10% of Gurugram’s biomedical garbage is related to Covid-19

Haryana’s Gurugram district is presently producing about 400 kilograms of Covid-19 related biomedical waste per day (against 3,800 kilograms of biomedical waste generated from other medical services) from 36 health care facilities, isolation wards and testing centres, and quarantined homes.

In just one month since March 16 when Gurugram reported its first positive case of Covid-19, biomedical waste associated with the suspected and positive Covid-19 patients has come to account for about 10% of total quantum of biomedical waste generated in the district.

Civic body workers fumigate the Gurugram’s DLF-4 area, during the lockdown (Yogendra Kumar / HT Photo)

The district is presently producing about 400 kilograms of Covid-19 related biomedical waste per day (against 3,800 kilograms of biomedical waste generated from other medical services) from 36 health care facilities, isolation wards and testing centres, and quarantined homes. This is according to data provided by Biotic, the district concessionaire for biomedical waste management.

While the concessionaire directly collects Covid-19 waste from hospitals, testing centres and isolation wards, suspected or confirmed patients under quarantine have been provided yellow bags to dispose of possibly infected waste, such as head caps, masks, and tissues. The civil surgeon’s office is coordinating collection from these homes and quarantine centres, officials said.

The waste is then sent to any of four collection centres in the district, where two Biotic vehicles dedicated only to collecting Covid-19 waste make pick-ups from. About 30 drivers and workers are involved in the collection of biomedical waste in the district.

The waste is then incinerated at a common biomedical waste treatment facility in Sector 37, at temperatures of over 800 degrees Celsius. Another 30 plant operators and sanitation workers are involved in this process. “The usual municipal waste collector is not involved in collection and treatment of Covid-19 related waste,” said Neeraj Yadav, deputy medical superintendent, Gurugram.

With non-essential surgeries being deferred and out-patient departments functioning at a decreased capacity, the quantum of routine (non-Covid) biomedical waste has dipped. “While the district was earlier producing about 5.5 tonnes of routine biomedical waste per day, this has now dipped to about 3.8 tonnes per day,” said Vikas Gahlot, spokesperson for Biotic.

Quantum of covid-19 waste set to increase

The National Centre for Disease Control (NCDC) and the Central Pollution Control Board (CPCB) have issued guidelines for the safe handling and disposal of Covid-19 related waste.

With India having expanded its testing criteria and capabilities for Covid-19, and experts predicting that the outbreak’s peak is still a few weeks away, the quantity of biomedical waste generated due to the pandemic is set to increase manifold. Dr Sushila Kataria, an internal medicine specialist at Medanta hospital who was involved in the treatment of 14 Italian tourists who were brought to the city from Jaipur, said, “Treatment of a confirmed Covid-19 case generates about 15 times more waste than an average patient. From what they wear to the plates you serve them food in, everything gets disposed.”

In Wuhan, which is the epicentre of the coronavirus outbreak, the total amount of biomedical waste shot up by six times in the wake of the pandemic, explained Sourabh Manuja, an environment and waste management fellow at The Energy Research Institute (TERI). “We have also been seeing reports from the US and Italy, which are struggling to deal with the mountains of Covid-19 related waste,” said Manuja.

However, Biotic’s Gahlot said, “There is no cause for alarm yet. Our facility in Gurugram can handle an intake of up to 20 tonnes of biomedical waste, Covid-19 and routine, per day. At the moment, we are operating at only 20 to 25% capacity per day, so for the foreseeable future we are equipped to handle an increase.”

Lack of PPE for collection staff

There are other issues, which have begun to plague the district’s biomedical waste management system. These include a shortage of personal protective equipment (PPE) for those involved in collecting and treating waste, and an increase in operating capital.

“We have a staff of close to 60 people, including drivers, collectors and waste handlers. We have had to pay them incentives to keep working in a high-risk scenario. With routine waste being reduced, and with costs of PPE going up, we are expecting a 30% dip in revenue for April,” Gahlot explained.

Three-ply surgical masks, which Biotic was earlier purchasing at a wholesale price of 62 paise per unit, are now being purchased at ₹11 per unit. Similarly, the cost of one unit of PPE has increased from ₹400- ₹600 to ₹900- ₹1,400.

