COLUMBIA — With limited data and ever-changing guidance about the novel coronavirus and its threats, South Carolina’s health care industry is left to make its own decisions about how to handle waste created by the pandemic.
Some have decided to take extra precautions, while others are sticking to federal standards.
Thirty years ago, Congress allowed a little-known law monitoring the disposal and transportation of medical waste to lapse, instead putting the onus on state regulators to hash out their own management systems.
During the coronavirus outbreak, federal health officials have advised that waste, including protective gear and medical tools, doesn't have to be treated any differently than usual.
But that's burdensome, because there's already a complex waste stream coming out of hospitals.
South Carolina's Department of Health and Environmental Control doesn’t have a tally of how much coronavirus-related infectious waste has been created, since federal guidelines don’t recommend any special handling procedures.
But industry leaders and at least one large state hospital say “overclassifying” waste derived from the coronavirus is becoming routine, given the disease’s long incubation period and ability to live on surfaces for extended periods of time.
That means where typically a set of gloves or a gown would be tossed into the regular disposal stream, items contaminated by the coronavirus find their way into “red bags” designed for biohazardous substances, and that changes how it’s disposed of.
Rather than being jettisoned to a landfill, red-bag waste materials are incinerated or blasted with high-pressure steam through a process known as autoclaving. Once waste is "red bagged," it's considered biohazardous, and can be up to 10 times more expensive to handle and treat than trash that ends up in the everyday garbage stream, according to Practice Greenhealth, a Virginia-based health care sustainability group.
“Within hospitals and the waste stream, this is not a qualitative change, but it is an increased amount of attention, and that probably will bring some increase in the red-bag waste that you previously would not have been putting in there,” said Peter Orris, chief of occupational and environmental medicine at the University of Illinois at Chicago Hospital and Health Sciences System.
Roper St. Francis Hospital in Charleston has taken those additional steps, spokesman Andy Lyons said.
“The volume has picked up, because we made the decision to treat our personal protective equipment as medical infectious waste,” he said.
Instead of three removal runs a week, Roper is up to five. The Medical University of South Carolina is also treating all of its COVID-19 related trash as medical infectious waste, going beyond the CDC's advice.
Within the medical waste disposal field, Stericycle is a household name. The firm handles many of South Carolina’s largest providers, including Prisma Health and MUSC regional sites.
Selin Hoboy, vice president of government affairs and compliance for the Illinois-based company, said in a March call with investors that coronavirus poses unique challenges.
"Having been in the medical waste field for over 20 years and having experienced managing the situation during Ebola in 2014, I've never seen anything to this magnitude," she said.
That Ebola outbreak gave the medical waste disposal industry a glimpse of what could happen should a pandemic spread across the country. A deadly virus that affects blood clotting, Ebola originated in the West African nation of Guinea, ultimately killing 11,325 people between 2014 and 2016 with a mortality rate of more than 50 percent.
Ebola was a bloodier and messier disease. Standards called for special handling of the trash the epidemic created.
In this year's coronavirus pandemic, protective equipment and other kinds of solid waste comprise much of the uptick in demand that Stericycle has been seeing, but handling that refuse doesn't require extraordinary care.
Although the discarded gloves, gowns, face shields and other personal protective equipment that has become a familiar sight can be eliminated through the traditional refuse stream, many providers are taking extra steps to treat COVID-19-tainted materials as medical waste. That means using specialized packaging, treatment and disposal methods.
That added care isn't impacting system capacity, however.
“While facilities have been generating more waste in terms of increased use of personal protective equipment, they have also seen a significant decrease in medical waste from the reduction in volume of routine surgeries and procedures that were suspended to increase bed availability in the state,” S.C. Hospital Association spokesman Schipp Ames said.
Like several hospitals here, Stericycle also put in place extra steps to protect its drivers and plant workers. Facilities are asked to put waste from care of COVID-19 patients in a cardboard box marked with a letter “C,” for example.
While Ebola was detected in just 11 U.S. citizens (it killed one person), Anne Germain knew there were lessons to be learned — and they’ve now been put into action as the coronavirus has changed the American landscape.
“We had kind of a dry run as an industry with Ebola. We weren’t sure how bad it was going to be, we wanted to be prepared as an industry. We wanted to make sure we were going to be able to pivot depending on what the issues were,” said Germain, vice president of technical and regulatory affairs for the National Waste and Recycling Association.
Gov. Henry McMaster on March 17 recommended a halt on elective medical procedures, which has helped free up beds and kept waste volumes down, officials said. The recommendation was reversed last month.
Germain said members of her organization began asking questions about the handling of coronavirus-related medical waste in February, including disposal of disinfectant wipes, tissues and other products.
Although more personal protective equipment is finding its way into the medical waste stream, much of it is lightweight and doesn’t threaten tonnage requirements set out by regulators, Germain said.
“It’s a volume business, because there’s only so much you can kind of fit into the incinerators,” she said.
“We have not heard of any of our members saying anything about there being capacity issues.”
Mary Katherine Wildeman contributed reporting.