How Should We Better Manage Human and Planetary Health in a Next Pandemic?

Health care generates a lot of waste that enters landfills, oceans, and incinerators and adversely affects the health of persons and communities close to waste processing and disposal areas. This article considers the nature and scope of individuals' and organizations' disposal responsibilities and discusses personal protective equipment use and waste during the COVID-19 pandemic.

Towards understanding respiratory particle transport and deposition in the human respiratory system: Effects of physiological conditions and particle properties.

Fly ash is a common solid residue of incineration plants and poses a great environmental concern because of its toxicity upon inhalation exposure. The inhalation health impacts of fly ash is closely related to its transport and deposition in the human respiratory system which warrants significant research for health guideline setting and inhalation exposure protection. In this study, a series of fly ash transport and deposition experiments have been carried out in a bifurcation airway model by optical aerosol sampling analysis. Three types of fly ash samples of different morphologies were tested and their respiratory deposition and transport processes were compared. The deposition efficiencies were calculated and relevant transport dynamics mechanisms were discussed. The influences of physiological conditions such as breathing rate, duration, and fly ash physical properties (size, morphology, and specific surface area) were investigated. The deposition characteristics of respiratory particles containing SARS-CoV-2 has also been analyzed, which could further provide some guidance on COVID-19 prevention. The results could potentially serve as a basis for setting health guidelines and recommending personal respiratory protective equipment for fly ash handlers and people who are in the high exposure risk environment for COVID-19 transmission.

Overcoming challenges due to enhanced biomedical waste generation during COVID-19 pandemic.

Biomedical wastes (BMWs) are potentially infectious to the environment and health. They are co-dependent and accumulative during the ongoing coronavirus disease-2019(COVID-19) pandemic. In India the standard treatment processes of BMWs are incineration, autoclaving, shredding, and deep burial; however, incineration and autoclaving are the leading techniques applied by many treatment providers. These conventional treatment methods have several drawbacks in terms of energy, cost, and emission. But the actual problem for the treatment providers is the huge and non-uniform flow of the BMWs during the pandemic. The existing treatment methods are lacking flexibility for the non-uniform flow. The Government of India has provisionally approved some new techniques like plasma pyrolysis, sharp/needle blaster, and PIWS-3000 technologies on a trial basis. But they are all found to be inadequate in the pandemic. Therefore, there is an absolute requirement to micromanage the BMWs based on certain parameters for the possible COVID-19 like pandemic in the future. Segregation is a major step of the BMW management. Its guideline may be shuffled as segregation at the entry points followed by collection instead of the existing system of the collection followed by segregation. Other steps like transportation, location of treatment facilities, upgradation of the existing treatment facilities, and new technologies can solve the challenges up to a certain extent. Technologies like microwave treatment, alkaline hydrolysis, steam sterilization, biological treatment, catalytic solar disinfection, and nanotechnology have a lot of scopes for the treatment of BMWs. Hi-tech approaches in handling and transportation are found to be fruitful in the initial steps of BMW management. End products of the treated BMWs can be potentially fabricated for the application in the built environment. Some policies need to be re-evaluated by the health care facilities or government administrations for efficient BMW management.

Assessment of medical waste generation, associated environmental impact, and management issues after the outbreak of COVID-19: A case study of the Hubei Province in China.

COVID-19 greatly challenges the human health sector, and has resulted in a large amount of medical waste that poses various potential threats to the environment. In this study, we compiled relevant data released by official agencies and the media, and conducted data supplementation based on earlier studies to calculate the net value of medical waste produced in the Hubei Province due to COVID-19 with the help of a neural network model. Next, we reviewed the data related to the environmental impact of medical waste per unit and designed four scenarios to estimate the environmental impact of new medical waste generated during the pandemic. The results showed that a medical waste generation rate of 0.5 kg/bed/day due to COVID-19 resulted in a net increase of medical waste volume by about 3366.99 tons in the Hubei Province. In the four scenario assumptions, i.e., if the medical waste resulting from COVID-19 is completely incinerated, it will have a large impact on the air quality. If it is disposed by distillation sterilization, it will produce a large amount of wastewater and waste residue. Based on the results of the study, we propose three policy recommendations: strict control of medical wastewater discharge, reduction and transformation of the emitted acidic gases, and attention to the emission of metallic nickel in exhaust gas and chloride in soil. These policy recommendations provide a scientific basis for controlling medical waste pollution.

