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Novel coronavirus disease 2019 (COVID-19) pandemic: considerations for the

biomedical waste sector in India

Shobhana Ramteke, Bharat Lal Sahu

PII: S2666-0164(20)30027-X
DOI: https://doi.org/10.1016/j.cscee.2020.100029
Reference: CSCEE 100029

To appear in: Case Studies in Chemical and Environmental Engineering

Received Date: 25 May 2020

Revised Date: 21 July 2020
Accepted Date: 25 July 2020

Please cite this article as: S. Ramteke, B.L. Sahu, Novel coronavirus disease 2019 (COVID-19)
pandemic: considerations for the biomedical waste sector in India, Case Studies in Chemical and
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Novel coronavirus disease 2019 (COVID-19) pandemic: considerations for
the biomedical waste sector in India
Shobhana Ramteke1*, Bharat Lal Sahu2
1
School of Studies in Environmental Science, Pt. Ravishankar Shukla University, Raipur-492010, CG, India
*Corresponding author: E-mail: [email protected]
2
Department of Chemistry, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur-495009, CG,
India

Abstract

In late December 2019, the world woke to a truth of a pandemic of Coronavirus Disease
(COVID-19), inspired by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-
CoV-2), which has a place with a gathering of beta-coronavirus. As of July 21 India is still
fighting to survive against the SARS-CoV-2 as called coronavirus disease. The
contaminations, first constrained in the Kerala state, have inevitably spread to every single
other area. The possibility to cause dangerous respiratory disappointment and quick
transmission puts COVID-19 in the rundown of the Public Health Emergency of International
Concern (PHEIC). There is a flow overall break out of the novel coronavirus Covid-19,
which started from Wuhan in China and has now spread to more than 212 countries including
14,753,034 cases, as of 12:20 AM on July 21, 2020. Governments are feeling the squeeze to
prevent the outbreak from spiralling into a worldwide wellbeing crisis. At this stage,
readiness, straightforwardness, and sharing of data are vital to hazard evaluations and starting
explosion control exercises. Since the episode of serious intense respiratory disorder (SARS)
18 years back, an enormous number of SARS-related coronaviruses (SARSr-CoVs) have
been found in their regular repository have, bats.
During this epidemic condition, expulsion of biomedical waste created from crisis facilities
treating COVID-19 patients in like manner demands unprecedented thought as they can be
potential bearers of the disease SARS-CoV-2. This article discusses the potential
consequences of the COVID-19 pandemic on biomedical waste administrations,
concentrating on basic focuses where option working methodology or extra moderation
measures might be fitting.

Keywords: COVID-19, coronavirus, SARS-Co-2 virus, biomedical waste.

1. Introduction

A third of the global population is on coronavirus lockdown, as of May, 2020. Another

