable and foreseeable, an effective solution for medical waste disposal is crucial.
Changes in Medical Waste
In China’s most infected city Wuhan, there were about 90,000 patient beds before the pandemic. Approximately 10,000 negative pressure beds were available for COVID-19 infected patients.
The Chinese government quickly established new shelter hospitals. Total beds for COVID-19 patients reached around 30,000 in Wuhan at its peak. Prior to the pandemic, Wuhan’s daily waste production was 45 tons, but the number soared to 247 tons per day during the outbreak – around six times higher.
Some European countries such as France, the Netherlands and Italy have experienced a growth of medical waste as well. According to SUEZ, a 40-50 percent increase was seen in the most affected areas in France, and quantities increased by 30 percent to 50 percent in their plant in the Netherlands during COVID-19.
In contrast, the United States has experienced a reduction of medical waste production due to the cancellation or delay of the elective surgeries as well as a reduction in hospitalizations. 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.
China’s Sharp Increase in Medical Waste
During the pandemic, in addition to the ordinary medical waste generated, more waste has been managed and treated as medical waste in China, which includes:
- PPE used in healthcare institutions
- general waste from hospitals with COVID-19 patients, such as food and dining boxes thrown by patients;
- general waste of suspected COVID-19 patients in quarantined areas; and
- infusion bottles and bags (usually disposed by nurses for recycling).
China used large quantities of PPE during the COVID-19 outbreak. PPE used by both healthcare personnel and patients increased exponentially. Under normal circumstances, patients do not wear facial masks and healthcare personnel do not wear protective suits, whereas each healthcare professional was required to wear at a new set of protective clothing every day, and all hospital staff wore protective suits during COVID-19 outbreak.
To provide the patient timely and adequate treatment, China mobilized more than 40,000 healthcare workers from other provinces to Wuhan. As the number of healthcare personnel per patient multiplied, so did the usage of PPE.
Hidden Risks of Medical Waste Management
According to the World Health Organization (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 infections. 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 services.
The Centers for Disease Control and Prevention (CDC) claims medical waste coming from healthcare facilities treating COVID-19 patients is no different than waste coming from facilities without COVID-19 patients, and management of medical waste should be performed in accordance with routine procedures.
On the contrary, the European Commission published guidance for waste management in the context of the coronavirus crisis. It states waste from cleaning healthcare facilities should be treated as infectious clinical waste. Analogously, China officially stipulated general waste produced by patients with infectious diseases as medical waste, and not only that, the general waste produced by suspected patients with an infectious disease should also be stipulated as medical waste.
Recent research suggests that the virus can spread nearly half of the clinical area within a mere ten hours. Eighty-six percent of people in all clinical areas tested positive within three days. The rooms closest to the original infection were the most contaminated. Furthermore, an article signed by 239 scientists over 32 countries displayed that the potential for airborne spread of COVID-19 has been underestimated. Coronavirus can live in the air and on various surfaces between several hours and several days. In fact, waste from hospitals with COVID-19 patients has a high probability of contamination.
Coronavirus can live in the air and on various surfaces between several hours and several days. More cases show that people may be infected by non-dangerous objects, such as the new outbreaks in a Beijing wholesale food market and a British meat factory. It reminds the world that coronavirus could return anytime. Since potential and unknown characteristics in coronavirus have not been discovered, the best solution is to take it cautiously and manage the potentially contaminated waste as medical waste.
The production of medical waste has seen explosive growth in China, and the medical waste management measures the country has taken could be one of the key reasons for the effective control of COVID-19. Meanwhile, great danger remains hidden in PPE and hospital waste with COVID-19 contamination if it not considered medical waste.
Medical Waste Management Optimization
In view of the continuous emergence of COVID-19 and the unknown and sudden nature of the coronavirus, infectious waste is likely overlooked. Governments should legally stipulate that both general waste and PPE used in infectious disease areas be labeled as medical waste to avoid the possibility of contaminated waste entering the general municipal waste collection and transportation systems and to prevent the virus from spreading to people through medical waste that has not been properly disposed of. It is sustainable and visionary to treat infectious diseases and medical waste in a more prudent manner, although this would increase the amount of medical waste during a pandemic.
Beginning in February 2020, the existing capacity was insufficient to deal with the large increase in medical waste. It led the China Ministry of Ecology and Environment to present three emergency solutions:
- It built temporary storage in every district in Wuhan city to store medical waste that could not be treated in time.
- It called for all mobile medical waste treatment equipment available in China to Wuhan. Around 60 mobile treatment systems were added in total.
- 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 total the medical waste generated during the pandemic in Wuhan.
China completed the revision of the new standard draft at the end of April 2020 and officially listed associated waste as medical waste. More rigorous and detailed classification criteria will be officially released in the near future. Most countries, especially developing countries, have to face the problem of inadequate medical waste treatment facilities that Wuhan once faced.
Because the existing medical waste treatment facilities in most developing countries around the world do not have the necessary capability to cope with the substantial increase of the medical waste during a pandemic outbreak, the capacity of existed medical waste treatment facilities must increase. The treatment must be more environmentally friendly and reliable, and new treatment facilities must be built.
China has been optimizing and expanding existing facilities widely and has initiated the construction of a new centralized medical waste treatment plants. By 2022, the treatment capacity of China's medical waste treatment facilities will at least double.
Because building many medical waste treatment facilities may be costly and difficult to implement, especially in developing countries, mobile medical waste treatment facilities could serve as a reserve solution. In the past decade, some regions of China purchased mobile treatment vehicles as preventive measures and have gained extensive experience. Each country and central city should be equipped with some mobile medical waste treatment facilities as a strategic reserve for emergency situations. Those facilities also can help some remote areas and islands with proper medical waste treatment when needed.
About the Authors
Mr. Gong Wei, Chairman of Gient Heating Industry Co., Ltd., a major manufacturer of medical waste treatment equipment in China. As an invited expert, Gong Wei recently participated in the review of China's latest medical waste treatment standards. During the outbreak of Wuhan from February to April 2020, he personally led the team to Wuhan, and completed the construction of a 30tons/day medical waste emergency disposal plant and another 30tons/day fully automated medical waste disposal plant. He has the first-hand direct experience in Wuhan’s anti-pandemic efforts, and he is also a participant in the emergency treatment plan for medical waste in Wuhan.
Ms. LI Manyu, who graduated from LMU University Munich with a physics major, currentiy is marketing supervisor at Gient.