Tuberculosis outbreaks declared in northern First Nations communities

Health authorities have declared tuberculosis outbreaks in two northern Saskatchewan First Nations communities with a combined 13 cases and hundreds of close contacts. 

Taiwo Olubanwo, executive director of primary health care for Athabasca Health Authority (AHA), released a report and declaration of the outbreaks in Black Lake Denesuline First Nation and Fond Du Lac Denesuline First Nation on Friday.

Both are located less than a few hundred kilometres from the province's northern border. 

So far, there have been seven confirmed cases in Fond Du Lac, with about 70 contacts identified, and six confirmed cases in Black Lake, with 157 contacts identified. 

Olubanwo explained that outbreaks are declared depending on several aspects, including the behaviour of the disease and how transmissible tuberculosis is in a community. 

"We looked into it, we flagged it and an outbreak was declared — especially when a five-week old baby is diagnosed with TB, it's raised a bit of a concern," Olubanwo told CBC News. 

"We've also identified some community transmission in order to reduce the spread of it." 

An outbreak management team composed of several health authorities, including the AHA, as well as Indigenous Services Canada and TB Prevention and Control are working on containing and managing the outbreak and addressing resource gaps.

"We are increasing the workforce towards it, we are increasing [the] resources towards it … I'm very confident that everything will be managed," Olubanwo said. 

He expects it may take time, though, because treating the illness can take months.

Officials said they haven't determined the source of the outbreak yet. 

Tuberculosis in Indigenous communities

Olubanwo said tuberculosis isn't uncommon in Indigenous communities and has an incident rate significantly higher than the Canadian or provincial average, though he didn't have recent numbers available. 

"TB cases are not new. It's been [in Indigenous communities] for a while … today it's an ongoing concern, particularly in the northern communities," he said. 

Black Lake and Fond Du Lac aren't the only northern communities with instances of tuberculosis, but Olubanwo said the illness has reached a severe level in the two communities that require an outbreak declaration to contain its spread.  

According to Indigenous Services Canada, the rate of tuberculosis among First Nations people living on reserve is more than 40 times higher than the Canadian-born, non-Indigenous population.

Experts like the medical health officer of the Northern Inter-Tribal Health Authority Dr. Nnamdi Ndubuka have attributed the higher rates of the illness to the social determinants of health — social and economic factors which play a role in community wellness. Experts often point to overcrowded and poorly ventilated homes. 

"These communities, particularly, have been TB-high incident communities," Ndubuka said, noting underlying conditions, like diabetes, also increase the risk of contracting the illness. 

Battling two diseases

Olubanwo said that there is a risk someone can contract both Tuberculosis and COVID-19, which could further health complications. 

The impact that COVID-19 has had on health care has also affected northern communities. Black Lake entered a lockdown in late July because of a COVID-19 outbreak. As of Saturday, there was one active COVID-19 case in the community.

"The same health teams in the communities that are overstretched have continued to manage those difficult COVID-19 outbreaks and now also expected to manage the TB outbreaks," Ndubuka said. "It's really tough and that's why we are mobilizing as [many] resources as we can to support the community."

Ndubuka also encouraged people in the community who may be experiencing symptoms — like a cough lasting two weeks, chest pain, fatigue and night sweats — to contact their local health clinic.