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Face Mask and Medical Waste Disposal during the Novel COVID-19 Pandemic in
Asia

Sarawut Sangkham

PII: S2666-0164(20)30050-5
DOI: https://doi.org/10.1016/j.cscee.2020.100052
Reference: CSCEE 100052

To appear in: Case Studies in Chemical and Environmental Engineering

Received Date: 5 August 2020

Revised Date: 21 September 2020
Accepted Date: 30 September 2020

Please cite this article as: S. Sangkham, Face Mask and Medical Waste Disposal during the Novel
COVID-19 Pandemic in Asia, Case Studies in Chemical and Environmental Engineering, https://
doi.org/10.1016/j.cscee.2020.100052.

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1 Face Mask and Medical Waste Disposal during the Novel COVID-19 Pandemic in Asia

3 Sarawut Sangkham

5 Department of Environmental Health, School of Medicine, University of Phayao, Muang

6 District, Phayao 56000, Thailand

7 Tel: +66-54-466666 ext. 3233, Fax: +66-54-466698

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25 Abstract

26 The origin of the novel human coronavirus (SARS-CoV-2) and its potential for harm

27 increased face mask and medical waste in the environment, thereby necessitating the urgent

28 prevention and control of the pandemic. The article estimates the face mask and medical waste

29 generation in Asia during the pandemic to convince the waste management and scientific

30 communities to find ways to address the negative impact that the waste disposal has on the

31 environment. Standardisation, procedures, guidelines and strict implementation of medical waste

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32 management related to COVID-19, community habitats and public areas should be carefully

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33 considered to reduce pandemic risks in hospitals, as proper medical waste disposal effectively

34 controls infection sources.

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47 Keywords: Infectious Waste; SARS-CoV-2; Transmission; Waste Management, Outbreak;

48 Disposal
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49 1. Introduction

50 The emergence of the novel coronavirus (COVID-19) disease has attracted global

51 attention [1] since December 2019. The first outbreak of coronavirus disease 2019 (COVID-19),

52 which is caused by a novel severe acute respiratory syndrome, namely, coronavirus 2 (SARS-

53 CoV-2), occurred in Wuhan, Hubei Province, China [2]. Although most countries have closed

54 their borders to prevent unnecessary travel and immigration, the possibility of confirmed cases

55 and deaths is still increasing due to increased community transmission and increased capacity for

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56 testing [3]. World Health Organisation (WHO) and the US Centers for Disease Control and

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57 Prevention, the National Centers for Disease Control and local governments have announced

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various guidelines, including frequent handwashing, social distancing and quarantine (home,
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59 local and state quarantine), to reduce the spread and health risks associated with COVID-19.
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60 These institutions have also recommended medical personnel and the general population to use
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61 personal protective equipment (PPE) such as surgical or medical masks, non-medical face masks

62 (including various forms of self-made or commercial masks of cloth, cotton or other textiles),
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63 face shields, aprons and gloves. More and more countries have recommended wearing masks
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64 when going out in public places. The press conference study of the Joint Prevention and Control

65 Mechanism of the State Council of China found that approximately 468.9 tons of medical waste

66 are generated every day in association with COVID-19 [4,5]. On the other hand, it was found in

67 Indonesia (Jakarta) that the medical waste scale had reached 12,740 tons approximately 60 days

68 after people were first infected by coronavirus in the area [6,7]. Infectious waste is characterised

69 as any material that is suspected to contain pathogens (bacteria, viruses, parasites or fungi) in

70 sufficient concentration or quantity to cause disease in susceptible hosts. It also comprises waste

71 contaminated with blood, bodily fluids, tissues, organs and sharp objects from treatment and,

72 therefore, also includes diagnosis, swabs, medical devices and so on [8,9]. Therefore, it is
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73 harmful to health. In particular, infectious waste generated by the COVID-19 outbreak has posed

74 a major environmental and health concern in many countries [1]. In particular, inadequate solid

75 waste management may increase the spread of coronavirus, especially in developing countries

76 [10].

77 Currently, millions of contaminated face masks, gloves and materials for diagnosing,

78 detecting and treating SARS-CoV-2 and other human pathogens are undergoing the irreversible

79 process of becoming infectious waste. This, in turn, will cause environmental and health

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80 problems if they are stored, transported and handled improperly [3]. Moreover, due to the

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81 increased healthcare waste owing to the COVID-19 pandemic, the threat that unsafe disposal of

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medical waste will spill over into environmental pollution is palpable and immediate [11]. A
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83 recent study Kampf et al [12] found that human coronaviruses can remain active on inanimate
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84 hard surfaces (such as metal, glass or plastic) for up to nine days. Although some Asian countries
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85 still do not follow proper management strategies and insufficient solid waste containers are one

86 of the major problems that lead to the contamination of infectious waste in solid waste containers
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87 in the general community, the threat will be greater in developing countries that do not have
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88 sufficient resources for solid waste management. In particular, most developing countries, such

89 as Cambodia, Philippines, Thailand, India, Malaysia, Indonesia, Bangladesh, Vietnam and

90 Palestine are widely perceived to be dump solid waste in poorly managed and open landfills

91 [13,14]. This is another example where improper management of contaminated PPEs and

92 healthcare waste may increase the spread of viral disease in the environment [3].

