Coronavirus disease (covid-19) and public health issues in developing countries-focus on biomedical waste management

India as a 2nd largest populous country with a high population density with lack of awareness, burden of neglected tropical diseases and a rising prevalence of non communicable diseases, have overburdened health infrastructure. In such conditions Covid-19 pandemic is stretching the health system to its limit. Most of population is a daily wager; unawareness is there already for many basic habits. There is poor access to safe food availability, safe water and sanitation, poor food storage facility or access to processed foods , affordability of processed foods and necessity supply chain are lacking. All such aspects have a public health importance. Meanwhile to protect the community from the covid infection has led to an increase in the Biomedical Waste (BMW) production for which no separate guideline is formulated as the WHO guidelines for waste management suffi ce to manage covid related waste too. The segregation of COVID waste as per requirements of Schedule I of the BMW Management Rules 2016 with some additional safety criteria is suffi cient to handle the waste. The waste generated at hospital and quarantine camps or houses if handled according to the guidelines then the problem can be steadily tackled with minimum problems.This pandemic Covid-19 disease can be used as a tool to educate the population. “Empowering masses about modes of transmission, debunking myths, associated risks and preventive strategies” and this will be is a cost effective key instrument not only for Covid 19 but also for other infectious disease. Review Article Coronavirus disease (covid-19) and public health issues in developing countries-focus on biomedical waste management Kuljeet Singh Anand1*, Bhuwan Sharma1, Rakesh Kumar Mahajan1, Sanjeet Panesar2 and Prachi Dubey3 1Departments of Neurology, Biomedical Waste Division, Atal Bihari Vajpayee Institute of Medical Sciences (Formerly PGIMER) &Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi-110001, India 2Medicine, Atal Bihari Vajpayee Institute of Medical Sciences (Formerly PGIMER) &Dr Ram Manohar Lohia Hospital, Guru Gobind Singh Indraprastha University, New Delhi-110001, India 3Department of Medicine, Pandit Jawahar Lal Nehru Memorial Medical College, Raipur, India Received: 21 September, 2020 Accepted: 31 October, 2020 Published: 02 November, 2020 *Corresponding author: Kuljeet Singh Anand, Professor, Neurology, Atal Bihari Vajpayee Institute of Medical Sciences (Formerly PGIMER) & Dr Rml Hospital, Guru Gobind Singh Indraprastha University, New Delhi -110001, India, Tel: 9810495019; E-mail:


Introduction
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), was fi rst identifi ed in December 2019 in Wuhan city, China, and later spread to many provinces in China [1]. On January 30th, 2020, the WHO declared COVID-19 a public health emergency of international concern [2]. The fi rst SARS-CoV-2 positive case in India was reported in the state of Kerala on January 30th, 2020. Initially cases were rising slowly and it took 110 days to reach 100,000 marks, but subsequently it grows exponentially and now 60000-70000 cases are reported daily, with more than 7 million total cases. India has reached in second position in list of countries with highest number of cases, behind only to USA [3]. In India there are only 0.53 hospital beds per 1000 population [4] and with such speed of Covid 19 cases can easily tear down the Indian health infrastructure. The Covid 19 is affecting the population not only by the disease itself but also by creating other public health issues. Even the developed nations with high Global Health Security Index (GHSI) are badly hit.The catastrophic capability of this infectious disease was grossly underestimated in the developed countries such as the USA and many countries in Europe and they paid heavy price for this imprudence in the form of a very rapid surge in disease transmission and high fatality. Developing countries are already facing the brunt of inadequate resources of health care, poor Citation: Anand  Thus the pandemic Covid-19 disease is acting as a double edged sword. In situation like this "Empowering masses about modes of transmission, debunking myths, associated risks and preventive strategies" is a cost effective key instrument that should be widely and judiciously used amidst scarcity of resources.

Biomedical waste management in covid time
The appalling increase in the number of people/regions/ countries infected with SARS-CoV-2 coupled with exponential increase in generation of bio medical waste from covid patients has indicated that the world may be overrun by COVID-waste and the outcome of this plenitude will have a deep impact on sustainable waste management practices in the coming years [6]. The resilience of our society and waste management practices are under scientifi c scrutiny with the contrasting reports of stability of SARS-CoV-2 on various surfaces [7].
The traces of this virus has been observed on plastics for 6.8 h, stainless steel for 5.6 h [8], and the outer layer of surgical mask up to 7 days [9]. It clearly indicates that COVID-waste (like needles and syringes used for blood samples, surgical facemasks, and PPE) can have a longer persistence of SARS-CoV-2. Virus transmissions from the contaminated dry surfaces have also been postulated including self inoculation of mucous membranes of the eyes, nose, and mouth [10]. The exposure to COVID-waste may potentially increase the virus spread by increasing the reproductive number (R0) from its determined range between 2.2 and 3.58 [11,12]. The major route of SARS-CoV-2 transmission is splatters or splashes liberated during breathing, coughing, sneezing etc. of an infected person. The improper management of COVID-waste would expose common people and healthcare workers in danger of infection spread.
Thus, effective management of COVID-waste including the appropriate disinfection and disposal techniques would be absolute necessity to control the pandemic spread.

Quarantine camps/Homes or Home-care facilities for Covid 19
Biomedical waste if any generated from quarantine centres/camps is to be collected separately in yellow coloured bags (suitable for biomedical waste collection) provided by the urban local bodies (ULBs). These bags could be handed over to

India's action in Covid 19
In this pandemic, India's approach was fast as well as aggressive. For this, it has already received accolades from Dr.
Henk Bekedam, the WHO's representative in India [15]. Other At present, social distancing has proven to be effective, but prolonging the lockdown can also increase poverty, mental illness and social inequality at individual level, and can affect the country's economy in long term which may have indirect effect of health and infrastructure as well as the population in a feedback manner. Furthermore, public health systems are under severe pressure as the COVID-19 pandemic continues and the government is unable to deal with other diseases, resulting in future long-term health concerns.