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Review 1: "Environmental Impact of Personal Protective Equipment Supplied to Health and Social Care Services in England in the First Six Months of the COVID-19 Pandemic"

Published onMar 31, 2022
Review 1: "Environmental Impact of Personal Protective Equipment Supplied to Health and Social Care Services in England in the First Six Months of the COVID-19 Pandemic"
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key-enterThis Pub is a Review of
Environmental impact of Personal Protective Equipment supplied to health and social care services in England in the first six months of the COVID-19 pandemic
Description

ABSTRACTObjectivesUse of Personal Protective Equipment (PPE) has been central to controlling spread of SARS-CoV2. This study aims to quantify the environmental impact of this, and to model strategies for its reduction.MethodsLife cycle assessment was used to determine environmental impacts of PPE supplied to health and social care in England during the first six months of the COVID-19 pandemic. The base scenario assumed all products were single-use, air freighted, and disposed via clinical waste. Scenario modelling was used to determine the effect of 1) switching mode of, or eliminating, international travel during supply, 2) reducing glove use 3) using reusable alternatives, 4) maximal recycling.ResultsThe carbon footprint of PPE supplied during the study period totalled 158,838 tonnes CO2e, with greatest contributions from gloves, aprons, face shields, and Type IIR surgical masks. The estimated damage to human health was 314 DALYs (disability adjusted life years), impact on ecosystems was 0.67 species.year (loss of local species per year), and impact on resource depletion costing US $ 20.4 million.Scenario modelling indicated one-third of the carbon footprint could be avoided through switching to shipping, and by 41% through manufacturing PPE in the UK. The carbon footprint was reduced by 83% compared with the base scenario through a combination of UK manufacturing, reducing glove use, using reusable gowns and reuse of face shields, and maximal recycling, estimated to save 259 DALYS, 0.54 species.year, and US $ 15 million due to resource depletion.ConclusionsThe environmental impact of PPE could be reduced through shipping supplies or domestic manufacture, rationalising glove use, using reusables where possible, and optimising waste management.SUMMARY BOXWhat is already known on this topicThe current COVID-19 pandemic has seen a massive global increase in the use and manufacture of PPE which has contributed, with other measures, to the reduction in transmission of the virus in many countries.What this study addsThe carbon footprint of PPE supplied to health and social care in England in the first six months of the COVD-19 pandemic was 158,848 tonnes CO2e, equivalent to around 65,500 return flights from London to New York.The environmental impact of PPE could be reduced through shipping supplies or domestic manufacture, rationalising glove use, using reusables where possible, and optimising waste processing.

RR:C19 Evidence Scale rating by reviewer:

  • Strong. The main study claims are very well-justified by the data and analytic methods used. There is little room for doubt that the study produced has very similar results and conclusions as compared with the hypothetical ideal study. The study’s main claims should be considered conclusive and actionable without reservation.

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Review:

The authors tried to quantify the environmental impact of PPE supplied to health and social care services in England through life cycle assessment and present the outcomes of scenario modelling for mitigation strategies. The topic is interesting and timely, and could be a valuable addition to the Journal for a wider readership and certainly useful for policy implication.

But, I think, the current form of the manuscript is lack of critical thinking in regards to modelling scenario and have missed a few points to include in, especially for glove use.

1. The model for reducing glove use by REPLACING USE OF GLOVES- this is quite vague to model despite various types of disposal gloves availability including Nitrile, Vinyl, Latex, and Polythene gloves. And its not very clear why the authors include only Nytril gloves without explaining the details about other types of gloves use, especially during the Covid-19 outbreak.

2. It would be better to model for reducing glove use by using other types of glass, certainly, those are the least impactful to the environment.

3. Authors have modelled the impact of using reusable gowns and reusing face shields. While reusing face shield certainly makes sense and are widely adopted procedure, but using reusable gowns are not well explained in the method. The confusion is, what types of reusable gowns were used for the LCA weather it includes full body protection similar to single-use gowns which cover almost full body including the head and toe. If not, then it needs to be explained in the methods section clearly.

4. Modelling of maximal recycling of products, assuming it was possible to recycle all items and their components. This part also needs detailed explanations rather than using an open-loop ‘recycled content method’ because clinical waste is treated very differently than other types of municipal solid waste. However, the authors have discussed these points in detail in the Opportunities to mitigate the environmental harm of PPE section but, still, in the LCA methodology, it can be addressed through different modelling such as clinical through waste incineration or Autoclaving, a heat-based treatment method, etc.

5. In the result section, maximal recycling reduced the carbon footprint of PPE by 35% (saving 37,266 tonnes CO2e), this needs to be explained in detail.

6. Opting for reusable gowns and reusing face masks could have saved 11,107 tonnes of CO2e over the study period (10% of the total for all PPE supplied). Opting for reusable gowns is not clear based on the methodology, it needs to be rechecked.

7. For reuse, the environmental impact of one use of a reusable gown was lower than that of a single-use gown across 16/18 environmental midpoint impact categories. In this part, detailed explanations about the single-use gown gowns are required for a better understanding.


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