“Fossil fuel combustion is a major contributor to air pollution-related deaths, which kill more than four million people around the world every year. More than tuberculosis, more than malaria, and more than AIDS combined,” Gary Cohen, president and co-founder of Health Care Without Harm (HCWH), told MedPage Today in November 2021. He added that pollution generated by the healthcare sector, has links to cancer, birth defects, neurological problems, and many other health issues.

Said Cohen, “75% of it is in the supply chain. The biggest share is in the stuff they buy. So it’s in the petro plastics, in the anesthetic gases, in the food. It’s in single-use devices that get thrown away. It’s in pharmaceuticals,” he said.

The industry’s rampant use of plastic and single use products, and the waste generated grew much worse during the COVID-19 pandemic. U.S. healthcare facilities generate approximately 14,000 tons of waste per day, most of which is  disposed of in landfills or by incineration, according to the Healthcare Plastics Recycling Council. Medical waste results in carbon dioxide and other greenhouse gas emissions that stay in the earth’s atmosphere for tens to hundreds of years, warming the climate and impacting present and future generations.

The volume grew explosively during the COVID-19 pandemic however with extra waste composed of PPE and COVID-19 testing and vaccination supplies, according to the World Health Organization. That has placed an extraordinary burden on waste management systems globally and is endangering entire communities located near poorly managed landfills and waste disposal sites based on contaminated air, poor water quality and disease-carrying pests. 

The WHO urged healthcare facilities to incorporate safer and more environmentally sustainable waste management practices into their pandemic response to protect human and environmental health. It highlighted the need for investment in non-burn waste treatment technologies, a focus on eco-friendly packaging and shipping, the adoption of safe and reusable PPE, and use of recyclable or biodegradable materials. 

Ten years ago Health Care Without Harm started working with the WHO to bring more of a focus on the healthcare sector’s role in battling climate change.  HCWH and its Global Green and Healthy Hospitals Network, 137 institutions it says represents more than 10,000 hospitals and health centers in 33 countries, delivered a Call to Action to the World Health Organization in 2017,  calling on the industry to implement renewable energy, clean transportation, green building and sustainable procurement strategies.

“Healthcare infrastructure should anchor resilience within their communities, Cohen said. “Understanding supply chains, designing for the climate disasters, that’s a crucial piece of what they need to do to anchor.” 

Disposable PPE Supply Chains Crumble: The 2020 Timeline

Jan. 21 – As word of the earliest cases of the novel coronavirus was coming out of China, Cardinal Health issued an Urgent Medical Device Recall of 9.1 million disposable Level 3 surgical gowns produced by an Chinese contractor not registered with the FDA. The subcontractor’s factory left surgical gowns exposed to air particulate and other contaminants.

Dublin, Ohio-based Cardinal, ranked number 14 in the Fortune 500, warned the gowns were potentially contaminated, increasing the risk of spreading infections to patients during surgery.

Jan. 31 – By the end of January, the company also recalled 2.5 million of its Presource Procedure Packs containing the potentially contaminated surgical gowns, all manufactured between Sept. 1, 2018, and Jan. 10, 2020.

The recalls affected 2,897 hospitals, surgery centers and other facilities, mostly in the U.S., and created a sudden shortage that left some healthcare providers scrambling for supplies and rescheduling surgeries. 

Mar. 11 – The FDA issued a letter to healthcare providers warning that the demand for commonly used PPE items might outpace supply in the U.S. and offering surgical mask and gown conservation strategies, including reusing disposable gowns. Reusing disposable gowns, prone to tearing, wasn’t a viable solution for many providers.

Mar. 26 – Nurses at Mount Sinai West in Manhattan, out of gowns and wearing Hefty bags, were famously pictured on the front page of The New York Post.  Social media posts of the picture carried the caption, “NO MORE GOWNS IN THE WHOLE HOSPITAL” and “NURSES FIGURING IT OUT DURING THE COVID-19 CRISIS.”  Caregivers in other hospitals followed suit. Healthcare workers protested the lack of  adequate supplies of masks, gowns and gloves, at the time their main line of defense against COVID. U.S. doctors created a volunteer organization called #GetUsPPE to marshal donations and make bulk purchases.

Smaller and rural providers that couldn’t compete with large health systems for supplies were especially hurt, as were nursing homes, prisons and some medical practices that shuttered due to lack of PPE.

Prices for isolation gowns used by skilled nursing and assisted living facilities rose by as much as 2000%, according to researchers at the Society for Healthcare Organization Procurement Professionals (SHOPP).

April 17 – Competition over limited single-use supplies during the COVID-19 pandemic drove prices up to dizzying heights. The Society for Healthcare Organization Procurement Professionals (SHOPP) reported to a 2000% price increase for isolation gowns, from $0.25 pre-COVID to $5 per gown in April.

Nov. 5 – ECRI issued a high-priority hazard alert to warn U.S. healthcare providers that more than half of the 34 models of disposable isolation gowns it tested failed to meet even AAMI’s lowest level for protection, putting healthcare workers at risk for blood and fluid exposure.

ECRI, an independent patient safety organization that conducts its own testing, also found that 50% of the tested gowns that claimed AAMI-level protection of disposable gowns did not meet AAMI’s PB70 standard, a system for the evaluation and classification of liquid barrier performance.