key: cord-0177968-wnk1bh7a
authors: Uddin, Mohammad Abbas; Afroj, Shaila; Hasan, Tahmid; Carr, Chris; Novoselov, Kostya S; Karim, Nazmul
title: Environmental Impacts of Personal Protective Clothing Used to Combat COVID-19
date: 2021-09-02
journal: nan
DOI: nan
sha: 467cb387b9ddc54b9aab81c86d32bd55ddab4749
doc_id: 177968
cord_uid: wnk1bh7a

Personal protective clothing is critical to shield users from highly infectious diseases including COVID-19. Such clothing is predominantly single-use, made of plastic-based synthetic fibres such as polypropylene and polyester, low cost and able to provide protection against pathogens. However, the environmental impacts of synthetic fibre-based clothing are significant and well-documented. Despite growing environmental concerns with single-use plastic-based protective clothing, the recent COVID-19 pandemic has seen a significant increase in their use, that could result in a further surge of oceanic plastic pollution, adding to mass of plastic waste that already threatens marine life. In this review, we briefly discuss the nature of the raw materials involved in the production of such clothing, as well as manufacturing techniques and the PPE supply chain. We identify the environmental impacts at critical points in the protective clothing value chain from production to consumption, focusing on water use, chemical pollution, CO2 emissions and waste. On the basis of these environmental impacts, we outline the need for fundamental changes in the business model, including increased usage of reusable protective clothing, addressing supply chain bottlenecks, establishing better waste management, and the use of sustainable materials and processes without associated environmental problems.

The recent surge in single-use protective clothing consumption due to COVID-19 represents the key environmental threat. Indeed, considerations of pollution and waste were not of primary concern for manufacturers and consumers, with the primary focus being on protection from the highly infectious COVID-19 pathogens. However, with growing warnings from the environmentalists and increased public awareness of the climate crisis and sustainability in general, the industry (manufacturers, suppliers and consumers alike) will be forced to seek more sustainable and "circular" protective clothing and consider their environmental impacts. In this review, we provide a brief overview about raw materials for personal protective clothing and their manufacturing processes. We then outline PPE global supply chains, and pre-COVID-19 and during COVID-19 market size. We discuss the environmental impacts of single-use personal protective clothing, specifically, the global map for single-use-plastic waste, pollutions (aquatic, marine and chemical), and its environmental footprints before and during COVID-19. Finally, we present our recommendations and perspectives on how the products or technology can be changed to become more sustainable, including decreasing the use of single-use protective clothing and their waste, and moving towards smart, sustainable and reusable protective garment usage and embedding a longer lifetime framework.

To minimise the exposure to infectious microorganisms or hazardous materials in medical environments, several different types of medical clothing products are used, including coveralls, footwear covers, full-body suits, independent sleeves, scrubs, surgical gowns, surgical masks, and scrub hats. 15 Single-use nonwoven fabrics are popular choice for such clothing, as they provide excellent protection against fluids (blood and other bodily fluids) and pathogens, as well as maintaining garment breathability and comfort. 16 Petrochemical-based synthetic fibres (such as polypropylene, polyester, and polyethylene) are typically used for single-use protective clothing, which have been engineered to achieve the desired performance properties based on fibre type, bonding processes, and fabric finishes (chemical or physical).

The raw material for any protective clothing is fibre whether from natural or synthetic sources.

Following the recognition of macromolecules by W. H. Carothers in 1928, and the subsequent development of the first synthetic fibre, polyamide 66 in 1935, and its commercial introduction as nylon in 1938, the growth of the use of synthetic fibre has been exponential. 17 Synthetic fibres are essentially polymeric materials, and depending on their use, could be generically classified as 'plastics', the quintessential product material for our modern lifestyle. Due to the ready availability of raw materials (derived from the petrochemical industry), tailor-made physio-chemical properties (e.g. flexibility, lightweight, durability), and production in economic scale, plastics quickly started to dominate many industrial sectors such as healthcare, packaging, agriculture, and fisheries, surpassing any other manmade materials. 18 Other than fossil fuel sources, plastic materials can also be produced from renewable sources (e.g. sugar cane, starch, vegetable oils) or mineral base (salt). 19 According to the Plastics Europe market research group, 20 total worldwide plastic production was ~368 million metric tons in 2019, (with slight reduction of approximately 0.3% in 2020) and Europe consumed ~50.7 million tons of the total plastic production. Asia is the leading consumer of plastics with ~51% of total global consumption (China ~30%, Japan ~4% and rest of Asia ~17%), followed by Europe (~17%), NAFTA 20 Table 1 shows that the most commonly used synthetic fibres for protective clothing applications are: polypropylene (PP), low-density and linear low-density polyethylene (LDPE and LLDPE), and polyester (PET). The properties of such fibres (e.g. inherent absorbency) determine the level of protection against the contaminants/microorganism, with microfibres usually preferred when a higher level of protection needed. 

