By Henrylito D. Tacio
Who among you have gambled with your health?
A few may admit but many are doing it without them knowing it. Many Filipinos – even the affluent ones – are practicing self-medication and doing so means betting their lives. Self-medication, defined as “the act or process of medicating oneself especially without the advice of a physician,” is actually a hit or miss thing.
Such is the case of “tuob” or steam inhalation therapy. Tuob is an age-old technique where a person covers his head with a towel over a pan filled with just hot water or some herbals. The hot steam is inhaled for several minutes.
For those undergoing flu, fever, sore throat, or cough, tuob moisturizes dry, irritated nasal and throat passages thus making them more comfortable. It also relieves nasal congestion. Some people report that it is also good for those having asthma.
An award-winning Filipina actress, who’s living with asthma, even shared her experience on it. “I was on the verge of having my asthma,” she wrote in her social media account. “I did tuob for two weeks, two times a day, morning and evening. I got healed and felt much better, so I didn’t have to take my medicines for asthma any longer. I continue to do tuob; it’s the best natural medicine and inexpensive. Just need time and consistency to do it!”
Steam inhalation may be an “alternative cure” for those types of diseases but not against SARS-CoV-2, the distant cousin of Severe Acute Respiratory Syndrome coronavirus that causes COVID-19 (coronavirus disease 2019).
But various social media forwards by Facebook, Twitter, and WhatsApp users claim that steam inhalation can kill SARS-CoV-2. “A Chinese expert assures everybody that inhalation of a steam from hot water kills coronavirus 100%,” one message stated. “Even if the virus entered the nose, throat, or lungs, coronavirus cannot stand the hot water steam.”
Several messages also assure that steam inhalation could kill the virus when one does steam inhalation along with gargling with saltwater.
One Facebook video shows a man asking people to inhale the steam from hot water mixed with salt and citrus fruit peels. The video claimed that this has to be done for 15-20 minutes for it to be effective.
Before probing deeper, let’s get some basic facts about COVID-19, the pandemic which was first reported in Wuhan, China. Every day, new cases are being reported and there’s still no vaccine available. But are there some treatments available if you’re one of those unlucky ones who gets infected?
SARS-CoV-2 is one of the hundred viruses that cause colds and flu symptoms in humans. “The infection ranges in severity from almost silent (asymptomatic) to a mild cold, all the way to lung and organ failure,” explains Dr. David King, a senior lecturer at the University of Queensland. “The symptoms may be worse than a normal cold or flu because the coronavirus is new to our species and we haven’t built up herd immunity to it yet.”
Fever, fatigue, and dry cough are the most common symptoms, according to the Geneva-based World Health Organization (WHO). Some patients may have aches and pains, nasal congestion, runny nose, a sore throat or diarrhea.
“The most bothersome symptoms tend to be fever and muscle pains,” Dr. King, who writes a feature for The Conversation. “You can safely treat these with paracetamol. You can treat nasal congestion with decongestants and nasal saline. Effective treatments for a sore throat include honey, salt water gargles, and sore throat sprays or gargles.”
Among the symptoms, the hardest to control is cough. “But you may be able to improve it with honey, steam inhalations and saline nose sprays,” the Australian doctor writes. “Cough suppressants have only minimal benefit in reducing a dry cough.”
Many Filipinos are wondering why there are those who were infected with COVID-19 but were able to recover. The reason is that many of those who recovered have not suffered from serious complications.
Current estimates suggest about 80% of cases will have relatively mild to moderate illness. “From the perspective of treatment, if your illness is reasonably mild, it doesn’t really matter whether you have a confirmed COVID-19 diagnosis or not,” Dr. Kang points out.
But the elderly, pregnant women, people with underlying medical conditions (like diabetes or liver disease), and those with compromised immune systems may suffer serious complications.
“About five to seven days after the onset of symptoms, some patients develop shortness of breath and trouble breathing, which will require medical attention,” Dr. Kang writes. “Shortness of breath occurs when pneumonia develops, causing a buildup of thick mucus in the lungs that blocks the transfer of oxygen into the blood vessels.”
Although Dr. Kang mentions steam inhalation, he never states that it can kill SARS-CoV-2. He recommends it only as a way to help improve the condition of those having cough. The United Nations health agency also reminds that tuob is not a cure for COVID-19 nor a prevention for the pandemic.
The WHO says heat at 56°C kills the SARS virus at around 10,000 units per 15 minutes. “It is not possible for hot steam to reach the whole respiratory tract,” a fact sheet says. “The moisture only reaches the upper airways, like the nose and throat, but not the bronchi and lungs.”
