COVID-19 Pandemic: Solid Waste and Environmental Impacts in Brazil

Science of the Total Environment 755 (2021) 142471

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Science of the Total Environment

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COVID-19 pandemic: Solid waste and environmental impacts in Brazil

Rodrigo Custodio Urban a,⁎, Liane Yuri Kondo Nakada b,⁎ a Pontiﬁcal Catholic University of Campinas (PUC-Campinas), Center for Exact, Environmental and Technological Sciences, Postgraduate Program in Urban Infrastructure Systems, Rua Professor Dr. Euryclides de Jesus Zerbini, 1516 – Pq. Rural Fazenda Santa Cândida, 13087571 Campinas, São Paulo, Brazil b University of Campinas, School of Civil Engineering, Architecture and Urban Design, Department of Infrastructure and Environment, Avenida Albert Einstein, 951 – Cidade Universitária, 13083852 Campinas, São Paulo, Brazil

HIGHLIGHTS GRAPHICAL ABSTRACT

• COVID-19 pandemic has hampered advances in sustainable development in Brazil. • Some locations have suspended recycling programs to safeguard public health. • Electric power enough to supply 152,475 households over a month could have been saved. • Potable water enough to supply 40,010 people over a month could have been saved. • The equivalent of US$ 781,000 has been disposed in landﬁlls.

article info abstract

Article history: The World Health Organization has recently declared South America the new epicenter of the COVID-19 pandemic, as Received 2 June 2020 Brazil has become one of the most affected countries. Besides public health and economic impacts, social isolation has Received in revised form 16 September 2020 also caused indirect environmental effects. The aim of this study was to assess environmental impacts caused by shifts Accepted 17 September 2020 on solid waste production and management due to the COVID-19 pandemic in Brazil. We have analyzed data from 30 Available online xxxx cities, representing a population of more than 53.8 million people (25.4% of the Brazilian population). Unexpectedly, Dr. Damia Barcelo solid waste production in the main cities in Brazil has decreased during the social isolation period, possibly because of reduced activity in commercial areas. The latest data on solid waste in Brazil have revealed that more than 35% of Keywords: medical waste has not been treated properly. Furthermore, improper disposal of facemasks has been reported in sev- Facemasks eral cities and may increase the risk for COVID-19 spread. The suspension of recycling programs has hindered natural Latin America resources from being saved, with emphasis on 24,076 MWh of electric power and 185,929 m3 of potable water – re- Medical waste spectively enough to supply 152,475 households and 40,010 people, over a month. Furthermore, total sale price for Natural resources recyclable materials during the suspension of recycling programs reaches more than 781 thousand dollars, being Recycling these materials disposed in landﬁlls – demanding an extra volume of 19,000 m3 – reducing landﬁll lifespan, and SARS-CoV-2 hence causing a double loss: economic and environmental. ©2020ElsevierB.V.Allrightsreserved.

1. Introduction

Worldwide public health and economy have been severely affected by the COVID-19 pandemic, with deaths and increased economic vulnerabil- ⁎ Corresponding authors. E-mail addresses: [email protected] (R.C. Urban), ity especially in middle-income countries (Chakraborty and Maity, 2020; [email protected] (L.Y.K. Nakada). UN, 2020). Recently, the World Health Organization has declared South