Single-use protective clothing is predominantly nonwoven in construction, as non-woven fabric facilitates relatively fast and cheap manufacturing, high levels of sterility, and infection control. Such nonwoven fabrics are typically made from polypropylene, and usually have a spunbond-meltblownspunbond (SMS) construction in the final products. Nonwoven fabrics are formed as a web by directly entangling textile fibres together, which works as a base for further bonding to increase the fabric's strength. Surface modification can be performed through mechanical treatment or coating, Figure 3 . 28 A detailed description of fabric manufacturing (both woven, knit and nonwoven) and anti-microbial finishing techniques can be found in our previous review. 2 Most commonly used web formation technologies for manufacturing nonwoven fabrics are: dry-laid, wet-laid and spun-laid. In dry-laid technology, carding or air laying of the fibres are used to produce nonwoven web. In contrast, the wet-laid technology uses a similar technique as papermaking to manufacture nonwoven fabric from a slurry of fibres and water. 29, 30 However, wet-laid nonwovens are differentiated from wet-laid papers by having more than 30% of its fibres with a length to diameter ratio greater than 300, and a density less than 0.40 g/cm 3 . 4, 31 Nonwoven webs can be formed from natural and manmade fibres in staple form using these two techniques. 30 The other web formation technique is the spun-laid process, which uses melt spinning technique to form the web, thus eliminating the expensive transformation of polymers into staple fibres. In the spun-laid process, only the synthetic fibres, predominantly high and broad molecular weight thermoplastic polymers such as polypropylene, polyester, and polyamide, are extruded through spinneret as endless filaments, which are then cooled and stretched by air, and are laid down in a continuous process. Several methods can be used to produce spun-laid nonwoven fabrics including spun-bond, melt-blown, aperture films, and the many-layered combinations. 32, 33 Among them, the melt-blown process ( Figure 3a ) provides the advantages of better filament distribution, better filtration via smaller pores between the fibres, softer feel, and also the possibility of manufacturing lighter weight fabrics. The difference between spun-laid and melt-blown processes is that the latter have a higher melt flow index of the polymer with lower throughput, which results in the manufacture of very fine fibres. 28, 31, 34 The strength of the nonwoven web is increased by consolidating the fibres using a thermal, mechanical or chemical bonding processes. The most common web bonding for producing medical textiles is thermal bonding (Figure 3b ), 29 which is achieved via melting thermoplastic fibres or their blends (often containing binder fibres). The binder fibre component (usually ~5-50 wt.-%) can be in powder, film, low melt webs, and hot melts form for disposable and durable products. 35 For thermal bonding, the webs are either moved in between heated calendar rollers or hot air is blown through the web.

Mechanical bonding is the oldest web bonding process produced through needle punching, hydroentanglement or stitching. Needles or high-pressure water jet are passed through the web to increase the physical entanglement of the fibres. Such hydroentangled fabrics have been used for surgical gowns, scrub suits, sheet and drapes due to their excellent comfort and softness, however they have low barrier properties. 36 The chemical web bonding takes place via liquid-based chemical, which works as a binder. The chemical bonding is a popular method, due to the availability of extensive range adhesive, the product durability and a broad range of properties that can be engineered in the fabrics. The bonding agent can be applied via saturation bonding, foam bonding, print bonding, coating or scraper bonding, and solution and partial solution bonding. 37 The finishing of nonwoven fabrics occurs as the last stage, mainly following traditional textile finishing techniques: dry finish and wet finish ( Figure 3c ). However, there are many nonwoven fabrics which do not undergo any finishing at all before packaging. Wet finishing includes colouration, washing, coating, and printing, while dry finishing includes calendering, embossing and emerising. The choice of finishing processes depends on the specific end-use application. In the hygiene and medical industry, nonwoven fabrics are often impregnated with detergents, cleaning agents, finishing agents or other lotions. 28, 38