coronavirus malady, formally named COVID-19 by the World Health Organization (WHO),
has caused a worldwide pandemic with significant changes in numerous parts of human life.
On 11 February 2020, the International Committee on Taxonomy of Viruses declared serious
intense respiratory disorder coronavirus (SARS-CoV-2) as the name of the new infection [1].
The main instance of the novel coronavirus was accounted for on December 30, 2019, in
Wuhan city, 2 Hubei regions, P.R. China. Quick moves were made by the Centre for Disease
Control and Prevention (CDC), Chinese wellbeing specialists, and analysts. The WHO briefly
named these pathogen 2019 novel coronavirus (2019-nCoV) [2]. During December 2019, a
novel Beta-coronavirus temporarily named 2019 novel coronavirus (2019-nCoV), and along
these lines authoritatively renamed extreme intense respiratory disorder coronavirus 2
(SARS-CoV-2) by the International Committee on Taxonomy of Viruses (ICTV), causing
coronavirus ailment 2019 (or COVID-19), was related with a group of respiratory tract
diseases in Wuhan, Hubei Province, China and has quickly spread across main land’s [3].
The family Coronaviridae incorporates a wide range of creatures and human infections, all
portrayed by an unmistakable morphology. Virions are encompassed and round
(coronaviruses) or plate, kidney, or pole molded (toroviruses). Every molecule is encircled by
a periphery or "crown" speaking to the bulbous distal parts of the bargains glycoproteins [4].
In India, the principal research centre affirmed instance of COVID-19 was accounted for
from Kerala on January 30, 2020. As of July 21, 2020, an aggregate of 11,118,206 confirmed
cases, 700,087 recovered cases and 27,497 passing were accounted for in India. As per data
available on various websites regarding COVID-19 infections worldwide, the cases are
increasing exponentially. On July 21, 2020, there were 14,753,034 reported cases, which
included 610,868 deaths and 8,805,686 recovered cases. From that point forward, the whole
world has been found napping by the clueless increment in the number of new cases because
of the exponential increment in the pace of transmission of 2019-nCoV, presently formally
alluded to as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) by the
International Committee on Taxonomy of Viruses, the causative operator of COVID-19 [5].
Additionally, 2019-nCoV showed halfway similarity with SARS-CoV and MERS-CoV, in
phylogenetic examination, clinical signs and path intelligent discoveries. Logical advances
from the SARS and MERS outbreaks can give important knowledge into fast understanding
and control proportions of the present pandemic [6].
The WHO authoritatively named the sickness 'COVID-19'. The International Committee on
Taxonomy of Viruses named the infection 'serious intense respiratory disorder coronavirus 2'
(SARS-CoV-2). Assignment of a conventional name for the novel coronavirus and the
ailment it caused is helpful for correspondence in clinical and logical research. This infection
has a place with the β-coronavirus family an enormous class of pervasive infections. Like
different infections, SARS-CoV-2 has numerous potential common hosts, middle of the road
hosts and last has [7]. Specialists sequenced the genome of new infection and made sense of
86.9% of the genome is equivalent to the SARS-CoV genome. Subsequently the name was
changed to Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) [8].
COVID-19 is decently irresistible with a generally high death rate, yet the data accessible out
in the open reports and distributed writing is quickly expanding. The point of this survey is,
to sum up, the ebb and flow comprehension of COVID-19 including causative operator,
pathogenesis of the malady, determination, and treatment of the cases, just as control and
counteraction methodologies. As the biggest known RNA infections, CoVs are additionally
isolated into four genera: alpha-coronavirus, beta-coronavirus, gamma-coronavirus and delta-
coronavirus. Until this point, there have been six human coronaviruses (HCoVs)
distinguished, including the alpha-CoVs HCoVs-NL63 and HCoVs-229E and the beta-CoVs
HCoVs-OC43, HCoVs-HKU1, serious intense respiratory condition CoV (SARS-CoV) and
Middle East respiratory disorder CoV (MERS-CoV). Coronaviruses have caused two
enormous scope pandemics in the previous two decades, SARS and Middle East respiratory
disorder (MERS). It has for the most part been imagined that SARSr-CoV which is primarily
found in bats could cause a future infection episode [9].

2. Morphology, structure and possible transmission routes of SARS-CoV-2

COVID-19 is an irresistible sickness brought about by a novel coronavirus. The COVID-19

pandemic is the third major zoonotic coronavirus sickness episode in just two decades,
following the SARS (Severe Acute Respiratory Syndrome) outbreak in 2002-2003 and the
MERS (Middle East Respiratory Syndrome) outbreak in 2012. The sickness was first
answered to the WHO by Chinese Health Officials on 31 December 2019 as atypical
pneumonia of obscure reason [10,11]. The infection is hereditarily like the SARS-CoV
coronavirus and is in like manner expected to 55 have crossed the species obstruction from
creature to human [12,13]. Even though its particular starting points are yet to be resolved,
the probable progenitor is a bat coronavirus [11].
COVID-19 is a circular or pleomorphic encompassed molecule containing single-abandoned
(positive-sense) RNA related with a nucleoprotein inside a capsid included framework
protein. The envelope bears club formed glycoprotein projections and some coronaviruses
likewise contain a fixed agglutinin-esterase protein (HE). The viral genome contains
particular highlights, including a novel N-terminal section inside the spike protein [14-16].
Genes for the major structural proteins in all coronaviruses occur in the 5′–3′ order as S, E,
M, and N (Figure 1).
The transmission behavior of SARS-CoV-2 also has important implications for waste and
wastewater services. SARS-CoV-2 specifically targets host cells containing ACE2 proteins.
ACE2 is an enzyme attached to the outer surface (cell membranes) of cells in the lungs,
arteries, heart, kidney and intestines. After infecting and exhausting all resources in the host
cell to multiply, the viruses leave the cell in a process known as shedding. Data from clinical
and virological studies provide evidence that shedding of the SARS-CoV-2 virus is most
significant early in the course of the disease, immediately before and within a few days since
onset of symptoms [1].