America the new epicenter of the COVID-19 pandemic (Feuer, 2020; WHO, X: Sale price; or volume in landfill; or saved: electric power/potable 2020), as Brazil has become one of the most affected countries, being cur- water/trees/oil/ore/sand rently the second leading country in number of cases with 1,759,103 con- Rec. Mat. n: Daily amount of solid waste of type n: 1: Plastic; 2: firmed cases as of July 09, 2020 (Worldometers, 2020), albeit social Paper; 3: Metal; 4: Glass isolation measures have been implemented in the Federal District on X αi : Transformation coefficientofamountofsolidwasteoftypen to March 11, 2020, in São Paulo state and in Rio de Janeiro state on March amount of resources of type X 16, 2020 and March 17, 2020, respectively. The numbers of daily disposable facemasks potentially used in cities Besides the alarming socioeconomic impacts, indirect environmen- under study were estimated using Eq. (2) (Nzediegwu and Chang, 2020). tal impacts caused by social isolation have been described in several studies, reporting positive impacts such as cleaner beaches and environ- Pop: Urb: FAR ADFPC TDF ¼ ð2Þ ment noise reduction (Zambrano-Monserrate et al., 2020), immediate 10, 000 improvements in air quality (Bao and Zhang, 2020; Collivignarelli et al., 2020; Nakada and Urban, 2020), and in surface water quality where: (Braga et al., 2020; Yunus et al., 2020). Nevertheless, negative impacts related to increased solid waste generation and reduced recycling pro- TDF: Total daily disposable facemasks grams may produce medium- or long-term effects and thus constitute Pop.: Total population a reason for concern (Zambrano-Monserrate et al., 2020). Urb.: Urban Population (%) Kampf et al. (2020) have reviewed the persistence of coronaviruses FAR: Facemask acceptance rate = 80% on different surfaces and have reported viruses' survival on metal for ADFPC: Average daily disposable facemasks per capita =2 5 days, on plastic for up to 5 days, on paper for 4 to 5 days, on glass for 4 days, and on aluminum for up to 8 h. Furthermore, one recent in- 3. Results and discussion vestigation on the stability of SARS-CoV-2 on several surfaces has reported viable SARS-CoV-2 virus on plastic for up to 72 h, on stainless Different levels of solid waste collection and recycling programs are steel for up to 48 h, and on cardboard for up to 24 h (van Doremalen observable on data referring to solid waste management in each ana- et al., 2020). Considering that plastic plus paper/cardboard represent lyzed city (Table 1). Recycling programs are not available in three 64.6% of recycling materials in recycling programs in Brazil, and because (10%) of the studied cities, albeit one of these cities (Macapá-AP) has re- the majority of recycling centers in Brazil are based on manual waste ported recyclable collection, probably by informal workers. Effectively sorting (Fidelis et al., 2020), COVID-19 infection risk for workers in recovered materials represent only 1%, pointing out: i) low levels of recycling centers is high. Therefore, the Brazilian Association for Envi- recycling programs in the studied cities; and ii) high rates of disposal ronmental and Sanitary Engineering has recommended the suspension of recyclable materials following collection due to decreased quality of recycling programs in Brazil (ABES, 2020a). for recycling or low commercial price. Another important aspect is the The aim of this study was to assess environmental impacts caused by recyclable collection system, which varies between door-to-door collec- shifts on solid waste production and management due to the COVID-19 tion and voluntary deposit in containers for recyclables (Campos, 2014; pandemic. Ibáñez-Forésa et al., 2018). The Brazilian Association for Environmental and Sanitary Engineer- 2. Materials and methods ing has reported decreases in solid waste production, as follows: 16% in Rio de Janeiro-RJ, 12% in Brasília-DF and Porto Alegre-RS, and 10% in In this study, we have analyzed data from the Federal District, and all Fortaleza-CE and Manaus-AM during the first week of April 2020, and 26 state capital cities of Brazil plus 03 non-capital cities with more than 22% – achieving 50% in central and thus commercial area – during 1 million people, totalizing 30 cities, which were selected based on the 30 days of partial lockdown in Belo Horizonte (ABES, 2020b). In the following criteria: i) state capital cities may represent the features of city of Campinas-SP solid waste production has decreased 15% during each state, considering social, environmental and economic diversity the first month of partial lockdown, albeit the recycling program has among Brazilian states; ii) data availability; and iii) solid waste produc- been suspended and the recyclable materials incorporated into the do- tion associated with large cities with high urbanization rates. So far, a miciliary solid waste collection (G1, 2020). total of 636,778 COVID-19 confirmed cases have been reported for the A recent study has foreseen an increase in solid waste production 30 analyzed cities, being the number of cases for each city as for July due to social isolation (Zambrano-Monserrate et al., 2020), which has 09, 2020 presented in Table S1. not happened in Brazil. Because in Brazil up to 200 L-solid waste pro- For the assessment of the impacts on solid waste management system duced daily by commercial and service sectors are collected as domicil- in Brazil, we have analyzed official time-series data (SNIS, 2019a), and the iary waste (Brazil, 2010), the reduction of commercial activities may latest published data about solid waste management in Brazil (Brazil, explain the decrease in solid waste production. 2019), made available by the National System for Sanitation Information. Estimates of sale prices for recyclable materials were obtained from the 3.1. Impacts on recycling programs Business Association for Recycling (CEMPRE, 2020). Resources saved by recycling were calculated according to Eq. (1), adapted from Calderoni Being Brazil a middle-income country, the purpose of recycling is (2003), being resources data presented in Table S2. Environmental and mainly income generation, besides resource recovery (Conke, 2018). economic impacts caused by the suspension of recycling programs were The Brazilian legislation regarding solid waste (Brazil, 2010) encourages calculated using Eq. (1), considering 30 days of suspension only in cities the integration of informal workers into the formal recycling sector, where recycling programs were actually suspended. being the organization as a cooperative an important means to reduce ÀÁ socio-economic fragilities (Fidelis et al., 2020; Ibáñez-Forésa et al., Rec:Mat αX 30 2018). Considering the continental size of the country with its cultural Resources ¼ ∑n n n ð1Þ X i¼1 365 and economic diversity, solid waste management also varies from similar to low-income countries to similar to high-income countries where: (Cetrulo et al., 2018). Informal workers such as waste pickers, itinerant traders, and middlemen constitute one important characteristic of Resources X: Amount of resources of type X from recycling recycling programs in Brazil (Conke, 2018), and even formal workers programs conduct manual waste sorting in recycling centers. Therefore, the