Compared to traditional garment making, PPE manufacturing requires fewer stages but may rely on some specialised machinery. Ultrasonic welding and sewing machines are required to stitch at the edge for masks and gowns. In many cases, several layers of nonwoven fabrics are used to provide different functionalities as required by the end users. 39 

Even before the COVID-19 pandemic, the use of protective clothing was increasing due to increasing regulation in the workplace, greater industrial awareness of employee protection, and high economic growth in countries such as Japan, India, China, Germany, and the US. The global market for PPEs in 2019 was worth over $52.7 billion, which was expected to grow at a Compound Annual Growth Rate (CAGR) of 8.5% to over or over $92.5 billion by 2025, Figure 4 . 41 Since the demand of the protective clothing is growing around the world, so is the demand/supply of associated textile fibre, and as a result, the relationship within the stakeholders of the textile supply chain has much more profound effect in the protective clothing market.

12 In general, any textile supply chain is characterised by a vertical set of globally dispersed industries: agriculture and farming for natural fibre production, petrochemical for synthetic fibre production, along with spinning, weaving/knitting, dyeing/finishing and apparel manufacture, and then logistics and distribution. 43, 44 Such complexity has further been increased in the case of protective clothing manufacturing, where local distributors with regular weekly supplies usually dominate the PPE supply chain. These distributors will either provide contracts directly to manufacturers or through a third party to manufacture PPE products. 45 Again, the distribution channels could also be divided based on direct/institutional sales or retail sales, where clients can buy PPEs directly from these distributors.

Although the global protective clothing market has an extensive network of small and medium enterprises, the market is still dominated by leading brands. The largest PPE manufacturers in the world are 3M, Honeywell International, Ansell 46 along with MSA Safety, DuPont, Lindström Group, Alpha Pro Tech Ltd, Avon Rubber, and Johnson Safety Products. 42, 45 However, there is no primary data available on domestic production of PPEs by those companies.

The PPE supply chain is characterised by high geographic and regional concentration with three emerging regional clusters: Asia, Europe, and the US. 47 into the market with 4000 existing manufacturers, which resulted in increased local production by ~1,000% for masks and 300-500% for gloves during the last quarter of 2020. China produces 200 million face masks a day, which is ten times higher than the monthly average in February 2020. 55

The global import and export market for four types of 

The environmental impacts due to plastic and plastic particles are well documented in the literature. 21, [66] [67] [68] [69] [70] [71] However, this environmental impact has increased significantly with increasing production and consumption of single-use PPEs, 6 and the new emergence of mandatory face masks has not reduced the challenge of PPE pollution in the environment, be it Africa, Asia, EU, the US or elsewhere. 6, 72

Plastic contributes to climate change through greenhouse gas (GHG) emission, marine pollution, food security and freshwater scarcity. 72 To reduce the environmental impact of plastics, and plastic leakage, several initiatives and directives have been developed at international, national, and regional levels,

including environmental taxes or bans on certain single-use plastics. 73 However, while the emergence of COVID-19 has caused some significant environmental improvements, for example, improved outdoor air quality and decreased number of smokers, 74 nevertheless, the pandemic has forced rapid and wide use of single-use plastic-based protective clothing by the mass population, and resulted in the accumulation of potentially infectious domestic solid waste streams. 1, 14 The shift of single-use PPEs is mostly driven by potential cross-contamination and hygiene concerns. 73 Accordingly human health has been prioritised over environmental health, reduction policies and 

The presence of microplastics is ubiquitous in the marine environment worldwide. 80 Single-use plastics (SUPs) contribute to ~60-95% of global marine plastic pollution, 73 with ~50% of plastics in the ocean more than 30 years old. In 2015, it was found that ~90% of the plastic was over two years old. 81 Perhaps not surprisingly, the world's ocean floor is littered with an estimated ~14 million tonnes of microplastics. 82 PPEs are lightweight and can easily be carried out by wind or surface currents and quickly spread in the natural environment. 44 Plastic waste can be broken down into millions of pieces of micro and nanoplastics. 13, 82, 83 However, microplastics can also come from other primary sources such as textile fibres, pastes, cosmetics, paints, and gels. 84 Animals, birds and fish can eat or choke on these microplastics. 77, 85 Additionally, the ecosystem structure could potentially fail in the long run, due to the sheer amount of non-biodegradable plastic waste in the environment, which can stay there for hundreds of years. Such plastic waste can also accumulate in food chains for human consumption and can be a pathogen carrier. 13, 72, 86, 87 

