INSIGHT: What Do We Do With Covid-19 Waste?

As our nation responds to Covid-19, many ask: What happens to the waste? How is it regulated?

Medical waste, also known as biohazardous or infectious waste, is waste that has a potential to cause infection during handling and disposal. It is contaminated with blood, bodily fluids, or other potentially infectious materials (OPIM). Medical waste generated from Covid-19 includes contaminated personal protective equipment (PPE) such as masks and gloves, sharps, laboratory waste, and pathological waste.

Medical waste management in light of Covid-19 has remained largely unchanged at the federal level, with additional flexibilities across many states.

Medical waste is regulated by a mix of federal and state agencies. Since nearly every state has issued statements about regulatory flexibility, regulated entities throughout the medical waste chain—from health-care facility generators to transporters to treatment facilities and landfills, should not hesitate to request flexibility from their regulators as needed.

Requesting such flexibility in advance, and confirming any specific demonstrations or documentation requirements, will help the entity minimize enforcement risk as it best manages Covid-19 waste.

Federal Guidance Designates Covid-19 as Category B

At the federal level, Occupational Safety and Health Administration (OSHA) and the Centers for Disease Control and Prevention (CDC) have released guidance specific to Covid-19 waste. OSHA regulates the safe handling of medical waste. OSHA requirements address the management of sharps, containers that hold medical waste and labeling of those containers, and employee training. The CDC provides guidance on infectious substances.

OSHA guidance for Covid-19 waste management is based on the CDC’s determination that the Covid-19 virus is a Category B infectious substance. As a Category B waste, medical waste generated in the treatment of Covid-19 patients and patients under investigation should be managed in accordance with routine procedures—those that currently exist apply across the board to all Category B infectious substances.

The CDC guidance also states that laboratory waste from testing suspected or confirmed Covid-19 patient specimens should be managed as medical waste. No additional packaging or disinfection procedures are necessary.

The OSHA guidance addresses medical waste, as well as municipal waste from business and households where there is potential Covid-19 exposure, recycling, and wastewater treatment. Workers should follow safe work practices and engineering and administrative controls, as well as wear PPE such as puncture-resistant gloves, face masks, and eye protection. In general, the protections employers should implement are to be based on the level of exposure of its workers.

The Department of Transportation (DOT) issued a notice clarifying that shipping papers may be exchanged by using social distancing (leaving a clipboard on a table) or electronically, and shipper certifications may be transmitted electronically, including through text message. The DOT regulates the packaging and transportation of medical waste, such as from a hospital to a medical waste treatment facility, like an incinerator or autoclave. Medical waste is regulated as a hazardous material under the DOT’s Hazardous Materials Regulations (HMR), and these regulations apply to the transporter of the waste.

States Diverge on Covid-19 Waste Guidance

State regulations address on-site management of medical waste, including packaging and storage, transportation, treatment of medical waste to render it noninfectious, and disposal. States also impose permitting, tracking, reporting, and recordkeeping requirements for medical waste.

California and New York, for example, issued guidance specific to Covid-19 medical waste. Both states’ guidance specifies that waste contaminated with SARS-CoV-2 should be treated in accord with routine procedures for Category B infectious waste. New York specifies that laundry and food service waste should also be managed in accord with routine procedures.

States have taken divergent approaches to PPE waste. Some states, like Idaho, require all PPE from health-care facilities to be managed as medical waste, regardless of contamination or potential for infection.

In other states, it depends on whether there is Covid-19 contact. Some states require, and others recommend as a best practice, that PPE from a business with confirmed Covid-19 contact be managed as medical waste. Given the divergent state positions on PPE waste, it is best to confirm requirements in your state and with your waste management providers, or over-manage PPE as medical waste.

Some best practices for waste from businesses and households include double-bagging and tying waste, storing it an inaccessible location until pickup, and identifying potentially contaminated Covid-19 waste so that it can be managed with due care. Local health departments and municipalities may impose additional requirements, and it is best to confirm whether such requirements apply.

States Exercise Enforcement Discretion

Many states have released guidance addressing waste management, and most states are exercising enforcement flexibility. States such as Kentucky, Vermont, and West Virginia have issued guidance explicitly allowing solid waste facilities to extend days and hours of operations to deal with increasing volumes of waste and changes in the workforce and allowing storage of additional tonnage and volume.

Other states, like Alabama, Arkansas, Connecticut, Florida, and New Jersey, have stated that they will make these concessions case by case. New York, like many other states, is exercising enforcement discretion by waiving the requirements for signatures on various waste-shipping documents during New York’s state of emergency declaration, which is in effect until Sept. 23.

This column does not necessarily reflect the opinion of The Bureau of National Affairs, Inc. or its owners.

Author Information

Elise Paeffgen is a partner at Alston & Bird and a member of the firm’s Coronavirus (COVID-19) Task Force. She works with health-care facilities, pharmaceutical companies, distributors, and retailers on issues ranging from air, waste, and water permitting; management of pharmaceutical and hazardous waste; and disposal of controlled substances and medical waste.