The Testing Challenge of Bio-Medical Waste Management During Covid-19

Introduction to Bio-Medical Waste and Related Legislations

In the past few years, the subject of biomedical waste management has assumed increased significance. Bio-Medical Waste (Management & Handling) Rules were first notified in 1998 by the Ministry of Environment & Forests, under the Environment (Protection Act), 1986.

In supersession of the Bio-Medical Waste (Management and Handling) Rules, 1998, and further amendments made thereof, the central government issued the Bio-medical Waste (Management and Handling) Rules in 2016. Bio-medical waste (“BMW”) is covered under the Bio-Medical Waste Management (“BMWM”) (Principal), Rules, 2016, BMWM (Amendment), Rules 2018 and 2019.

The 2016 Rules define BMW as any waste, generated during the diagnosis, treatment, or immunization of human beings or animals or research activities pertaining thereto or in the production or testing of biological or in health camps. These rules apply to all persons who generate, collect, receive, store, transport, treat, dispose, or handle BMW in any form, including hospitals, nursing homes, clinics, dispensaries, veterinary institutions, animal houses, pathological laboratories, blood banks, AYUSH hospitals, clinical establishments, research or educational institutions, health camps, medical or surgical camps, vaccination camps, blood donation camps, first aid rooms of schools, forensic laboratories, and research labs.

‘Guidelines for Handling, Treatment, and Disposal of Waste Generated during Treatment/Diagnosis/Quarantine of COVID-19 Patients’ were issued by the Central Pollution Control Board (“CPCB”) in 2020. The guidelines have been revised from time to time to fill in the lacunae. The CPCB is the focal agency for making any directions regarding BMW in India. However, various other government agencies pass guidelines and regulations, occasionally, to fill up the lacuna. Various State Pollution Control Boards (“SPCBs”) guidelines, for example, the Maharashtra Pollution Control Board guidelines, have been issued to fill in the gaps that exist in the treatment, handling and disposal of bio-medical waste management. There was also an advisory issued to consider services of Common Biomedical Waste Treatment & Disposal Facilities (“CBWTFs”) as essential services during the lockdown. Covid-19 has brought unprecedented challenges in various sectors of our ecosystem and exponential growth in bio-medical waste is one of them.

Exponential rise in Bio-Medical Waste during the Covid-19 pandemic

BMW is a dangerous waste category that has the potential to cause great harm to the health of humans, animals, and the environment. This is the main reason why we have different rules and regulations governing its management, altogether separate from the treatment and handling of municipal waste. As mentioned earlier, scope of the multiple guidelines issued in 2020 is wide, covering the handling of BMW generated from Hospitals/ Isolation wards treating Covid-19 patients; Quarantine Camps/ Homes; Sample Collection Centers; Laboratories, responsibilities of persons operating Quarantine camps/ Home-care, duties of CBWTF, responsibilities of CPCB, SPCB, urban local bodies et cetera. As explained by experts in this scholarly piece, these guidelines have recommended the use of double-layered bags (using two bags), mandatory labeling of bags and containers as “COVID-19 waste,” regular disinfection of dedicated trolleys, separate record-keeping of waste generated from COVID-19 isolation wards, in addition to the recommendation for following existing practices of BMW Management Rules, 2016. CPCB has also developed an application – COVID-19 BM Waste Tracking App; (Mobile and Desktop) for the effective tracking of Covid related BMW.

During the devastating second wave, the quantity of bio-medical waste increased rapidly. One thing to note is that many people were quarantined and treated at home. However, in this period, there was no publicization of guidelines by any governmental authorities for BMW generated at home. Therefore, due to the poor management of Covid related BMW, there was no effective disposal or treatment of the same. BMW was treated the same as any municipal waste, putting at risk the lives of many frontline workers including sanitation workers who collect garbage. The disastrous wave of Covid cases led to heavy suffering and casualties among municipal corporation workers.

The Covid-19 pandemic has also led to a substantial increase in the demand for single-use plastics. Plastic based BMW comprises of PPE (Personal Protection Equipment), latex gloves, syringes, surgical and face masks, disposal blades, scalpels, face shields, shoe covers, sanitizer containers, waterproof aprons et cetera. One can easily spot single-use plastic products like masks, face shields lying discarded by the roadside, on beaches, in landfills, and at any household. It is worth mentioning that more than 8 million tons of plastic waste related to the pandemic has been generated globally, of which more than 25,000 tons has entered the global ocean. This has created a long-standing problem for our marine life and exacerbated the pressure on an already out-of-control global plastic problem.

During the second wave of the pandemic, the country witnessed the unfortunate situation of dumping of dead bodies in the Ganges. It mainly affected the people who directly use river water. According to a study, while the risk of transmission of COVID-19 from handling the body of a deceased person is low, health care workers and others handling dead bodies should apply standard precautions at all times.

