The Mould Show

Back To School Moisture Damage & Your Child's Health

January 30, 2020 Dr Cameron Jones Episode 32
The Mould Show
Back To School Moisture Damage & Your Child's Health
Show Notes Transcript

BREAKING NEWS - the corona virus, followed up with some new information linking fungi to grass pollens as a key contributor to thunderstorm asthma. Also, I have been receiving calls about the dubious practice of fogging for mould. Find out a legitimate method of aerosolized microbial control that's not suspect!

The main topic today is School Buildings and the Home and the potential connection with adverse respiratory health. Watch the video for the KEY PAPERS you should cite in any dialogue you have with your School or University if you suspect that mould or water damage is connected with poor or worsening health symptoms.

Towards the end of the video I tell you the 4 QUESTIONS you need answers for. Finally, I cite a paper that shows how to easily approach the MEASUREMENT of thee problems and how this information can be used to address parent, staff or child fears over exposure.

REFERENCES:

1. School attendance and daily respiratory symptoms in children: influence of moisture damage
 https://www.ncbi.nlm.nih.gov/pubmed/27224645/

2. Respiratory Diseases in University Students Associated with Exposure to Residential Dampness or Mold
 https://www.ncbi.nlm.nih.gov/pubmed/27869727/

3. Onset of respiratory symptoms among Chinese students: associations with dampness and redecoration, PM10, NO2, SO2 and inadequate ventilation in the school.
 https://www.ncbi.nlm.nih.gov/pubmed/30907194/

4. Onset and remission of rhinitis among students in relation to the home and school environment—A cohort study from Northern China
 https://www.ncbi.nlm.nih.gov/pubmed/30985976/

5. Does dampness and mold in schools affect health? Results of a meta-analysis.
 https://www.ncbi.nlm.nih.gov/pubmed/31310034/

6. Indoor Culturable Fungal Load and Associated Factors among Public Primary School Classrooms in Gondar City, Northwest Ethiopia, 2018: A Cross-sectional Study
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6813266/

NEWS:

1. Efficacy Of Hydrogen Peroxide Fumigation In Improving Disinfection Of Hospital Rooms And Reducing The Number Of Microorganisms
 https://www.ncbi.nlm.nih.gov/pubmed/31965767

2. https://doi.org/10.1016/j.envres.2019.108911
A systematic review of the role of grass pollen and fungi in thunderstorm asthmahttps://doi.org/10.1016/j.envres.2019.108911

1:05 Corona virus
3:02 Update on Thunderstorm asthma
4:44 Fogging and mould control
7:36 Hydrogen peroxide fumigation
12:20 Back to School Moisture Damage - What You Need To Know?12:59 The Letter - My Child Died From Environmental Impacts 
14:46 Key Questions
15:53 Are weekends and holidays connected with symptoms?
19:04 Onset and remission of rhinitis
23:25 What should you do?
26:02 Key Questions to consider
27:25 If it’s all too much for your school, here’s what to do or ask for?

Hello, and welcome to this week's show. My name is Dr Cameron Jones, and everyone has been asking me about coronavirus (SARS-CoV-2) and the pneumonia problems that are in ensuing from infection with this particular virus. I've got a picture of the coronavirus up on the screen now, and you can see that I want to talk about some of the facts about what we do know about this infection and particularly a new paper that came out overnight published on January 29th, 2020 in the journal The Lancet.

This is a very, very important paper. You can get it on the home page of The Lancet Journal today. The full PDF paper is up, and I want to go through what we actually know about this infection and its relationship to different types of pneumonia. Now, this particular publication reviews the clinical problems that have occurred for the first 99 patients who were in hospital in China.

Yes, we do know that there is an 11% morbidity. We also know that the expectation of people who succumb to this infection is predominantly men with the mean age of 55.5 years. The majority of people who were admitted to hospital with this coronavirus lived and worked at the wet seafood market and came into contact with the live animals that were also on sale.

Now, the majority of these patients had what's called bilateral pneumonia, and anyone who follows this show and my own interest in fungal microbiology know that the three causes of respiratory issues like pneumonia are obviously infections with bacteria, infections by a virus like the coronavirus as well as infections with fungi. When I delve into some of the data in this particular publication, we're finding that out of these 99 patients, four of them have fungal or yeast mediated pneumonia, and one of them has Aspergillus flavus. So I urge you, anyone who is interested in the coronavirus story, I suggest that you have a read of this publication because it does have some reliable facts and figures about this particular illness.

In any case, I want to move on to some other stories that have come out this week, and there has been an update on thunderstorm asthma. Now, again, thunderstorm asthma is something which occurred certainly in Melbourne a couple of years ago, and we know that the connection between acute symptoms is linked to the amount of grass pollens in the air. Of course, the epidemiology or the symptoms that occur are breathlessness, wheezing, and cough. Yet, this particular publication that just came out also in the last week reviews the fact that back in 2016, 3,000 people were admitted to hospital and 10 people died.

