Multi-strategic approaches to healthcare wastewater treatment amidst COVID-19 pandemic in India—a narrative review

The COVID-19 pandemic has led to a significant increase in healthcare waste, including personal protective equipment (PPE), pharmaceutical residues, and viral pathogens, posing environmental and public health risks, especially in emerging economies like India. This study evaluates the environmental and health risks of healthcare wastewater during the pandemic, focusing on emerging pollutants like microplastics from PPE and pharmaceutical residues. A literature review analyzed the environmental impact, including the presence of SARS-CoV-2 RNA, antimicrobial residues, and microplastics, and explored wastewater-based epidemiology (WBE) for tracking viral spread and antimicrobial resistance (AMR). The review found that traditional wastewater treatments are insufficient for emerging pollutants, while advanced methods like ozonation, nanofiltration, and hybrid approaches offer better removal efficiencies but are hindered by high costs. Cost analysis reveals that some effective methods may not be economically viable in low-resource settings. Future research should enhance treatment efficiency, reduce costs, and explore the long-term impacts of microplastics and pharmaceutical residues. The study highlights the need for robust, cost-effective wastewater management strategies to address the growing environmental and health risks in the post-pandemic era.