On a balmy Tuesday afternoon in the city of Faridabad in the Indian state of Haryana, an orange and blue Municipal Corporation truck drives through a residential street, playing a loud recording reminding residents to wash their hands and not leave their homes during the country’s strict coronavirus lockdown . Ashok, a garbage collector who goes by only one name, jumps out and rings the doorbells of each house. Some people bring out their trash and hand it to him, while others stand on their balconies and throw it directly into the truck. This is the first month he has been given gloves and a mask to wear. He used to be accompanied by a colleague, but since the lockdown began, he comes alone. Ashok is worried and fears for his health while doing his rounds. But he has to eat, and so he must work. India’s waste is handled by between 1.5 and 4 million informal garbage collectors and state employees, many of whom go door-to-door to collect trash from residential neighbourhoods, commercial enterprises, and hospitals. They often work without any protective gear. Ashok and other workers like him who deal with trash have always been at risk in India , where the disposal of biomedical waste is often ineffective, despite guidelines. But the coronavirus crisis brings with it an entirely new set of challenges and vulnerabilities. The waste from most Indian households is separated by these garbage collectors, but due to a large number of coronavirus patients and suspected patients quarantining at home, sometimes even before they become symptomatic, used tissues, face masks, and other medical gear end up in the everyday trash. This means that waste pickers and garbage collectors will often come into contact with biomedical waste, even though it is not classified as such because the classification is based on origin, said Bharati Chaturvedi, founder and director of the Chintan Environmental Research and Action Group, a non-profit organisation that works with waste pickers around the country. “We have to recognise that biomedical waste, if generated from the household, is hazardous,” she said. Furthermore, while residents are taking care to sanitise surfaces in their home environment, the cardboard, plastic, and paper they throw out still has the potential to carry the virus. “Waste is not a thing you disinfect,” Chaturvedi pointed out. I worry about my children catching the disease and dying. But if we don’t work and buy food, we’re all dead anyway. Sahana Khatun, waste collector In March, the Central Pollution Control Board (CPCB) released updated guidelines on the handling, treatment, and disposal of waste generated during the treatment, diagnosis and quarantine of Covid-19 patients. For quarantine camps and home care of the suspected patients, the CPCB advised the collection of biomedical waste in yellow bags and that the bins containing these be handed over to authorised waste collectors. But households are neither aware of the need for this segregation nor have the means to do so, making these guidelines difficult to comply with, said Chaturvedi from Chintan. The problem is not entirely limited to homes. India does not have a good track record of biomedical waste disposal, even when it comes to hospitals and medical facilities. The country generated 608 tonnes of biomedical waste per day in 2018, of which 87 per cent was treated. However, during that same year, 27,427 instances of violations of government rules were reported. These included the mixing of biomedical waste with general waste, fears of “virus spreading”, illegal dumping of hospital waste in agricultural land, and burning of obsolete medicines. How herd immunity could help India contain coronavirus Dr Jugal Kishore, head of the department of public health at Safdarjung Hospital, has noticed a sharp uptick in the amount of biomedical waste generated since the start of the pandemic. As far as he can tell, the bigger hospitals are being extremely careful about how they are disposing of waste from coronavirus wards, but this may not be true with smaller establishments and outside the cities, he said. In late March, a heap of medical waste, including discarded face masks, tunics, gowns, caps, and syringes, was found lying in the open in New Delhi. That same month, a man was arrested in Mumbai for leaving 100,000 used face masks outside, with the intention of selling them. And in Pune, in the state of Maharashtra, face masks dumped by more than 2,000 people under home quarantine were found in household garbage, collected by local waste pickers. “What is very vital is that we understand that every waste picker will, by the nature of their job and the nature of the rules which are not in sync, encounter biomedical waste,” said Chaturvedi. The problem is not a lack of guidelines; it’s how to implement them in a way that can help protect millions of lives, she said. Mumbai’s slums threaten to become a Covid-19 breeding ground Meanwhile in New Delhi, Sahana Khatun and her husband, both waste pickers, have been unable to work since the lockdown. “The rubbish is just piled up outside my home,” she said. “I can’t go picking, nor can my husband, and every day that we don’t work, we risk not being able to feed the children.” Once the lockdown is over, Khatun expects that the oldest of her four children, aged 10, will join her in working in the landfill. The prospect of catching the Covid-19 disease scares her, but the family has to eat, she said. “I worry about my children catching the disease and dying,” she said. “But if we don’t work and buy food, we’re all dead anyway.” Help us understand what you are interested in so that we can improve SCMP and provide a better experience for you. We would like to invite you to take this five-minute survey on how you engage with SCMP and the news.