93 Consequently, one of the many problems that will inevitably occur is contagious waste,

94 which, if not managed properly, may be the root cause of severe diseases and environmental

95 problems. Hence, the purpose of this work is to estimate face mask use and medical waste during

96 the COVID-19 pandemic, thereby calling on the waste management and scientific communities
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 97 to express their concerns and take the requisite actions for the formulation of appropriate solid

98 waste management policies and strategies to governments at all levels.

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100 2. Materials and Methods

101 2.1 Population, Urban Population (Percentage) and Covid-19 Cases Confirmed on

102 Databases

103 Data on the population and the total number of confirmed COVID-19 cases were

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104 collected from 49 countries in Asia from https://www.worldometers.info/coronavirus/ [15]. In

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105 addition, information about the urban population (percentage of the total population) was

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collected from https://www.worldometers.info/population/asia/ [16]. This method was used to
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107 highlight the spatial variation of the pandemic, which not only exists between different countries
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108 but also, more importantly, exists within each country. These data are important to estimate
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109 COVID-19 related face mask and medical waste generation in Asia.

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111 2.2 Estimation of Daily Face Mask Usage and Medical Waste
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112 2.2.1 Estimation of daily face mask usage of general population

113 The quantity of daily face mask is estimated using an equation adapted from Nzediegwu

114 and Chang [3] as follows:

115 DFM = P × U × F ×
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116 where

117 DFM = Daily face mask use (pieces)

118 P = Population (persons)

119 UP = Urban population (percentage)

120 FMAR = Face masks acceptance rate – 80 per cent [3]

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121 FMGP = Assumption that each person in the general population uses one face mask each

122 day [17]

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124 2.2.2 Estimation of medical waste

125 The amount of medical waste generated at different hospitals is proportional to the

126 number of infected persons and the average waste generation per bed. An early study reveals that

127 the daily generation of medical waste in Jordan is 2.69 kg/bed/day [18]. Meanwhile, estimated

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128 values and analysis of medical waste in the city of Istanbul showcased that the yearly average

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129 values of daily unit medical waste per hospital bed have increased from 0.43 kg/bed/day in 2000

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to 1.68 kg/bed/day in 2017 [19]. In April 2020, the highest rate of medical waste was estimated
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131 at around 14,500 tons during the COVID-19 pandemic. This has undoubtedly increased since
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132 then due to the increasing infection rate [20]. For instance, the amount of medical waste peaked
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133 to 240 tons per day [6,7] in Wuhan City. At the same time, the medical waste amounted to the

134 average value of 206 tons per day in Dhaka, Bangladesh [20]. Recently, in Jordan, the study
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135 conducted by Abu-Qdais et al [21] found that the average medical waste generated in King
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136 Abdullah University Hospital as a result of COVID-19 treatment was 3.95 kg/bed/day. In

137 general, in the context of the COVID-19 pandemic, medical waste related with diagnoses and

138 patients’ treatment is expected to be higher than the general average of infectious disease and the

139 detected upper limit [7]. Therefore, the estimation of medical waste provided by previous studies

140 in Jordan (3.95 kg/bed/day) has been further considered in the medical waste analysis as follows:

141 MW = N ×M

142 where

143 MW = Medical waste (tons/day)

144 NCC = Number of COVID-19 cases (infected persons)

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145 MWGR = Medical waste generation rate, that is, 3.95 kg/bed/day

146 The number of confirmed cases is available at

147 https://www.worldometers.info/coronavirus/ for the Asia region. The total number of confirmed

148 cases represents the infected persons who were treated in hospitals without recovering or those

149 who were declared dead after being infected with COVID-19. Consequently, the total confirmed

150 COVID-19 cases comprise the ones wherein patients were treated in hospitals during the

151 emergency state.

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153 2.3 Limitation of the Study

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This is a cross-sectional study that aims to provide a rapid estimation of potential face
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155 mask and medical waste associated with the COVID-19 pandemic in Asia. This examination
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156 depends on the reliability of COVID-19 case statistics and available information in this regard,
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157 as mentioned in Sections 2.1 and 2.2 [number of confirmed cases, number of populations, urban
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158 population (per cent), and so on]. On the other hand, the medical waste generation rates

159 (kg/bed/day) and waste generation rates are taken into consideration and supported by previous
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160 studies [7].

161

162 3. Results and Discussions

163 3.1 Daily Face Mask Usage and Medical Waste in Asia during COVID-19 Pandemic

164 This study estimates the number of face masks used in self-defence and medical waste

165 generated by the total COVID-19 cases in developed and developing countries in Asia during the

166 crisis. The result showed that more than one hundred thousand people were infected in Asian

167 countries, such as India, Iran, Pakistan, Saudi Arabia, Turkey, Bangladesh, Qatar and Indonesia.