Effects of medical waste incineration fly ash on the promotion of heavy metal chlorination volatilization from incineration residues.

High contents of heavy metals and Cl are major challenges for incineration residue disposal. Classification by the Chinese government and the coronavirus disease 2019 pandemic have changed the characteristics of incineration residues, thereby increasing the difficulty of disposal. In this study, medical waste incineration fly ash (MWI FA) was proposed as an additive to promote chlorination volatilization of heavy metals from municipal solid waste incineration fly ash (MSWI FA) and medical waste incineration slag (MWI S). When the mixing ratio of MWI FA to MSWI FA was 1:3, the chlorination volatilization efficiencies of Cu, Zn, Pb, and Cd at 1000 °C for 60 min were 50.2%, 99.4%, 99.7%, and 97.9%, respectively. When MWI FA was mixed with MWI S at a ratio of 1:1, the chlorination volatilization efficiencies of Cu, Zn, Pb, and Cd at 1200 °C for 40 min were 88.9%, 99.7%, 97.3%, and 100%, respectively. Adding MWI FA can replenish Cl in MSWI FA and MWI S while increasing the surface area and forming pore structures by sublimation of NaCl and decomposition of CaSO4, or can reduce the melting point and viscosity by Na2O destroying the glass matrix. Therefore, MWI FA can be co-disposed with MSWI FA and MWI S respectively to enhance the chlorination volatilization of heavy metals.

A review on emergency disposal and management of medical waste during the COVID-19 pandemic in China.

The surge of medical waste (MW) generated during the COVID-19 pandemic has exceeded the disposal capacity of existing facilities. The timely, safe, and efficient emergency disposal of MW is critical to prevent the epidemic spread. Therefore, this review presents the current status of MW generation and disposal in China and analyzes the characteristics and applicability of emergency disposal technologies. The results show that movable disposal facilities can dispose of infectious MW on site, even though most of their disposal capacity is at a low level (<5 t/day). Co-disposal facilities need to be reformed completely for emergency MW disposal, in which separate feeding systems should be taken seriously. Specifically, municipal solid waste (MSW) incineration facilities have great potential to improve emergency MW disposal capacities. For hazardous waste incineration facilities, compatibility of the wastes must be matched to the composition and calorific value of the waste. As for cement kiln, MW can only be used as an alternative fuel instead of a raw material for cement. Based on the environmental risk and technical adaptability, the six emergency MW disposal technologies are recommended to be prioritized as follows: movable microwave sterilization, movable steam sterilization, movable incineration, co-incineration with hazardous waste, co-incineration with MSW and co-disposal in cement kilns. Infectious MW, especially COVID-19 MW, should be prioritized for disposal by centralized and movable disposal facilities, while non-infectious MW can be disposed of using co-disposal facilities. All stakeholders should strengthen the delicacy management of the end-of-life stage of MW, including collection, classification, packaging identification, transportation, and disposal. Currently, it is necessary for centralized disposal enterprises to follow the emergency disposal operation flowchart. From a long-term strategic perspective, making full use of regional movable and co-disposal facilities in the megacities can effectively enhance the emergency MW disposal capacity.

Characterization and evaluation of the leachability of bottom ash from a mobile emergency incinerator of COVID-19 medical waste: A case study in Huoshenshan Hospital, Wuhan, China.

To dispose of the medical waste generated during the COVID-19 pandemic, a new type of mobile emergency incinerator (MEI) was used in Huoshenshan Hospital, Wuhan, China, and consequently, it produced a number of medical bottom ashs (MBAs). In this study, the characterization and environmental risk evaluation of these MBAs were conducted to evaluate the disposal effect of this MEI used during the pandemic. Three types of leaching tests, EN 12457-2, TCLP 1311, and HJ/T 299-2007, were compared to investigate the release behaviors of major and trace elements from these MBAs. Lack of detection of COVID-19 in MBAs showed that this mobile emergency incinerator could thoroughly eliminate the COVID-19 virus in medical wastes to avoid secondary transmission. The results indicated that the increasing usage of chlorinated disinfectants and physiological saline solutions resulted in high Cl contents in MBAs. In addition, the increasing usage of polypropylene (PP) products changed the chemical properties and compositions of MBAs, with Ca as the main element. The leachability investigation revealed that the main metals in leachates were Ca, Na and K, and the toxic heavy metals such as Zn, Pb, Cu, and Cr in MBAs were difficult to extract because of the high pH (>12) of these MBAs. This study could provide consultation for the treatment and management of MBAs produced from MEIs dealing with emergent infectious diseases such as COVID-19.

