Masks, gloves, and other contaminated garbage from hospitals and households, which have been piling up by the thousands of tons as Spain battled through the peak of the COVID-19 pandemic, have undermined recycling chains and overwhelmed processing plants.
Before the pandemic, only 15% of hospital waste material around the world was considered dangerous: 10% was contagious, and 5% was harmful because of its chemical or radioactive properties, according to World Health Organisation (WHO) figures from 2018.
In Spain the most hazardous materials such as cytostatic or cytotoxic medicine was incinerated in specialised plants while the rest was sterilised.
The pandemic has seen an exponential growth in the amount of infectious waste, generated by hospitals and health centres as well as care homes and “medicalised” hotels and homes
In Madrid and Catalonia, the country’s two worst-affected regions, healthcare waste has increased by 300 and 350%, respectively, according to official data.
The Health Ministry on March 19 called for the incineration of urban waste that might be contagious and set up temporary storage units and cement kilns to help waste management companies deal with the excess rubbish.
But the country only has 11 incineration plants for urban waste; four in Catalonia and only one in Madrid. The former opted for the quick incineration of hospital waste while the latter has let the waste pile up.
Responding to – and leaning from – the emergency
Catalonia has three autoclave sanitary waste processing plants (which kill microorganisms using saturated steam under pressure), which were able to absorb an average of 275 tons each month before the outbreak.
Between the middle of March and the middle of April, at the height of the pandemic in Spain, waste from COVID-19 rose to 1,200 tons in the region, according to the Catalan Waste Agency (ACR).
“The plants that are authorised to treat the waste are overwhelmed, they cannot cope with such volumes coming from hospitals and hotels converted into clinics. In Catalonia, we discarded storage and have agreed to incinerate the waste at three urban garbage plants,” ACR director Josep María Tost told Efe.
By mid April, this plant had incinerated some 700 tons of COVID-19 waste.
In the Madrid region, the three sterilisation treatment plants are working at full capacity processing a total of 50 tons per day, leading city officials to authorise the burning of part of the region’s sanitary waste in its only urban incinerator, located 15km outside the capital.
The Valdmingómez plant’s director, Maria Jose Delgado, told Efe that some 430 tons of COVID-waste had been incinerated up to 29 April.
Madrid has sent part of its health-care waste to plants in other regions in the country as well as to incinerators in France, while six temporary storage units have been set up “to collect the rest of the waste until the emergency is over and it can be treated,” the regional director for Circula Economy, Vicente Galván, told Efe.
Madrid and Catalonia reflect the uneven approaches being applied in Spain’s two most populated regions to deal with the excess contagious COVID-19 waste, which has presented an additional challenge: the new locations where this waste is now being generated.
Teams from Doctors Without Borders (MSF) have advised around 350 nursing homes throughout Spain, most with face-to-face visits, on how to handle the contagious medical waste generated by the COVID-19 crisis.
“What we teach them is very basic: first we ask them to locate the area of the centre where they can dispose of this kind of waste. Before throwing them into the containers, we recommend that they at least double bag them,” MSF’s emergency coordinator, Montserrat Bartui told Efe.
“And we tell them that whoever is working in the contaminated area should not be the same person who goes to the rubbish container.”
This waste goes into the urban mix container, with the so-called “residual waste”.
The same instruction was given by the Health Ministry to the Spanish households that are home to coronavirus patients or those in quarantine: double bag the contaminated material and place it in the non-recyclable general waste.
But making sure this message reaches everyone in the country is the responsibility of city councils, who have varied widely in their information campaigns.
Tost and Bartui agree that clear and publicly available information is crucial to deal with the ubiquitous gloves and masks that, like the virus, will be a part of everyday life for the foreseeable future
Waste management officials contacted by Efe believe that it will be difficult to prevent plastic or latex gloves from ending up in the yellow rubbish bins intended for containers made out of plastic, metal or cardboard.
Before the pandemic, Europe implemented an action programme to limit incineration to non-recyclable materials and progressively reduce what is dumped into landfills.