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168 The number of masks used in 49 Asian countries was estimated from the COVID-19 pandemic

169 database on July 31, 2020. Subsequently, it was found that 2,228,170,832 face masks were used

170 in Asia in total. In particular, the selected countries that use the most daily face masks are China

171 (989,103,299 pieces), followed by India, Indonesia, Bangladesh, Japan, Pakistan, Iran,

172 Philippines and Vietnam with 381,179,657, 99,155,739, 92,758,754, 61,762,860, 50,648,022,

173 48,967,769 and 46,288,632 pieces, respectively (see Table 1). The maximum face mask use by

174 the general population in Asian regions was found in Eastern Asia (1,110,472,794 pieces),

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175 followed by Southern Asia, Southeastern Asia, Western Asia and Central Asia, thereby

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176 amounting to 648,945,814, 295,458,617, 142,162,166 and 31,131,442 pieces, respectively (Fig.

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178 total number of face masks used every day has increased during the COVID-19 outbreak. This
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179 study used mathematic calculation to estimate the numerical value of face mask usage across
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180 Asian countries. Consequently, it was found that the quantity of daily face mask usage depends

181 on the number of people residing in a certain country, urban population (per cent), face masks
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182 acceptance rate (per cent) and average daily face masks per capita. Thus, this equation can be
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183 applied to the estimation of face mask scenarios during the COVID-19 pandemic for healthcare

184 waste management (HWM).

185 It was found while conducting this study that the total medical waste generated in Asia is

186 around 16,659.48 tons/day. The countries with the highest medical waste are India (6,491.49

187 tons/day), followed by Iran (1,191.04 tons/day), Pakistan (1,099.30 tons/day), Saudi Arabia

188 (1,083.17 tons/day), Bangladesh (927.81 tons/day) and Turkey (908.07 tons/day). Information

189 about the medical waste of other countries has been included in Table 1. Indeed, due to the rapid

190 increase in the number of confirmed cases, the amount of medical waste related to COVID-19

191 has also significantly increased. The use of medical gloves, surgical face masks and aprons has
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192 been recommended for essential healthcare service staff such as physicians, nurses, medical

193 technologists and nurses’ aides. Moreover, face mask use has been mandated for citizens [3,5].

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195 3.2 Infection Control Special Team and Medical Waste Management Frame during the

196 COVID-19 Pandemic

197 A special infection prevention and control team was established to discuss potential

198 problems and countermeasures. The administrative and operating boards include the nosocomial

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199 infection control expert, director of infectious disease department, respiratory disease

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200 department, nursing department, local government organisations, multi-level quarantine

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departments, environmental health and safety, logistics departments (special waste management
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202 in the private sector or partnerships) and administrative leaders. Each department has specific
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203 personnel who are allocated to coordinate and improve the management of medical and
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204 household waste during COVID-19 outbreak (Fig. 2).

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206 3.3 Managing Infectious Waste for Final Disposal during the COVID-19 Pandemic
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207 The COVID-19 outbreak has increased medical waste all across the world. The results of

208 this study showed that it has also led to a huge amount of face mask and medical waste. The

209 SARS-CoV-2 pandemic has caused a global emergency and aroused social and economic

210 concerns in addition to excessive medical and household waste, which adversely affects

211 municipal waste management, thereby spilling over into environmental issues [22]. In particular,

212 another aspect of the spread of COVID-19 is improper solid waste management. If waste is not

213 managed properly, it may lead to the spread of the virus. Consequently, the number of confirmed

214 cases has rapidly increased and the amount of medical waste associated with COVID-19 has also

215 significantly increased [5]. In addition, existing operational protocols for HWM and municipal
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216 solid waste (MSW) management should be continued for SARS-CoV-2 waste, with specific

217 precautionary measures, adjustments and arrangements applied to reduce any potential risk of

218 SARS-CoV-2 infection due to the improper waste management process. The following sections

219 describe the used mask and medical waste management in detail.

220 3.3.1 Categorised containers or packaging and pre-treatment

221 Medical waste includes those elements that have been contaminated by blood, body

222 fluids and cultures produced in laboratories, stockpiles of infectious agents or waste generated

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223 through medical wards and equipment [23]. During the COVID-19 pandemic, the disposal

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224 capacity of medical waste is seriously insufficient [24]. This is because the use of protective

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masks has greatly increased the possibility of carrying pathogens. Therefore, some medical waste
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226 buckets with obvious mark points are placed in the public areas of hospitals and communities to
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227 collect abandoned masks. They are packaged in double-layered medical waste bags and treated
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228 as general medical waste by specific personnel, municipal solid waste workers and the

229 company’s special waste management department [25]. Meanwhile, by stratifying patients on the
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230 basis of risk, special care facilities can be facilitated with appropriate health care personnel,
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231 procedures and PPEs (long-sleeved gowns, gloves, boots, masks and goggles or face masks) to

232 provide maximum protection against nosocomial infections and optimise patient care [26],

233 thereby effectively managing infectious waste in hospitals.

234 Therefore, the medical waste generated by clinics, wards, specialised examination rooms

235 and medical laboratories (especially, nucleic acid testing laboratories) should be regarded as

236 medical waste related to COVID-19 and should be labelled as ‘COVID-19 infectious waste’.