Plastic waste management: A road map to achieve circular economy and recent innovations in pyrolysis.

The contemporary world is challenged by mounting of plastic waste on the environment due to increase in economy and population. Over 90% of virgin plastics are produced from fossil fuels, hence, recycling is the best solution to reduce extracting and exploiting fossil fuels, and grow towards a circular economy. The type of waste and its hierarchy offers a route to pick up proper waste recycling policies which get the most out of the available resources and its protection. Pyrolysis process offers more valuable ways to turn the plastic waste to useful products for fueling and raw materials for making new plastics, and acts as an environmentally sound alternative to incineration and inefficient landfilling. This study provides a basic insight into plastic pyrolysis technology with recent trends and innovations in various countries, and their path towards the achievement of a circular economy. Plastic manufacturers, waste managers and the public plays a vital role in the development of the recycling sector. Recycling will stay underdeveloped and borderline without specific regulations to increase its effectiveness. Sustainable development in managing the plastic would be possible only through significant policies to instruct the individual and social challenges. The current article also targets the readers without scientific knowledge to get a basic idea of pyrolysis and general awareness of proper plastic waste management in a closed loop system.

Biomedical waste generation and management during COVID-19 pandemic in India: challenges and possible management strategies.

The COVID-19 pandemic has resulted in the massive generation of biomedical waste (BMW) and plastic waste (PW). This sudden spike in BMW and PW has created challenges to the existing waste management infrastructure, especially in developing countries. Safe disposal of PW and BMW is essential; otherwise, this virus will lead to a waste pandemic. This paper reviews the generation of BMW and PW before and during the COVID-19 pandemic, the regulatory framework for BMW management, policy interventions for COVID-19-based BMW (C-BMW), the capacity of BMW treatment and disposal facilities to cope with the challenges, possible management strategies, and perspectives in the Indian context. This study indicated that policy intervention helped minimize the general waste treated as C-BMW, especially during the second pandemic. Inadequacy of common BMW treatment facilities' (CBMWTFs) capacity to cope with the BMW daily generation was observed in some states resulting in compromised treatment conditions. Suggestions for better management of BMW and PW include decontamination of used personal protective equipment (PPEs) and recycling, alternate materials for PPEs, segregation strategies, and use of BMW for co-processing in cement kilns. All upcoming CBMWTFs should be equipped with higher capacity and efficient incinerators for the sound management of BMW. Post-pandemic monitoring of environmental compartments is imperative to assess the possible impacts of pandemic waste.

Assessing the management of healthcare waste for disease prevention and environment protection at selected hospitals in Kinshasa, Democratic Republic of Congo.

Incineration is the most used healthcare waste (HCW) disposal method. Disease outbreaks due to Ebola virus and SARS-CoV2 require attention to HCW management to avoid pathogens spread and spillover. This study describes HCW management prior to incineration and hospital incinerators performance by analysing bottom ashes from hospitals in Kinshasa, Democratic Republic of Congo. We used semi-structured interviews to capture information on pre-incineration waste management and analysed the chemical composition of 27 samples of incinerator bottom ashes using the energy dispersive X-ray fluorescence. Neither sorting nor waste management measures were applied at hospitals surveyed. Incinerator operators were poorly equipped and their knowledge was limited. The bottom ash concentrations of cadmium, chromium, nickel and lead ranged between 0.61-10.44, 40.15-737.01, 9.11-97.55 and 16.37-240.03 mg kg-1, respectively. Compared to Chinese incinerator performance, the concentrations of some elements were found to be lower than those from China. This discrepancy may be explained by the difference in the composition of HCW. The authors conclude that health care waste in Kinshasa hospitals is poorly managed, higher concentrations of heavy metals are found in incinerator bottom ashes and the incinerators quality is poor. They recommend the strict application of infection prevention control measures, the training of incinerator operators and the use of high-performance incinerators.

