The Pandemic Has Increased Clinical Waste: What’s The Impact And How Can We Safely Dispose It

To reduce the spread of the COVID-19 virus, healthcare personnel have had to don on their PPEs, face shields and masks, among other paraphernalia at work. For the public, masks have become a compulsory ‘garment’ the minute we step out of our homes. When the first batches of vaccines were produced, everyone stood in line waiting to be jabbed to ensure greater protection against the virus. Then there were the COVID-19 self-test kits that were made available to public, on top of the existing PCR and RTK test kits. 

With these mandatory habits and happenings, have you ever thought about the amount of waste it has generated since the start of the pandemic?  

Among these, three states recorded the highest amount of clinical waste. Selangor produced 9.7 thousand metric tonnes of clinical waste, followed by Sarawak and W.P. Kuala Lumpur (both recorded 4.1 thousand metric tonnes)^[1].

This is considered a significant figure that can threaten the earth’s greenery and environmental sustainability if not managed properly. – Datuk Dr Ahmad Masrizal Mohamad, Deputy Environment and Water Minister^[3]

The PPE Problem 

It is estimated that 87% of excess plastic waste globally originates from hospitals during the pandemic, rather than from households^[4]. It is no longer a rare sight when we see frontliners manning COVID-19 swab centres or vaccine centres decked in full personal protective equipment (PPE).

PPE is composed of surgical masks, non-surgical masks, gloves, goggles, face shields, gowns and N95 masks to minimise hazards in the healthcare setting. However, most of the components of a PPE are only for one-time use. To date, the management of clinical waste in Malaysia adheres to the Environmental Quality (Scheduled Wastes) Regulation^[5].

The guidelines require clinical waste to be segregated, collected, transported and disposed of either through incinerating, recovered or recycled. Alternatively, it would end up in landfills employing used tin mines as its ground. However, during COVID-19’s outbreak in Sabah back in 2020, residents of an industrial area in Lok Kawi reported spillage of clinical waste from a nearby landfill on the roadsides^[6].

The burden of managing clinical waste isn’t just isolated to Malaysia. It is also an issue that most South Asian nations without fully developed solid waste management systems face^[4].

Declassifying Clinical Waste 

At the start of the outbreak, the Ministry of Health classified both food waste and containers from quarantine centres as clinical waste. 

We have highlighted that this has significantly increased the quantity of clinical waste, upsetting the performance of the licensed treatment facilities. – Malaysia’s Department of Environment (DOE)^[2]

The designated clinical waste treatment facilities struggle to cope with the heavy load, the Department of Environment stated that some of the facilities employed by the government are now operating at “full and beyond their capacity”^[2].

In an attempt to reduce the among of clinical waste at quarantine centres, food waste and containers originating from these quarantine centres were segregated into municipal waste. 

Yet, experts believe this decision posed greater harm than benefits. 

There is a risk that the coronavirus is passed from the food. Most [asymptomatic or Covid-19 patients with mild symptoms quarantined at home] will not know how to sterilise their food containers before they throw them. So garbage collectors or waste scavengers would risk being exposed to the virus. – Prof Dr P. Agamuthu from the Jeffrey Sachs Center on Sustainable Development at Sunway University^[2]

To this date, the guidelines for disposing of face masks have been scarce and sparse^[11]. There have been calls to provide designated bins for masks only and be treated as medical waste, especially with some COVID-19 cases being categorised as asymptomatic^{[12, 13]}. At the same time, households are recommended to segregate their disposable face masks and not to lump them together with other domestic waste.

Positive Self-Test Kits And The Ensuing Question

In recent months, the availability and affordability of self test kits have made it easier for everyone to detect the virus. With the rising fear of Omicron and Deltacron variants, it can be anticipated that testing at home would increase. How can we ensure that test-kits are safely dispose of?

Consumers are advised to put the used Covid-19 self-test kits into the plastic bag provided, fasten it and dispose the used kit in a domestic waste bin. This is because improper disposal will endanger other people if the individual that used the kits were detected to be Covid-19 positive because the test kits would have the person’s saliva specimen. – Prof Dr Sharifa Ezat Wan Puteh, Universiti Kebangsaan Malaysia (UKM) community health physician^[14]

However, a question that remains to be answered is, ‘What would happen to self-test kits with positive results?’ By disposing of self-test kits supposedly in the biohazard bag and into a domestic waste bin may at the same time expose our garbage collector to the risk of contamination.