237 This label should be attached by special personnel during the packaging phase. Subsequently,

238 this waste is placed into double yellow or red medical waste bags. Finally, before placing the bag

239 in the medical waste bucket for temporary storage on site, 0.5 per cent (5,000 ppm) chlorine
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240 disinfectant should be sprayed on the surface of the bag [27]. Alternately, chlorine-based

241 products (for example, hypochlorite) at 0.1 per cent (1,000 ppm) can be used for general

242 environmental disinfection [28]. However, chlorine solutions at lower pH have much shorter

243 shelf lives [29]. Thus, chlorine solutions (0.1 per cent or 0.5 per cent) should ideally be freshly

244 prepared every day [28]. Therefore, after isolation and packaging in another double-layered

245 medical waste bag, a chlorine-rich disinfectant was sprayed again to disinfect the waste. The

246 specimens or preservation solutions containing pathogens in laboratories or clinics should be

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247 sealed and packaged first. Subsequently, they should be autoclaved at 121 °C for 110 minutes [5]

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248 or maintained at a high temperature (more than 70°C) for over five minutes. This process is

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reported to be extremely effective in inactivating SARS-CoV-2 [30] from the waste. The bag
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250 should then be placed in a medical waste bucket and incinerated in hospitals until the storage
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251 period is less than 24 hours [5]. This quickly and efficiently reduces the potential for
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252 contamination of medical waste, which may have the potential to spread COVID-19, and

253 protects patients who are in sickbeds and medical personnel during COVID-19 outbreak within
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254 hospitals. Thus, the facts have proved that timely, orderly, effective and harmless treatment of
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255 medical waste related to COVID-19 has also become an important part of the fight against the

256 pandemic [5]. In addition, public areas and households are advised to place used face masks in

257 Ziploc bags or bags that are sealed with ropes or rubber bands before placing them in red or

258 special bins, which are subsequently collected for proper disposal.

259 3.3.2 Segregation and storage

260 Screening and examination from hospitals and COVID-19 in outpatient treatment areas

261 directly generate infectious waste. These wastes must be immediately separated from the general

262 wastes, packaged and then stored and collected for transportation to the hospital for centralised

263 disposal. A separate temporary storage area has been established for COVID-19-related medical
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264 waste with easily visible warning signs. Medical waste buckets from clinics, observation wards,

265 isolation wards and nucleic acid testing laboratories are placed in this area to prevent mixing

266 with other wastes in the general wards. The temporary storage time of COVID-19-related

267 medical waste in hospitals should not exceed 24-48 hours [5] while waste related with COVID-

268 19 generated by people should undergo mandatory quarantine sorting at home and the authorities

269 should wait for 72 hours before collection [31]. The inorganic part of most municipal solid

270 wastes in developed and developing countries is mainly composed of plastic, rubber, metal and

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271 glass [32]. This suggests that waste materials generated from households and quarantine facilities

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272 with infected or suspected patients may possibly contain traces of COVID-19 and could be a

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source of infection for people outside the facility [31]. As recently discovered, SARS-CoV-2 can
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274 stay on hard surfaces for long periods of time, specifically, 72 hours on plastic, 48 hours on
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275 stainless steel [33] and 24 hours on paper and cardboard [25]. Therefore, a 72-hour-delay in the
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276 collection does not seem to be sufficient to ensure safety and may lead to COVID-19 infection

277 amongst waste workers [31,34]. Moreover, poor management can possibly increase the chances
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278 of COVID-19 spread in the environment due to transmission of the SARS-CoV-2 through two
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279 channels, namely, respiratory channels and physical touch [35]. Respiratory droplets are

280 generated when an infected person coughs or sneezes. Apart from human-to-human

281 transmission, droplets may also stay active on surfaces where the virus could remain viable.

282 Thus, the immediate environment of an infected individual can serve as a source of transmission

283 [35]. This, in turn, may affect the spread of the infection in urban areas and similar set-ups

284 through inadequate management of municipal solid waste [22]. Therefore, MSW management

285 implemented under the government in local governments or private sector’s partnership should

286 include the provision of infectious or special waste containers for used masks and other

287 infectious waste in communities and public areas to ensure proper collection operations.
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288 3.3.3 Collection and transportation

289 Additional vehicles should have a non-absorbent, sealed loading area, which can be

290 locked, disinfected and separated from the main vehicle. The vehicle identification or chassis

291 number should be recorded for future control [36]. In addition, the disposal of medical waste

292 related to COVID-19 should be arranged by specially trained workers and special vehicles,

293 which should be different from general medical waste collection vehicles. A specific logbook is

294 used to maintain detailed records of the time spent by waste and quantity of waste in internal and

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295 external carriers. In addition, the transportation routes should avoid crowds as much as possible,

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296 and the time should avoid morning and evening rush hours. The vehicles for medical waste

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should be installed with closed loading box and maintained at 4 °C when transporting the
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298 medical waste storage from hospitals [37]. If there is no dedicated special waste collection
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299 mechanism in place for masks used in households and generated in public areas, then the waste
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300 should be double-packaged and disposed by following the general waste management strategies

301 during the COVID-19 outbreak by increasing collection frequency to incineration or secure
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302 landfills. These transportation vehicles should be disinfected immediately after loading and
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303 unloading. Thus, considering the risk exposure level in the working environment of waste

304 collectors, they need to be provided with PPEs for collecting and transferring waste and wearing

305 medical masks, gloves, protective clothing and waterproof shoes should be mandated for them.

