COVID-19: Rethinking Single-use Personal Protection Equipment

Since its emergence last year, the COVID-19 pandemic has fundamentally changed global communities, lives, and priorities. Faced with perhaps one of the greatest health challenges of our generation, countries worldwide have reprioritized their investments in efforts to minimize the impact of COVID infections and develop a vaccine. As a result of this shift in priorities, the COVID-19 pandemic has significantly hindered numerous global initiatives — among them, recent efforts to eradicate single-use plastics.

As medical staff and members of the public scramble to protect themselves from the virus, usage of disposable personal protective equipment (PPE) has sharply spiked. In March of 2020, the World Health Organization (WHO) estimated that 89 million surgical masks, 76 million pairs of medical gloves, and 1.6 million googles would be required each month to combat COVID-19. The core of the problem is that a large portion of this PPE is single-use, resulting in substantial quantities of medical waste produced each day by hospitals globally. Fortunately, this astonishing wastefulness of single-use PPE has been highlighted by the pandemic, encouraging researchers to now develop more sustainable and reusable PPE options.

The unsustainability of single-use PPE

Most medical-grade PPE items are currently designed to be disposed of after a single use, creating large amounts of waste. Face shields, surgical masks, protective gowns, goggles, shoe covers, and other related medical items are made of plastics and polymers like polypropylene, polycarbonate, polyester, and rubber. Unfortunately, these materials are not biodegradable and thus pose a significant burden on waste management systems.

Moreover, plastic-based medical waste is subject to more environmentally harmful disposal methods. PPE worn by staff who interact with COVID-19 patients is classified as infectious waste by the WHO. If disposed improperly, infectious and highly infectious medical waste could contaminate groundwater systems and infect local communities. As such, the WHO recommends that disposed PPE is thoroughly sterilized — a complicated process that utilizes saturated steams and chemicals — and/or incinerated to eliminate the risk of infection. However, these methods are far from ideal; for example, improper filtering of incinerated  PPE may result in infectious pathogens polluting the air.

Disposing of PPE exposed to pathogens like COVID-19 is a tedious, expensive, and environmentally harmful process. Besides the harms associated with properly disposed PPE, improperly disposed PPE also poses major threats to wildlife. Following a clean-up mission around the Côte d'Azur in May 2020, French clean-up charity Opération Mer Propre warned that “there risks being more masks than jellyfish [in the Mediterranean Sea]”. Similarly, on the other side of the world, marine conservation organization OceansAsia has observed a staggering amount of masks washed up on islands near Hong Kong. Although long-term measures of the ecological harms caused by PPE are currently unknown, the danger PPE presents to ecosystems in the status quo is clear, real, and substantial.

Promising alternatives

Thankfully, researchers have begun researching solutions that address the concerns surrounding disposable single-use PPE. One obvious solution is to develop reusable PPE capable of being worn several times, which would significantly reduce the volume of incinerated plastic medical waste. One notable prototype is a silicone rubber mask developed by MIT and Brigham and Women’s Hospital. The silicone prototype mimics the shape of the traditional N95 mask, which is extremely effective against small viral particles like COVID-19. In addition, the mask uses silicone rubber, allowing it to be sterilized and reused several times. Although the mask’s filters will still have to be disposed of after each use, this design still results in a major net reduction in plastic waste.

Progress has also been made in the realm of biodegradable PPE. Reelshield, developed by the sustainable packaging pioneer Reelbrands, is a compostable face shield made from wood pulp. The headband and clear shield are both made from cellulose fibers and contain no plastic — allowing the face shield to be safely placed into paper recycling or food waste composting bins. Although Reelshield and many other biodegradable PPE products are not yet medical grade, they are still a sustainable option for non-medical workers.

Instead of creating completely new products, some scientists are developing sustainable ways to disinfect single-use PPE. Researchers from the University of Auckland, the University of Otago, and the University of Waterloo have developed a process to more sustainably disinfect gowns, surgical masks, and other PPE for reuse. Their proposed method uses storage, heat, and ultraviolet light. Since few harsh chemicals are employed, this solution uses less energy and produces little waste. Although this process has not yet been approved for official usage, the researchers estimate that it would increase the available supply of N95 masks by 400%. Once expanded to hospitals worldwide, this procedure could save millions of tonnes of PPE from being disposed of annually.

Besides their environmental benefits, reusable PPE could also prove to be a more economically viable choice for hospitals. Numerous early-adopters of reusable PPE have reported significant savings from making the switch. For example, the Ronald Reagan UCLA Medical Center saved over $1.1 million over 3 years after replacing their single-use medical gowns with 3.3 million reusable ones. Carilion Clinic, a healthcare system that includes over 195 hospitals and clinics, reported savings of nearly 50% per disposable gown. As COVID-19 related hospitalizations in the U.S. currently have very high costs of treatment safely lowering the amount spent on PPE would help alleviate hospital financial burdens.

These savings may also be vital during times of high demand. The COVID-19 pandemic is the most recent proof of this: the Society for Healthcare Organization Procurement Professionals found that the cost of a full set of PPE increased by over 1000% following the onset of the COVID-19 pandemic. With global supply chains often unable to quickly increase production during large-scale health crises, having a reliable supply of reusable PPE could protect hospital budgets from unpredictable market fluctuations.

Conclusion

Even after COVID-19 subsides, PPE will continue to be present in hospitals and clinics. Current PPE products are extremely wasteful and harmful: properly disposed PPE creates large-scale air pollution, whilst improperly disposed PPE threatens wildlife and ecosystems. As such, improvements that will make PPE more sustainable and cost-friendly ought to be made. Thankfully, there are already numerous promising solutions that are environmentally friendly and effective. Although single-use PPE will still be around for the foreseeable future, reusable and biodegradable PPE are exciting, up-and-coming alternatives.

SOURCES:

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World Health Organization, pp. 7–23, Fundamentals of Health-Care Waste Management, www.who.int/water_sanitation_health/medicalwaste/en/guidancemanual1.pdf. Zimmet, Marc, et al. Society for Healthcare Organization Procurement Professionals, 2020, pp. 1–4, PPE Cost Analysis.