According to the formula, in Mexico, 43,606,224 facemasks are disposable daily only in its most populated cities (Table 1). Such an amount of health waste is a challenge for urban waste management because garbage separation is mandatory for citizens in Mexico City only. Poorly managed medical waste is the major infection source for patients, health care workers, waste handlers, and the general public (Ferronato and Torretta 2019). The solid waste from patients who are treated for infectious diseases in their homes is a risk to waste collection workers and the environment, depending on the conditions of transport and disposal of the waste (Ferronato and Torretta 2019; Gomes y Caldas 2020). In Nicolas Romero town, Mexico, tons of medical residues were thrown away starting in April of 2020. When cleaning inspectors arrived at the zone on May 4th, around 3.5 tons of material, including biological residues and human tissue partially incinerated were found. The case of Nicolas Romero town is one example of bad waste management with future environmental implications (Deutsche Welle, 2020). Environmental contamination due to SWM is as well a global issue. The inadequate SWM has environmental and social impacts, placing at risk the health and life quality of urban populations. This problem is more severe in developing countries, where less than 30% of domestic garbage is handled appropriately.
Table 1
Estimates of daily disposable FM in cities with more than 1 million people in Mexico, during the COVID-19 pandemic*
State
|
City
|
Total population
|
Masks discarded per day
|
Ciudad de México
|
Ciudad de Mexico
|
8,851,080
|
17, 702,160
|
Estado de México
|
Ecatepec
|
1,655,015
|
3,310,030
|
Jalisco
|
Guadalajara
|
1,495,182
|
2,990,364
|
Puebla de Zaragoza
|
Puebla
|
1,434,062
|
2,868,124
|
Baja California
|
Tijuana
|
1,321,004
|
2,642,008
|
Chihuahua
|
Ciudad juarez
|
1,300,983
|
2,601,966
|
Guanajuato
|
Leon
|
1,238,962
|
2,477,924
|
Jalisco
|
Zapopan
|
1,142,483
|
2,284,966
|
Nuevo León
|
Monterrey
|
1,135,512
|
2,271,024
|
Tamaulipas
|
Reynosa
|
1,124,244
|
2,248,488
|
Estado de México
|
Nezahualcoyotl
|
1,104,585
|
2,209,170
|
Total
|
21,803,112
|
43,606,224
|
* Considering each person uses 2 units per day, with acceptance by 80% of total population
The health waste and waste pickers in Latin America
In worldwide, two million informal recyclers work in SWM, particularly in the low- and middle-income countries, where the waste management is undertaken poorly, causing significant impacts on human health and the environment (Cruvinel et al. 2019; Ferronato and Torretta 2019). Incorrect SWM intensifies the risk of problematic health conditions of waste pickers, an informal working group widely recognized in informal landfills in Latin America and the Caribbean. This population is the first to suffer the consequences of inadequate SWM. Studies have shown that waste pickers face unhealthy situations, such as poor hygiene practices and lack of access to personal protection equipment, or the inadequate use of the same (Cruvinel et al. 2019; Ferronato and Torretta 2019). One study in South Sudan, Africa, evidence that waste pickers working with recyclable materials are at higher risk of developing pulmonary diseases, HIV, and hepatitis C as a result of contact with sharp items and hazardous health waste (Cowing 2013). More worrying, without adequate management of domiciliary waste infected by COVID-19 from patients undergoing treatment at home, waste pickers, formal waste collection workers, and the whole population are at risk of contagion (Ferronato and Torretta 2019; Gomes and Caldas 2020). Furthermore, decomposing organic waste is a rich medium or culture for the growth of numerous micro-organisms, many of which could drive to zoonotic diseases if passed on to humans (Ziraba et al. 2016; Fadare and Okoffo 2020).
In addition to the conditions of labor vulnerability, waste pickers present risk factors that make them more vulnerable to suffer the most severe conditions than the COVID 19 contagion. In a study conducted with waste pickers in Brazil, Colombia, and Mexico, the following health conditions were found tiredness, coughing, shortness of breath, asthma, allergies, dengue fever, tuberculosis, smoking, hypertension; bronchitis, diabetes, HIV/AIDS infections, hypertension, respiratory diseases, and obesity. Additionally, to their work conditions, the health of waste pickers can be worsened if they are living in marginalized areas (slum areas), which do not have a public water supply or sewer system (Cruvinel et al. 2019). The aforementioned put the waste-pickers within the most vulnerable population to contract COVID-19 or any other disease spread through poor SWM. According to the WHO guidance on water, sanitation program (WASH), hygiene, safe water, sanitation, waste management, and hygienic conditions are essential for preventing and protecting human health against infectious diseases, such as COVID-19. Given the ease of transmission of COVID-19 through contaminated materials or even through feces, waste pickers are at higher risk due to exposure to biological matter, not just with contaminated FM, but with fecal material (WHOc).