306 Moreover, alcohol solution should be prepared in the plastic bottles, which are provided to

307 collectors and transporters. This should be used for disinfecting the vehicles with 70 per cent

308 alcohol solution before and after waste collection and end operations so that proper hygiene is

309 maintained during such disposal [35].

310 3.3.4 Disposal

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311 Most countries that generate excessive waste should evaluate their management systems

312 to properly incorporate medical waste disposal during the COVID-19 pandemic. Therefore,

313 waste management through its different phases (that is, pre-treatment, segregation, storage,

314 delivery, collection, transportation and disposal) can represent another way for SARS-CoV-2 to

315 spread, mainly through contact with contaminated surfaces and objects. Hence, all necessary

316 precautions must be taken to prevent the potential spread of infectious viruses and feasible

317 guidelines should be put forward. The guidelines should also consider socio-economic conditions

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318 and technologies available in specific environments [34]. However, healthcare waste must be

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319 treated by incineration and secure landfill. Thus, priority is given to high-temperature

320
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incineration to dispose medical waste related to COVID-19. This is the most common,
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321 biologically safe [38] and suitable method to destroy traces of the virus with high furnace
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322 temperature, and the incineration temperature and duration are set to 1,100 °C for three minutes.
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323 In these facilities, combustion efficiency is ensured by using specific equipment capable of

324 maintaining a minimum temperature of more than 850 °C and a residence time of waste in the
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325 furnace of more than one hour [39]. For example, emergency incineration of medical waste in
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326 China during COVID-19 includes the use of municipal solid waste incinerators to co-process

327 medical waste for medical waste disposal in rotary kilns whose temperature is controlled above

328 850 °C [24]. However, in some areas without incineration capacity, medical waste can be also

329 treated with high-temperature sterilisation (autoclave) and boiling before entrance into the

330 sanitary landfills. Nevertheless, the overall capacity for medical waste disposal during the

331 COVID-19 pandemic is seriously inadequate. For instance, in developing countries in Asia such

332 as India, Bangladesh, Thailand, Indonesia, Myanmar and Malaysia, landfills continue to be one

333 of the most common MSW management options [40]. Thus, the management of mask use and

334 medical waste needs strict operations such as segregation, sorting, storage, collection, transport
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335 and final disposal. This, in turn, should reduce the spread of COVID-19 in the environment and

336 in several countries. Mostly, each country recognises and attaches great importance to preventing

337 the spread of the pandemic amongst its citizens. The recommended practice that is widely used is

338 wearing a mask to reduce COVID-19 infection and spread. Consequently, there has been a

339 dramatical increase in face mask and medical waste during the COVID-19 pandemic. However,

340 every country is aware that waste management and proper disposal of face masks and medical

341 waste play a critical role in preventing the spread of COVID-19 in the neighbouring communities

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342 and healthcare service sectors. Moreover, the author gathered guidelines and recommendations

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343 for management and disposal of used face masks in certain Asian nations, as illustrated in Table

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2, and practices for related COVID-19 waste management generated from healthcare facilities,
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345 which have been adopted by some countries during COVID-19 pandemic (Table 3).
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346
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347 3.4 New Challenge in Plastics Waste Management

348 This comprises disposable gowns made from polyester or polyethylene such as a surgical
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349 masks, gloves, N95 respirators, face shields (polycarbonate or polyvinyl chloride) as well as
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350 hand sanitisation products with packaging made with polyethylene terephthalate (PET) for

351 alcohol and other disinfectant solutions [41,42]. The COVID-19 pandemic presents growing

352 environmental consequences related to plastic use and follow-up waste. In this context, PPEs are

353 critically needed. Most of these PPEs comprise single-use plastic. Therefore, it was found that,

354 during the peak of the outbreak, hospitals in Wuhan produced more than 240 tons of waste per

355 day in comparison to the 40 tons that was earlier produced during normal circumstances with

356 most of the waste comprising plastic PPEs [42]. Furthermore, COVID-19 face masks are a

357 potentially high source of microplastic fibres, which have the possibility of being released into

358 the environment [43]. These emerging challenges in solid waste management during and after
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359 the pandemic have been discussed from the perspective of novel study and environmental

360 policies. Thus, it is necessary to plan and consider separation, storage and collection for

361 recycling and disposing face masks and medical waste to reduce plastic waste and adopt

362 alternative technology in the form of waste with a view to facilitating energy recovery.

