Again, It's back-to-school time. My own daughter started year 7 at school this morning. Parents all over Australia are getting ready, or their kids have just gone back to school or about to go back to school this week, and this leads me to a letter I received in the mail last week. This letter is quite a heartfelt letter, and I'm going to read out to you what it says.
I've highlighted the three sections in this letter that are particularly emotive, and this particular parent wrote to me stating would I do a show or a video presentation commenting on the relationship between the school buildings and the health of the children.
That leads me into the fact that I have done numerous inspections, and water damage, and mould, and air quality investigations in schools over the last decade, and this is a source building which is highly contentious. There are different stakeholders from the parents through to the children who use these buildings, and of course, the management of the school and also the teachers who work within the school.
Every one of them has a different perspective on the sometimes dilapidation that you find in schools, but going back to her letter, she States, "My child passed away from viruses she got at school and mould. The school is very dismissive and said there is no evidence. We have received evidence from an integrative medical doctor who they ignored and said was not a specialist. I would like you to do a show on this focus topic of what is the relationship with the school environment and mould exposure."
What does the literature say? I've got a lot to say on this, and that is the topic of today's show. So there are some key questions that we need to consider here, and I want you to stick around through the show because I'm going to be running through how you can best approach your school if you have concerns about mould or water damage at your child's school being connected with any adverse health symptoms they may be experiencing.
So the key questions are, how much exposure to visible or hidden mould has there been? How much exposure has the children or staff been exposed to water damage building elements? How wet did they get? Were there exposure conditions to elevated humidity? Were there exposure conditions to elevated condensation levels indoors? Overall, what is worse for symptoms? Is it exposure at the school environment during the day, or is it exposure at home?
So we move into the first peer reviewed publication that also has come out in the last 12 to 24 months focusing on school attendance and daily respiratory symptoms in children and the influence of moisture damage. The URL is up here on screen and will also be in the show notes. They were looking at the fundamental question, "Is there a connection between the frequency and severity of respiratory and other symptoms, and the levels of moisture damage at schools?"
They discovered, after they examined 57 schools in Spain, the Netherlands, and Finland, and what they did importantly is they sent in and performed a standardized building inspection to classify the school buildings as either moisture damaged or non-moisture damaged, and then they ranked them according to severity extent, and the location of the dampness, and any mould they found. Then, they looked at the lower and upper respiratory tract symptoms, allergy experienced at school, or on the weekends, or over the summer, the holiday period over the last 12 months, and they used a self-administered questionnaire...
I didn't catch that.
My watch just talked to me there. A self-administered questionnaire for first to sixth grade kids, and they examined 433 of them. They discovered and their conclusion was that respiratory symptoms were less frequent and less severe during the summer holidays and weekends. The take-home message here one can hypothesize is that the home environment is potentially better control for moisture and mould, and that therefore, there is less chance of the home environment contributing to adverse health.
The pattern was much stronger for children attending moisture-damaged schools. Meaning, that the higher the exposure level to mouldy conditions, or dampness, or condensation, the less likely they are to really get better in a sense. So the weekends and the school holidays are fundamentally important in showing an improvement to these adverse health conditions, and moisture damage in school buildings may have an important impact on school attendance and indirectly on school performance. The take-home message was the school environment may be a very important source of risk factors and of acute symptoms during childhood.
Now, I now want to talk about another paper that has also come out very frequently, and it's talking about something called rhinitis. Rhinitis needs to be understood as an inflammation and a swelling of the mucus membranes in the nose, which really leads to a runny nose, stuffiness, and it is commonly connected with either allergy or experiencing of a cold.
So this paper is focusing on whether or not you experience this constellation of symptoms and whether or not they are connected to the school environment or the home environment. Just to put the problem of rhinitis in perspective and certainly with regard to where this study took place in China that over the last two decades, there has been an increase from 11% to 18% in the experience of rhinitis for the entire population, and so the question is, is dampness and mould at home a known risk factor for rhinitis?
They also have discovered that yes, it is, as well as exposure to chemicals, and they're the two things that need to be looked at. So in this publication, they applied a questionnaire to students age between 11 and 15, and then they measured a whole lot of the metrics concerning indoor air quality at the school and at home. They looked at the symptoms over a 12-month period, and they attempted to connect this with the metrics for dampness and mouldiness. Guess what they found?
They discovered that self-reported dampness and exposure to indoor mould at home was associated with the onset and a decrease in the remission of rhinitis for two years after the experiment began. Furthermore, recent redecoration of the home such as renovation, indoor painting, and also buying of new furniture was associated with the onset of rhinitis.
Poor ventilation at school, especially measured by carbon dioxide, was associated with increased onset and decreased remission of rhinitis. Again, carbon dioxide is a very sensitive metric for measuring ventilation levels and rates, and many buildings may have inadequate ventilation, which again contributes to this rhinitis phenomenon.