“Any such changes should comply with the EU law on waste, be necessary and proportionate to protect human health in particular by limiting them to areas and time periods strictly necessary to respond to the risk (…) and strive to maintain the overall objective of separate collection and recycling,” the European Commission said on April 14.
The EC urged member states that decide to “exceptionally” allow alternative waste treatment that could be more environmentally damaging than the normal procedure to make sure that “their use is limited in time and strictly necessary to address identified storage and treatment capacity shortages”.
As a whole, the EU recovered 53.3% of its garbage in 2016, according to Eurostat data. Spain was below that average, with 46.4% of recovered waste.
But COVID-19 has forced even countries with greater recovery capabilities such as Italy (83%) to prioritise burning their waste, a common approach during epidemics such as Ebola in Africa and which is advised by WHO in the first stage of disaster or emergency responses.
At the start of the pandemic, a debate was raised in the European association of waste managers on how to articulate “different disposal methods for households with a confirmed COVID-19 case, such as by taking their waste in red or yellow bags, but we ruled it out because it could be harmful from the point of view of discretion and it could generate problems between neighbours,” ACR director Tost said.
“Common sense compels us to be practical, and we agreed on the ‘three bags’ route,” Tost added.
All of the rubbish collected in the “residual waste” containers during the pandemic will not be separable at the processing plants, after health authorities banned opening the plastic bags and any kind of non-mechanical filtering.
In Spain, “waste management was already an important pending matter” before COVID-19: 82% of the garbage was collected mixed up “and very little was recovered,” Julio Barea, expert in waste management at Greenpeace-Spain, told Efe.
“More than 60% of the garbage was dumped in a landfill.”
“Since the outbreak, that amount has increased significantly because there is no manual sorting of the mixed waste, so it is not recovered. There is no data on how many masks, gowns and gloves are being generated each day.”
“Because of the evidence, we fear that most of this COVID-contaminated waste is being poorly managed and ending up buried in landfills. There is no capacity to do anything else, we are not prepared,” Barea said.
Health vs environment, the COVID paradox
Before the crisis, incineration plants only processed around 10% of waste generated in Spain, according to Greenpeace.
Environmentalists reluctantly admit that the emergency has forced Spain to resort to burning waste, something which they have spent years fighting against.
“Greenpeace is not in favour of the incineration of waste but, given the exceptional situation and following the advice of the experts, temporarily, for this specific waste, there is no other option,” Barea said.
“Ideally there would be enough autoclaves to sterilise the material, but there aren’t.”
Barea warned that “slag and ash make up 30% by weight of what is burned. They become toxic and dangerous waste, only a part of the toxins that are generated is catalogued.”
In its 2018 report “Safe Management of Waste from Health Care Activities,” the WHO warned of the health risks of incorrect management of medical waste “through the release of pathogens and toxic pollutants into the environment.”
“Landfills can contaminate drinking-water if they are not properly built. If waste is incinerated inadequately, this can cause the release of pollutants into the air, such as human carcinogens that have been associated with a range of adverse health effects,” the organisation said.
Authorities in Madrid and Catalonia say that their waste incineration procedures comply with worker safety standards and don’t exceed limits of toxic emissions into the atmosphere.
Madrid’s sustainability director said that the region’s incinerator has “continuous emissions controls, which are maintained during the management of bio-sanitary waste” linked to the coronavirus.
Tost specified that the garbage processed in the incinerators for urban waste in Catalonia is made up essentially of protective personal equipment.
“PPE is made of cellulose or polypropylene in the case of gowns, caps and masks and latex in the case of gloves. They do not carry chlorinated elements, which is what environmentalists are concerned about,” Tost said.
The Greenpeace expert pointed out that along with the PPE tests, tubes, probes, bags, syringes, respirators and other materials with plastic and metal components are being thrown away amid the emergency.
Barea added that “there is no technology to continuously measure dioxins and furans. This is done with annual checks by taking samples in the stacks and taking them to the laboratory for analysis. The plant managers know exactly when the controls are going to take place.”
[Edited by Sam Morgan]