Personal protective equipment (PPE) and plastic pollution during COVID-19: strategies for a sustainable environment

Introduction

The COVID-19 pandemic caused by the SARS-COV-2 virus has profoundly affected human lives, with over 5.5 million deaths and 321 million affected by the disease [1].

The protection of healthcare workers (HCWs) from exposure to the SARS-COV-2 virus and cross-infection to ensure safe healthcare delivery remains the foremost challenge of global health care systems. Personal protective equipment (PPE), is equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses. Personal protective equipment (PPE) is widely recommended and used as a part of infection control measures (ICM) [2]. However, due to the emerging evidence of viral transmission and regional disparities in PPE availability linked to disrupted demand and supply chains, there have been inconsistencies in these recommendations. Significant concerns regarding safety and efficacy of these measures have been raised by HCWs, adding to their anxiety levels which can be linked to unnecessary overuse of PPE [3]. A standard set of PPE donned by HCWs includes a gown (surgical or isolation), surgical mask, N95 or equivalent respirator (in case of aerosol-generating procedures), surgical hat, shoe coverings, goggles or face shields, and gloves [2, 4].

Single-use plastics (SUP) are compounds of synthetic polymers derived primarily from fossil fuels, designed for single-use with meagre recyclability rates (∼12%) [5]. Given the high rates and multiple modes of SARS-COV-2 transmission and its persistence on inanimate surfaces, SUP-based PPEs have been integrated into healthcare systems [2, 4, 5]. This increased demand is translated into a surge of plastic production during the pandemic, with an estimated escalation to 700 million tonnes in 2020 from 400 million tonnes in 2018 [6].

This article aims to highlight the environmental impacts of SUP-based PPE, review the existing recommendations and mitigation strategies in context to its use by HCWs, discuss potential challenges faced in their broader implementation and outline possible solutions to these challenges.

The environmental impact of SUP-based PPE

As global plastic medical waste generation sky-rockets [6], [7], [8], a concomitant decline in recycling programs due to the risk of transmission and exhaustion of waste disposal strategies have resulted in indiscriminate littering within the environment [9, 10]. These waste items can be advected by wind, rainfall-runoff, and drainage systems, eventually ending up into oceans and surface water, posing significant harm to the aquatic bio-environments. Alternatively, they are degraded into micro (<5 mm) and nano (<1 mm) particles, with a prolonged half-life and the ability to be embedded within the land and aquatic organisms [6]. Furthermore, greenhouse gas emissions (GHGe) during the production, transport and decomposition of this waste threaten air quality and exacerbate global warming and health risks such as respiratory disorders [11]. Figure 1 outlines the environmental impacts of SUP-based PPE.

Figure 1:

Impacts of PPE on aquatic, atmospheric and terrestrial environments.

There are significant gaps in knowledge about the exact quantifiable impacts of PPE-generated pollutants on the environment. However, independent studies have provided estimates based on extrapolation of pre-pandemic statistics, modeling techniques, number of COVID-19 patients, and per patient medical waste generated for each country.

Peng et al. estimate excess mismanaged plastic waste generated during the pandemic to reach 11 million tons by the end of 2021, with 34,000 tons subsequently discharged in the oceans. 87% of this excess waste is attributed to the healthcare settings [12].

Rizan et al. modeled 106,478 tonnes of GHGe from the PPE during the first six months of the pandemic in the UK. Production of materials and their waste disposals contributed the most to these emissions, whereas proportion-vise, gloves and aprons were the leading contributors [13].

Silva et al. noted that without improvements to the current system, an estimated 12 billion mt of plastic litter will end up in landfills and the natural environment by 2050, along with GHGe from the entire plastic lifecycle contributing to 15% of the total global carbon budget [5]. Table 1 provides a relevant summary of these findings.

The effects of the COVID-19 pandemic on pre-existing plastic curbing strategies

Over 127 countries have developed national plastic reduction policies targeting SUPs due to their massive carbon footprint. These include legislative measures restricting manufacturing, importation, and retail distribution of SUP, environmental taxes, and waste disposal fees [5, 14], [15], [16], [17].

As human health during the pandemic takes precedence over environmental health, plastic reduction policies have recently been reversed or temporarily postponed, such as delayed SUP bans amid COVID-19 concerns [5].

Increased plastic medical waste, aggravated by eliminated restrictions and unaddressed plastic mismanagement, jeopardizes the climate action, life below water, and life on land targets of the UN SDGs [18].

Mitigation strategies and challenges for implementation

A 5R framework- Reduce, Reuse, Recycle, Redesign and Restructure, adapted to the context of PPE use by the HCWs [5, 19], is used to summarize current best practices and provide solutions to implementation challenges.

Conclusions

The infection control benefits of PPE remain unargued; however, their uninhibited use places pressure on its production, transport, and proper disposal, scaling up the atmospheric, terrestrial, and aquatic pollution paving its way to an emerging plandemic. The development of safe and sustainable PPE management through best practices, monitoring, and enforcement of policy and regulations are a global need of the hour.