PPEs may become contaminated with microorganisms during patient care or personal use, spread via contact, droplets or aerosols. 88 A diverse community of approximately 400 different types of bacteria, mostly toxic, were found in 275 pieces of plastic collected on three beaches in Singapore, and reported to be responsible for coral bleaching, wound infections and gastroenteritis in humans. 89 PPEs in the environment could therefore act as a carrier of COVID-19 or other pathogens to the waste collectors, litter pickers, or public. Under certain conditions, the virus such as SARS Cov-2 can survive up to seven days in the plastic. 90 In many cases, those are persistent pathogens and can survive from a few weeks to several months. [91] [92] [93] [94] Indeed, 22 gram-positive bacteria were found on five commonly used hospital products (clothing, towels, scrub suits and lab coats, privacy drapes, and splash aprons), and some of them survived for more than 90 days. 94 In a study, 95 it was found that coronavirus droplets live longer on plastic than other surfaces such as paper or cardboard. It was also showed that textile and PPE play a critical role in bacterial transmission or viral infections. 5, 93, 94, 96-98

The textile industry is reported to be the second largest polluter of the environment after the oil industry, and annually half a million tons of microfiber are discharged into the environment. 99, 100 However, the environmental impacts of textiles are unevenly distributed globally due to a dispersed global textile supply chain. The developing countries (mostly in Asia) are hubs of textile manufacturing and bearing most of the burden of these environmental impacts, particularly for natural fibres, such as cotton, wool and silk due to agriculture, farming and processing. In the case of single use PPEs, such environment burden mainly lies on energy and waste, due to its sheer volume production and use. 44, 101 A life cycle analysis (LCA) evaluates the possible environmental impacts of product, processes, and materials, to enable making sound choices for the design, materials or processes involved in manufacturing a product. 102 Within the LCA, a life cycle inventory is considered for quantitative measurement of energy and emissions during the manufacture, use, and disposal. The environmental impacts such as carbon footprints, human toxicity, and eutrophication were quantified based on these inventory outputs. 103 However, the diverse nature of the PPE supply chain makes it difficult to assess the actual environmental impacts. 44

Disposable gown (HS Code 621010) with weight ~224 g/pc. 104 

with weight ~2.45 g/pc. 105 Environmental impacts are calculated and compared based on import data for three major countries in 2019 (Pre-COVID- 19) vs 2020 (During COVID -19) . Import data is taken in tons from ITC Database. 53, 54 The environmental impact parameters such as energy consumption, greenhouse gas emission, blue water consumption and solid waste has increased linearly to that of importing figures as given in Figure 5 .

In Figure 6a ,b, we compare the environmental footprints of PPEs for three main countries in 2019 and 2020. For disposable gown (HS code 621010), the quantity of import has soared for USA (606%), France (6209%) and UK (606%), Figure 6a . Similarly for surgical mask (HS code 630790), the the import quantity increased dramatically for USA (415%), France (1207%) and Germany (838%), Figure 6b . Such dramatic increase in import quantities has resulted in surge for environmental impacts with these products in terms of energy, greenhouse gas emission, water, and solid waste.

