Re: Covid-19 and net zero for health. Healthcare should not cost us the Earth
Dear Editor,
It is certainly admirable that the NHS has announced, in the midst of the COVID-19 pandemic, its ambition to become the world's first net zero health service before 2050. Although the pandemic has given us opportunities to reduce our carbon footprint such as walking or cycling to work and the advent of telemedicine [8], I would like to highlight the hidden environmental challenges this has placed on the health service.
One cannot overlook the vast quantities of personal protective equipment now required in excess of pre-COVID-19 levels. The European Centre for Disease Prevention and Control estimated that the health service requires 14-24 separate sets of PPE per day for each confirmed coronavirus case in hospital, depending on whether symptoms are mild or severe [1]. The World Health Organisation estimated some 89 million medical masks, 76 million examination gloves and 1.6 million pairs of goggles would be required worldwide in response to the pandemic each month. These figures are a stark reminder of our plastic waste, something which is likely to increase as the pandemic continues. Owing to globalisation, the majority of our PPE is imported from China [2] and not sourced locally, unnecessarily increasing the overall carbon footprint of commonly used items.
To add insult to injury, recycling systems in place for non-contaminated waste are now largely obsolete due to potential COVID-contamination in many cases. A system wide recycling policy is urgently required to identify where we can be reducing waste to landfill or incineration [3]. Furthermore, the NHS estimated that 5% of the total carbon footprint of an acute NHS organisation was attributable to anaesthetic gases [4] and with increasing number of patients needing hospitalisation and critical care for COVID-19 this is likely to increase.
At a time where there is set to be increased pressure on the healthcare service to meet demands whilst under increasing austerity it is important we do not take financial shortcuts for less environmentally sustainable options. There are many studies assessing the cost-benefit analysis of treatments and surgical interventions, but very few quantifying their carbon footprint. Studies in the USA have begun to unpick the environmental impact of procedures [4], but more studies are urgently needed so that going forward health care decisions can be balanced between being cost effective and carbon neutral.
References
1. https://www.ecdc.europa.eu/sites/default/files/documents/RRA-seventh-upd.... Coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK—seventh update. 25 Mar 2020. 2020.
2. Feinmann, J., PPE: what now for the global supply chain? BMJ, 2020. 369: p. m1910.
3. Tudor, T.L., et al., Realising resource efficiency in the management of healthcare waste from the Cornwall National Health Service (NHS) in the UK. Waste Manag, 2008. 28(7): p. 1209-18.
4. Thiel, C.L., et al., Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States. Environ Sci Technol, 2015. 49(3): p. 1779-86.
Competing interests:
No competing interests
16 October 2020
Ruth Bennett
Plastic Surgery ST3
Jane Maraka
University Hospital of North Durham, North Road, Durham, DH1 5TW
Rapid Response:
Re: Covid-19 and net zero for health. Healthcare should not cost us the Earth
Dear Editor,
It is certainly admirable that the NHS has announced, in the midst of the COVID-19 pandemic, its ambition to become the world's first net zero health service before 2050. Although the pandemic has given us opportunities to reduce our carbon footprint such as walking or cycling to work and the advent of telemedicine [8], I would like to highlight the hidden environmental challenges this has placed on the health service.
One cannot overlook the vast quantities of personal protective equipment now required in excess of pre-COVID-19 levels. The European Centre for Disease Prevention and Control estimated that the health service requires 14-24 separate sets of PPE per day for each confirmed coronavirus case in hospital, depending on whether symptoms are mild or severe [1]. The World Health Organisation estimated some 89 million medical masks, 76 million examination gloves and 1.6 million pairs of goggles would be required worldwide in response to the pandemic each month. These figures are a stark reminder of our plastic waste, something which is likely to increase as the pandemic continues. Owing to globalisation, the majority of our PPE is imported from China [2] and not sourced locally, unnecessarily increasing the overall carbon footprint of commonly used items.
To add insult to injury, recycling systems in place for non-contaminated waste are now largely obsolete due to potential COVID-contamination in many cases. A system wide recycling policy is urgently required to identify where we can be reducing waste to landfill or incineration [3]. Furthermore, the NHS estimated that 5% of the total carbon footprint of an acute NHS organisation was attributable to anaesthetic gases [4] and with increasing number of patients needing hospitalisation and critical care for COVID-19 this is likely to increase.
At a time where there is set to be increased pressure on the healthcare service to meet demands whilst under increasing austerity it is important we do not take financial shortcuts for less environmentally sustainable options. There are many studies assessing the cost-benefit analysis of treatments and surgical interventions, but very few quantifying their carbon footprint. Studies in the USA have begun to unpick the environmental impact of procedures [4], but more studies are urgently needed so that going forward health care decisions can be balanced between being cost effective and carbon neutral.
References
1. https://www.ecdc.europa.eu/sites/default/files/documents/RRA-seventh-upd.... Coronavirus disease 2019 (COVID-19) pandemic: increased transmission in the EU/EEA and the UK—seventh update. 25 Mar 2020. 2020.
2. Feinmann, J., PPE: what now for the global supply chain? BMJ, 2020. 369: p. m1910.
3. Tudor, T.L., et al., Realising resource efficiency in the management of healthcare waste from the Cornwall National Health Service (NHS) in the UK. Waste Manag, 2008. 28(7): p. 1209-18.
4. Thiel, C.L., et al., Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States. Environ Sci Technol, 2015. 49(3): p. 1779-86.
Competing interests: No competing interests