An Application of Algae Technology for Surgery and Public Health

The authors propose a novel application of algae technology to create biodegradable personal protective equipment (PPE) to protect surgeons and other healthcare workers from COVID-19 and other diseases, diversify the medical supply chain, and aid the environment.   

At the start of the COVID-19 pandemic, there was an initial mad scramble by the U.S. government, non-governmental organizations, hospitals, healthcare workers, and other individuals to procure PPE¹. Yet this shocking turn of events was not only limited to the U.S., but the entire globe². The pandemic ended up creating a tumultuous supply chain with dire consequences for healthcare workers as well as the medical supply chain¹. It is a travesty that healthcare workers have in fact died from COVID-19 due to lack of PPE³. Since the U.S. and other countries are heavily dependent on global imports, it is imperative to diversify the global supply chain in order to prevent a decrease in PPE protection and, more importantly, loss of life¹. 

The pandemic has not only led to a devastating loss of life, but has also led to environmental public health implications. Even as the fluctuating amount of PPE available to healthcare workers ebbed and flowed throughout the pandemic, there was one constant: a steady stream of PPE piling up as medical waste due to the overall increase of PPE used to combat COVID-19⁴. Indeed, the increase in discarded single use PPE has led to the concern that it is polluting terrestrial environments and aquatic ecosystems⁴. The pileup of PPE as a consequence of COVID-19 is thus an urgent environmental and public health issue.  

Applications of algae and algae technology offer a beacon of hope to combat pathogens and COVID-19 while also addressing public health concerns. Seaweed, a type of algae, already has antimicrobial properties to successfully defend against multiresistant pathogens and antifungal properties⁵. Seaweed extract has already been used in antimicrobial wound dressing. When compared to the typically used wound dressing Acticoat, the antimicrobial seaweed wound dressing was just as successful in combating nine pathogens that were clinically relevant to wounds⁶.              

Research on algae technology, specifically microalgal biotechnology, started in the 1950s in Germany, Japan, and the U.S⁷. In the U.S., there are over 50 research institutions and 100 companies researching and working on algae technology and various applications of it⁸. The U.S. has the annual capacity to sustainably produce 104 to 235 million metric tons of algal biomass according to a Department of Energy (DOE) analysis⁹. Investments in algae technology, research, and development in both the public and private sector surpass two billion dollars⁸. In looking only at last year, the DOE funded $18.7 million to improve algae farming and enhance algae production¹⁰.  The DOE also funded $27 million in 2020 in the recycling, research, and development of plastics, including algae-based bioplastics which the University of California, San Diego and its partner company Algenesis have been working on^{7, 11}.

Algae technology has been used by the University of California, San Diego and its partner company Algenesis to create a sustainable algae-based surfboard in 2015 and biodegradable algae apparel such as flip-flops in 2017¹². Algae oil is extracted from algae and turned into polyurethane foam to make these biodegradable products^{11, 13, 14}. The ability to create other kinds of biodegradable products is thus possible. Due to the high standards and difficulty in creating N95 respirators which must filter a minimum of 95% of airborne particles to meet NIOSH approval, it is probably not feasible at this time to first try applying algae technology in creating this particular type of PPE¹⁵. While 3D printing has been used to create PPE, these kinds of homemade PPE do not meet the air filtration and fluid barrier protection standards as required by the FDA for surgical mask clearance and as required by NIOSH for N95 approval¹⁶. With this in mind, it is important to consider other kinds of PPE which can first be created using algae technology.

The necessity of biodegradable algae-based PPE with potentially anti-microbial properties that can be used to protect healthcare workers leads us to suggest that surgical PPE be created. Surgical caps and shoe covers are considered 510(k) exempt Class I medical devices, which means they are considered low risk compared to N95 respirators and surgical masks categorized as Class II medical devices¹⁷. Bypassing the more rigorous approval standards that surgical masks and N95 respirators need to meet will allow for a faster creation of essential yet environmentally friendly PPE for healthcare workers, namely surgeons. 

Using algae technology to create surgical caps and shoe covers are in fact urgently needed by surgeons during this pandemic. A study of spine surgeons which looked at their PPE use, recycling, and disposal methods determined that there was high PPE usage in the majority of the 19 countries examined particularly regarding surgeries with COVID-19 patients¹⁸. Aside from N95 respirators and surgical face masks, PPE such as surgical caps and shoe covers experienced high usage during surgeries. The recycling of PPE did not typically occur, which also highlights the need for biodegradable PPE¹⁸. While the biodegradation of biomedical plastic wastes can take numerous years, the biodegradation of the algae flip-flops takes 16 weeks¹⁹. In U.S. hospitals alone, disposable linen constitutes 53% of surgical waste which could be sharply reduced with the help of sustainable surgical PPE²⁰.