One Man’s Trash Another Man’s Treasure

In 2020, a newspaper article reported that our landfills became a means of income to the indigenous Jakun community living in Muadzam Shah, Pahang^[15]. Some members of the community and their children scavenged the landfills looking for recyclable items. Alarmingly, among the mess were clinical waste that should not be in those landfills.

These children run around barefoot amongst the garbage and are often injured by broken glass, rusty tin cans and other sharp objects. I have personally seen hazardous medical waste like syringes and items contaminated by blood as well. -SC Shekar, a photojournalist ^[15]

Corresponding departments (i.e. Ministry of Health and Department of Environment) have ascertained that all clinical waste pre and post-pandemic have been treated in the manner that befits each.

Even so, it remains a cause for concern as a survey in 2014 found that hospital staff (i.e. doctors, nurses) dealing with the segregation stage of clinical waste lack awareness and proper training on its management.

Lack of proper training in the hospitals poses serious risks to personnel as far as the hazards of hospital waste are concerned. – Dr Dasimah Omar, Dr Subramaniam Karuppanan, and Siti Nurshahida Nazli, as quoted from the International Journal of Innovation, Management and Technology^[16]

The good news is that there is an ongoing push to increase in awareness and training for proper clinical waste disposal among medical personnel, especially for those handling COVID-19 cases^[17].

As for individuals and households, we can do our part in responsibly disposing our clinical waste everyday by segregating used disposal masks and self-test kits from other domestic waste. Used self-test kits and disposable masks can be discarded safely through these steps:

1. Once you have utilised the self-test kits, disinfect the clinical waste and store it in an airtight container or plasticware ^[18].
2. The same goes with other clinical waste around your household such as disposable masks. Disinfect and store them in containers ^[18].
3. If you’re self-quarantining at home, disinfection is key to ensure the virus wouldn’t transmit to other members of your household ^[18].

Explore our sources:

1. Department of Statistics Malaysia. (2021). Compendium of Environment Statistics, Malaysia 2021. Link
2. M.K.Yuen. (2021). Covid-19 waste problem. The Star. Link
3. Bernama. (2021). Clinical waste up 111pct since pandemic, says Ahmad Masrizal. New Straits Times. Link
4. M.Kumar. N.Tsydenova. P.Patil. (2021). Unmasking the pandemic’s impact on plastics waste management Across South Asia. World Bank Blogs. Link
5. N.Ng. (2020).Clinical Waste In Malaysia Has Risen 27% Since MCO. How Are We Getting Rid Of It? CiliSos. Link
6. The Borneo Post. (2020). Mounting medical waste sparks concerns. Link
7. Bernama. (2021). Health Ministry disposes 6.25 tonnes of empty vaccine vials as of June 28. New Straits Times. Link
8. Fatimah Zainal, N. Trisha, Manjit Kaur. (2020). Expert: Over 10 million face masks binned daily. The Star. Link
9. T.P.Bondaroff & S.Cooke. (2020). Masks on the Beach: The Impact of Covid-19 on Marine Plastic Pollution. OceansAsia. Link
10. R.S.Bedi & A.Tang. (2020). PPE waste posing a big threat. The Star. Link
11. J. Chee. (2021). The Trash Left Behind By Covid-19 : An Overdue Overhaul Of Waste Disposal Management. KSI Strategic Institute for Asia Pacific. Link
12. B.M. (2020). Hazard in rubbish bin. The Star. Link
13. P.Singh. (2021). Dispose used masks in special bins. The Sun Daily. Link
14. R.N. Raja Rahim. (2021). Be careful when disposing of Covid-19 self-test kits. New Straits Times. Link
15. R.Wong. (2020). Forgotten, Orang Asli in a Pahang town live off a landfill of toxic garbage. Malay Mail. Link
16. S.N. Nazli, D.Omar. & S. Karuppannan. (2014). Knowledge and Awareness of Clinical Waste Management among Medical Practitioners in Hospital Batu Pahat, Johor. International Journal of Innovation, Management and Technology. Link
17. P. Agamuthu. & J. Barasarathi. (2021). Clinical waste management under COVID-19 scenario in Malaysia. Waste Management & Research: The Journal for a Sustainable Circular Economy. Link
18. I.Mcintyre. (2021). Careless disposal of self-test kits can spread Covid-19, warns Penang exco. The Vibes. Link