Ms Arasmani Devi, 36, plucks out a needle from a used syringe with her bare hands, before throwing its plastic barrel and plunger into a sack of potentially recyclable items.
Her 40-year-old husband Akhilesh Paswan works next to her at a recycling yard in Noida, a suburb near Delhi. "These days, we find more masks and gloves in the waste," he said, picking up a dirty set of plastic gloves with his bare hands.
Cows and dogs scavenging in the background for potential treats suddenly disperse as another waste picker chases them away.
"We are scared of the coronavirus, but we came here two months back and took up this work as we could barely survive back home," added Mr Paswan, who is from the state of Bihar.
Waste pickers like them today face an increasing direct risk from a spike in biomedical waste in India because of the coronavirus outbreak. From almost 609 metric tonnes of daily biomedical waste generation in 2018, India now generates 710 tonnes daily, including 101 tonnes of Covid-19-related waste.
This latest available government figure was recorded at the end of May and is likely to have gone up, given the increase in the number of Covid-19 cases since then. India yesterday recorded a total of more than 1.85 million cases, with 38,938 deaths caused by the disease.
The surge in biomedical waste could soon overwhelm India's installed capacity to treat it, which is around 840 tonnes daily and spread over more than 195 common biomedical waste treatment facilities (CBWTFs). Poor segregation of biomedical waste from solid municipal waste, which also ends up at these facilities, threatens to further hasten this process.
Biomedical waste from healthcare facilities and laboratories is collected by authorised agents and sent to CBWTFs for incineration. While this process has worked relatively well through the pandemic, vast amounts of biomedical waste have also been generated from households, including from Covid-19 patients under home isolation and general households with potentially asymptomatic and undiagnosed cases.
This has brought to the fore a chronic failure in India's waste management - poor segregation of waste in Indian households and a lack of enforcement of this practice by urban local bodies. This has resulted in biomedical waste mixing with municipal waste and reaching dump yards and landfills, posing a health risk to an estimated four million waste pickers in India.
Improper disposal of biomedical waste can lead to adverse health and environmental impacts, including the release of chemical or biological hazards such as drug-resistant micro-organisms, said the World Health Organisation.
A July 27 report from the Environment Pollution (Prevention and Control) Authority said biomedical waste being generated in households presents a "key complication", as urban local bodies and village councils will have to track patients on a real-time basis and set up systems for collection of biomedical waste from individual households.
The latest guidelines from the Central Pollution Control Board specify that masks, gloves and tissues or swabs from Covid-19 patients under home isolation have to be collected separately and treated as biomedical waste and sent to a CBWTF.
They even added that general households should cut masks and gloves to prevent reuse and keep them in a paper bag for a minimum of 72 hours prior to disposal as general municipal waste.
But these guidelines are being flouted, with some petitions filed in courts and the National Green Tribunal even claiming that Covid-19 waste is being dumped carelessly in the open, including in dumping grounds.
"India has some very progressive waste management rules, but there is no point in having these extremely good rules if they are not implemented on the ground," Ms Chitra Mukherjee, head of advo-cacy and policy at Chintan - a not-for-profit organisation that works on environmental sustainability and social justice issues - told The Straits Times.
Mr Dinesh Raj Bandela, a deputy programme manager for municipal solid waste at the Centre for Science and Environment, visited a neighbourhood in north-west Delhi in June to track the collection of waste from some Covid-19-affected households.
While waste from such households was being collected separately, it was not segregated, and biomedical waste came mixed with solid municipal waste, he told ST.
"All this finally ended up in a landfill," Mr Bandela said. "There is very poor knowledge among the public on how to handle Covid-related waste and the government has done little to build awareness," he added.
Ms Mukherjee pointed out that the focus should not just be on segregation but also on reduction of biomedical waste. "If you have less waste to manage, you will handle it better," she said, adding that the general public needs to be encouraged to use reusable cloth masks.
The Central Pollution Control Board has asked for the CBWTFs to operate extra hours and even permitted the use of common hazardous waste and industrial captive incinerators to burn biomedical waste.
There have been suggestions to set up more CBWTFs, but Ms Mukherjee said this is not an ideal solution given how similar incinerators such as waste-to-energy plants have been poorly monitored, including for levels and types of harmful emissions they release while incinerating waste.
"With the pandemic getting worse day by day - every day there is a new spike - is the answer really building more and more CBWTFs, knowing that in India we do not have a history of monitoring similar incinerators?" she added.