Plastic waste in the pandemic

Covid-19 and the healthcare response have generated vast amounts of plastic waste. Dr Grace Hatton FRSA argues that far from being insurmountable or an issue to come to when the pandemic has passed, innovation is needed now to reduce and recycle.

I recently enjoyed a conversation (at a distance, and masks on, before you ask) with a local restaurateur of mine, in which we debated the impact of Covid-19 on her business. She gave me an interesting opinion I had not yet heard. Gingerly prefaced by a short monologue of guilt for the rampage of death and destruction the virus had wreaked on her colleagues, friends and beyond throughout the year so far, she admitted to an unpopular truth of hers: that she had revelled in the quietude her business’ enforced closure had brought. Returning from a ski trip in early March, she and her staff had, as usual, ordered in the following weeks’ worth of ingredients for the restaurant’s anticipated service, only to be forced into closure two days later. “We lived off that food for a month and a half. I sat in my garden. I had a beautiful taste of retirement”.

Her sentiments struck a chord with me for two reasons: The first being that she rightly and proudly runs and owns a successful zero-waste restaurant in the heart of one of the largest cities in Europe, albeit where recycling schemes and rates are unfortunately way lower by comparison to those of other nation states’ with similar or higher populations. The second was, as she went on to elaborate, how much her business’ environmental emission contributions were offset by offering a meal collect service in place of an in-house experience during the weeks that had followed in April. She was now seriously contemplating both a pickup-only model and early retirement.

This provides a prime example of how previously unthought-of solutions can reframe seemingly impossible business decisions. This restaurant’s transition to exclusively click-and-collect food was by no means revolutionary: the owner just hadn’t been forced to consider it in her business model before (nor, it seemed, had retirement seemed either appealing or feasible). And the same can be applied to any industry, even healthcare. Popular opinion – if it can be called that – has been engineered against believing sustainability in healthcare is a priority where contamination of equipment and supplies poses a heady problem. Indeed, unclean surfaces equate to a primary means of transmitting the virus we have all come to fear. And so, disposable plastic – in the form of gloves, masks, packaging, sanitizer bottles and disposable visors, to name but a few examples – abounds, possibly now more than ever.

As an early-career physician working in a large urban emergency department last year, I was horrified by the sheer volumes of plastic waste I alone would generate daily, even pre-Covid-19, and which were uncontaminated. This included cannula wrappers, syringe plastic caps, sleeves for saline bags (themselves also plastic) all torn apart in a clean prep room, but by default thrown into the same hazardous orange waste bags as those tainted by bodily fluids and detritus. There had to be a better way; a solution to reducing this waste that didn’t lead to it burning up in an incinerator, or being shipped off to landfill. I started a petition, and a website, which gained traction until the arrival of the Covid-19 pandemic. I wanted there to be a separate stream for disposing it and recycling any uncontaminated plastic waste in clinical settings. But then, quite suddenly, disposable plastic rushed right back into vogue. Nobody wanted to risk touching any surface at all beyond those of their own home that wasn’t contactless, let alone a package or kit from a virally-wrought hospital.

It is an arguable catch-22 situation. Alternatives I have met with in my efforts to seek solutions have almost always been jettisoned with the argument that such streams of disposal simply are not feasible due to the risks of cross-contamination; even more so now due to Covid-19. But doing nothing exacerbates another wealth of problems, of which environmental pollution is at the heart, and risks compounding our efforts to mediate development and progression of the very diseases driven by them, from water-borne infections to lung diseases and cancers.

The solutions may appear superficially well below the Covid-19-influenced list of priorities. On the contrary, we must strike whilst the iron remains hot. As a nation and as an industry, we have an unprecedented opportunity to start anew when it comes to plastic utility in healthcare. But change needs the backing of government, and radical intervention on behalf of manufacturers and supply chains.

Whilst PPE remains essential, there are alternative solutions to its disposal. Itdoes not need to be wrapped in endless plastic-based sheets and minimally-recyclable packaging. Indeed, effective PPE itself can be produced without any plastic at all. There are excellent initiatives such as Sterimelt®, already pioneered in primary care in Wales, in which propylene surgical shrink wrap (normally disposed of by incineration) is recycled into its reusable base component by thermal compaction. A similar process could likewise be adopted for other in-hospital plastic waste including aprons, gloves and packaging.

Ultimately, smaller steps taken are better than none. On a global scale, we are embroiled in a marathon, not a sprint, and the sooner change is addressed and implemented, the sooner we shall all begin to win.

Dr Grace Hatton MPharm MBChB DTM is a London-based physician with degrees in both medicine and pharmacy and a diploma in tropical medicine and currently working in the field of clinical artificial intelligence. She has specialist interests in sustainability, digital health and artificial intelligence and has published widely, including in peer-reviewed journals.