Since COVID-19 was declared a public health emergency of international concern by the World Health Organization (WHO) on January 30, 2020, more than three million COVID-19 confirmed cases had been reported in 215 countries with more than two hundred thousand confirmed deaths as of May 02, 2020. Although most countries, including Canada and the US, have closed their borders to non-essential travel, confirmed cases and deaths are still increasing likely due to community transmission and increased capacity for testing. To reduce the spread of COVID-19 from human-to-human, the WHO and other national disease control centers (e.g., US Centers for Disease Control and Prevention) have issued various guidelines, including social distancing, frequent handwashing, and practicing proper respiratory etiquette, such as coughing and sneezing into a flexed elbow. The use of personal protective equipment (PPE) such as medical gloves, facemasks, and aprons has been recommended for essential service workers (e.g., doctors, nurses, caregivers, etc.) and other people handling patients infected with COVID-19. More and more countries are recommending that the people wear facemasks when going to public places. Because of these recommendations, millions of PPE are manufactured and used daily during the pandemic. The number of PPE (e.g., facemasks) used daily in Africa is estimated to reach seven hundred million (see Table 1 ), as several African states (e.g., Ghana, Nigeria, South Africa) with confirmed COVID-19 cases have mandated compulsory facemask use for their citizens. Table 1 Estimated daily facemask use in some African states with confirmed COVID-19 cases Table 1: Country *Population *COVID-19 Cases *Urban Population (%) ⁎⁎Facemasks Acceptance rate (%) ⁎⁎Average Daily Facemasks per Capita Total Daily Facemasks South Africa 59,308,690 5,951 67 80 2 63,578,916 Egypt 102,334,404 5,895 43 80 2 70,406,070 Morocco 36,910,560 4,569 64 80 2 37,796,413 Algeria 43,851,044 4,154 73 80 2 51,218,019 Nigeria 206,139,589 2170 52 80 2 171,508,138 Ghana 31,072,940 2,074 57 80 2 28,338,521 Cameroon 26,545,863 1,832 56 80 2 23,785,093 Guinea 13,132,795 1,537 39 80 2 8,194,864 Ivory Coast 26,378,274 1,333 51 80 2 21,524,672 Djibouti 988,000 1,097 79 80 2 1,248,832 Senegal 16,743,927 1,024 49 80 2 13,127,239 Tunisia 11,818,619 998 70 80 2 13,236,853 Niger 24,206,644 728 17 80 2 6,584,207 Burkina Faso 20,903,273 649 31 80 2 10,368,023 DR Congo 89,561,403 604 46 80 2 65,917,193 Total daily facemasks = population x urban population (%) x facemask acceptance rate (%) x average daily facemasks per capita / 10000 ⁎ Data retrieved on May 02, 2020 from: https://www.worldometers.info ⁎⁎ Arbitrary data Millions of contaminated PPEs (e.g., facemasks and gloves) would end up as wastes, which, if improperly managed, can pose environmental and health threats, especially as a recent study (Kampf et al., 2020) finds that the coronavirus can survive on material surfaces (e.g., metals, glass, and plastics) for up to 9 days. Such threats may be ameliorated in developed countries where green and sustainable waste management strategies, capable of containing such viruses, are practiced. However, the threats would be much higher in developing countries that have poor waste management strategies. In many developing countries, solid wastes are dumped in the open and in poorly managed landfills where waste pickers without wearing proper PPE would scavenge for recyclable materials (World Bank, 2019). Such landfills also serve as a “food bank” for livestock such as dogs and goats, which can roam about in developing countries such as Nigeria. Such acts may expose humans and livestock to diseases (including COVID-19), exacerbating their spread. It was reported that following the interment of a COVID-19 patient at the Gudu Cemetery in Abuja (Nigeria), a Mortician dumped his disposable safety coverall in a public space; the Public Health Department in Nigeria had to intervene to decontaminate the space (Ebeleke, 2020). This is another example where improper management of contaminated PPEs may increase the spread of viral disease. Improper disposal or disinfection of plastic bottles used for packaging drinks and water sold in many developing countries, including in healthcare facilities and isolation centers, may be another potential source of viral disease spread in those countries. Used bottles may be contaminated with the virus (Butot et al., 2007). However, disposed/used bottles are often sourced and reused to package locally made drinks and herbal medicines that are sold across such countries. Such reuse of contaminated plastic bottles would certainly increase the spread of viral diseases. Although the governments of many developing countries are taking active measures to contain and reduce the spread of COVID-19, strategies to manage solid wastes, including used PPE, during and after the COVID-19 pandemic, are lacking. The government could adopt the strategies developed by the Lagos State Waste Management Authority, where proactive measures are taken to restrict access of waste pickers to its landfills. Special waste collection buckets to collect disposable PPEs could be provided in buildings (residential, government and hospitals) and in public places. Such waste collection buckets could be emptied, at least daily, by trained personnel who would then decontaminate or dispose the PPE following Nigeria Centre for Disease Control (NCDC) guidelines. Used plastic bottles could be decontaminated with a 70% alcohol solution, as per NCDC guidelines, before reuse in packaging local drinks and herbal medicines. There are other potential pathways where improper management of used PPEs can pose a significant risk for increasing the transmission of COVID-19. We thus call on the scientific community to voice their concerns to governments at various levels on the need to develop proper strategies for managing solid wastes, such as used PPEs, to curb the spread of the novel coronavirus. Uncited References: Nigeria Centre for Disease Control 2020 CRediT authorship contribution statement Christopher Nzediegwu: . Scott X. Chang: Writing - review & editing.