“More worryingly, there is a shortage of PPEs in the market. We only have stock for another nine or 10 days. After that, we will require some assistance from the Municipal Corporation of Gurugram to procure PPEs. We have written to the MCG and to the chief secretary, Haryana, to help us procure them at cheaper prices through government channels. So far we have been buying PPEs independently,” said Gahlot.

Challenge to waste management

Experts have said that both biomedical and municipal waste management systems in Gurugram, as with the rest of the country, will be challenged by the Covid-19 outbreak, particularly given their poor compliance with Central guidelines, such as the Solid Waste Management Rules, 2016, and the Biomedical Waste Management Rules, 2016.

“Only half of all health care facilities in Gurugram are following the necessary barcoding procedure, which helps us track how much waste is generated and how much is treated,” said an official in the Haryana State Pollution Control Board (HSPCB), who requested anonymity.

Such a flaw in the system, according to TERI’s Manuja, may lead to inadvertent ‘leakages’ of hazardous waste, which, in turn, poses adverse health impacts for waste and sanitation workers.

Equally worrying, experts said, is the fact that many households are now producing biomedical waste of their own, which may cause further transmission of the virus through surface contamination. A study, recently published in New England Journal of Medicine, states that the Sars-Cov-2 virus, which causes Covid-19, may continue to live on cardboard for up to 24 hours, and on plastic and stainless steel for up to 72 hours.

“These are all materials commonly found in household waste,” said Natasha Zarine, a solid waste management expert from Aurangabad, Maharashtra, who is working with the municipal corporation there to improve working conditions for waste pickers during the outbreak. “Without proper segregation, one might be putting the lives of sanitation workers, waste pickers, and health workers at risk. Municipal authorities need to ensure full protective gear for these people,” Zarine added.

Dr Rajib Dasgupta, associate professor at the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, said, “While household items, such as fabrics and other surfaces, can be washed and disinfected, tissues, face masks and single-use applications which may contain nasa-pharngyeal secretions will remain infectious for some time, and must be disposed keeping this in mind. Those involved in sanitation work should be given full protective gear as they are more at risk.”

With this in mind, experts have advocated for a third level of segregation to ensure that possibly infectious waste does not make its way into the general municipal waste system. “Given the general state of waste collection in India, the system will come under pressure. A third level of segregation is imperative to contain the outbreak, especially if the waste is infectious,” said Swati Sambyal, an independent waste management expert and former head of the Centre for Science and Energy’s waste monitoring programme.

Both the NCDC and CPCB guidelines state that, for those practicing ‘home care’, all biomedical waste must be collected separately in yellow bags and handed over to authorised waste collector until it is picked up by the biomedical waste facility.

What district administration says

According to health officials, such segregation is being enforced in homes where residents have either tested positive or have been advised to self-quarantine. Meanwhile, for other households at large, an advisory has been issued by the district administration to dispose of single-use items (such as masks) separately, and with adequate care. The advisory also clearly states that possibly infectious waste should be left alone, “in a tightly knotted plastic lined dustbin where it can be left for 48 hours to avoid spread of the virus”.

In a press release issued on April 14, deputy commissioner Amit Khatri said, “Just as it is necessary to wear a face mask to avoid coronavirus infection, it is also necessary to safely dispose face masks after use. Anyone wearing the mask should take care to not touch the front of the mask, as it may contain germs. All the district residents should understand these methods of disposal to keep themselves and others around them safe.”

While representatives of multiple private hospitals in the city declined to comment, or did not respond to requests seeking comment for this story, JS Punia, chief medical officer, Gurugram, said, “All medical waste must be handled and disposed of in accordance with the Centre’s biomedical waste management rules, which are adequate.”

Meanwhile, Ecogreen Energy, the MCG’s concessionaire for solid waste management, is also taking precautions to protect general waste collectors from contracting Covid-19. A spokesperson for Ecogreen said, “Our waste collectors who are going to other homes have been provided masks, hand sanitizers, and briefed on how to stay safe. Garbage is being collected from people’s homes regularly and with great caution. Thermal scans and health check-ups are also being provided for all employees. Garbage cars are also being sanitized three times a day.”