The plastic pandemic: could the environmental impact of the NHS response to covid-19 be reduced?

The NHS disposes of around 133,000 tonnes of plastic each year, but only about 5% of it is recovered. The recently published Delivering a “Net Zero” National Health Service document reports that the NHS is responsible for 4% of England’s total carbon footprint. The NHS Long Term Plan recognises the health service’s huge carbon footprintabout 60% of which is from the procurement of goods and services. Although there have been improvements, there is a long way to go and time is running out.

As covid-19 spread, so did panic. Guidelines were implemented quickly. Measures such as hand hygiene, face coverings, and social distancing were promoted to protect individuals and the public. To maintain public trust, every organisation had to be seen to be “doing something” that makes people “feel safer.” Was there enough evidence to back these policies? 

Many safety measures came with a pricedisposable plastic. It seems to have come to the rescue. But while feeling safe is important, any measure must improve safety, not just create an illusion of it, particularly if that measure causes long-lasting harm to the environment.

Understandably, some targets set in the NHS Long Term Plan may be put on hold while the pandemic is dealt with. But the pandemic should not eclipse the climate emergency.

Personal protective equipment (PPE), has been a hot topic since the beginning of the covid-19 crisis, and policies regarding PPE have been updated multiple times. In the updated Infection Prevention and Control guidance, published by Public Health England, patients are categorised into low, medium, and high risk groups. The majority of attendees at outpatient services are “medium risk” where an asymptomatic individual with unknown covid-19 status is accessing care. The PPE advice includes single-use plastic aprons, single-use gloves, plus surgical face masks and visors/goggles.

A single clinic, with about 50 patients daily, disposes of approximately 500 plastic aprons and 1000 gloves every week. Multiplied by the number of outpatient clinics running in all trusts, the waste produced becomes immense. 

Two questions need answers. Does wearing gloves and an apron when treating an asymptomatic patient offer any meaningful protection? And is there a more pragmatic alternative which reduces the amount of plastic waste without endangering healthcare workers?

The National Infection Prevention and Control Manual (NIPCM), which provides the evidence published in the infection prevention and control guidance, refers to literature reviews on single-use aprons and gowns and single-use gloves. But these documents provide no evidence for using aprons and gloves to prevent transmission of an airborne infection from an asymptomatic individual wearing a face covering. 

The NICE guidance states “wear (aprons) if there is a risk that clothing may be exposed to blood, body fluids, secretions or excretions”. A WHO scientific brief (June 2020), states “despite consistent evidence as to SARS-CoV-2 contamination of surfaces and the survival of the virus on certain surfaces, there are no specific reports which have directly demonstrated fomite transmission. And although the WHO report emphasises the role of asymptomatic and presymptomatic transmission of covid-19, it states that according to a few studies, 0% to 2.2% of people with asymptomatic infection infected anyone else. Hand hygiene mitigates most of that risk. 

According to the Department of Health environment and sustainability manual, if aprons and gloves are not mixed with other waste (often the case in clinical practice), they should be disposed of in orange waste bags to be incinerated or undergo “alternative treatment” (chemical or heat disinfection). Incinerators release an average of 1 tonne of CO2 for every tonne of waste.

As healthcare workers we should avoid measures aimed at mitigating the pandemic which are of no significant benefit and which increase the environmental damage caused by single-use plastics. The environmental damage caused by dealing with the pandemic has already been recognised. The NHS could continue to be at the forefront of efforts to contain covid-19 in a more environmentally friendly manner. Work has begun to reduce the environmental impact of NHS PPE, such as trialling reusable face masks

By incorporating evidence-based medicine and common sense, we could reduce our plastic waste while continuing to work in a safe environment and help to make the NHS ambition of achieving net zero emissions by 2040 a reality. It is one we must achieve if we are to address the global climate change and ecological emergencies.

Fareed Shiva is a consultant in genitourinary medicine and HIV. He is currently working at St Mary’s Hospital, London.
Arturo Castillo Castillo is research fellow in Resource Efficiency at Imperial College London where he leads the Ocean Plastic Solutions Network aiming to stop plastic pollution.
Benjamin Black is a specialist adviser in sexual and reproductive health for humanitarian contexts working with national, international, and humanitarian organisations. He is also an obstetrician and gynaecologist at the Whittington Hospital, London. Twitter @benjamblack