363

364 4. Conclusion

365 This is the first study to estimate the face mask and medical waste use in the context of

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366 the COVID-19 pandemic in Asia. The finding shows that the number of face masks used and

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367 medical waste has increased with the steady increase in the number of confirmed SARS-CoV-2

368
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cases. COVID-19 is pathogenic virus, and the concerned authorities should pay significant
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369 attention to all aspects of prevention and control. Standardisation, procedures, guidelines and
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370 strict implementation of medical waste management for the COVID-19 pandemic should be
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371 carefully considered to reduce the risk of the pandemic spreading to the environment within

372 hospitals, community residences and public areas.

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535 Conserv. Recycl. 164 (2021) 105074.
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536

537
na

538
ur
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23
539 Table 1 Estimated daily face mask use and medical waste in Asia with confirmed COVID-19 cases.

Country *Population *Total **Urban Face masks Number of Total daily Medical waste

Covid-19 population acceptance face mask face mask use (tons/day)

cases (%) rate (%) need of each (pieces)

general

of
ro
population

-p
each day

re
India 1,381,085,714 1,643,416 35 80 1 381,179,657 6,491.49

lP
Iran 84,077,062 301,530 75 80 1 50,648,022 1,191.04

na
Pakistan 221,213,683 278,305 35 80 1 61,762,860 1,099.30

Saudi Arabia 34,855,542 274,219 ur 84 80 1 23,367,155 1,083.17

Jo
Bangladesh 164,820,045 234,889 75 80 1 99,155,739 927.81

Turkey 84,410,984 229,891 39 80 1 26,066,112 908.07

Iraq 40,288,721 121,263 96 80 1 30,973,969 478.99

Qatar 2,807,805 110,460 60 80 1 1,341,008 436.32

Indonesia 273,753,080 106,336 73 80 1 159,214,791 420.03

24
Philippines 109,694,822 89,374 56 80 1 48,967,769 353.03

Kazakhstan 18,794,372 89,078 58 80 1 8,675,482 351.86

China 1,439,323,776 84,292 86 80 1 989,103,299 332.95

Oman 5,115,955 79,159 47 80 1 1,927,692 312.68

Israel 91,97,590 70,379 100 80 1 7,358,072 278.00

fo
ro
Kuwait 4,275,450 66,529 86 80 1 2,941,510 262.79

-p
United Arab 9,899,794 60,223 100 80 1 7,919,835 237.88

re
Emirates

lP
Singapore 5,854,053 51,809 93 80 1 4,364,782 204.65

na
Bahrain 1,705,531 40,755 25 80 1 343,835 160.98

Armenia 2,963,706 ur
38,196 89 80 1 2,114,901 150.87
Jo
Afghanistan 38,992,638 36,542 63 80 1 19,589,901 144.34

Kyrgyzstan 6,532,418 35,619 56 80 1 2,916,071 140.70

Japan 126,443,231 33,049 92 80 1 92,758,754 130.54

Azerbaijan 10,146,497 31,560 21 80 1 1,712,729 124.66

Uzbekistan 33,506,746 23,558 50 80 1 13,456,309 93.05

25
Nepal 29,176,450 19,547 82 80 1 19,046,387 77.21

South Korea 51,272,891 14,305 36 80 1 14,561,501 56.50

Palestine 5,110,066 11,548 78 80 1 3,180,505 45.61

Malaysia 32,398,441 8,964 27 80 1 7,049,901 35.41

Tajikistan 9,553,361 7,366 80 80 1 6,083,580 29.10

fo
ro
Lebanon 6,822,802 4,334 51 80 1 2,756,412 17.12

-p
Maldives 541,266 3,719 34 80 1 148,090 14.69

re
Thailand 69,814,554 3,310 18 80 1 10,220,851 13.07

lP
Hong Kong 7,501,879 3,152 79 80 1 4,711,180 12.45

na
Sri Lanka 21,420,649 2,814 100 80 1 17,136,519 11.12

Yemen 29,874,304 1,726 ur

38 80 1 9,033,990 6.82
Jo
Jordan 10,211,202 1,191 91 80 1 7,425,586 4.70

Georgia 3,988,514 1,168 67 80 1 2,131,462 4.61

Cyprus 1,208,070 1090 58 80 1 557,645 4.31

Syria 17,531,446 738 79 80 1 11,009,748 2.92

Vietnam 97,408,737 509 59 80 1 46,288,632 2.01

26
 Taiwan 23,820,377 467 37 80 1 7,050,832 1.84

Myanmar 54,439,424 353 31 80 1 13,500,977 1.39

Mongolia 3,282,334 291 67 80 1 1,767,209 1.15

Cambodia 16,736,949 234 24 80 1 3,186,715 0.92

Brunei 437,813 141 79 80 1 276,698 0.56

o f
ro
Bhutan 772,280 101 45 80 1 278,639 0.40

-p
Macao 650,024 46 100 80 1 520,019 0.18

re
Timor-Leste 1,320,331 24 32 80 1 342,230 0.09

lP
Laos 7,283,730 20 35 80 1 2,045,271 0.08

na
Total 4,612,337,109 4,217,589 2,228,170,832 16,659.48

540
ur
* Data source: retrieved on July 31, 2020 from: https://www.worldometers.info/coronavirus/
Jo
541 ** Data source: retrieved on July 31, 2020 from: https://www.worldometers.info/population/asia/

542

543

544

545

546

27
547 Table 2 Disposal management of face masks during the COVID-19 pandemic in Asian

548 countries.