The traditional textile industry is a recognised source of water pollution, and has associated water consumption around 79 billion cubic metres of water in 2015. 106 In general, the water consumed to produce one kg of textile fabrics is between 100 to 150 L/kg, which impacts on the wastewater generated downstream. 107 For example, a study found that between 2012 to 2016, the annual water footprint in the Bangladesh textile industry was found to be ~1.8 billion cubic metres. 108 Additionally, the textiles industry emitted ~1.75 billion CO2e (carbon dioxide equivalent) tons globally in 2015, 106 an estimated 8.1% 109 to 10% 110 of total global greenhouse gas emission. In general, the production of nonwoven fabric involves less water consumption and similarly, less water is needed for single-use PPE during their usage. However, it was estimated that two-thirds of CO2e emissions of textile industry is associated with synthetic textiles processing including fibre production, textile manufacturing and apparel production. 44 The high carbon footprint of synthetic fibre production comes from the sources of energy used. For example, China uses coal to produce energy, 111 which will have a ~40% larger carbon footprint than in Turkey and Europe. 112 However, in the life cycle, fibre extraction from fossil fuel has the highest energy use and GHG emission in case of synthetic fibre. 113 To understand the environmental impact of disposable and reusable gowns, study has been undertaken which includes raw materials to the production of the finished gown and commercial use, cleaning and sterilising of reusable products to the final end-of-life cycle (either incinerated or landfilled as a more prevalent disposal option). 114 Traditionally reusable surgical gowns are made of 100% cotton, followed by cotton-polyester (PET) blends or full PET fabrics 115 -differentiated by woven PET fabric for non-critical zones and knitted PET fabrics in the critical zones 104 with mostly polytetrafluoroethylene liquid-resistant barriers (~70%) or polyurethane breathable barrier membranes (~30%). 116 On the other hand, disposable surgical gowns are made of nonwoven PET and nonwoven polypropylene fabric for the noncritical zones and critical zones, respectively. It was found that the environmental impact of a reusable gown was far less than that of the disposable gown, for example, the use of reusable gowns could reduce natural resource energy consumption (~64%), greenhouse gas emissions (~66%), blue water consumption (~83%), and solid waste generation (~84%). 104 In previous studies between 1993 and 2011, comparative life cycle studies of six reusable 20 and disposable surgical textile were conducted. The result shows that reusable surgical gowns and drapes use more natural resource energy (~200%-300%) and water (~250%-330%), but have lower carbon footprints (~200%-300%) and generated lower volatile organics, and solid wastes (~750%) than disposable gowns and drapes. 114 Additionally, a commercial reusable surgical gown requires ~36.1 g of packaging compared to ~57.8 g for the same for disposable gowns -which eventually translates into a 8% total energy consumption and greenhouse gas emission for reusable surgical gowns compared to 13% for the comparable disposable gown. 104 However, it will be difficult to substitut disposable gowns or any other single-use PPEs of synthetic fibre, unless a recyclable alternative is found, which could meet stringent regulatory requirements for tackling highly infectious diseases like COVID-19. 

The use of chemicals for single-use PPEs occurs in the following manufacturing/end-use stages: a) the nature of polymer raw materials and additives, b) chemicals used during processing, c) degradation of polymers in the environment, 117, 118 and d) sterilizing, cleaning and disinfecting. 119 The polymers used in PPEs are usually biochemically inert; however, the polymerisation reaction is, in most cases, incomplete and contains residual monomers, which can be hazardous to human health and the environment. 120 The fraction of the residual monomer varied from ~0.0001% (100 ppm) to ~4% (40,000 ppm), and depends on the type of polymer, polymerisation technique and other variables. 121 With its diverse polymer types, PPE pollution can contain various additive chemicals, which are usually used to provide certain properties and functionalities to the PPEs. 122, 123 More than several thousand different additives exists for plastic polymers, but these are unevenly distributed. PVC typically requires the most additives (~73% of total production volume), followed by PEs and PPs (10% by volume), Figure   7 . 124 These additives are organic chemical compounds like polychlorinated biphenyls (PCBs), polycyclic aromatic hydrocarbons (PAHs), persistent organic pollutants (POPs), organochlorine pesticides (2,2′bis(p-chlorophenyl)-1,1,1-trichloroethane, hexa-chlorinated hexanes), polybrominated diphenyl ethers, alkylphenols and bisphenol A, other additives or plasticisers and associated degradation products in the range of concentration from sub ng g -1 to µg g -1 . 81, 118, 125 These are persistent toxic chemicals in the marine environment, which can leach out and adhere to the surface and add further contamination. 126 The release of these degradation products could occur during production, use and in the end of life phase. 127 When plastic materials are exposed to the dissolved chemicals already present in the ocean environment 118 , it can also release harmful chemicals as evident in the nutrientrich stomach oil of seabirds over time, 47, 117, 128 which may negatively affect reproduction through disrupting hormone release and may have long term genetic effects in birds 117 and other marine animals. 129, 130 The transfer of these chemicals from plastic materials in a living organism could be by ingestion, excretion, as a direct source, dietary or dermal transfer. 81 The debate of the use of bioplastics (e.g PLA), 131, 132 as a substitution of petrochemical-based plastics, is also significant, as the sources are mainly sugar and starch materials -a direct competition to food crops, and also include chemicals and additive during manufacture. 133 The traditional textile industry is reported to use more than 8,000 chemicals in its many and varied manufacturing processes, and the persistence of the materials in the environment is the ongoing challenge. 134 Similarly in the manufacture of PPEs, chemicals are used in the spinning of fibre (solvents, lubricants), processing (chlorine for bleaching, dyes in dope dyeing, flame retardant, water repellents, antibacterial finish etc.), fabric production (epoxy or other resins). 44 However, the actual amount of chemicals required to produce a kg or a piece of protective clothing is unknown. The sterilizing, cleaning and disinfecting of PPEs also uses chemicals such as hydrogen peroxide as a disinfectant.