2 R.C. Urban and L.Y.K. Nakada Science of the Total Environment 755 (2021) 142471

Table 1 Data referring to solid waste management in state capital cities and in cities with more than 1 million people in Brazil in 2018.

City-state code Population Urb. Collected solid Door-to-door recycling Collected Effectively recovered waste (t) collection (%) Recyclable (t) materials (%)

Belém-PA 1,492,745 99 709,492 3.01 3780 0.53 Boa Vista-RR 399,213 98 204,090 NA – 0.00 Macapá-AP 503,327 96 93,287 NA 252 0.27 Northern Manaus-AM 2,182,763 99 943,813 18.32 10,145 1.07 Palmas-TO 299,127 97 85,833 97.57 494.4 0.58 Porto Velho-RO 529,544 91 111,814 31.07 1506 1.35 Rio Branco-AC 407,319 92 124,894 24.50 240.5 0.19 Aracaju-SE 657,013 100 235,456 40.80 1032 0.44 Fortaleza-CE 2,669,342 100 1,533,559 0.00 7170 0.47 João Pessoa-PB 809,015 100 258,932 26.80 13,740 5.31 Maceió-AL 1,018,948 100 385,195 19.87 1433 0.37 Northeastern Natal-RN 884,122 100 366,080 12.91 2633 0.72 Recife-PE 1,645,727 100 863,732 29.86 1697 0.20 Salvador-BA 2,872,347 100 916,649 0.00 7860 0.86 São Luís-MA 1101,884 94 401,815 0.00 21,868 5.44 Teresina-PI 864,845 94 413,721 0.00 829.8 0.20 Brasília-DF 3,015,268 97 1,267,313 51.30 17,143 1.35 Campo Grande-MS 895,982 99 488,882 55.61 2282 0.47 Center-Western Cuiabá-MT 612,547 98 185,141 5.82 2649 1.43 Goiânia-GO 1,516,113 100 421,327 93.72 16,955 4.02 Belo Horizonte-MG 2,512,070 100 888,254 15.43 4900 0.55 Campinas*-SP 1,204,073 98 415,197 75.68 3464 0.83 Guarulhos*-SP 1,379,182 100 346,951 11.11 4903 1.41 Southeastern Rio de Janeiro-RJ 6,718,903 100 3,079,233 44.45 10,889 0.35 São Gonçalo*-RJ 1,084,839 100 230,006 NA – 0.00 São Paulo-SP 12,252,023 99 3,811,785 79.51 33,427 0.88 Vitória-ES 362,097 100 163,831 4.18 1499 0.91 Curitiba-PR 1,933,105 100 511,222 99.18 10,260 2.01 Southern Florianópolis-SC 500,973 96 209,318 71.59 9514 4.55 Porto Alegre-RS 1,483,771 100 521,473 99.69 11,266 2.16

Urb.: urbanization rate (%); NA: not applicable (recycling program not available); * non-capital cities. Data source: SNIS (2019a).

