As the foreseen worst is yet to come to the Philippine health-care industry, another nemesis has awakened and the embattled country should muster all its resources to avert a thrashing.
In a study published by the World Health Organization (WHO) in 2018, high-income countries generate an average health-care waste of 0.5 kilograms per hospital bed, while low-income countries generate 0.2 kg on the average. This number has inevitably increased in the Coronavirus Disease 2019 (CoVid-19) pandemic where the utilization of single-use personal protective equipment (PPE) has been necessary in mitigating the spread of the virus and protecting our frontline health-care professionals.
One hospital in Region 3, which requested anonymity, told the Trumpet that it is treating about five confirmed CoViD-19 positive patients and has treated nine and 10 suspected and probable patients in their emergency room on April 16 and 17, respectively, thus an average of 14.5 patients per day.
Safewaste Inc., a treatment, storage and disposal (TSD) facility registered as an infectious waste treater, told the Trumpet that, during the same period of time, it collected around 23 kg of CoViD-19 waste from said hospital.
Based on this actual data, the average of two days’ worth of infectious wastes per CoViD-19 patient is around 1.6 kg, or 220 percent more than the industry average for regular infectious waste.
On April 16, the Philippine Institute of Development Studies (PIDS) published a study simulation conducted by the Department of Health-Epidemiology Bureau which reveals that the best case scenario for the country is a peak of 900,000 infected people by May or June of 2021. Emphasis on best case.
This scenario is based on the bureau’s disease transmission model where utmost efforts are exerted to suppress the outbreak, specifically: isolation of at least 70 percent of the infected through better contact tracing, social distancing, individual or household isolation. The PIDS also emphasized that there should be reduced delays in time to seek care for symptomatic cases.
Otherwise, once the Enhanced Community Quarantine (ECQ) is lifted, and if there will be no successful isolation of at least 70 percent of infected individuals while still observing the same delay in caring for symptomatic cases, at least 8 percent of the population will be infected by August of this year. This figure is equivalent to a staggering 8.5 million infected Filipinos in the next four months.
In the worst case scenario model, the country’s health-care system will be overwhelmed with 18.9 million infected people without intervention, the PIDS adds.
Following the actual data of 1.6 kg of average waste per CoViD-19 patient, even with the best case scenario of the pandemic, the industry’s present capacity will not be able to handle a whopping 1,440 metric tons of daily CoViD-19 waste from health-care facilities.
A total of 1,440 MT of wastes is equivalent to 1.4 million kilograms of garbage.
In the worst case scenario with intervention, a peak of 8.5 million infected people will generate more or less 13,600 MT (13.6 million kilos) of infectious wastes.
Never mind the resulting economic setback from these different scenarios, which has been repeatedly tackled. This writer’s concern is the amount of infectious wastes that this country will be dealing with not only as an environmental hazard, but as another potential source of contagion, if unmanaged.
Is the infectious waste industry prepared for this onslaught?
Incineration of waste has been banned by the Clean Air Act of 1999 for its deleterious effects to public health and the environment, reason why treaters of infectious waste use thermal heat or the no-burn high temperature (autoclaving) technology in treating such waste.
In a contingency plan furnished by EMB-3 Regional Director Wilson L. Trajeco to the Trumpet, the combined capacity of four TSDs with M501 certificates in the region, in addition to Tarlac Provincial Hospital, which is allowed to conduct onsite treatment of its own wastes, is 30.72 metric tons per day.
M501 is a certificate that allows a TSD facility to treat infectious wastes. Not all TSD facilities can treat such hazardous materials that include hospital wastes.
Based on incomplete* data from the EMB Central Office, other M501 TSD facilities in the country have a combined capacity of only 21.87 metric tons per day, which brings the total industry capacity to a measly 52.59 metric tons per day or only 3.6 percent of infectious waste treatment capacity even with the best case scenario.
Trajeco thus proposed that the DENR should also tap other licensed TSD facilities that use thermal equipment, but are not registered for M501 wastes.
Trajeco also recommended that cement plants like Holcim Philippines and Republic Cement, which use certain types of residual wastes as an alternative fuel in cement manufacturing processes, be issued special M501 certificates to allow them to treat infectious wastes. This will then require a revisit of Department Administrative Order No. 2010-06 which provides guidelines for the use of alternative fuels and raw materials in cement kilns.
The contingency plan cites an example of a cement company in the United States, Trioxy Inc., which uses health-care wastes as substitute fuel for its cement kilns.
Nevertheless, the combined capacity of all these TSD facilities will only be 202.80 metric tons per day (180.22 in Region 3 and 21.87 in other regions based on EMB’s incomplete data) or 14.08 percent of the total infectious waste in the best case scenario, and 1.5 percent of the worst case scenario with intervention.
Our waste treatment industry is therefore ill-equipped to handle a surge of infectious wastes, not only in the worst case scenarios, but even with the best.
Incineration may be a reactive approach to putting out the proverbial fire, hence it should be a last option. Otherwise, we will be creating a moral dilemma of sacrificing the environment for public health, which is a paradox, since the burning of synthetic materials will also release toxic substances that are harmful to health.
As the DOH grapples with the prospect of running out of hospital beds and PPEs, the DENR is also as embattled with the imminent danger of infectious wastes not only choking the environment but also as another source of contagion.
The best and worst case scenarios envisioned by the DOH-Epidemiology Bureau, however, do not mention the intervention of social distancing, mass testing and discovery of cures, both medical and alternative, to flatten the curve. It may mean that we can still do something about the grim picture painted by the data.
The burden therefore lies not only with the National Government, but on all stakeholders, which means everyone, who will be affected by an Armageddon-like surge of infectious waste that will be clogging and impacting our ecosystem.
This early, it may help to already explore proactive solutions to help mitigate environmental and health impacts in the disposal of infectious waste with the data at hand.
So far, the EMB has been a few steps ahead when it issued guidelines to simplify procedures for collection and treatment of infectious wastes. The EMB-3’s contingency is replete with data that should be enough to serve as a wakeup call not only for the DENR to step up further, but also for the private sector to pitch in.
There are challenges to be faced, such as the possibility of the need to recalibrate thermal machines of non-M501 TSD facilities, not to mention the length of time and costs entailed; the training of personnel to handle infectious wastes; and the willingness of the industry to share in the burden.
Ultimately, however, as we strive to Heal as One, the yoke rests on the people to seriously obey protocols to minimize the spread of the infection. With the best case scenario still portraying a grim future for infectious waste treatment, there is nothing that beats collective effort in fighting this invisible enemy.
Stay at home. Handwash frequently. Respect the distance.
*EMB Central Office does not have a complete public report of all TSD facilities in the country.
Disclaimer: Analysis and conclusions (such as 1.6kgs of waste per patient and percentages of treatment capacity) are the writer’s own computation based on data received. Experts and qualified statisticians are welcome to refute or contribute their two cents’ worth to the issue.