Ethylene oxide for sterilisation is also recommended for the use of recyclable PPEs. A list of products that can be used is also specified by USEPA, particularly for COVID-19. 135 The use of anti-microbial finishing in protective clothing is discussed elsewhere. 2 In general, it appears that the chemical footprint of single-use nonwoven protective clothing is comparatively lower than the traditional clothing. However, there are still many unknown factors, such as the production environment, pollution mitigating technology, and waste treatment facility. These all could lead to higher environmental impacts, and health and safety risk to the workers, producers and users. Although the physical and chemical toxicity of microplastics due to contamination, consumption and other factors on human are yet to be fully determined, 70, 128 nevertheless it has been reported that depending on the pre-existing health conditions, microparticles from plastic can cause alterations in chromosomes which may lead to infertility, obesity, and cancer. 71, 101

The UN Economic Commission for Europe (UNECE) identified the textiles industry as a significant contributor to plastic entering into the ocean. 136 and polypropylene. 90 In these six decades, 0 to 9% of the municipal plastic waste was recycled, ~2% to ~17% were recovered for energy and ~75% to ~100% was landfilled in the 10 year period . 90 In addition, the total plastic waste in the waterbodies arising from land-based waste, particularly in densely populated or urban areas such as Tokyo, Nagoya and Osaka was high. 81 The problems associated with these microplastics are increasingly pervasive and are found in seafood, beer, honey, table salt and bottled mineral water. 69 After domestic or hospital use, single-use PPEs are discarded either into landfill and may impact on landfill seepage in future years. 2 It is estimated that without systematic change, 12 million tons of plastic litter will end up in the environment such as landfill and ocean. 18 and will contribute greenhouse gas emissions up to ~5% of the global carbon budget by 2050. 137 The effect of this plastic accumulation in nature could be multifold. If land pollution is considered then the blockage of the sewage system can increase the risk of flooding, 138 can be a breeding ground for vector-borne zoonotic diseases (e.g. Aedes sp. mosquitoes, as a vector of dengue and zika), 139 and can degrade soil and be responsible for poor crop development. 140 Additionally, plastic debris can reach the aquatic ecosystem through various water channels such as a sewage line, wastewater treatment plant, rivers and ocean and can reach the furthest areas of the Earth such as Antarctica. 101 23 

The use of single-use PPEs will not be a sustainable practice into the future. 1 Reuse of PPEs is an option, and are already used in many settings, for examples face shields and reusable gowns in operating theatres. Reusable face shields and gowns were found to lower environmental impacts up to five-fold compared to a single-use version. 59, 141 The UK and Wales government has reiterated not to use singleuse PPEs wherever possible to manage their environmental impact and to support recycled and reusable alternatives. 63 A detailed analysis of these approach will be required so that reusable PPEs do not compromise the primary function of protecting health. PPE sterilisation on a large scale will be needed for reuse, which is possible through hydrogen peroxide vapour, ultra-violet or gammaradiation or through other spray-on disinfectants. 59, 142 In a recent study 22 on the most commonly used PPE items by the National Health Services (NHS) in UK, the overall environmental impacts of masks, gloves, aprons, gowns, and face/eye protection were evaluated. From February to August 2020 of the COVID-19 pandemic, the total carbon footprint of all PPEs supplied was 106, 478 tonnes CO2e for base scenario, in which ~61% was derived from raw materials extraction, manufacture and use, 35% from waste and 4% from the transportation, Figure 8a , b. However, carbon foot prints could be reduced by 11%, 46%, 10.5% and 35% via UK manufacturing, reduce PPE use (eliminating gloves), reusing and recycling of PPS PPE, respectively (Figure 8a, c) . 22 In addition, PPEs will be in high demand into the foreseeable future and the investment in new PPE materials at a global level is key. A multi-disciplinary team with technical expertise including material science, biomedical science, environmental science and product engineering is essential to tackle the PPE pollution problem.

