COVID-19 is not the "great equalizer," as some proclaim. As the pandemic unfolds in the U.S., the nation has witnessed the disease's unequal impacts on minority communities, with Hispanic and Black Americans disproportionately bearing mortalities. This stems from various systemic inequities, including limited access to health insurance and heightened chronic disease due to urban food deserts and restricted green space. A critical but less-publicized factor is COVID-19's environmental impact on vulnerable populations, specifically via waste generation.
The recent upsurge in use of personal protective equipment (PPE), plus greater consumption of hospital materials in general, translates to increased waste production. Whether this solid waste is destined for landfills or incineration, the health implications most strongly affect low-income and minority populations that live and work near waste treatment sites. This connection between health, the environment, and social inequities exemplifies environmental racism -- the "disproportionate impact of environmental hazards on people of color."
While environmental injustices around hazardous waste have existed for centuries, the healthcare industry exacerbates them through its unsustainable resource use and waste processing. For example, many medical instruments and supplies are designed for single-use disposal, leading hospitals to produce over 29 pounds of waste per bed each day. This figure represents hospital activity before COVID-19, and has only been augmented during the pandemic as facilities utilize more single-use PPE.
When COVID-19 first appeared in Wuhan, the Chinese government built medical waste plants alongside its new hospitals to manage the sixfold increase in demand. While an analysis of COVID-related U.S. hospital waste has yet to be published, one prominent medical disposal company confirms that there has been an uptick in waste production.
Medical waste bears unique risks, as products that have contacted potentially infectious surfaces must undergo rigorous treatment. This process often ends in landfills after industrial autoclaving, which may aerosolize harmful chemicals in the waste, impacting machine operators. Non-infectious medical waste is sent straight to landfills, which themselves have been linked to elevated neighborhood rates of birth defects, cancer, and respiratory ailments. Although less common in the U.S., incineration is used in some municipal landfills to dispose of pathogenic waste; this can release dangerous inhalable dioxins.
These threats represent an environmental injustice, as race is the strongest predictor of residential proximity to a hazardous waste site. Black populations have historically comprised the majority of those living near landfills, and unregulated waste disposal sites are concentrated in minority and low-income communities. People of color also often work in the waste disposal industry; occupational risks include exposure to deleterious fumes and accidental contact with contaminated surfaces when handling improperly disposed trash.
Increases in waste from COVID-19 exacerbate existing environmental injustices. How can the healthcare industry mitigate such downstream impacts by moving toward sustainability?
First, healthcare facilities must curtail the quantity of their waste, particularly in times of high PPE demand. Hospitals recently implemented strategies to reuse or reprocess single-use PPE to maintain appropriate supply levels throughout the crisis. Analyzing these conservation strategies may help identify safe and effective approaches to reduce waste generation beyond the immediate needs of the COVID pandemic. As a longer-term solution to these challenges, healthcare facilities should source PPE that is designed to be reusable.
Second, hospitals should tackle the low-hanging fruit of waste reduction -- improper use of "red bag" or infectious waste disposal bins. By providing appropriate receptacles and enforcing responsible separation practices between infectious materials and standard medical trash, healthcare systems could reduce the amount of "red bag" waste, which requires much more energy-intensive disposal processes with more hazardous byproducts. This process is overused when non-infectious waste, which includes the majority of COVID-related PPE, is discarded with biowaste during hospital clean-up.
Finally, public health messaging and research should intentionally prioritize the health of sanitation workers who sort recycled trash, clean public spaces, and work in proximity to landfills. Public health campaigns could reinforce to the general population that disposable PPE is non-recyclable and unsafe to litter, while encouraging PPE that is safe to reuse.
Moving forward from COVID-19, those in the healthcare field must be intentional about adhering to the pledge "do no harm," not just in immediate patient care, but in long-term environmental and social impacts. Acknowledging that disposed waste continues to disproportionately threaten the health of minority communities, hospital systems should pursue sustainable solutions that incorporate the perspectives of local stakeholders. Let this be the juncture at which healthcare commits to halting its role in the cascade of waste-based environmental injustice.
Genevieve Silva is a rising second-year medical student at the University of Pennsylvania Perelman School of Medicine. Pallavi Sreedhar is a rising fourth-year undergraduate at Columbia University studying 20th-century American history. Hannah Greene is a rising third-year undergraduate at NYU Abu Dhabi studying biology and social research & public policy. The authors are conducting research on healthcare sustainability with the Thiel Lab at NYU Grossman School of Medicine. The opinions expressed herein do not reflect those of their affiliated academic institutions or hospital systems.