Brazilian recycling system is highly vulnerable to the effects caused by over a month, considering each person uses 154.9 L/day (SNIS, 2019b). the COVID-19 pandemic, considering both environmental and eco- Furthermore, total sale price for recyclable materials during the suspen- nomic impacts of the suspension of recycling programs in Brazilian cit- sion of recycling programs reaches more than 781 thousand dollars, ies due to the COVID-19 pandemic (Table 2). being these materials disposed in landfills demanding an extra volume As a measure to avoid SARS-COV-2 transmission in recycling centers, of 19,000 m3 – reducing landfill lifespan, and hence causing a double 14 out of 30 cities have suspended recycling programs. In São Paulo, the loss: economic and environmental. largest city in Latin America, recycling program has not been An important income loss has been reported because of the suspen- suspended; nevertheless, only automated segregation is still working sion of recycling programs using manual waste sorting in recycling cen- (São Paulo, 2020b). As a consequence of the suspension of recycling ters, albeit this measure was intended to safeguard public health, and programs, considerable amounts of natural resources have not been therefore some city governments – for example, Belém-PA and São saved over a month, such as 24,076 MWh of electric power – amount Paulo-SP – have approved emergency financial support for recycling- enough to supply 152,475 households over a month, considering an av- related workers (MPF, 2020; Jovem Pan, 2020). Because there is a high erage consumption of 157.9 kWh/household∙month (Brazil, 2018), and rate of turnover in recycling centers (Fidelis et al., 2020), at least 6581 185,929 m3 of potable water – amount enough to supply 40,010 people formal workers have been affected by the COVID-19 crisis (Table S4).

Table 2 Environmental and economic impacts caused by the suspension of recycling programs in Brazilian cities due to the COVID-19 pandemic.

City-state code Sale price Not Saved electric Not Saved potable Not Saved Not Saved oil Not Saved Not Saved Volume in (US$) power (MWh) water (m3) trees (barrel) ore (t) sand (t) landﬁll (m3)

Manaus-AM 119,202 3544 27,827 4716 2708 135.6 0.0 2386 Northern Palmas-TO 4600 142.3 1011 170.7 100.5 6.1 4.0 107.6 João Pessoa-PB 127,835 3956 28,109 4743 2794 168.7 110.2 2990 Maceió-AL 12,678 427.8 4037 687.5 291.2 13.8 14.4 329.7 Northeastern Salvador-BA 73,128 2263 16,080 2713 1598 96.5 63.1 1710 São Luís-MA 11,767 389.1 2639 445.9 251.0 14.4 29.7 362.3 Teresina-PI 4925 192.7 1927 330.3 113.8 2.7 22.2 207.9 Brasília-DF 193,020 5579 43,030 7334 4496 138.1 88.0 4323 Center-Western Campo Grande-MS 24,458 711.4 6348 1088 593.0 10.2 8.2 554.2 Cuiabá-MT 24,546 811.6 10,664 1838 650.5 1.3 0.0 580.9 Belo Horizonte-MG 45,589 1411 10,024 1691 996.3 60.1 39.3 1066 Southeastern Campinasa-SP 32,232 997.5 7087 1196 704.4 42.5 27.8 753.9 Guarulhosa-SP 50,529 1559 11,056 1863 1101 69.9 35.3 1141 Southern Florianópolis-SC 56,562 2091 16,091 2752 1238 31.5 303.2 2526 Total 781,071 24,075.4 185,930 31,568.4 17,635.7 791.4 745.4 19,038.5

a Non-capital cities; currency exchange: U$$ 1 = R$ 5.50 (R$ 1 = U$$ 0.18); Estimates calculated considering recycling suspension for 30 days.

3 R.C. Urban and L.Y.K. Nakada Science of the Total Environment 755 (2021) 142471

Fig. 1. Estimates of daily disposable facemasks in state capital cities and in cities with more than 1 million people in Brazil, during the COVID-19 pandemic considering each person uses 2 units per day, with acceptance by 80% of total population.

