M
ICAS
LADUA
The pandemic of wastes
Written by Micas Ladua
Shots by Majoy Siscar
Two years ago, when the sudden and rapid spread of the coronavirus alarmed and caught the whole world off guard, there were only surgical masks used and proper handwashing directives to face the threatening situation. The lack of preparedness and knowledge of everyone forced them to rely on these simple measures for protection and containment of rapid virus infection.
Eventually, medical experts and organizations have raised concerns about the effectiveness of simple masks. They said that using the protective mask alone is inadequate and improper to protect the medical workers. Meanwhile, it also lacks the potential to prevent the swift transmission and spread of the virus in the case of infected individuals. Therefore, the national government assigned standardized personal protective equipment or PPE as a necessity in COVID-prone areas.
Due to these necessities and mandates, there had been a sudden increase in the amount of COVID-born wastes in the Philippines. Our country is now facing a new conflict: the threats of medical waste on the environment.
Safety protocols in Pagamutan ng Dasmariñas
In March 2020, the World Health Organization (WHO) warned the governments of the growing number of healthcare workers getting infected because of the disruption and late application of mandatory standard protective equipment. Due to the pertinence of the issue in the Philippines, the government assigned the usage of PPE to be essential in COVID-prone areas such as checkpoints, hospitals, and isolation facilities. In relation to it, is the proper optimization of the materials’ availability.
The Department of Health (DOH) mandates the medical facilities and practitioners in health care and community settings to abide by the safety measures under the DOH Memorandum No. 2020-0197. It states that medical and isolation area personnel shall always wear the standard quality PPEs, such as disposable gown, face shield, medical-grade masks, and gloves, before attending to the symptomatic and asymptomatic patients.
The Pagamutan ng Dasmariñas abide by these safety measures until now, where most of the cities are already under lower alert levels. The healthcare workers in the Pagamutan have relied on personal protective equipment to guard them against possible infection. Meanwhile, surgical masks remained a requisite for patients, both COVID and non-COVID patients, to prevent the severe spread of the virus.
Dr. Gerald Valenzuela, a 36-year old doctor in Pagamutan ng Dasmariñas, shared how personal protective equipment has become a daily necessity for him and his colleagues at work as well as their patients.
“Essential na talaga sa araw-araw yung PPE sa amin. Kahit naman noong wala pa yung COVID, required na talaga kaming magsuot at gumamit ng ilang protective equipments to avoid infection, both on us and our patients. Halos two years na nakasalalay kaligtasan namin ng mga katrabaho ko diyan. Eh syempre nakakasalamuha talaga namin yung mga pasyente na may COVID,” Dr. Gerald said.
DOH has suggested the minimum use of PPE per day.
The Department Memorandum No. 2020-0185 B. Infection and Prevention states that “Single-use or disposable, and dedicated equipment such as stethoscopes, blood pressure cuffs, and thermometers must be used for each patient, especially for the suspect or probable cases. If equipment needs to be shared among patients, proper disinfection must be done between use for each patient.”
However, the healthcare professionals may also consume as needed to ensure their safety.
"If the healthcare workers feel that they are not safe or they want added protection, I think they should have the freedom of that discretion because it’s their lives on the line,” said Dr. Edsel Salvana, a member of the DOH Technical Advisory Group.
The doctors and nurses in Pagamutan ng Dasmarinas use an average of ten PPE sets for one patient in a single day. They change and throw PPE immediately, specifically gloves, often when exposed to dirt or infectious medical waste and fluids and when having direct contact with patients.
“Nakaka-ilang beses rin ako ng palit ng PPE (gloves and apron) sa isang araw. Lahat kami actually. Kapag nadumihan o basta ginamit na sa isang pasyente, halimbawa kapag kailangan i-check ‘yung pasyente tapos kukuhaan ng dugo, magpapalit agad ng gloves at ‘yung syringe nun alam naman natin na tinatapon agad yun in a proper way na hindi magca-cause ng harmful contamination sa environment,” Dr. Gerald shared.
What makes a PPE?
A complete PPE set includes gloves, surgical masks, respirators, goggles, gown, and face shield. When used correctly, they can help reduce the risk of spreading the virus from one person to another and prevent infectious materials from getting on a person’s skin, eyes, and nose. However, it is important to know and consider their impacts on the environment and human health.
Bonita Valenzuela is a seller of PPE and other medical products in hospitals in NCR. She said that hospitals are heavily dependent on the products because they are effective in protecting her customers, which are health care workers who are usually directly in contact with sick individuals or covid patients.
The total sales of PPE and other medical products per month during the pandemic were higher than before the pandemic.
