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Green Circle April edition

Biomedical waste management and the COVID-19 Pandemic: Things to care about

Written by Masroor Azam, Centre for Chronic Disease Control

In early December 2019 when coronavirus cases were reported in China and subsequently in other parts of the world, none of us had imagined it would become a pandemic. Since then there has been a steep rise in the number of cases. With approximately 3,139,588 cases (as on 29th April 2020) reported worldwide and a death rate of 6.95%, the pandemic has brought humanity on its knees.

While almost a third of the global population is under lockdown and the global economy is at a standstill, we find ourselves in the middle of the COVID-19 pandemic. At this difficult time, the healthcare sector is working with full rigor and is putting enormous effort to win the big battle. However, at the same time, the health sector is also facing numerous challenges.

In hospitals, medical and hazardous waste are generated, including infected masks, gloves, and other protective equipment, together with a higher volume of non-infected items of the same nature. Mismanagement of this waste could cause dangerous effects on human health and the environment. The safe handling and disposal of biomedical waste generated from hospitals treating COVID-19 patients’ demands extreme care as they can be potential carriers of the coronavirus.

To ease this challenge the Central Pollution Control Board (CPCB), has released guidelines for handling, treatment and safe disposal of biomedical waste generated during treatment, diagnosis, and quarantine of patients confirmed or suspected to have the coronavirus disease.

Healthcare Facilities having isolation wards for COVID-19 patients need to follow these steps to ensure safe handling and disposal of biomedical waste generated during treatment;

  • Ensure the segregation of waste per 2016 BMWM rules and amendments thereof.
  • Use double-layered bags for collection of waste to ensure no-leakage.
  • Collect and store biomedical waste from COVID-19 wards in a dedicated bin labeled as "COVID-19 waste". Before sending it off to the treatment facility, it must either be stored in a separate room or lifted off directly into the collection van.
  • A separate record of waste generated from COVID-19 isolation wards has to be maintained
  • The (inner and outer) surface of containers/bins/trolleys used for storage of COVID-19 waste should be disinfected with a 1% sodium hypochlorite solution daily.
  • Report opening or operation of COVID-19 ward and COVID ICU ward to State Pollution Control Board and respective biomedical waste treatment facility located in the area.
  • Depute dedicated sanitation workers separately for biomedical waste and general solid waste so that waste can be collected and transferred timely to the temporary waste storage area.
  • General waste not having contamination should be disposed of as solid waste as per Solid Waste Management Rules, 2016;

Sample Collection Centers and Laboratories for COVID-19 suspected patients should report opening or operation of COVID-19 sample collection centers and laboratories to concerned State Pollution Control Boards. Above mentioned guidelines should also be applied suitably in case of test centers and laboratories.

Sound biomedical waste management practices at the time of COVID-19 pandemic carry dual benefits for the healthcare sector. It will not only help hospitals and healthcare institutions contain potential spread of coronavirus cases but also help them prepare a robust waste management strategy for any challenge of similar kind in the days to come.

Webinar: Responding to COVID-19 by Strengthening the Health Infrastructure and Systems in Low Resource Setting.

On Saturday 11th April, SELCO Foundation co hosted a 3-hour webinar with Public Health Foundation of India, Centre for Chronic Disease Control, Health Care Without Harm and Shakti Foundation on Responding to COVID-19 by Strengthening the Health Infrastructure and Systems in Low Resource Setting.

While the health sector is making the best use of the existing healthcare infrastructure in India, public health experts convened to discuss the existing challenges pertaining in the health sector and the steps to tackle in making headway towards rebooting the entire health care infrastructure of India. Over 350 participants from government institutions as well as staff from Primary and Tertiary Health Centres, private NGOs operating clinics and hospitals, think tanks and enterprises joined and enriched the webinar.

We sincerely thank all the public health professionals who shared their learning experiences and the participants who took the time to join and contribute to this webinar and putting forth important questions.

Highlights from the Session

While the pandemic remains a challenge, the learnings shared through this webinar affirms the need to build resilience in India’s health sector and gives us an opportunity to equip ourselves for the future. The time has come for humanity to come together and make health services accessible and universal.

Thanks again for your attendance, we look forward to connecting with you in the future.

Does the lock-down define a new baseline for air quality in Indian cities?

By Sanya Prakash, Masroor Azam & Shriram Manogaran, CCDC

The year 2020 has not been a kind one, so far. Earlier, the bush fires in Australia and now, a novel form of coronavirus (COVID-19) has brought the world to a halt. This pandemic has resulted in thousands of deaths globally and has led to the collapse of health-care systems among many of the developed countries. However, India has done a commendable job in containing the virus so far, resulting in a lesser number of cases.

Amidst the chaos, the pandemic also brought forth a silver lining for the environment. The lockdown imposed by the government last month has somehow provided temporary relief to another major public health threat: Air Pollution. Unfortunately, in India, more than 76% of the population lives in areas that do not meet Indian air quality standards and are exposed to various associated health risks. According to the State of India's Environment (SoE) report, 2019, air pollution is responsible for 12.5 percent of all deaths in the country. But with the shutdown in place, the air pollution levels have fallen drastically throughout the country.