3. Replication process of SARS-CoV-2

SARS-CoV-2 (COVID-19) ties to ACE2 (the angiotensin-changing over compound 2) by its

Spike and permits COVID-19 to go into the cell and taint cells. All together for the infection
to finish section into the cell following this underlying procedure, the spike protein must be
prepared by a compound called a protease. Comparable on account of SARS-CoV, SARS-
CoV-2 (COVID-19) utilizes a protease called TMPRSS2 to finish this procedure. To append
an infection receptor (spike protein) to its cell ligand (ACE2), actuation by TMPRSS2 as a
protease is required [17]. The infection enters into the respiratory tract and ties with the
receptor and the infection goes into the host cell the genome is deciphered and afterward
interpreted. Coronavirus genome replication and interpretation happens at cytoplasmic layers
and includes facilitated procedures of both nonstop and intermittent RNA amalgamation that
are intervened by the viral repeat, a colossal protein complex encoded by the 20-kb replicase
quality. The proteins are amassed at the cell layer and genomic RNA is joined as the develop
molecule shapes by growing from the inward cell films [18]. The COVID-19 is required to
get destructive through human to human transmissions because of hereditary bottlenecks for
RNA infections regularly happen during respiratory bead transmissions (Figure 2).

4. Implications for biomedical waste

Biomedical waste is a result of medicinal services rehearses that incorporates sharps, non-
sharps, blood, body parts, synthetic substances, pharmaceuticals, clinical gadgets and
radioactive materials. At the end of the day, it incorporates a wide range of waste produced
by social insurance foundations, inquire about offices, and research centres including minor
or dispersed sources, for example, treatment is taken at home for example insulin infusion
[19]. WHO detailed that genuine wounds are much of the time brought about by contact with
combustible, destructive or receptive synthetic compounds in clinical waste. A WHO report
guaranteed that in the year 2000, 21 million individuals were tainted with Hepatitis B, 2
million individuals with Hepatitis C and 260,000 individuals with HIV on the planet because
of polluted needle stick wound [20].
WHO expresses that 85% of hospital wastes are really non-hazardous, though 10% are
infectious and 5% are non-infectious yet they are remembered for hazardous wastes. About
15% to 35% of hospital waste is directed as infectious waste. India roughly produces 2
kg/bed/day and this biomedical waste envelops wastes like an anatomical waste, cytotoxic
waste, sharps, which when insufficiently isolated could cause various types of fatal
irresistible ailments and furthermore cause interruptions in the earth, and antagonistic effect
on biological parity. Around 600 g for each day per bed in a general professional's
facility/E.g. 100 had relations with the clinic will create unsafe/infectious waste at the pace of
5 to 10 kg/day [21]. As indicated by the Ministry of Environment and Forest (MoEF) net age
of BMW in India is 4,05,702 kg/day, out of which just 2,91,983 kg/day is disposed, which
implies that practically 28% of the wastes is left untreated and not disposed to discover its
way in dumps or water bodies and re-enters our framework.
In India around 30% of the total injections administered every year were finished utilizing
reused or inappropriately sanitized clinical gear, and around 10% of medicinal services
establishments offer these pre-owned syringes to the waste pickers. An exploration
demonstrated that the population which lives inside 3kms good ways from old incinerators
saw an expansion of hazard is contracting malignant growth by 3.5%. BMW is classified into
different categories and each category has its own methods of disposal [22] (Figure 3).
Removal of biomedical waste produced from emergency clinics treating COVID-19 patients
likewise requests extraordinary consideration as they can be potential bearers of the infection
SARS-CoV2. Sanitation labourers and cloth pickers are in danger from dealing with plain
clinical waste rising out of homes where COVID-19 patients are isolated, clinical specialists,
and waste administration masters cautioned. Disposed of covers, gloves and tissues could be
potential hotspots for the spread of this profoundly infectious infection.
Most emergency clinics follow the Biomedical Waste Management (BMWM) Rules 2016
and all the more thoroughly so in the hours of COVID-19. In any case, it is squander
discarded by isolated families, where there is constrained mindfulness about the issue that
could uncover strong waste/sanitation labourers to greater risks. It is extremely basic to deal
with this waste identified with COVID-19, be it masks, gloves, the hazardous materials suit.
This waste could taint cloth pickers, kids, or the poor living in the city. It is additionally
essential to guarantee that this waste doesn't arrive at regular dumping grounds. The tale
coronavirus gets transmitted through direct touch and tainted surfaces and items, as per an
administration report on the utilization of personal protective equipment (PPE). Sanitary staff
associated with cleaning now and again contacted surfaces and cloths are at moderate hazard
and should utilize N-95 masks and gloves.