FM as a source of environmental contamination by solid waste mismanagement
The under-covered issue from these materials is also the generation of microplastics, given the fact that FM is produced from polymers, such as polypropylene, polyurethane, polyacrylonitrile, polystyrene, polycarbonate, polyethylene, or polyester. Polymers can be degraded/fragmented into smaller pieces of particles under 5 µm, known as microplastics, under environmental conditions (Fadare and Okoffo 2020). Besides, microplastics contain toxic chemicals like phthalates, organotin, nonylphenol, polybrominated biphenyl ether, and triclosan, which can be released during chemical or biological degradation processes in open-air conditions. As a consequence, flora, fauna, and the environment are threatened by this kind of contamination. Besides, FM are easily ingested by aquatic organisms, such as fishes affecting the food web that could end up in human consumption and finally in human health problems (Aragaw 2020).
Alternatives to reduce the spread of COVID 19 by the incorrect use and disposition of FM
There are several feasible alternatives for disinfecting FM. Heat and ultraviolet germicidal irradiation, to highlight the main ones standing out among them. These methods have proven successful for inactivating the virus COVID-19. 15. However, in Latin America and the Caribbean, this option is not viable for the most vulnerable population and workers involved in formal and informal urban waste management due to the cost involved in these disinfection methods. However, they are the ones who are most at risk if we assume that about 43,606,224 facemasks are discarded only in the most populated cities in Mexico
Cheaper disinfection methods such as chemicals like soap, ethanol, or sodium hypochlorite have demonstrated their effectiveness as methods of disinfecting FM and medical equipment (Reychler et al. 2005). However, for COVID-19 these methods are not recommended since they would remove the electrostatic mask charge, impairing its filtration capacities (Moreno et al. 2020). Therefore, chemical disinfection methods should be avoided by the general population who intend to reuse FM. For the above mentioned, health authorities should inform the general population about the risks involved in the reuse of FM with or without disinfection. However, chemical methods for disinfection can be part of the process of disposing of FM at home to reduce the risk of exposure to formal and informal workers related to urban solid waste management.
The mandatory use of FM at a global level has been developed as one of the main measures to reduce the contagion risk and dispersion of COVID-19. These materials should be considered as biological waste. However, health authorities, especially in Latin America, do not provide adequate information on how to dispose of these materials once they are used. The information could be distributed through social networks, television, radio, and print media to ensure that it reaches the entire population.
Countries as Rwanda it was introduced a guideline to buffer the environment from potential harm and health risks. According to this guideline, used FM must be segregated and confined from other kinds of waste in domiciliary places or offices. This guideline mentions that the waste should be discarded in a dry place uniquely used for FM disposal away from the population’s houses, workplaces, or any other spaces close to people, within a 4-meter distance from a sleeping area or where people perform activities, especially at open air. Besides, they should not be reused and should be used properly (Mugemana 2020).
Due to the waste generated by the Covid-19 pandemic in Mexico was developed the “Cartilla de Mejores Prácticas para la Prevención del COVID-19 en el Manejo de los Residuos Sólidos Urbanos (RSU)” explains in detail how to handle SUW at home, in public places, and in the cleaning of public transportation, as well as SUW generated by a household of infected people or a non-hospital organization where one or more infected people reside (Ministry of Environment and Natural Resources 2020). However, this information has not been understood by the population since it is frequent to see in the streets and public places the incorrect disposition of used masks (Fig. 1). Which increases the risk of dispersion of COVID-19 and environmental contamination.
Solid waste mismanagement is a global issue in terms of environmental contamination, social inclusion, and economic sustainability, which requires integrated assessments and holistic approaches for the solution (Ferronato and Torretta 2019). Universal FM use is a necessary adjunctive public health measure to decrease the infection risk by COVID-19 in densely populated cities. Among the many adverse consequences of the COVID-19 pandemic, is the sudden surge in the volume of plastic waste, particularly for medical equipment used for health professionals and healthcare purposes that should be considered as side effects. The crucial priority is the destruction of residual pathogens for safe disposal waste. Effective healthcare waste management requires appropriate identification, collection, separation, storage, transportation, treatment, and disposal.
According to the Sustainable Development Goals (SDGs), the correct SWM is part of the environment and health preservation. Stakeholders and governments should know that SWM is a complex system that involves environmental, social, and economic issues. New laws and regulations in Latin America about SWM should include environmental, social, and health beneficial impacts, which must be prioritized by decision-makers and researchers.