In locations where recycling programs have not been suspended, sales Gonçalo-RJ. Using the criteria described by Nzediegwu and Chang for recycling materials have also been compromised because some sec- (2020), an estimate show that more than 85 million facemasks may tors – such as recycling facilities and also middlemen – of the complex be daily disposed (Fig. 1). Considering the high demand of disposable solid waste management system are not fully working (Conke, 2018; facemasks and in order to control improper disposal, the Ministry of Peduzi, 2020). Health of Brazil (MS, 2020) and the Brazilian Health Regulatory Agency (ANVISA, 2020) have recommended the use of disposable masks only 3.2. Impacts on medical waste by health personnel, and the use of homemade reusable fabric facemask by population in general, according to the World Health Organization The latest data on medical waste in Brazil has shown installed treat- recommendations. One recent study has assessed the effectivity of cot- ment capacity for 479,653 t/year, and an annual production of 252,948 t, ton facemask as an alternative to disposable facemasks and has con- being 63.8% of this amount properly treated (ABRELPE, 2020). cluded that daily use of washable cotton facemask by healthy people Based on the evidence that medical waste production has increased in community is a suitable measure (Ho et al., 2020). up to 6 fold in Wuhan, China due to the COVID-19 pandemic (Calma, 2020), a recent study has foreseen an increment in medical waste pro- 3.3. Impacts on solid waste collection in São Paulo megacity duction (Saadat et al., 2020). Assuming a 2 fold increase in medical waste in Brazil, the current treatment capacity would be exceeded. São Paulo is the largest city in Brazil, producing the highest amount Moreover, although Brazil is one of the developing countries with of solid waste in the country, being data regarding solid waste collection most studies on its medical waste (Ansari et al., 2019), improper man- monitored by an information system maintained and made available by agement of medical waste in small medical units is still a reason for con- the city government (São Paulo, 2020a). cern (Moreira and Günther, 2013). Time-series data on solid waste production from January to April The COVID-19 pandemic has become more critical in Brazil in mid- over the last 11 years (Fig. 2) reveal some impacts on solid waste pro- dle April 2020, and non-ofﬁcial preliminary data report an increment duction caused by social isolation measures in the city of São Paulo, in medical waste production in May 2020 (Azevedo et al., 2020). By con- Brazil. As a result of environmental education campaigns as well as in- trast, estimates on medical waste production in Brazil in the ﬁrst week spection of irregular waste disposal by the city government (São of April 2020 point out a 17% decrease in collected and treated waste Paulo, 2020a), before the COVID-19 pandemic the following situations (ABETRE, ABLP, ABRELPE and SELUR/SELURB, 2020), possibly because have been observed: i) variations in domiciliary solid waste collection, of the suspension of non-emergency medical and odontological ap- with a stable trend; ii) increasing recyclable collection; iii) increasing pointments from late March 2020 on, and also improperly disposal voluntary deposit in containers for recyclables; and iv) decreasing among domiciliary waste (Azevedo et al., 2020). Furthermore, increas- amount of solid waste on streets. In April 2020, during the COVID-19 ing use of personal protective equipment such as facemasks and gloves pandemic and consequent partial lockdown, the following situations (Calma, 2020; Zambrano-Monserrate et al., 2020), both in hospitals and have been observed: i) the lowest (276,684 t) domiciliary solid waste in general, also increases the chances for inappropriate disposal leading collection over 11 years; ii) increased recyclable collection; iii) de- to environmental- (Saadat et al., 2020) and public health- (Nzediegwu creased voluntary deposit in containers for recyclables; and iv)) the and Chang, 2020) risks associated with potentially infective material. lowest (3887 t) amount of solid waste on streets over 11 years. Recently, a few studies have depicted improper disposal of facemasks in distinct parts of the world, such as Soko Islands, Nigeria, 3.4. Future perspectives and challenges Portugal, and Canada (Kalina and Tilley, 2020; Fadare and Okoffo, 2020; Prata et al., 2020). During the social isolation period in Brazil, The COVID-19 pandemic has caused several impacts on the solid the press has reported inappropriate disposal of facemask in several cit- waste management system in Brazil, considering socioeconomic and ies analyzed in this study such as Campinas-SP, Campo Grande-MS, environmental effects, and hence has hampered advances in sustainable Goiânia-GO, João Pessoa-PB, Palmas-TO, São Luís-MA and São development. The suspension of recycling programs over a month has