Country Recommended for Face Masks’ Waste Management References

- Bangkok Metropolitan Administration (BMA) places special red

Thailand bins labelled ‘For used face mask only’ in highly visible areas to [44-46]

(Bangkok prevent the stealing of used face masks for reuse or resale.

and local - These bins are separated from ordinary rubbish bins.

of
government) - Households can keep used face masks in Ziploc bags before

ro
disposal in red bins to waste collection vehicles, which have
-p
special bins to store masks while transporting them to the local
re
government (municipality or waste management service provider)
lP

under the local administration organisations’ norms for proper

na

disposal.

- The governor advised separating waste in different bags if there

ur

are no red bins near your area and labelling the bags containing
Jo

HW so that disposal staff can dispose them safely.

- HW separates and disposes incinerated waste at specialist

facilities in Nong Khaem and On Nut.

China - In Wuhan, used masks are collected in special trash cans. If [47,48]

unavailable, waste is wrapped in plastic bags before disposal to

prevent air exposure.

- Medical masks used by healthy people are disposed with

domestic waste.

28
 - If special waste containers are unavailable, residents disinfect

and fold their used face masks before placing them into sealed

plastic bags in dustbins.

- In Chongqing, special containers for collecting discarded masks

are placed at residential communities’ entrances.

- Sanitation workers wear special masks and gloves while

disposing garbage bags, disinfecting dustbins and keeping garbage

of
bags in garbage collection vehicles.

ro
- The vehicles are sealed, clearly marked and sterilised when

entering and leaving a community.

-p
re
- The collected municipal solid waste is directly sent to
lP

designated incineration plants, regularly sterilised and disinfected.

na

India - Quarantined homes or other households: Used face masks are [49]

kept in a paper bag for 72 hours before disposal as general waste.

ur

- Face masks’ straps are cut before disposal to prevent reuse.

Jo

- Greater Chennai Corporation (GCC) has advised non-

quarantined homes and residents to dispose used masks by

disinfecting them with ordinary bleach solution (5%) or sodium

hypo-chlorite solution (1%). Masks are wrapped and kept in a

closed bin before provision to the sanitary workers. They are

treated as domestic hazardous waste and incinerated by GCC.

Singapore - Face masks and associated wastes, such as tissues, with potential [50]

exposure to COVID-19 contamination is managed like ordinary

29
 non-contaminated municipal waste.

- Face mask disposal is advised in residential and public areas.

South Korea - Used masks from households are disposed in garbage bags [37]

labelled ‘Waste for incineration’ and ‘Waste bag for landfill’

through the volume-based waste free (VBWM) system.

- The recyclable waste is separated from the bag in the VBWM

system for transportation to recycling facilities.

of
- Used mask waste must be incinerated or disposed in landfills

ro
without recycling.

Malaysia
-p
- The public hygienically disposes their used face masks instead of [51]
re
placing them with ordinary rubbish.
lP

- Residents are advised to fold masks with the contaminated part

na

facing inwards, rolling it up, wrapping it in plastic and placing it

in the rubbish before disposal collection by Kepong MP Lim Lip

ur

Eng. Cleaning services are essential under the movement control

Jo

order (MCO). In Kuala Lumpur, Alam Flora Sdn Bhd is the

appointed cleaning contractor.

Taiwan - Folding the mask in half with the contaminated side of the mask [52,53]

facing inwards is recommended if masks are reused.

- Taipei City Government remarked that discarded masks are

general waste and should be disposed in regular garbage bins to

prevent virus contamination, as per the Ministry of Health and

Welfare (MOHW). It added that disposing face masks on public

30
 property is dangerous, as virus remnants might persist.

- Discard the used masks in a lidded trash can.

- Wearing face masks in public is mandatory. Environmental

Protection Administration has introduced 122 US dollars ($NT

3,600) fines for improperly disposing mask under The Waste

Disposal Act.

- City government encourages citizens to record and report

of
evidence of mask littering acts to authorities for the cash reward of

ro
30% of the fines issued to the offenders.