5. Biomedical waste management in India

BMW (management and handling) rules 1998, figured by the Ministry of Environment and
Forests, Government of India (GOI) came into power on 28 July 1998. The standards applied
to each one of the individuals who created, gathered, got, put away, arranged, treated and
took care of BMW in any way. These standards had been proclaimed as an authoritative
obligation of all social insurance foundations. Under the Environment Protection Act 1986,
these BMW have been sorted into 10 classifications with the end goal of safe removal.
According to BMW rules 2011, these classes were additionally changed to eight for simpler
removal by human services labourers. Then after, BMW rules 2016 were presented [23].
The principles further explained the meaning of BMW in this way including immunization
camps, blood gift camps, careful camps or social insurance exercises undertaken outside the
medicinal services office. It visualized the health care facilities (HCF) to make an
arrangement inside their premises for a protected, ventilated and made sure about the area for
a capacity of isolated biomedical waste. It further states pre-treatment of the research centre
and microbiological squander, blood tests and sacks through purification on location in the
way as recommended by WHO or National AIDS Control Organization (NACO) rules and
afterward sent to the normal biomedical waste treatment office for definite removal.
Strikingly, it eliminates utilization of chlorinated plastic sacks, gloves and blood packs two
years from the date of notice of these principles. It further features the significance of
preparing and inoculation of social insurance labourers. It further proclaims the foundation of
a standardized identification framework for the removal of BMW (Figure 4). The most
punctual revealing of both major and minor mishaps has likewise been given due importance.
Considering the treatment and removal of BMW, the human services offices are coordinated
to abstain from developing nearby office if such office is accessible inside 75 km separation.
According to BMW Rules 2016, the squanders would be classified into four classifications
dependent on treatment methodology [24] (Figure 5).
6. Crises for handlings of BMW during coronavirus pandemic
Recently, Delhi and Mumbai are the two most affected cities from coronavirus in India. In
Delhi, more than 40 sanitation workers have tried positive for the infection, and 15 have lost
their lives. In Mumbai, 10 workers and two security monitors at the city's two landfills, in
Deonar and Kanjurmarg, have been contaminated with COVID-19 and recouped. These are
simply figures from two of the most influenced cities in the nation today. India is near the
very edge of a COVID-induced waste crisis, and the specialists know about it. Likewise, used
masks, tissues, head covers, shoe covers, expendable material outfits, non-plastic, and semi-
plastic coveralls were to be discarded in a yellow pack implied for incineration at a common
biomedical waste treatment facility (CBWTF). So were extra food, expendable plates,
glasses, utilized covers, tissues, and toiletries of COVID-19 patients.
The nation has 200 biomedical waste treatment offices; these two are in Delhi and one is in
Mumbai. Furthermore, as per CPCB information, these offices are as of now running at 60%
limit – that is a 15% bounce since March. The national average is low in light of the fact that
numerous cases have not flooded in numerous urban communities, the manner in which they
have in Delhi and Mumbai. In these two cities, the CBWTFs are running at 70-75% and 70%
limits, as indicated by CPCB and the Maharashtra Pollution Control Board respectively.
Before the COVID-19 episode, an administration or a private emergency clinic would
ordinarily deliver 500 g of biomedical waste (like needles, pee packs, dressing, and so on) per
bed, every day. Presently, that number has gone up to between 2.5 to 4 kg per bed, daily,
according to SMS Water Grace BMW Private Limited, one of the two CBWTFs in Delhi,
which gathers squander from labs, isolate focuses, and emergency clinics, including one of
the city's COVID-19 government offices, the Lok Nayak Jai Prakash Narayan Hospital. An
enormous COVID-19 office can anyplace between 1800 to 2200 kg of biomedical waste
every day. Presently duplicate this with the quantity of Covid-19 emergency clinics in the
nation: 2,900. Add to it the biomedical waste created from 20,700 quarantine centres, 1,540
sample collection centres, and 260 laboratories managing the COVID-19 pandemic, and the
biomedical waste gathered by regions (Delhi alone has 12,000 home isolation facilities) and
one gets a feeling of the sheer volume of the issue. Delhi creates 27 tons of non-COVID
biomedical waste and as much as 11 tons of COVID-19 related waste each day, as per the
CPCB; Mumbai has been producing 9 tons of COVID-19 waste and 6 tons of non-COVID
biomedical waste each day, BMC (Brihanmumbai Municipal Corporation) estimates.
In the event that, and it's probably going to be along these lines, Covid-19 cases rise further in
the coming months and testing limits keep on getting inclined up – a few cities, including
Delhi, may need to send its COVID-19 waste to neighbouring states for removal, CPCB
scientists warned. Not simply Delhi and Mumbai, the expansion in biomedical waste is
stressing authorities in Kerala as well. Two months after the state began dealing with COVID
biomedical waste dependent on revised CPCB rules, Kerala has rewarded in excess of 100
tons of waste from COVID-care centres.
During the peak of the emergency, Wuhan, the city where the flare-up started, created 240
tons per day of clinical decline – six times the ordinary level, as per the nation’s Environment
Ministry. Manila in the Philippines delivered an extra 280 tons per day of clinical waste,
while Jakarta produced 212 tons, the Asian Development Bank evaluated. By April, 50 tons
of infectious waste were accumulating every day in Thailand's clinical focuses, which just
had the ability to adequately burn 43 tons, as indicated by the Thailand Environment Institute.
In Wuhan, the irregularity was far and away more terrible, with just 49 tons of limit for each
day to manage almost multiple times the degree of debased waste during the peak of disease.