In the wake of the current scenario, we decided to look at the air quality of Delhi. The main reason for selecting Delhi is the high capacity of Continuous Ambient Air Quality Monitoring Stations (CAAQMS) in the city. Therefore, it was interesting to compare the levels of pollution before and after the lockdown implemented. We primarily focused on estimating PM 2.5 levels, the tiny particles which increase the likelihood of respiratory and cardiovascular diseases.

Delhi is known to be the world’s most polluted capital. Several studies have reported that annual PM2.5 concentrations in Delhi NCT exceed India's annual National Ambient Air Quality Standard (annual NAAQS) by more than 200%. But, it also enjoys the best air quality during its late summer-monsoon. With March-April being the spring season, the air quality has already lowered compared to the harsh winter months.

We analyzed PM 2.5 data from all 38 stations starting from 1st March till 14th April 2020. Considering 1st March to 23rd March to be the pre-lockdown (Business as usual) period and 24th March to 14th April 2020 to be lockdown period. The analysis and graph below shows that the maximum and minimum level of PM 2.5 in Delhi before the lockdown was 176.46 μg/m3 and 11.55 μg/m3 respectively with an average of 62.9 μg/m3. To our surprise, the levels of PM 2.5 during the lockdown plummeted to a maximum of 105.47 μg/m3 and a minimum of 10.91 μg/m3 with an average of 35 μg/m3. Indicating an over 44% decrease in average PM2.5 values owing to reduced activities such as vehicular emissions, industries, and thermal power plants.

The minimum, maximum and average air quality (PM 2.5) during the observed period of 1st March to 14th April (45 days)

Given the fact that Delhi lies in a semi-arid climatic region, the geographical and meteorological conditions were largely held responsible for high air pollution in the city throughout the year. But, the current trend, however, indicates that polluting sources which are currently shut or running on reduced capacity were primarily responsible for deteriorating the air quality of the capital. These changes prompt us to ponder on what should be the baseline air quality of the city.

We will continue to track the air quality of Delhi through this period to see how the trends may or may not affect. Meanwhile, the best advice is to stay at home, follow precautionary measures and advisories issued by the Ministry of health and family welfare.

Efforts done by HELP members

Fr Mathew Abraham CSsR attends conference call with the Prime Minister on Covid-19

On 25 March 2020, the Christian Coalition for Health (CCH), which includes CHAI, the Christian Medical Association of India (CMAI), Emmanuel Health Association (EHA) and the Christian Medical Colleges (CMC) of Vellore and Ludhiana, wrote a letter to the honourable Prime Minister of India, Mr Narendra Modi, pledging its support to the government in the fight against COVID-19. The Christian healthcare networks together have more than 1,000 hospitals and about 60,000 inpatient beds spread across the country.

Following the receipt of the letter, the Prime Minister invited Fr Mathew, representing CCH, to a high-level meeting with other faith-based and social organisations on 30 March 2020. During the 1 hour 45 min meeting, the honourable Prime Minister listened attentively to all 16 partcipants. The Prime Minister personally expressed his appreciation for the letter of support from the CCH and thanked Fr Mathew. Along with CCH, CHAI is now working on follow-up measures with the PMO and the Ministry of Health to support the efforts of the Government at the national and state levels.

AHPI's Contribution In Combatting Covid-19

Health Care Without Harm's Coronavirus Resource Center

The coronavirus pandemic puts an extraordinary and unprecedented burden on health systems, organizations, and professionals. Never before have we faced a global crisis of this magnitude, one that challenges every country’s capacity to deliver health care services. Health Care Without Harm has developed a new Coronavirus Resource Center for our GGHH members, partners and the broader community around the world engaged at the intersection of environment, climate change and health.

Our priorities are to first support the work professionals and organizations are doing on the frontlines by providing strategies, solutions, and resources that address the unique challenges posed by the coronavirus. Second, together with many others, we are exploring the long-term influence of this pandemic on human and planetary health in order to begin to collectively chart a course for the future.

Our staff has curated a list of resources and guidelines produced by Health Care Without Harm, its partners and multilateral organizations to offer solutions to some of the challenges this crisis brings. We will regularly update this page with new information.

Webinar by Quality Accreditation Institute

Message from Health Care Without Harm during this 50th Earth day

Op-eds on COVID-19 in relation with Climate Change; and Air Pollution

To join HELP or to know more about the platform, kindly write to help.ceh@phfi.org or click here

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HELP was established by Public Health Foundation of India and Centre for Chronic Disease Control with Health Care Without Harm. Photo credits: various artists from Pexels: Free Stock Photos. Copyright © Health and Environment Leadership Platform, 2020. All rights reserved.
Created By
Masroor Azam
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Credits:

Created with images by camilo jimenez - "untitled image" • John Schnobrich - "type away"