549
-p
re
550
lP

551
na

552

553
ur

554
Jo

555

556

557

558

559

560

561 Table 3 Existing practices for infectious waste separation, storage, transportation and disposal in

562 Asian countries.

31
Country Practices for COVID-19 Waste Generated from Healthcare COVID-19 Waste

Facilities Treatment and

Disposal

India - Use dedicated trolleys and collection bins in COVID-19 isolation - Common biomedical

wards, laboratories and test centres. Used masks are discarded and waste treatment

collected in separate ‘yellow colour-coded plastic bags’ (suitable facility (CBWTF).

for biomedical waste collection) labelled ‘COVID-19 waste.’ - Disposal permitted

of
- Disinfect inner and outer surfaces of containers, trolleys and bins by deep burial only in

ro
with 1% NaClO solution daily. rural or remote areas
-p
- Depute dedicated sanitation workers for biomedical and general without CBTWF
re
solid waste collection and timely transfer to temporary storage. facilities.
lP

- Use vehicles with GPS and barcoding systems for containers - Large volume of
na

containing HCW for waste tracking. Label vehicles with yellow colour-coded

‘Biohazard’ sign. (incinerable) COVID-

ur

19 waste beyond the

Jo

capacity of existing

CBWTFs and BMW

incinerators,

necessitates permitting

HW incinerators’

usage at existing

treatment, storage and

disposal facilities

32
 (TSDFs) or captive

industrial incinerators

if any exist in the

state/union territory.

In such cases, ensure

separate arrangement

for handling and waste

of
feeding.

ro
- Wuhan improved the process by closing the municipal solid - Temporary
-p
waste disposal site and enhancing disinfection and sterilisation of incinerator installation
re
China waste-related facilities. suggested for waste
lP

- Medical waste collection is performed with strict technical management.

na

guidelines to avoid virus transmission. - Municipal solid

- Medical waste is collected from individual containers placed at waste incinerators to

ur

medical institutions and public areas. co-process medical

Jo

- Medical waste is transported and disposed through specially waste in rotary kiln.

designed registered vehicles operated by professional workers at Hazardous waste is

scheduled times. thoroughly incinerated

- Healthcare workers are equipped with protective equipment, in high-temperature

including masks, gloves, goggles, protective clothing and flue gas and slag

disinfectants. residue after 60

minutes of high-

temperature (850 °C)

33
 incineration.

Bangladesh - Use color-coded bins (red: sharp waste, yellow: Incineration

infectious/pathological waste and black: non-hazardous waste)

- Store the bins on premises. They are regularly collected by

covered vehicles for transportation to treatment sites.

- Identify the classification and communication (labels, symbols)

Indonesia means. Mostly incineration,

of
- Designate COVID-19 infectious waste bins. disinfecting at source

ro
- Conduct internal sterilisation and disinfection before bags are and transporting to the

tied.
-p disposal site, open
re
- Label bags ‘Danger, do not open.’ burning (if no
lP

- Disinfect bags before collection. incinerator) or

na

- Schedule regular waste transportation by cleaning services on hazardous waste

weekdays. landfill.
ur

Japan - Separate and store infectious, non-infectious and general wastes Incineration, melting,
Jo

and sharp objects from other infectious wastes with proper steam sterilisation

containers. (autoclave), dry

- Seal easy-to-use and durable containers. sterilisation and

- Transport by a designated cart to avoid scattering and spilling disinfection followed

wastes within facilities. by shredding and

- Use short storage periods. disposal to sanitary

- Access storage rooms, if you are an authorised person. landfills.

- Apply clear labelling on infectious waste containers at storage

34
 rooms.

Malaysia - Do not separate COVID-19 waste from other infectious waste. Mostly incineration

- Equip cold rooms in bigger healthcare facilities.

- Collect daily or three times a week depending on the quantity.

- Transport only by a special lorry licensed to transport hazardous

waste.

Nepal - Designate waste storage in health facilities Mostly burned, small-

of
- Use specific trollies for transportation within hospitals. scale incineration or

ro
- Use specific vehicles for transportation from healthcare facilities dumped in backyards,
-p
to waste management service providers (WMSPs). municipal landfills
re
Thailand - Separate into sharp and non-sharp COVID-19 waste. Incineration,
lP

- Disinfect and use double bags. autoclave, WMSP,

na

- Designate specific storage areas. sanitary landfill.

- Send waste from community healthcare facilities to district

ur

healthcare facilities once a week.

Jo

- Temperature-controlled storage available at the district level.

- Transport by licensed WMSPs (requires temperature-controlled

vehicles).

- Treat within 48 hours after transportation.

- Disinfect vehicles and bin daily with NaClO.

563 Source: UNEP [25] and information in China section derived from ERIA [6], Ma et al [24], and

564 Yang et al [54].

35
565 Fig. 1. Face mask usage of general population in Asia region.

566

567 Fig. 2. Scheme of medical waste management frame during COVID-19 outbreak.

568

569

570

571

of
572

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573

574
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re
575
lP

576
na

577

578
ur

579
Jo

580

581

582

583

584

585

586

587

588

36
589 Highlights

590 • A rapid estimation of face mask and medical waste generation related with the COVID-

591 19 pandemic.

592 • The COVID-19 pandemic has caused a sharp increase in the generation of face mask and

593 medical waste.

594 • Medical waste related to COVID-19 confirmed cases is presented.

• COVID-19 plays a key role in plastic-related waste pollution.

of
595

• Solid waste collectors may be infected with COVID-19 due to improper medical waste

ro
596

597 management.
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37
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Declaration of interests

☒ The authors declare that they have no known competing financial interests or personal relationships
that could have appeared to influence the work reported in this paper.

☐The authors declare the following financial interests/personal relationships which may be considered
as potential competing interests:

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