In February last year, when a Nepal Airlines plane was sent to Wuhan of China, where the coronavirus is said to have originated, to rescue Nepalis stranded there, the flight was also carrying separate waste “collection” bins.

Training was imparted to crew members regarding the management of what would come as “waste” considered risky, such as masks and personal protective equipment.

“All were serious at that time about the spread of the coronavirus infection and were extremely careful when it came to the management of contaminated waste,” Mahesh Nakarmi, chairman and executive director at the Health Environment and Climate Action Foundation (HECAF 360), an NGO working with hospitals in management of medical wastes, told the Post.

At that time, Nepal had reported only one Covid-19 case.

Nepal then went into a lockdown in the third week of March, which continued for four months. Cases continued to rise. Masks were made mandatory. The country imported personal protective equipment, gloves and other materials in thousands of numbers.

In January this year, Nepal started vaccinating people.

The country has already seen the second Covid-19 wave. Cases have declined but experts have warned of a third wave. Vaccination, meanwhile, has been scaled up.

Concerns are now growing about a silent crisis—management of the waste related to coronavirus infection.

In July last year, the Health Ministry issued interim waste management guidelines and a separate protocol for the infected people isolating at home.

But no one paid attention to their implementation.

“We worked day and night to prepare the protocol but authorities did not pay attention to its implementation,” Chudamani Bhandari, former chief of Training Material Development Section at the National Health Training Centre under the Department of Health Services, told the Post. “People are not aware of the risks associated with the waste.”

Experts say apathy towards Covid-19 waste could lead the country to another crisis.

According to them, Covid-19 waste that includes personal protective equipment, face masks, face shields, gloves, shoe covers and tissue papers used by infected persons; laboratory waste, and immunisation waste like vaccine vials, syringes, needles and packaging materials, among others, used in millions of numbers cannot be ignored.

“When the pandemic had just started, the quantity of the Covid-19 waste was small,” said Nakarmi. “But later, Covid-19 became a full-blown health crisis in the country. The more the cases, the more the waste. And this waste needs proper management.”

All waste produced from Covid-19 treatment centres is considered infected and needs to be handled with caution, doctors say.

Masks are one example.

People have been asked to use masks, but no one knows how they are disposed of. Nepal so far has used 13,166,598 doses of Covid-19 vaccines. The authorities need to properly manage the syringes and needles, which are used only once, as well as the millions of vials of vaccines.

In a country like Nepal where regular garbage management is an issue, failure to manage waste related to Covid-19 could turn into yet another crisis, experts warn.

Health Ministry officials say they do not know the quantity of the infected medical waste produced every day from health facilities and from households.

“All municipal waste is infected waste and we have discarded such waste on streets for weeks,” said an official at the Health Ministry, asking not to be named. “Who cares about the consequences of discarding such waste on the streets?”

When Covid-19 infections rose sharply, especially during the second wave in April, authorities turned their focus on managing the cases, increasing the number of beds, setting up isolation and quarantine facilities.

No one had time to pay attention to waste management.

“Plannings used to be made for purchase of the ventilators, beds, oxygen concentrators and other items, but not for the equipment and chemicals needed for waste management,” said Bhandari. “How can medical waste management become effective when officials are not concerned about it?”

Doctors say medical waste can be segregated from general waste but Covid-19 waste must be placed in designated regulated medical waste containers for a certain time and sterilisation or disinfection should be done thoroughly.

Experts say the virus can easily spread in communities from the contaminated waste and materials used by the infected people.

Even 22 months after the pandemic began, authorities failed to manage the hospital waste and contaminated waste properly and no one is concerned about waste management and no one knows how many people are infected from the contaminated waste.

After new cases started to explode, authorities allowed people to stay in home isolation but no agency monitored the waste from the infected persons. Moreover, a lot of people did not undergo testing after the government stopped providing free tests. Despite having symptoms, people did not undergo tests, meaning they are unaware of their infection status.

The United Nations Environment Programme estimated last year that health care facilities around the world were producing about 7.5 pounds of Covid-related medical waste per person per day.

The Ministry of Health and Population said that it has been managing Covid-19 waste produced in hospitals with the help of the several national and international organisations working in the health sector.

“We have been managing immunisation waste of the Kathmandu valley with the financial as well as technical support from the World Health Organisation,” Dr Surendra Chaurasia, the chief of the Environmental Health and Health Care Waste Management Section at the health Ministry, told the Post. “Several other organisations have also helped hospitals in waste management.”

According to officials, syringes and vaccine vials are being collected and managed at Paropakar Maternity Hospital and at Civil Hospital. They are disinfected, autoclaved and recycled.

Some waste materials are being disinfected and sent to the landfill sites, according to Dr Chauraasia.

He, however, admitted that no one is monitoring if all hospitals and clinics have been properly managing their Covid-19 waste.

Nakarmi of the Health Environment and Climate Action Foundation, said that Covid-19-induced waste crisis is not a problem that only Nepal is facing.

“The pandemic started all of a sudden, and not only Nepal. Various countries are facing similar problems,” Nakarmi told the Post. “That said, we cannot ignore the fact that garbage could be a new crisis after Covid-19. We cannot wait for another crisis to strike us so it’s better to wake up now and act.”