7. Guidelines for handlings of BMW by the Central Pollution Control Board (CPCB)

Recently, India produces around 600 metric tons of biomedical waste daily, which is
approximately 10% more wastes, due to this pandemic situation of COVID-19 (Figure 6).
With COVID waste being produced at a quicker pace and high volume, it is all the more
testing to see that it is arranged without causing extra medical issues. It is evaluated that
overall, 2 tons of COVID waste is created in each state from analyses, isolate and treatment
of the illness. This is excessively low contrasted with the 240 tons of waste created each day
in Wuhan, the focal point of the pandemic [25].
A set of guidelines on dealing with, treatment, and removal of waste produced during
treatment, determination and isolation of COVID-19 patients was released by the Central
Pollution Control Board, New Delhi, Government of India on March 18, 2020. Under these,
isolation wards in hospitals need to keep up discrete shading coded canisters for the isolation
of waste. A committed container marked 'COVID-19', should have been kept in a different,
brief extra space and should just be taken care of by approved staff. The separate arrangement
of sanitation labourers in these wards for biomedical waste administration was likewise
suggested. The board also requested a record of the waste produced in segregation wards. For
isolate camps and home consideration of the presumed patients, the CPCB instructed
assortment concerning biomedical waste in yellow packs and the canisters containing these
ought to be given over to approve authorities (Figure 7). The guidelines suggest that those
handling such wastes need to be provided with adequate training and PPE, including three-
layered masks, splash-proof aprons, gloves, gumboots and safety goggles (Figure 8) [25].
8. Conclusion

In the condition of the COVID-19 scourge, this article shows that huge research is expected
to evaluate the business as usual for plague mindfulness and reaction in the biomedical
squanders. We require exposing the discussion around potential changes to rehearse, for
example, for the assortment and treatment of biomedical waste materials from emergency
clinics and isolate offices with positive or suspected COVID-19 patients. Current relief
practices, for example, the utilization of retaining times may do a lot to decrease the dangers
to labourers taking care of strong squanders, yet extra amendments to systems might be
required and ought to be thought of. Here is likewise a squeezing requirement for information
on SARS-CoV-2 pervasiveness and determination in biomedical waste to all the more likely
comprehends related transmission pathways and to illuminate proper hazard the board
activities for the biomedical part. Further examination into a conceivable airborne
transmission of COVID-19 is likewise justified, as exercises from past episodes including
SARS-CoV demonstrated that this pathway was a factor in sickness spread. At long last, the
capacity to distinguish SARS-CoV-2 in bio medical waste gives a perfect chance to return to
its benefits as an information source. Albeit singular protection contemplations and a need to
guarantee information security can be a test, given the scale, human cost and monetary effect
of COVID-19, this exploration ought to continue with earnestness.

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Declaration of interests

The authors declare no conflict of interest.

 Graphical Abstract
Figure. 1 Representation of the structure of Coronavirus
Figure.2 Representation of COVID-19 with the cellular attachment factor ACE2 and antigen
infection of lung cells.
Figure.3 Categories of BMW.
Figure. 4 Elements and consecutive steps of the biomedical waste management plan.
Figure. 5 Biomedical Waste Management Rules 2016.
Figure. 6 Generation of BMW (in metric tons per day) in India [25], (Statista, 2020).
Figure. 7 Guidelines by the CPCB for the biomedical waste management.
Figure .8 Safety equipment for the biomedical laborer by the CPCB guidelines.

Graphical Abstract
Figure 1

Figure 2
Figure 3.

Figure 4
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Figure 7
Figure 8