KARACHI: The Sindh government is yet to wake up to the threat posed by “Covid-19 waste” as countless contaminated face masks, gloves and body suits, along with other medical waste, find their way to roadside garbage dumps, it emerged on Monday.

Conversation with sources privy to the matter revealed that decades-old official indifference towards management of waste, including highly infectious medical waste, continued till to date and the government had neither developed a mechanism focusing on the safe disposal of Covid-19 waste nor hospitals had been given any instructions.

Sepa inactive for almost two months

The lack of official interest, they said, was evident from the fact that the government had not made operational the Sindh Environmental Protection Agency (Sepa), which is responsible under the law to ensure that no hazardous material including medical waste was thrown in open and endangered public health, for almost two months.

The Sepa director general was not available for comments.

A Sepa official, on the condition of anonymity, told Dawn that the department had opened last week with limited staff presently tasked only to get its offices fumigated.

Hospitals, patients in home isolation are generating waste; govt urged to create awareness about proper disposal

“As for Covid-19 waste, I believe this job has been assigned to a committee comprising officials of the health department and Sindh Healthcare Commission (SHCC),” he said.

When asked whether such a committee exists, a health department official suggested that the SHCC should be contacted in this regard.

A SHCC official, however, said, the commission was not part of any such body.

“If such a committee exists, we are not part of that committee,” said director-clinical governance Dr Ahmed Raza.

According to him, it’s the responsibility of Sepa to check the capacity of hospitals for waste management and see whether they have functional incinerators and also ensure that the waste is being safely disposed of.

“Our role is limited to see that hospitals have a waste segregation system in place and the staff is trained to do the task. We also conduct training sessions on waste segregation and other relevant topics but we are not authorised to take action in case of violation (of hospital waste management rules),” he said.

Citing his interaction with doctors, Dr Raza said they often questioned the utility of training sessions on waste management as agencies tasked to collect refuse from hospitals did not do their job.

He admitted lapses in proper disposal of hospital waste and said there was a need for collaboration among all relevant government departments.

Is Covid-19 waste more hazardous?

Explaining the necessity of showing more caution towards Covid-19 waste, Dr Rafiq Khanani, senior pathologist and president of the Infection Control Society, said it’s simply because the world currently did not know much about the new virus.

“But, we do know that coronavirus has higher transmissibility as compared to other viruses. Second, what’s worrisome is the massive quantum of Covid-19 waste as it is being generated not only by healthcare facilities in large quantities but also by patients under home isolation.

“Thirdly, we are already facing multiple public health problems due to lack of infection control practices in place and absence of a proper waste management system. It’s time that we start paying attention to this important matter,” he said.

He emphasised that the government create awareness about how to disinfect Covid-19 waste at home, which could easily be done by washing it with any good detergent before disposal.

To a question whether any federal/provincial government guidelines exist on Covid-19 waste, Dr Altaf Ahmed, head of infection prevention and control at the Pakistan Kidney and Liver Institute, Lahore, said the National Institute of Health (NIH) in Islamabad had done so while Punjab had developed its own guidelines.

“While these guidelines should have been more elaborated and detailed, what bothers experts is the official neglect towards this important subject of infection prevention and control. No health guidelines or rules are of any use if they are not being followed in letter and spirit and their implementation is not being monitored,” he said.

About the threat posed by Covid-19 waste being thrown in the open, he said given the fact that the virus had the ability to survive for a prolonged period without a host meant that it could contaminate environment and infect many people — whoever came in close contact with it in a given time.

No guidelines from Sindh health dept

Sources said the Sindh health department had neither developed its own guidelines nor notified any instructions on Covid-19 waste to healthcare facilities, which were continuing with past practices without any official monitoring.

This included dumping of bio-hazardous waste — such as contaminated sharps, needles, syringes, vials — in the open.

There are also reports that a significant part of clinical waste is stolen at source.

The scale of official negligence could be gauged from an incident reported last year when medical waste was found littered on the Clifton beach. The waste apparently flushed onto the beach from a clogged drain following a rain spell.

The sources said a small part of the city’s clinical waste was collected by the Karachi Metropolitan Corporation and burnt in two old incinerators installed in Mewashah. In the absence of any official monitoring, it’s hard to say about the safety and transparency of the whole process.

Senior environmental lawyer Zubair Abro pointed out that the issue of unsafe disposal of clinical waste attracted the Supreme Court’s attention in 2017 when the court was hearing a petition and found that not a single incinerator was operational at any government hospital in the province.

“On court’s directives, the government initiated a project for installing incinerators at eight government hospitals in 2018. Last November, Sepa had issued notices to 64 hospitals across the province to submit waste management plans and by that time no incinerator was installed at any government hospital.”

The Hospital Waste Management Rules, 2014, he said, were developed by Sepa, which required obtaining a licence from Sepa for management of hazardous waste and hospital waste. Each hospital was required to submit a hospital waste management plan.

“But I doubt any hospital, which deals with Covid-19 patients, has submitted any relevant plan. This may be due to the closure of Sepa offices for two months,” he said.

He also called for transparency in Sepa affairs and building its capacity as an environmental watchdog.

“Most hospitals (government as well as private) manage hospital waste through Sepa-approved waste management companies and grant of approvals to these companies is another scandal which requires a thorough investigation as these companies don’t have expertise and facilities to manage the hospital waste,” he said.

Published in Dawn, May 19th, 2020