Part 2 of a two-part feature. Read Part 1 here.
MANILA, Philippines — The Department of Environment and Natural Resources is worried that large amounts of waste coming from hospitals handling coronavirus patients, if not managed soundly, might end up in seas and rivers.
This has not happened yet although surgical masks, gloves, and alcohol and hand sanitizer plastic bottles have washed up on so-called Baseco Beach in Manila and in coastal areas in the Philippines.
While others fear the pandemic could lead to an even larger environmental calamity in the future, Paeng Lopez, a campaigner at non-profit Health Care Without Harm, believes the health crisis “does not necessarily have to make things worse for us” in terms of managing healthcare waste.
"There are examples of hospitals actually that are able to reduce [healthcare] waste during the crisis. So that means the pandemic is not necessarily a reason for the volume of waste in households or hospitals to increase,” Lopez told Philstar.com in an online interview.
One of these hospitals is St. Paul’s Hospital of Iloilo, a tertiary hospital in the Western Visayas.
Model hospital
St. Paul’s Hospital of Iloilo was able to reduce the volume of medical waste generated in the facility with reusable protective gear although a decrease in the number of patients there has also helped.
Instead of using disposable PPEs, medical frontliners at St. Paul’s wear gowns, head caps and booties made from taffeta cloth, which can be washed and safely reused. Hospital workers are also provided with cloth masks with filters where they can put their surgical or polypropylene masks.
Housekeeping personnel use laundry gloves, which are also reusable, instead of nitrile and latex gloves.
Single-use plastic can be an irresistible option for hospitals—it is cheap, durable and efficient in facilitating hygiene especially at this time when medical frontliners are battling an infectious disease. But Sr. Arcelita Sarnillo, SPC, the hospital administrator, believes there is a need to reduce their plastic waste to become better environmental stewards.
“We thought we need to devise something that has to be sustainable so it can be economical on our part and less impact on the waste, on the environment. We just have to reprocess it,” Sarnillo told Philstar.com in an online interview.
St. Paul had been reducing its plastic waste even before the pandemic struck. In a plastic audit conducted in January, St. Paul’s found that only 30% of the waste disposed of in the hospital were essential medical waste such as IV bottles and IV tubings. The remaining 70% were general or non-hazardous waste such as coffee sachets, plastic bottles and juice beverages. Some of these can be recycled and are sold to junk shops.
The hospital also returns packaging containers to suppliers during scheduled deliveries to minimize the generation of plastic waste.
While avoiding plastic in facilities awash with pathogens such as the novel coronavirus seems impossible, at least for now, cutting down on its use can be attainable.
“What we found out [in plastic audits] is that a lot of plastic waste that hospitals are producing belong actually to non-essential plastics, meaning these are the types of plastics in hospitals that they can really do away with,” Lopez said, referring to plastic water bottles and coffee sachets.
Plastic pandemic
The use of disposable masks, latex and nitrile gloves and other protective gear made of plastic has seen a sudden increase as the number of coronavirus cases continues to skyrocket.
The public is also turning to plastic items such as face masks and face shields as affordable and reliable personal protection.
According to an estimate by the UN Conference on Trade and Development, global sales of disposable masks will reach some $166 billion this year, up from around $800 million in 2019.
Environmentalists warned that the coronavirus pandemic threatens to exacerbate the proliferation of plastic waste and its pollution of bodies of water, which were already a major environmental problem in the Philippines even before the coronavirus pandemic.
Licensed diver Danny Ocampo told Philstar.com he saw single-use face masks along the coastline of Anilao Bay in Mabini, Batangas and even underwater—on a seagrass bed.
Ocampo, who also works for non-profit Oceana Philippines, expressed concern over how things will be once the government further eases quarantine measures and allows tourism to return.
“My worry is when Anilao is reopened for tourism. Maybe that’s when we can see more disposable plastics and face masks [littered by people],” he said.
According to a 2020 study of The Pew Charitable Trusts and SYSTEMIQ on ocean plastic pollution, the amount of plastics dumped into the ocean will triple by 2040—from 11 million metric tons in 2016 to 29 million metric tons two decades from now—if no action is taken.
This is equivalent to 50 kilograms of plastic per meter of coastline around the world.
The Philippines—along with China, Indonesia, Vietnam and Thailand—accounted for up to 60% of the plastic waste leaking into the world’s ocean, according to a 2015 report by environmental campaigner Ocean Conservancy.
A 2018 study of Global Alliance for Incinerator Alternatives found that Filipinos throw away around 59.8 billion pieces of plastic sachets and more than 17 billion shopping bags every year.
Filipinos also discard around 16.5 billion pieces of “labo” bags. The bags, which are smaller, thinner and are often transparent, are commonly used by neighborhood stores and eateries.