Although initiatives are emerging encouraging local production, particularly for emergency supplies, it is still a challenge due to the fragmented nature of the supply chain and the need for rigorous quality assurance. The process of sourcing materials, designing assembly processes, machining and scaling up the production, quality and testing procedures, certifications, etc. will be required in all cases. 48 In addition, transport and shipping, containers, limited workforce all will be significant factors in managing the complex global supply chain of textiles. 43

The pandemic has stressed the solid waste management infrastructure globally, highlighting the supply chain difficulties across PPE manufacture, demand-supply, use, logistics and disposal. 1 145 which should be incinerated at high temperature followed by landfilling of the residual ash. 146 Some larger economies were able to manage this option; for example, China deployed mobile incineration facilities around Wuhan to tackle infectious waste. 147 But in most cases, the significant increased consumption of single-used PPEs along with other medical waste due to the pandemic will most likely overload waste management. 14 In general, the basic principles of waste management strategy are: reduce-reuse-recycle and these fundamentals should be applied to

PPEs. Also, within the circular economy philosophy these principles should guide policy development during and after the current pandemic. National policy should encourage recycling, incentivise adoption and embed "cheap" product pricing. The economic model will promote the adoption of green good health and wellbeing, SDG 6 -clean water and sanitation, SDG 8 -decent work and economic growth, SDG 12 -responsible consumption and production and SDG 13 -climate action. 57 Traceability of production of PPEs and corresponding waste management perhaps could be a key for unlocking these challenges.

As discussed before, nonwoven PE and PP fabrics are the main raw materials for single use PPEs, based on various spunbond-melt-spun materials. Such materials would be very difficult to replace, particularly for hygiene and health requirements. However, it is possible to use in combination with some natural, regenerated or biodegradable fibres, 131, 132, 149 which can then be either biodegradable and/or could provide reusable properties. In addition, the substitution of some chemicals/additives currently used in the production of PPEs provides an opportunity for an integrated approach to eliminating persistent and damaging materials. Additionally the use of new materials such as graphene 150 for manufacturing PPE could potentially help moving towards sustainable products with enhanced mechanical properties. However, substitution of these chemicals used in the production of PPEs should be enforced by legislation and regular monitoring. Coupled to these local changes, wider scale import restrictions could also help to accelerate the acceptance of a greener philosophy in selecting raw materials and chemicals of PPEs.

Smart PPE, has also gained significant attention in recent years due to their ability to improve workplace safety and achieve operational excellence. Such PPEs are usually connected to wearable devices, and continuously track movement and monitor vital physiological conditions including temperature, heart rate and breathing rate. Smart PPE can capture and track thousands of different data points, which can be used to address any number of safety concerns, everything from fever to heat exhaustion to fatigue to improper lifting motions. Smart wearable e-textile technologies 151 could be integrated with protective clothing to produce truly "Smart" wearable medical clothing. In previous studies, [152] [153] [154] [155] we reported washable, durable, and flexible graphene-based wearable e-textiles, which are highly scalable, cost-effective, and potentially more environmentally friendly than existing metalsbased technologies. It could potentially lead to manufacturing of smart, sustainable and reusable personal protective clothing with less environmental impacts. pandemic. medRxiv 2020.

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He is also working on future skills development of textile graduates in collaboration with a2i, and as Assistant Director in skill development project funded by ADB. Dr Abbas is one of the authors for producing 'National Chemical Management Guideline for Textile industry' 2021. He has over 18 years of experience, specialising in Textile wet processing, value chain and environmental sustainability. He holds a PhD from the University of Manchester

He has research interests into environmentally sustainable clothing and wearable electronic textiles. He is currently part of a BUTex research team working on graphene

Research has focused on easy care finishing of cotton and wool, laundering processes, conservation science, technical textiles, hair processing, surface chemistry, novel colouration and healthcare textiles/materials. He has published widely

Novoselov is an condensed matter physicist, specialising in the area of mesoscopic physics and nanotechnology. He is currently Tan Chin Tuan Centennial Professor at National University of Singapore with broad research interests from mesoscopic transport, ferromagnetism and superconductivity to electronic and optical properties of graphene and twodimensional materials

The authors respectfully acknowledge all the front-line workers ("Heroes") around the world for the wonderful care and support they are providing daily during the current Covid-19 pandemic. This research was supported by E3 Research England Funding (UK).