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Seeing the amount of these sheets accompanying each medication, I have realised how much paper (do) we waste on a daily basis?

Seeing the amount of these sheets accompanying each medication I have realised how much paper (do) we waste on a daily basis?

  • It's certainly not "needed" - it's actually ungrammatical (or at least, seriously non-idiomatic) to include do that way in the cited utterance. In certain "emphatic refutation / surprise" contexts, it would be possible to say I've realised how much paper we do waste (where some prior context implied there's little or no such waste). But your example isn't one of those contexts. The comma would normally be included (as would a pause in speech), but I wouldn't say it's required. – FumbleFingers Reinstate Monica Jan 5 at 14:03
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    "I have realised how much paper (do) we waste on a daily basis?" is written like a question, but is not one. – Michael Harvey Jan 5 at 20:29
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A direct question inverts the subject and auxiliary, requiring "do-support" for most verbs:

How much paper do we waste on a daily basis?

An indirect or embedded question does not invert, and so does not require "do-support":

I've realised how much paper we waste on a daily basis.

We always have the option of emphatic do, but there is no inversion in the embedded question:

I've realised how much paper we do waste on a daily basis!

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Better to say the number (or quantity) of sheets. Leave out 'do'. You can leave out 'these'. I would only use it if indicating the sheets to someone present at the time.

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