But that really interesting question is, what is the connection with fungal or mould spores that are present also in the air and are reasonably ubiquitous? They do show concentration gradients throughout the day and year, and so what is the association with fungi? So these dominant group of authors at Melbourne University, they reviewed the literature, and out of 10 further studies, they found that nine of the studies showed a very strong positive correlation with thunderstorm asthma. So that key take-home message here is it's not just the pollen, but it is the combination of the pollen plus the fungal/mould spores, which lead to these very acute symptoms in susceptible persons.

Now, I also want to talk about a contentious topic about fogging and mould control. I received two phone calls in the last week from very concerned tenants telling me that contractors were coming into their property to fog their environment. Not deal with the underlying cause for the water damage, but to fog the property, and so I want to talk about also a paper that came out in the literature this week, which was talking about the ability of thermal mists or fogs to actually decontaminate volumes when they are contaminated.

I want to make it very clear that a lot of the contractors that are promoting fogs for mould control are doing this in complete contravention to what the international standards and recommendations are with regard to mould control. So the fogging promoted by the restoration industry is definitely not a recommended method of mould control. In fact, the IICRC S500 and R520 state very clearly, and I quote, "Remediators should not mist or fog disinfectants or sanitizers in an attempt to kill mould in lieu of complete source removal."

Now the people who called me this week told me that they had been provided with material safety data sheets by one or more of these contractors who stated that tea tree was the dominant ingredient that was being aspirated or dispersed using a thermal fogger or a ULV fogger and that these were examples of specialist mould control products. But I point out that when we and other scientists have gone looking for the peer review on these supposed fogs, we can't find any. So at best, these are disinfectants or sanitizers added at unknown concentrations, probably with the addition of surfactants. Essentially, they are visually behaving exactly like a vaping mist.

So it looks like something is occurring inside the room volume, but really, nothing very actionable is actually happening to the bacteria, yeast, or fungi within these room volumes, and so I want you to say no if anyone recommends fogging for mould control inside your property. But this is the breaking news this week, so I want to talk to you about what actually came out this week, and the link to the paper regarding hydrogen peroxide fumigation, I've put up here in red. It will also be in the show notes to the Livestream video at the bottom of this after we get off the live stream and also in the podcast, themouldshow.com, which will be uploaded later today.

However, I want to talk about those situations where a room aspiration or a mist is appropriate, and it is certainly plausible to use a recognized disinfectant or sterilant at the correct concentration to deliver this into a fixed room volume. The most appropriate settings for this are in healthcare settings. Although I'm certainly aware of some situations where hydrogen peroxide can be successfully used within domestic residences really as a final stage.

Think of it as something additional, but not as the primary method of mould control. It's like adding an additional cleaning step into the process. There's no reason to do it, but also no logical reason not to do it if the client, for example, wanted a whole of home aerosolized disinfection step. There are some situations where this could be done, and this type of paper that came out this week shows you how it can be done.

So if we move on to what the paper actually stated is that they were looking in the hospital context where patients actually contaminate a room, and people contaminate this by coughing obviously, and these particles end up sitting out on horizontal surfaces and contaminating really what's in the room, which is no different to a water damage situation where mould spores end up being dispersed or cross-contaminated through just natural events when someone is moving about or whether there is uncontrolled mould remediation and air is used to a spread and cross-contaminate a property, which sometimes happens with poor quality control during mould restoration.

But this particular paper is focusing on filling up the room with a concentrated solution of hydrogen peroxide, and certainly, various different vendors have been working with concentrations from as low as 2% right up to 30% hydrogen peroxide. Bear in mind that hair dye often used to change the colour of hair is often at 3% to 5%, so aspirating a 3%, 5%, or 8%, or 12% concentration into the air is going to be very toxic.

Mucous membranes are particularly susceptible, and this has to be done under strictly controlled conditions because there is a dwell time associated with it as well. Hydrogen peroxide is very effective at killing bacteria, yeast, and fungi, and viruses, and I suspect that hydrogen peroxide fumigation will definitely be used in the decontamination of the hospitals used for the coronavirus control.

Now, the results showed that just to put this context of disinfection in perspective, when rooms were sampled after patients were discharged after having been in them, 95% of the surfaces showed high levels of germs. After hospital-grade cleaning was performed by approved cleaners, 80% of the surfaces still registered disease-contaminated germs.

However, after vaporized hydrogen peroxide, only 2% of the room surfaces showed the contamination. So hydrogen peroxide fumigation is very successful at doing what it says it will do to reduce the bioburden or the load of bacteria, yeast, and fungi on surfaces and should definitely be considered in certain circumstances where it is appropriate, or required, or wanted in water damage and mould remediation situations. There is literature showing that hydrogen peroxide fumigation is successful. Although this is limited.

Now, I want to get onto the topic of today's show, and this is focusing on... Again, It's back-to-school time. My daughter started year seven 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 controlled 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 the 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 potentially 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.