Repercussions of clinical waste co-incineration in municipal solid waste incinerator during COVID-19 pandemic.

During coronavirus disease 2019 pandemic, the exponential increase in clinical waste (CW) generation has caused immense burden to CW treatment facilities. Co-incineration of CW in municipal solid waste incinerator (MSWI) is an emergency treatment method. A material flow model was developed to estimate the change in feedstock characteristics and resulting acid gas emission under different CW co-incineration ratios. The ash contents and lower heating values of the feedstocks, as well as HCl concentrations in flue gas showed an upward trend. Subsequently, 72 incineration residue samples were collected from a MSWI performing co-incineration (CW ratio <10 wt%) in Wuhan city, China, followed by 20 incineration residues samples from waste that were not co-incineration. The results showed that the contents of major elements and non-volatile heavy metals in the air pollution control residues increased during co-incineration but were within the reported ranges, whereas those in the bottom ashes revealed no significant changes. The impact of CW co-incineration at a ratio <10 wt% on the distribution of elements in the incineration residues was not significant. However, increase in alkali metals and HCl in flue gas may cause potential boiler corrosion. These results provide valuable insights into pollution control in MSWI during pandemic.

Mapping healthcare waste management research: Past evolution, current challenges, and future perspectives towards a circular economy transition.

Improper healthcare waste (HCW) management poses significant risks to the environment, human health, and socio-economic sustainability due to the infectious and hazardous nature of HCW. This research aims at rendering a comprehensive landscape of the body of research on HCW management by (i) mapping the scientific development of HCW research, (ii) identifying the prominent HCW research themes and trends, and (iii) providing a research agenda for HCW management towards a circular economy (CE) transition and sustainable environment. The analysis revealed four dominant HCW research themes: (1) HCW minimization, sustainable management, and policy-making; (2) HCW incineration and its associated environmental impacts; (3) hazardous HCW management practices; and (4) HCW handling and occupational safety and training. The results showed that the healthcare industry, despite its potential to contribute to the CE transition, has been overlooked in the CE discourse due to the single-use mindset of the healthcare industry in the wake of the infectious, toxic, and hazardous nature of HCW streams. The findings shed light on the HCW management domain by uncovering the current status of HCW research, highlighting the existing gaps and challenges, and providing potential avenues for further research towards a CE transition in the healthcare industry and HCW management.

Comparative life cycle assessment of emergency disposal scenarios for medical waste during the COVID-19 pandemic in China.

The COVID-19 pandemic attracts concerns globally and leads to an exponential increase in medical waste generation, and disposal of medical waste is an urgent need for preventing the epidemic spread. Emergency disposal scenarios of medical waste generated during the COVID-19 pandemic require a systematic assessment to quantify their potential environmental impacts. The environmental impacts and key factors of three movable disposal scenarios (i.e. incineration disposal vehicle, movable steam and microwave sterilization equipment both followed by co-incineration with municipal solid waste) were quantified via life cycle assessment approach. Furthermore, the environmental impacts of three movable disposal and two co-incineration scenarios were compared via life cycle assessment by expanding system boundaries. The results show that co-incineration with municipal solid waste has the lowest environmental impacts due to environmental benefits produced by power generation, while co-incineration with hazardous waste is the highest due to the high energy consumption. Energy consumption (i.e. kerosene, electricity and diesel) are the key factors for three movable disposal scenarios. For movable steam and microwave sterilization equipment followed by co-incineration with municipal solid waste, power generation from incinerating disinfected medical waste has significant beneficial environmental impacts due to avoided impacts of electricity consumption. The recommendations for improvement of the emergency disposal and management of medical waste during the COVID-19 pandemic globally and other serious epidemic in the future are provided.

Pyrolysis: An effective technique for degradation of COVID-19 medical wastes.

