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

the biomedical waste sector in India

Shobhana Ramteket •, Bharat Lal Sahu2
School of Studies in Environmental Science, Pt. Ravishankar Shukla University, Raipur-492010, CG, India
*Corresponding author: E-mail: shubrmtk21@gmail.com
Department of Chemistry, Guru Ghasidas Vishwavidyalaya (A Central University), CG,
India

Abstract

In late December 2019, the world woke to a ffuth of a pandemic of Coronavirus Disease
(COVID-19), inspired by the Severe Acute Respiratory Syndrome Coronaurus 2
(SARSCOV-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.

I, 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 I I February 2020, the International Committee on Taxonomy of Viruses
declared serious intense respiratory disorder coronavu•us (SARS-CoV-2) as the name of the
new infection [l]. 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 Imes 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 18,206 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 thesicknesy'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 ß-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)
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 deltacoronavirus. 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 [10,1 1] 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 [12,131. Even though its particular starting points are yet to be resolved,
the probable progenitor is a bat coronavirus [l l].
COVID-19 is a circular or pleomorphic encompassed molecule containing single-
abandoned (positive-sense) RNA related with a nucleoprotein inside a capsid
protein„ included framework 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 [l].

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 fimsh section into the cell following
this underlying procedure, the spike protem must be prepared by a compound called a
protease. Comparable on account of SARS-CoV, SARSCOV-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,

nonsharps, 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 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 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, IWW 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 semiplastic 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 700/0 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 Il 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 varned. Not simply Delhnmd _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 threelayered masks, splash-proof aprons, gloves, gumboots and safety
goggles (Figure 8) [25].

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.

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Graphical Abstract

Fi ure. 1 Re resentation of the structure of Coronavirus

Figure.2 Representation of COVID- 19 with the cellular attachment factor ACE2 and
antigen infection of lun cells.
Fi ure.3 Cate ories of BMW.
Fi ure. 4 Elements and consecutive ste s of the biomedical waste mana ement Ian.
Fi ure. 5 Biomedical Waste Mana ement Rules 2016.
ure. Generation of BMW in metric tons r da in India 25 , Statista 2020 .
6
Fi ure. 7 Guidelines b the CPCB for the biomedical waste mana ement.
Fi ure .8 Safe e ui ment for the biomedical laborer b the CPCB idelines.
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Figure 2
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Biomedical Waste

Biomedical waste minimisation/separation

Biomedical waste identification (labelling)

Biomedical waste handling

Schedule for collection within the health care premises

Selection of storage area till on-site treatrnent

Biomedical waste treatment (On-site/off-site)

Biomedical waste disposal

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Record/report

Figure 4

100
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Year
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Figure 6