Table 1.
Effects of coronavirus disease 2019 (COVID-19) on environmental anaesthesiology. PPE, personal protective equipment.
| Negative environmental effects of COVID-19 | Positive environmental effects of COVID-19 |
|---|---|
| Behaviour | |
| Maximal effort and resources to combat COVID-19, regardless of environmental costs Fear-based excessive consumption, even as evidence became available to the contrary |
Greater awareness of need for and efforts to conserve resources Innovation on safe extended/reuse of some medical devices (notably PPE) |
| Patient care | |
| Initially, high intubation and critical care rates for COVID-19 patients, leading to increased consumption of single-use disposable supplies and anaesthetic drugs, with associated environmental emissions | Avoiding intubation with greater reliance on noninvasive ventilation, and high-flow O2 is often better for patients and preserves resources Use of dexamethasone reduces length of/need for critical care |
| Virtual telehealth visits and meetings | |
| Increased technological and energy requirements Decreased access for low-income patients and family Ongoing need for pre-admission investigations (virology swabs, blood, and imaging) |
Reduced travel with reduced emissions and more time for other activities/improved quality of life for patients and staff7 Increased access to (specialist) care for those in rural communities and with impaired mobility Social investments to distribute electronics and internet access, and improve access to health services |
| Postponed non-emergency surgery | |
| Impaired quality of life (untreated cancer, pain, and mobility impairments), psychosocial impacts (anxiety/depression), and financial strains (lost vocational activity) | Fewer elective cases caused some patients to question need for/cancel elective surgery altogether, reducing procedure environmental emissions A new focus on preventive medicine (diet, exercise, and stress reduction) rather than surgical cure may improve health and wellness |
| COVID-19 PPE | |
| Dramatic increase in consumption of PPE and increased solid waste generation Increasing demand for negative-pressure rooms with higher air exchange rates compared with standard rooms (leading to increased energy consumption) Increased use of chemical disinfectants, with terrestrial and water pollution and occupational exposures Halting of waste segregation efforts and overtreating waste as biohazardous |
Extending the use of single-use disposable PPE conserves resources and reduces environmental emissions Reprocessing single-use disposable respirators and impermeable gowns Shifting to reusable PPE, such as respirators (elastomeric P100s, powered air-purifying respirators, etc.) and reusable impermeable and contact precaution gowns Use of steam/mechanical cleaning procedures in lieu of chemical disinfectants Rapid research and protocol development for safe reprocessing and reuse of PPE marked as single use8 |
| Other COVID-19 waste | |
| Increased mandate for single-use disposable equipment (gowns, hats, laryngoscope blades and handles, etc.) Shortages of single-use equipment, leading to extended use/reuse of single-use disposables Single-use food and drink packaging and utensils |
Development of safe protocols to extend use of/reprocess medical devices marked as single use and reduce their waste Societal norms challenging the need to use disposable packaging and to treat as biohazardous/clinical waste |
| Resilience | |
| Surges in patients with respiratory failure, leading to ventilator and i.v. sedative shortages Emergency use of anaesthesia machines and inhaled anaesthetics, leading to excessive consumption of CO2 absorbers necessitating high-flow anaesthesia |
Revision of ICU protocols on i.v. drug and tubing changeovers to minimise drug waste Augmented local manufacturing leading to reduction of ‘carbon miles’ for transportation and improved supply chain resilience |
| Research | |
| Distraction from all other non-COVID-19 research, including environmentally sustainable anaesthesiology No planning for a circular economy |
Recognition of the value of reusable medical devices from both a supply chain resiliency and environmental sustainability perspective Innovation to conserve resources, including policies to reduce waste and safely reclaim and reuse materials |