Now, obviously, indoor relative humidity is associated with an increased onset and decreased remission rate of rhinitis. Furthermore, the PM10, which is particulate matter, which is the coarse particles, these are also associated with rhinitis. We saw with the recent problems with the bushfire colloids, so the bioaerosols from the smoke that they are predominantly the PM 2.5, but there was also a big spike in the PM10 levels as well. PM10 levels are a big huge issue, so measuring those at school can also be connected with rhinitis. Certainly for rooms with carpets, often PM10 levels are easily elevated when people move around.
So the take-home conclusion from this paper was that there is a need to increase ventilation flow in classrooms by installing mechanical ventilation. But even when mechanical ventilation is installed, it needs to have appropriate filtration to make sure that the particles don't get through. As well, there needs to be a big effort focusing on adequate maintenance of buildings, and avoidance of risky construction practices, and anything that could allow dampness and moisture to build up within the school building.
So what you've been waiting for, what should schools do? Again, I am looking at this next question here from another publication that is also very recent, and schools should design, operate, and maintain their school buildings in a manner that minimizes dampness and mould problems. Now, when dampness and mould problems do occur in schools, corrective action should promptly be undertaken, so we don't end up with a situation where a mother is writing me a letter to promote this concept because her child died.
Now, this is not a good thing obviously, and we need to be very aware of the potential devastating impact that exposure to the built environment can have for some people. I don't know what the ins and outs of all of this case is, but I do know that from the perspective of the parent, they are convinced that had their school taken the exposure problem of the child being exposed to mould and water damage seriously even after a doctor became involved, that her child might still be alive today.
So schools obviously need clear criteria defining what is dampness and what are unacceptable mould levels that in a sense flag fall when remedial actions need to occur. A lack of these criteria create situations that promote needless debate over what is or is not damp and mouldy, and this therefore hinders any efforts to reduce dampness and mould related health impacts.
So it's very important because the peer reviewed literature shows that there are statistically significant improvements in respiratory health outcomes after renovations. However, partial renovation, that means only doing half the job, doesn't improve health, and that's what the academic literature says. So the schools also need to not just do bandaid measures, but properly address all sources of water infiltration or accumulation.
So some key questions to consider. There definitely is a positive connection between the home environmental factors and measured exposures in classrooms. You need to be asking your school, "Have you noticed any water damage or floor dampness during the last 12 months?" This slide of the keynote presentation is perhaps one of the most important ones for this week because these are how you would frame a dialogue with your school to open up the debate about whether or not the school needs to take action, and so, "Have you noticed any water damage or floor dampness during the last 12 months? Have you noticed any indoor mould during the last 12 months?"
These are very simple questions. "Have you bought new furniture or renovated during the last 12 months?" This applies not only to the school, but also, at home and, "Have you painted your dwelling indoors during the last 12 months?" All of these are known factors linked with adverse health outcomes, and so these are the key questions to frame your connect-the-dots pathway towards working out whether or not there is a problem.
Now, this last paper came out in 2018, and this is some beautiful research actually from Ethiopia. I have titled this slide "If it's all too much for your School...!?" because in some situations, the school might say, "Well, we don't know if it's a problem." So I should say download this paper and read it. It's very easy to understand and perhaps give it to your school because suggesting to the school that they might need to consider measuring the impact of the indoor air contamination, and it might not be contaminated, but measure it to work out whether there is any potential risk or hazard to the students' or teachers' health and wellbeing.
In this publication, they talk about some of the history of indoor air pollution, and they highlight the fact that even the World Health Organization have stated that 3.8 million deaths per annum are due to adverse indoor air pollution and that 2% to 6% of the overall population in developed countries is allergic to mould or fungi. Therefore, it's very possible that when your child says, "I feel worse when I'm at school. We've had water damage," that there could be a connection here and just remember that exposure to mould could cause irritation, acute infection, and toxic effects due to a whole range of mycotoxins and microbial volatile organic compounds.
Now, the Ethiopian research shows how the schools were approached, and they suggested and carried out measuring indoor air quality particle counts using settle plates, a very simple method. We sell do-it-yourself kits to do this all week long, and these settle plates allow you to quantify the amount of mould in the air. This is what this academic publication did. They also use self-reporting questionnaires plus building inspections all to build up a picture of the fungal load inside the building linked to visual observations and the self-reported symptoms.
So at the end of the day, if you think that your child is being exposed to unwanted mould, then you may need to approach the school. Have a responsible conversation with them about the fact that you are concerned about the indoor air quality, that you are concerned about potential water ingress and accumulation, and that these are factors which could be adversely affecting not only the children's health, but the teachers' health and any persons who come into contact with this. This is not to have a go at individual schools and suggest that they are being badly maintained, but sometimes it takes the wider school community to highlight very real problems within the built environment.
In any case, my name is Dr. Cameron Jones. Next week, we will be back with another aspect of indoor air quality and mould, and we'll be focusing on how you can maximize your own health within urban environments and the built environment in particular. Anyway, have a great week, and I hope it's a good one for you. Bye for now.