Bushfires are currently burning in Australian states including Victoria, Tasmania, Western Australia and South Australia. In some areas, fire authorities have warned residents about the presence of smoke.

Bushfire smoke is harmful to our health. Tiny particles of ash can lodge deep in the lungs.

Exposure to this type of smoke may worsen existing conditions such as asthma, and induce a range of health effects from irritation of the eyes, nose and throat to changes in the cardiovascular system.

Public health recommendations during smoke events tend to provide general advice, and don’t often include advice specifically geared at children. But children are not just little adults. They are uniquely vulnerable to environmental hazards such as bushfire smoke for a number of reasons.

Different physiology, different behaviour

Children’s lungs are still developing and maturing.

Airways are smaller in children, especially young children, which is associated with greater rates of particle deposition – when particles settle on the surfaces of the airways.

Children also breathe more air per kilogram of body weight compared with adults, and therefore inhale more polluted air relative to their size.

Further, children’s detoxification systems are still developing, so environmental toxins take longer to effectively clear from their bodies.

Meanwhile, children’s behaviour and habits may expose them to more environmental toxins than adults. For example, they tend to do more physical activity and spend more time outdoors. Higher levels of physical activity lead to more air inhaled per kilogram of body weight.

Also, a normal and important part of children’s early play is exploring their environment, including by putting things in their mouth. This can result in kids ingesting soil, dust and dirt, which often contain environmental contaminants.

For these reasons, it’s important to consider the specific needs of children when providing advice on what to do when there’s smoke in the air.

Keeping our environments healthy

The Australian government offers recommendations for minimising the health risks from exposure to bushfire smoke. The main advice includes staying indoors and keeping doors and windows closed.

This is great advice when the smoke is thick outside, but air pollutants may still accumulate inside the home. So it’s important to air your home once the smoke outside starts to clear. Take advantage of wind changes to open up and get air moving out of the house with a cross breeze.

Kids are natural scientists, so get them involved. For example, you and your child can “rate” the air each hour by looking at a landmark outside your home and rating how clearly you can see it. When you notice the haze is reducing, open up the house and clear the air.

Because air pollutants settle onto surfaces in our home and into household dust, an easy way to protect kids during smoky periods is to do a daily dust with a wet cloth and vacuum regularly. This will remove pollutants and reduce ingestion by children as they play. Frequent hand washing helps too.

Healthy bodies and minds

Research exploring the effects of bushfire smoke exposure on children’s health is sparse. However, during smoke events, we do see an increase in hospital visits for asthma, as well as children reporting irritation to their eyes, nose and throat.

If your child has asthma or another medical condition, ensure they take any prescribed medications on a regular schedule to keep their condition well controlled. This will minimise the risk of a sudden worsening of their symptoms with bushfire smoke exposure.

Make sure any action plans for symptom flare-ups are up to date, and ensure you have an adequate supply of in-date medication somewhere easy to locate and access.

Kids can get worried during bushfires, and fire emergencies have been linked with a reduction in children’s mental health. Stories such as the Birdie’s Tree books can help children understand these events do pass and people help one another in times of difficulty.

Learning more about air pollution can help too. Our group has a children’s story explaining how air pollution affects our bodies and what can help.

It’s also important for parents and caregivers not to get too stressed, as children cope better when their parents manage their own anxiety and help their children do the same. Try to strike a balance between being vigilant and staying calm.

What about masks?

N95 masks can protect the wearer from fine particles in bushfire smoke, but their use is a bit complicated when it comes to kids. Most young children won’t be able to fit properly into an N95 mask, or won’t tolerate the tight fit for long periods. Also, their smaller airways make it harder for young children to breathe through a mask.

If you choose to use an N95 mask for your children, it’s best to save them for instances when high-level outdoor exposure is unavoidable, such as if you’re going outside when the smoke is very thick.

N95 masks should be replaced after around four hours or when they become damp.

If your child has an existing heart or lung condition, consult their doctor before having them wear an N95 mask.

Our team is currently recruiting for a study exploring the effects of bushfire smoke in children. If you live in south east Queensland and are interested in participating in the event of a bushfire or hazard reduction burn near your home, please express your interest here.

Dwan Vilcins, Group leader, Environmental Epidemiology, Children’s Health Environment Program, The University of Queensland; Nicholas Osborne, Associate Professor, School of Public Health, The University of Queensland, and Paul D. Robinson, Conjoint Professor in Respiratory and Sleep Medicine, Child Health Research Centre, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Medical experts recommend antivirals for people aged 70 and older who get COVID, and for other groups at risk of severe illness and hospitalisation from COVID.