In the status quo, there is a very poor practice of segregation of waste at the site of generation and due to the exponential growth of bio medical waste, the risk to the environment is much higher.

Almost every major hospital has a set of procedures for effective management and disposal of BMW. Most rules require facilities to follow a color-coded segregation system for waste disposal and hand it over to treatment facilities. According to a research, the majority of waste produced in health care facilities is general, non-infectious waste (e.g., packaging, food waste, disposable hand drying towels). General waste should be separated from infectious waste in clearly marked trash bins, bagged and tied, and disposed of as general municipal waste. Infectious waste generated during patient care and treatment, including those with confirmed COVID-19 infection (e.g., sharps, bandages, pathological waste) should be collected safely in clearly marked lined containers and sharp boxes. This waste should be treated, preferably on-site, and then safely disposed of. Preferred treatment options are high temperature, dual-chamber incineration, or autoclaving. If waste is moved off-site, it is important to understand where and how it will be treated and disposed of. But the heavy burden on hospitals during the pandemic has led to several challenges, including the effective management of the waste.

Local clinics need to receive intensive training to deal with bio-medical waste. CPCB has classified Covid-19 BMW waste as ‘hazardous. The nationwide vaccination campaign has set the pressure high.

The Opinion of Indian Courts on Environmental Pollution & Bio Medical Waste Management

In the case of Maitree Sansad vs State of Orissa And Ors. 2006, the Orissa High Court while discussing the issue of biomedical waste, noted the following:

“The health hazards due to improper waste management will not only affect the occupants within the organization but also spread in the vicinity of the organization. Occupational health concerns exist for janitorial and laundry workers, nurses, emergency medical personnel, and refuse workers. Exposure to harmful chemical waste and radioactive waste also causes health hazards to employees in organizations generating bio-medical waste. Due to lack of information, the problem of occupational health hazards due to bio-medical waste is not publicized”.

The Supreme Court has invoked its inherent constitutional powers from time to time to protect the ecosystem of this country. Indian courts have given a liberal interpretation to Article 21 of the Constitution. A number of directions have been passed from time to time to facilitate an effective administrative setup, in order to prevent environmental degradation resulting from developmental activities. The Supreme Court of India also referred to the doctrine of “Sustainable Development” in the case Vellore Citizens’ Welfare Forum v. Union of India. The Court held that every person has the right to live in a pollution-free atmosphere. Other prominent legal principles, such as the precautionary principle and the polluter pays principle are an integral part of Indian environmental jurisprudence. The polluter pays principle binds the polluter to pay the cost to the victims of environmental damage (that is usually caused by actions attributable to the polluter) as well as the cost of reversing the damage caused to the environment. In Rural Litigation and Entitlement Kendra v. State of U.P., the Hon’ble Supreme Court ordered compensation to be paid to the victims of environmental degradation.

Way Forward

Untreated biomedical waste is a potential source of pathogens. Based on a report, more than 40 species of harmful micro-organisms possess the potential to transmit and cause human illness. The etiological agent of the pandemic is highly contagious and rapidly transfers from one person to another via various routes. Due to its high transmission rate, the risk of infection has always been high.

Proper waste classification will greatly reduce the burden on health and other governmental authorities. Lack of awareness with respect to bio medical waste management can lead to many more epidemics. Awareness drives on biomedical waste management, moment marketing, i.e., advertising or to gain traction by piggybacking on the crescendo of the trending topics, can be used by authorities to make the public aware of the guidelines on segregation and disposal of waste. For instance, make in India, the Beti Bachao Beti Padhao Andolan and the Swachh Bharat Abhiyan are quoted everywhere, recognized everywhere now. Similar attention is warranted for environmental policies.

The typical goal of an environmental policy is to protect human health, environment and ensure the viability of wildlife so as to make the world sustainable. It cannot be on the back foot of the government authorities. Any beneficial and favorable policy will require substantial publicization and advocacy. For successful implementation of any such policy, certain facilities are essential in concerned institutions, namely the infrastructure of regulatory agencies, thorough scientific understanding about the fate of environmental pollutants and monitoring skills, etc. It is recommended to take inputs from all the stakeholders including doctors, innovators, and medical items, and equipment manufacturers. For the effective management of bio-medical waste, especially single-use masks, head cover, and non-woven PPE (personal protective equipment) kit etc., a young man from Gujarat has launched an initiative to recycle the COVID-related bio-medical waste into bricks.

Conclusion

The most important thing to remember about environmental pollution is that it has the character of a public wrong, i.e., it is wrong against the whole community. Proper waste disposal is an integral part of control measures that are required to preserve the environment. It is of paramount importance to understand the ambit of BMW and the domestic laws regulating it, and take immediate actions to avoid any further environmental degradation crisis following the COVID-19 outbreak in India. Environmental justice requires collective action and large scale public understanding of waste management.

(This essay has been authored by Mehak Daga, a second year law student at the Faculty of Law, Delhi University.)