Use your COVID-19 awareness to help First Nations kids breathe easier, doctor urges

Dr. Tom Kovesi can skip a step these days when he wants to explain how stagnant indoor air is a problem for First Nations children.

"Before COVID, aerosols and droplets weren't common concepts, now they're ever more familiar," said Kovesi, the paediatric respirologist at CHEO and investigator at the CHEO Research Institute.

We're also thinking a lot more about how crowded spaces spread contagions, so we should be better able to understand how overcrowding in First Nations homes makes kids ill, he said.

Kovesi's latest research, in partnership with remote First Nations in northern Ontario, shows children there were up to 16 times more likely to suffer from respiratory illness than other Canadian children. Previous studies in Nunavut looked at lung health of Inuit children aged zero to three years old, but Koveski says this is the first research of its kind on First Nations babies.

Public health Ontario says unsuitable housing also puts Indigenous people at more risk of contracting COVID-19. While there remains uncertainty about precisely how COVID-19 spreads, scientists are certain that influenza can spread both through droplets and through the air.

"If you catch influenza through air transfer it penetrates much deeper into the lungs and you end up with pneumonia," Kovesi said. "So if you sneeze in a house in Nunavut, there's a cloud of aerosol and the ventilation is really poor" so everyone in the home is at a greater risk of getting sick.

Young children are especially vulnerable. Respiratory illness affects children in Nunavut at a rate of 200 per 1,000 and First Nations children in northern Ontario at a rate of 35 per 1,000, Kovesi said. In some First Nations studied, that rate rises to 160 per 1,000.  The rate in Toronto or Ottawa is 10 per 1,000.

"Overcrowding and reduced ventilation are significantly associated with bronchiolitis" a viral infection in the lungs that can sometimes be fatal in children, Kovesi said. Underlying lung conditions in-turn make people more susceptible to COVID-19.

Roughly half of the houses in the four First Nations studied do not meet the Canadian standards for air circulation, Kovesi said, and only 15 per cent had working heat recovery ventilators, to improve ventilation.

"This study is significant as it documents the substandard quality of air in homes," said Grand Chief Alvin Fiddler of the Nishnawbe Aski Nation, whose communities were involved in the research. "I look forward to putting the knowledge we gain into action to improve housing in our communities."

About 40 per cent of First Nations people living on reserve in Ontario live in overcrowded conditions, according to Public Health Ontario.

'You have to build more homes'

"Number one you have to build more homes, that's such an important part of the fix," Kovesi said. "Number two is ventilation."

Previous research in Nunavut has shown a two-thirds reduction in colds and wheezing illnesses when heat recovery ventilation (HRV) systems are installed and working in homes, he said.

Kovesi said it's one of his dreams to see the enhanced public understanding of virus transmission during the pandemic, coupled with government efforts to stimulate the economy result in the political will to build more homes and better infrastructure in First Nations.

"Wouldn't that be amazing," he said.

Carlton University chemistry professor David Miller agrees, adding it's important to consider the type of houses being built. Miller, a leading national expert on household contaminants such as mould also took part in the research in northwestern Ontario First Nations.

'Saying there's a problem is not enough'

The prevalence of homes with poor air quality was greater than what Miller sees in the rest of Canada and in First Nations, "when they're bad, they're very much worse than what we see in other communities," Miller said. "It's a huge public health issue.

"Doing health research and saying there is a problem is not enough," Miller said. "It's easy to say it's terrible. We need to understand how to build the houses that are appropriate for the communities they're in."

Since new homes can't be built overnight, the project also aims to help First Nations families make their existing homes safer. The project team designed new information sheets on how to operate ventilation systems and deal with mould, then enlisted local help to make them relevant in a northern context and translate them into Oji-Cree.

"Information that is relevant in a typical urban centre might not be the right information in a rural community," Miller said. "For example, wood stoves are an important source of heat, but people in the city usually don't have one, and Health Canada's website doesn't have information about how to limit their impact on indoor air quality."

The Sioux Lookout Zone Children's Environmental Health Study Team, of which Kovesi and Miller are members, studied 101 homes in four First Nations: Lac Seul, Kasabonika Lake, Sandy Lake and Kitchenuhmaykoosib Inninuwug.

The results of the research are still being analyzed and have yet to be peer reviewed but the research team has already garnered a national award from Health Canada for excellence in environmental science.