With the absence of a national policy on plastics, some local governments in the country have instituted regulations on plastic bags and other single-use items. However, sachets and other primary packaging are not covered by the bans.
Plastic pollution is wreaking havoc on marine wildlife, fisheries and costing at least $8 billion in damage to marine ecosystems, according to the United Nations Environment Programme.
Plastic that ends up in marine environments breaks down into tiny particles called microplastics, whose harmful effects on humans are not yet determined. Fossil fuels required to produce plastic items can also pollute air and water.
Gaps in implementing laws
Environmental lawyer Gloria Estenzo-Ramos told Philstar.com the lack of proper implementation of Republic Act 9003 or the Ecological Solid Waste Management Act of 2000 and RA 6969 or the Toxic Substances and Hazardous and Nuclear Wastes Control Act of 2000 is aggravating the country’s plastic problem.
RA 9003 mandates local government units to divert at least 25% of all solid waste from waste disposal activities through re-use, recycling and composting activities. Such waste diversion goals must be increased every three years.
Another salient point of the law is the mandatory segregation of solid waste, which is largely unimplemented.
“So everything goes to the landfill. There’s no system when the law requires such a system. This reduction of waste at source, there’s a solution for that and the law has provided for it,” Estenzo-Ramos, Oceana Philippines vice president, said.
Environment Undersecretary Benny Antiporda, who oversees local government units and solid waste management, acknowledged there are lapses in the implementation of the law.
“Contrary to their objectives, all they (garbage collectors) need to do is fill up their trucks and haul the waste to the sanitary landfill segregated or not. They will just fast track the collection without the check and balance of local government if indeed proper segregation was implemented or not,” Antiporda said in a virtual forum organized by Eco-Business in May.
Antiporda also lamented the absence of proper funding for local governments, especially poor municipalities, to implement the measure.
“The law said they need to stop open dumping and yet we don’t give support to local governments on opening sanitary landfills… So what happens is they don’t have a choice but to dispose of their trash here and there,” he told Philstar.com.
The proposed Better Normal for the Workplace, Communities and Public Spaces bill that the House of Representatives passed this month seeks the strict monitoring of RA 9003.
House Bill 6864 also proposes that the government implement regulations on the manufacture and importation of single-use plastics, and develop single-use plastic packaging alternatives and provide incentives to plastic industries that will shift to other manufacturing activities.
Reusables or disposables?
Aside from the surge in the use of protective equipment often made of plastic, the coronavirus pandemic is also setting back efforts to reduce the country’s dependency on plastic.
Movement restrictions and fear of getting infected forced many people to turn to online deliveries. Some food and beverage establishments also temporarily paused the use of reusable cups and utensils over virus fears.
“There’s a lot of disruption in terms of the developments that were made previously for single-use plastic bans and a lot of policies that were supposed to be implemented had to be postponed," Greenpeace zero waste campaigner Marian Ledesma said.
"There’s also the intervention of the plastic industry and how they took advantage of this pandemic to really advance their agenda,” she added. “Together, [they] disrupted the gains of the anti-plastic movement in the past three years or so.”
For environmental groups, more plastics does not always mean safer practices.
“We need to take a step back and realize that if we stay on the track of disposable materials, disposable masks, disposable PPEs, disposable gloves, then definitely we’re putting ourselves in a position where it will be problematic for us to deal with the tons of waste that are coming out of hospitals,” Lopez said.
Green groups have been urging the public to utilize reusable masks as safe and cost-effective alternatives, while leaving medical-grade masks to health workers and other frontliners.
A group of researchers from Duke University in the United States found that N95 masks—hospital-grade protection worn by medical frontliners—reduced droplet transmission to less than 0.1%. The virus that causes COVID-19 spreads from person to person, mainly through respiratory droplets produced when an infected person coughs, sneezes or talks.
Surgical masks brought down droplet transmission by 90%, while cotton face coverings reduced droplet transmission by 70% to 90%.
Last June, more than 100 scientists issued a statement saying that reusable items can be used safely by “employing basic hygiene,” noting detergent or soap and hot water can be used to clean reusable items.
Green facilities
Lopez of HCWH said the case of St. Paul’s Hospital of Iloilo shows other medical facilities can actually go green and stay true to their promise of doing no harm to their patients and environment.
In order to do this, hospitals should “use their economic muscle” and demand that manufacturers supply them with reusable items, Lopez said.
For Sarnillo, who vows to turn hospitals she is assigned to lead into green health facilities and models of sustainability, it was the Payatas dumpsite incident in July 2000 that prompted her to practice environmental awareness and rely on reusables.
More than 200 people were killed when an avalanche of garbage in Payatas dumpsite in Quezon City collapsed due to incessant rains, while more than 655 families were rendered homeless because of the incident.
“I thought we should not wait for the same incident to happen in any other place before we get to act,” she said.
Reporting for this story was supported by Internews’ Earth Journalism Network.