COVID-19 has led to the enormous rise of medical wastes throughout the world, and these have mainly been generated from hospitals, clinics, and other healthcare establishments. This creates an additional challenge in medical waste management, particularly in developing countries. Improper managing of medical waste may have serious public health issues and a significant impact on the environment. There are currently three disinfection technologies, namely incineration, chemical and physical processes, that are available to treat COVID-19 medical waste (CMW). This study focuses on thermochemical process, particularly pyrolysis process to treat the medical waste. Pyrolysis is a process that utilizes the thermal instability of organic components in medical waste to convert them into valuable products. Besides, the technique is environmentally friendly, more efficient and cost-effective, requires less landfill capacity, and causes lower pollution. The current pandemic situation generates a large amount of plastic medical wastes, which mainly consists of polyethylene, polypropylene, polystyrene, polyethylene terephthalate, and nylon. These plastic wastes can be converted into valuable energy products like oil, gas and char through pyrolysis process. This review provides detailed information about CMW handling, treatment, valuable product generation, and proper discharge into the open environment.

Compromising situation of India's bio-medical waste incineration units during pandemic outbreak of COVID-19: Associated environmental-health impacts and mitigation measures.

COVID-19 induced pandemic situations have put the bio-medical waste (BMW) management system, of the world, to test. Sudden influx, of COVID-infected patients, in health-care facilities, has increased the generation of yellow category BMW (Y-BMW) and put substantial burden on the BMW-incineration units of India. This study presents the compromising situation of the BMW-incineration units of India, in the wake of COVID-19 pandemic, from 21st March 2020 to 31st August 2020. This analysis revealed that on an average each COVID-infected patient in India generates approximately 3.41 kg/d of BMW and average proportion of Y-BMW in it is 50.44%. Further, it was observed that on 13th July 2020, the total Y-BMW, generated by both the normal and COVID-infected patients, fully utilized the BMW-incineration capacity of India. Also, it was made evident that, during the study period, BMW-incineration emitted several pollutants and their concentration was in the order: NOx > CO > SOx > PM > HCl > Cd > Pb > Hg > PCBs > Ni > Cr > Be > As. Subsequently, life time cancer risk assessment depicted that with hazard quotient >10-6, Cd may induce carcinogenic health impacts on both the adults and children of India. Therefore, to mitigate the environmental-health impacts associated with the incineration of BMW, evaluation of various options, viz., alternative technologies, substitution of raw materials and separate treatment of specific wastes, was also done. It is expected that the findings of this study may encourage the global auditory comprising scientific community and authorities to adopt alternate BMW-management strategies during the pandemic.

Incineration of sewage sludge and recovery of residue ash as building material: A valuable option as a consequence of the COVID-19 pandemic.

Circular economy principles were adopted by European Commission, to support a sustainable growth. They contain general rules that should be considered in all situations. At present, during pandemic, some waste disposal practices are under evaluation to guarantee safety conditions. For example, in view of the recent results reporting the presence of SARS-CoV-2 virus in sewage sludge, the possibility that it diffuses in the environment is alarming. The situation may result critical in densely populated cities, which are the largest sources of sewage sludge. In this frame the diffused practice of reuse of this waste in agriculture is under revision. In this context, incineration may represent a valuable alternative strategy to manage sewage sludge during pandemic. Indeed, due to thermal treatment, the destruction of organic micropollutants and pathogens, eventually present in the waste, is guarantee. Moreover, it is fundamental to highlight that also if the management of sewage sludge changes, the ash resulting from its combustion may have suitable reuse opportunities, and their landfilling should be avoided. This work presents the available possibilities of sewage sludge ash recovery in building applications and shows the results obtained by the analysis of their sustainability. The approach is based on the use of embodied energy and carbon footprint values, to make a simple and fast new method able to be a suitable tool to support and promote sustainability also in critical situations (such as pandemic) and when all the information about a technology are not available, making not possible to perform a full-LCA approach. This work aims to be not only a reference paper for promotion of strategies able to increase waste management safety, but also an example showing that circular economy principles should be pursued also if boundary conditions can change.

Biomass use and COVID-19: A novel concern.

Evidence supports the link between air pollution and COVID-19 and thus it is likely that exposure to biomass smoke is associated with COVID-19. The poor, including refugees and migrant workers staying in fragile conditions, are most vulnerable. An outbreak of COVID-19 in a place where the concept of physical distancing is next to impossible could easily overwhelm the public health system. It is thus essential to understand the consequences of being exposed to smoke in relation to COVID-19 infection.