But many older Australians have missed out on antivirals after getting sick with COVID. It is yet another way the health system is failing the most vulnerable.

Who missed out?

We analysed COVID antiviral uptake between March 2022 and September 2023. We found some groups were more likely to miss out on antivirals including Indigenous people, people from disadvantaged areas, and people from culturally and linguistically diverse backgrounds.

Some of the differences will be due to different rates of infection. But across this 18-month period, many older Australians were infected at least once, and rates of infection were higher in some disadvantaged communities.

How stark are the differences?

Compared to the national average, Indigenous Australians were nearly 25% less likely to get antivirals, older people living in disadvantaged areas were 20% less likely to get them, and people with a culturally or linguistically diverse background were 13% less likely to get a script.

People in remote areas were 37% less likely to get antivirals than people living in major cities. People in outer regional areas were 25% less likely.

Even within the same city, the differences are stark. In Sydney, people older than 70 in the affluent eastern suburbs (including Vaucluse, Point Piper and Bondi) were nearly twice as likely to have had an antiviral as those in Fairfield, in Sydney’s south-west.

Older people in leafy inner-eastern Melbourne (including Canterbury, Hawthorn and Kew) were 1.8 times more likely to have had an antiviral as those in Brimbank (which includes Sunshine) in the city’s west.

Why are people missing out?

COVID antivirals should be taken when symptoms first appear. While awareness of COVID antivirals is generally strong, people often don’t realise they would benefit from the medication. They wait until symptoms get worse and it is too late.

Frequent GP visits make a big difference. Our analysis found people 70 and older who see a GP more frequently were much more likely to be dispensed a COVID antiviral.

Regular visits give an opportunity for preventive care and patient education. For example, GPs can provide high-risk patients with “COVID treatment plans” as a reminder to get tested and seek treatment as soon as they are unwell.

Difficulty seeing a GP could help explain low antiviral use in rural areas. Compared to people in major cities, people in small rural towns have about 35% fewer GPs, see their GP about half as often, and are 30% more likely to report waiting too long for an appointment.

Just like for vaccination, a GP’s focus on antivirals probably matters, as does providing care that is accessible to people from different cultural backgrounds.

Care should go those who need it

Since the period we looked at, evidence has emerged that raises doubts about how effective antivirals are, particularly for people at lower risk of severe illness. That means getting vaccinated is more important than getting antivirals.

But all Australians who are eligible for antivirals should have the same chance of getting them.

These drugs have cost more than A$1.7 billion, with the vast majority of that money coming from the federal government. While dispensing rates have fallen, more than 30,000 packs of COVID antivirals were dispensed in August, costing about $35 million.

Such a huge investment shouldn’t be leaving so many people behind. Getting treatment shouldn’t depend on your income, cultural background or where you live. Instead, care should go to those who need it the most.

People born overseas have been 40% more likely to die from COVID than those born here. Indigenous Australians have been 60% more likely to die from COVID than non-Indigenous people. And the most disadvantaged people have been 2.8 times more likely to die from COVID than those in the wealthiest areas.

All those at-risk groups have been more likely to miss out on antivirals.

It’s not just a problem with antivirals. The same groups are also disproportionately missing out on COVID vaccination, compounding their risk of severe illness. The pattern is repeated for other important preventive health care, such as cancer screening.

A 3-step plan to meet patients’ needs

The federal government should do three things to close these gaps in preventive care.

First, the government should make Primary Health Networks (PHNs) responsible for reducing them. PHNs, the regional bodies responsible for improving primary care, should share data with GPs and step in to boost uptake in communities that are missing out.

Second, the government should extend its MyMedicare reforms. MyMedicare gives general practices flexible funding to care for patients who live in residential aged care or who visit hospital frequently. That approach should be expanded to all patients, with more funding for poorer and sicker patients. That will give GP clinics time to advise patients about preventive health, including COVID vaccines and antivirals, before they get sick.

Third, team-based pharmacist prescribing should be introduced. Then pharmacists could quickly dispense antivirals for patients if they have a prior agreement with the patient’s GP. It’s an approach that would also work for medications for chronic diseases, such as cardiovascular disease.

COVID antivirals, unlike vaccines, have been keeping up with new variants without the need for updates. If a new and more harmful variant emerges, or when a new pandemic hits, governments should have these systems in place to make sure everyone who needs treatment can get it fast.

In the meantime, fairer access to care will help close the big and persistent gaps in health between different groups of Australians.

Peter Breadon, Program Director, Health and Aged Care, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.