4 R.C. Urban and L.Y.K. Nakada Science of the Total Environment 755 (2021) 142471

Fig. 2. Variations over the last decade (2010−2020) in domiciliary solid waste collection, domiciliary recyclable collection, voluntary deposit in containers for recyclables (started on 2016) and solid waste collection on streets and squares in the city of São Paulo, Brazil. Data source: São Paulo (2020a). hindered natural resources from being saved, with emphasis on 24,076 References MWh of electric power and 185,929 m3 of potable water – respectively enough to supply 152,475 households and 40,010 people, over a month. ABES, 2020a. Recomendações para a gestão de resíduos em situação de pandemia por co- ronavírus (COVID-19). ABES: Rio de Janeiro. http://abes-dn.org.br/?p=33224 Recycling-related workers have experienced economic issues, albeit the (acessed 10 May 2020). government has approved emergency financial support. ABES, 2020b. Pesquisa da ABES aponta redução da geração de resíduos domiciliares em Given behavior shifts in the post-pandemic period, the solid waste capitais brasileiras no período de isolamento pela pandemia da Covid-19. http:// abes-dn.org.br/?p=33570 (acessed 20 May 2020). management system may demand adjustments seeking to: i) increase ABETRE, ABLP, ABRELPE e SELUR/SELURB, 2020. Gestão de resíduos na proteção contra a both recycling capacity and environmental education, considering the Covid-19. http://web-resol.org/textos/gestao_de_residuos_na_protecao_contra_a_ increment in the use of disposable utensils and also packages from covid.pdf (accessed 23 May 2020). food delivery and online shopping; ii) encourage training of waste ABRELPE, 2020. Panorama dos resíduos sólidos no Brasil 2018/2019. ABRELPE, São Paulo. pickers for adoption of safe methods for recyclable sorting; and iii) mon- Ansari, M., Ehrampousha, M.H., Farzadkiac, M., Ahmadie, E., 2019. Dynamic assessment of economic and environmental performance index and generation, composition, envi- itor both the production and the installed capacity for medical waste ronmental and human health risks of hospital solid waste in developing countries; a treatment, in order to assess an eventual need for system expansion. state of the art of review. Environ. Int. 132, 105073. https://doi.org/10.1016/j. envint.2019.105073. ANVISA, 2020. Orientações gerais – Máscaras faciais de uso não profissional. Agência Nacional de Vigilância Sanitária, Brasília http://portal.anvisa.gov.br/documents/ 219201/4340788/NT+M%C3%A1scaras.pdf/bf430184-8550-42cb-a975-1d5e1c5a10f7. CRediT authorship contribution statement (Accessed 24 May 2020). Azevedo, T., Barcello, F., Tsai, D., Cremer, M., Gaudereto, F., Coluna, I., Albuquerque, I., Alencar, A., Zimbres, B., Brandão Jr, A., Costa Jr, C., Piatto, M., Quintana, G., Potenza, Rodrigo Custodio Urban: Conceptualization, Methodology, Formal R., 2020. Impacto da pandemia de COVID-19 nas emissões de gases de efeito estufa analysis, Investigation, Writing - original draft, Writing - review & no Brasil. SEEG. https://seeg-br.s3.amazonaws.com/OC_nota_tecnica_FINAL.pdf. editing. Liane Yuri Kondo Nakada: Conceptualization, Methodology, Bao, R., Zhang, A., 2020. Does lockdown reduce air pollution? Evidence from 44 cities in Investigation, Writing - original draft, Writing - review & editing. northern China. Sci. Total Environ. 731, 139052. https://doi.org/10.1016/j. scitotenv.2020.139052. Braga, F., Scarpa, G.M., Brando, V.E., Manfè, G., Zaggia, L. 2020 COVID-19 lockdown measures reveal human impact on water transparency in the Venice Lagoon. Sci. Total En- viron. 139612. doi:https://doi.org/10.1016/j.scitotenv.2020.139612. Brasil, 2010. Presidência da República. Casa Civil. Lei n° 12.305, de 02/08/2010. Institui a Política Nacional de Resíduos Sólidos; altera a Lei n° 9.605, de 12 de fevereiro de Declaration of competing interest 1998; e dá outras providências. http://www.planalto.gov.br/ccivil_03/_ato2007- 2010/2010/lei/l12305.htm (acessed 20 May 2020). The authors declare that they have no known competing financial Brasil, 2018. 2018 Statistical Yearbook of electricity 2017 baseline year. EEP: Brasília fl http://www.epe.gov.br/sites-pt/publicacoes-dados-abertos/publicacoes/Publicacoes interests or personal relationships that could have appeared to in u- Arquivos/publicacao-160/topico-168/Anuario2018vf.pdf (acessed 29 May 2020). ence the work reported in this paper. Brasil, 2019. Sistema Nacional de Informações sobre Saneamento: Diagnóstico do Manejo de Resíduos Sólidos Urbanos – 2018. SNS/MDR, Brasília. Appendix A. Supplementary data Calderoni, S., 2003. Os bilhões perdidos no lixo (The Billions Lost in Garbage). 4 ed. São Paulo, Humanitas. Calma, J., 2020. The COVID-19 pandemic is generating tons of medical waste. https:// Supplementary data to this article can be found online at https://doi. www.theverge.com/2020/3/26/21194647/the-covid-19-pandemic-is-generating- org/10.1016/j.scitotenv.2020.142471. tons-of-medical-waste (accessed 20 May 2020).

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