Based on a 2022 Cornell University study, a new PPE disposal method involves pyrolysis. This method which eliminates the use of landfills and incineration can reduce the current plasticized PPE into its original petroleum form and other chemicals which can then be recycled²¹.Yet once the recycled materials are used, they could potentially end up in a landfill or go through incineration. In using algae-based PPE, however, pyrolysis would reduce the algae-based PPE into its biodegradable components which would not contribute to plastic pollution even if it was incinerated or ended up in a landfill²¹.

Based on the United Nations Environment Programme, healthcare services associated with COVID-19 has generated 7.5 pounds of PPE waste per person every day on a global scale²². A COVID-19 handling facility deals with over 400 tons of PPE waste each year with a single hospital of 300 healthcare workers producing over a ton of PPE waste every day^21,22. Standard PPE is mostly composed of plastics made out of propylene which are developed from non-renewable fossil resources like shale gas or crude oil²¹. Since mass production of standard PPE involves a large amount of fossil fuels, the production and materials of standard PPE contrast sharply with the more environmentally friendly algae-based PPE²¹.

North of six billion metric tons of plastic waste have been produced for the past half century with approximately 9% of it recycled, 12% incinerated, and 79% left in the natural environment or landfills¹³. If the status quo of plastic production and waste management continued, it is projected that about 96 billion tons of plastic waste will be in the natural environment or landfills by 2050¹³. Most plastic products last for centuries and gradually degrade into microplastics which initially move through the food chain via primary consumers. Metabolism and reproduction are affected and there is an increase in respiratory conditions, cardiovascular disease, cancer, and mortality rates¹³. 

It will take approximately three to five years to produce biodegradable PPE based on the creation and production times of the algae-based surfboard and flip flops as well as the approximate timeline to meet FDA standards^{7,14, 23, 24}. Initial pilot studies of the effectiveness of algae-based surgical caps and surgical shoe covers compared to standard surgical PPE can be conducted and replicated throughout the world including in low resource settings. The potential antimicrobial properties of algae-based PPE would certainly differentiate it from the current PPE^5,6. As the algae technology advances, other kinds of PPE including surgical masks and N95 respirators can be made to further protect surgeons and other healthcare workers. The certainly limitless possibilities of other algae-based products spark the imagination.

Potential problems in competing against the current PPE include cost, marketing to increase awareness of biodegradable algae-based PPE, and a limited number of algae biorefineries and farms^8,25. There needs to be an increase in the number of algae biorefineries and farms to produce products at scale. Not being able to buy enough algae from algae farmers due to the limited number of biorefineries and farms is a limitation in the algae supply chain²⁵. Possible solutions to the limitations in the algae supply chain which are already being used by other research institutions and startups include using a combination of algae oil and other plant oils to create biodegradable products²⁵. Using 100% algae oil is still preferable to using a combination of algae oil and plant oil because algae is more environmentally friendly; it uses less water and less land compared to other plants^{25, 26}. Additional challenges include making sure the algae-based PPE meets FDA standards²⁷.

While discussing sustainable algae-based products, it is worthwhile to consider the cost of biodegradable PPE. The low cost in creating algae-based flip-flops at approximately $3 per pair indicates that creating surgical caps and shoe covers will also be at a roughly similar price point¹². Bioproducts annually created alongside biofuels could potentially be sold for $0.67–$2.2 kg⁻¹ at a volume of 10,000 to 1,000,000 metric tons based on the DOE National Algal Biofuels Technology Roadmap²⁸. In looking at biobased plastics, the price for polysaccharide-derived plastics is currently assumed to be consistent with petroleum-based plastics²⁸. 

As the technology improves and there is an increase in production, the price will decrease²⁹. Algae technology thus allows for affordable PPE which can be distributed all over the globe. The importance of low-cost PPE with potential antimicrobial properties being provided to healthcare workers, particularly those in vulnerable communities, is essential to improving healthcare and saving lives regardless of socioeconomic status or geographic location. 

The uses and implications for algae-based PPE and future products are as vast as the sea itself. Ultimately, our proposal of the creation of environmentally friendly biodegradable PPE will reduce medical waste, increase the amount of PPE available, diversify the medical supply chain, and protect healthcare workers from devastating diseases like COVID-19.