“Mas marami na yung pinoproduce namin na products kasi mas marami na umorder yung mga hospital. Makikita mo talagang gamit na gamit nila for protection yung PPE tsaka iba ring products kasi mas maraming pasyente. Punuan. Average of 200 units per month order ng mga hospital sa PPE,” said Bonita.
She sells medical products designed to be single-use and must be immediately thrown away when contaminated or after using on a patient. They are synthetic fibers such as polypropylene, polyester, and polyethylene, commonly used to make straws and single-use plastics that stay in the environment for hundreds of years.
COVID-19 waste surge and its human and environmental effect
The convergence in protective measures has led to a surge in medical waste in the Philippines. The increasing production and consumption of single-use PPEs have severely impacted the environment and human health.
Juvy Serafin of the Environmental Management Bureau said, “the increasing number of COVID-19 cases has direct effects in medical waste generation.” She also noted that EMB recently reported that it has been collecting 1,000 metric tons of medical waste per day for several months already.
They warned about the serious impact of improper management of intensifying infectious medical waste on human health and the environment. COVID-19 waste has become a new form of pollution as single-use personal protective equipment floods our ocean. With practically no recyclable purposes, they are disposed of mindlessly in environmentally delicate areas like waterways, coral reefs, landfills, and prime agricultural lands, joining the daily litter in the ocean ecosystem.
The massive impacts of the pandemic on the environment curb the abilities of recycling and use of unattended plastic. PPE is lightweight and can be easily carried by wind or surface currents and spread rapidly in the natural environment. They break down into millions of macro and nano-plastics, leading to a large volume of waste.
The WHO claims that the issue of the waste surge is linked to COVID-19 management and prevention.
Even with the threatening effects of PPE to humans and the environment, WHO described it as the only effective measure within the administrative and environmental and engineering controls, especially in infection prevention and control of epidemic-and pande
Disposal proper
According to WHO, it is impossible to minimize the use of protective equipment because it may hinder the progress of the fight against COVID-19 and compromise the safety of frontliners. Instead, it proposed to inform users of proper application, handling, and disposal of it. Specifically, it called for reform and investment in the reduction of plastic packaging and the manufacture of protective gear from reusable and recyclable materials.
On the national level, the DOH requires the medical facilities to conduct and build proper waste disposal systems corresponding to the prescribed scheme in the Department Memorandum No. 2020-0197. Precautions to be implemented for health care workers caring for COVID-19 patients include using PPE appropriately; this involves selecting proper PPE and being trained on how to put on, remove, and dispose it.
Health Undersecretary Maria Rosario Vergeire said, “ a medical facility will not be licensed to operate if it does not have a proper waste disposal system.”
The DOH coordinates with the Department of Environment and Natural Resources (DENR) and local government units (LGUs) on the proper disposal of medicine waste.
“The DOH checks their capability to process their medical wastes. We’re closely monitoring that along with the DENR,” she said.
Both at the international and national level, PPEs are well deemed to be essential. The authorities perceive and regulate its harmful effects on the environment. The way they see it, the wastes must be managed properly and not reduced in usage.
The EMB urges households to practice prevention of the spread of the COVID-19 virus by following precautions in handling special wastes following the provisions of RA No. 9003 and RA No. 6969.
All generated wastes in household health care must be treated infectious and must be distinguished from other wastes.
The proper disposal of special household healthcare waste are as follow:
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Directly dispose of used masks, gloves and tissue in a separate waste bag.
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If available, dispose them in a yellow bag labeled with “hazardous healthcare waste” or “infected waste”
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Disinfection of used face mask and gloves can be done before disposal to reduce the risk of contamination by soaking them in a diluted bleach solution (1 tbsp to 1.5L of water) for 30 minutes
The collection and transportation of healthcare waste include daily collection, tightly sealing waste bags, daily cleansing and disinfecting collection vehicles, and wearing of PPEs of waste workers.
Where should medical wastes go?
According to the Ecological Solid Waste Management Act of 2000 of Republic Act No. 9003, LGUs must implement waste reduction, recycling, and composting plans. Under it, LGUs are obliged to particularize the 10-year solid waste management plan that identifies disposal sites and waste management facilities in the locality. Sanitary landfills act as the final disposal site for solid and residual waste, while open dumpsites are prohibited.
It is good news that our government is in collaborative efforts to address and somehow attenuate such problems’ effects on the environment and humans. But we, the general public, must also involve ourselves by being informed and mindful of our actions towards nature.
This issue is just one of many that the Philippines is facing. As we get informed of what’s happening in the environment while dealing with the pandemic, we must also take it as a wake-up call before it is too late and there is nothing left for us to do to save our natural habitat.