Dr. Benjamin Neuman, of the biological sciences department at the Texas A&M University-Texarkana, explained that lungs are delicate and inhaling hot steam is not a good idea as it may damage the lungs and the airways.
In Cebu, however, the provincial government issued a memorandum to all its employees “a wellness program” in the form of tuob. “Everyone is enjoined to perform hot steam inhalation twice a day between 8:00-9:00 am and 4:00-5:00 pm at their respective workstations.”
There are some reports, although unconfirmed, that some COVID-19 patients were healed after doing tuob. Because of this, some people believed in its efficacy. “So, we don’t need to go to the hospital anymore as hot steam inhalation is the treatment for COVID-19,” one man said. “Doctors are already useless against the disease. We have to do steam inhalation so the government won’t have to spend much money.”
But how true are those recovered COVID-19 cases after undergoing hot steam inhalation? As stated earlier, most people who have been confirmed with COVID-19 were having mild cases. “For many with mild infections, the coronavirus could be virtually indistinguishable from the common cold or seasonal flu,” said a medical professor at the University of Hong Kong. Additionally, “some of these patients, they just go unrecognized,” he surmised. “It could be just as small as a sore throat. Then one day, two days, it’s gone.”
The Department of Health (DOH) itself confirmed that tuob is not a cure for COVID-19. “There is no scientific evidence yet proving that steam inhalation can kill the virus that causes COVID-19,” said Health Undersecretary Maria Rosario Vergeire citing WHO, the US Centers for Disease Control and Prevention, and local medical societies.
Dr. Albert Rizzo, chief medical officer of the American Lung Association, revealed that steam inhalation methods could help alleviate respiratory symptoms but they won’t work as a cure for SARS-CoV-2. Inhaling steam, he said, may help with the symptoms like nasal congestion, cough and chest congestion. The relief, he added, would only help decrease the severity of symptoms and it would not treat any viral infection.
“While we understand this initiative (of steam inhalation), we emphasize that this is just part of other supportive measures that one may opt to do to relieve one’s symptoms,” said part of the joint statement issued by medical societies. “We stand by up-to-date medical evidence that steam inhalation has not been demonstrated to kill viruses, specifically SARS-CoV-2.”
The practice may even be precarious, if done by infected individuals, as it may facilitate spread if done communally, the statement adds. “Because steam inhalation does not kill the virus and may cause potential harm, we cannot, in good conscience, endorse its use as preventive or curative measures,” it further states.
Dr. Teofredo “Ted” T. Esguerra, who had a bout with the serious complications of COVID-19, also confirms saying that tuob doesn’t kill the coronaviruses. But he believes in tuob though.
“I underwent tuob when I was still a kid in the province, particularly when my coughing was dry,” he admits. “For the most part, it gave me relief. My breathing became better. As far as I could remember, I was made to inhale steam only after it is boiled, with a tablespoon full of salt mixed in hot water, and a few times, with a towel covering me.”
But it’s a different story when it comes to COVID-19. “As to the coronavirus which causes COVID-19, it is intracellular,” the doctor who grew up in Bansalan, Davao del Sur explains. “If you want to kill the virus, go inside the cell. The only way to kill this neutralizer of humanity is with an antiviral drug or antibodies against the virus. Tuob cannot do that. If you think the steam can kill the germs, it will be a grave mistake.”
Actually, doctors are not against tuob, especially now that people should be doing something for their health in this time of pandemic. “Should you decide to proceed with tuob,” the statement from medical societies states, “we strongly advise you to be careful and mindful of the first stages of burn injuries.”
The British Journal of General Practice published a study stating that the primary adverse effect of steam inhalation therapy is burns. “Two children had burns to the feet as a result of kicking the hot bowl of water,” the study said. “Another child had burns to the chest as a result of water spilling from the bowl.”
In fact, putting trust on steam inhalation may cost one’s life. In Cagayan de Oro City, ABS-CBN reported the case of a 34-year-old woman who died from serious complications of COVID-19 as she relied more on tuob.
“Days prior to her admission, she had complaints of abdominal pain and vomiting,” Dr. Bernard Julius Rocha, liaison officer of the Northern Mindanao Medical Center, was quoted as saying. “She did not seek medical consultation; instead, she relied on tuob as home remedy.”
The statement from medical societies also urged: “We appeal to members of the public doing tuob see if symptoms persist or worsen, to seek medical consultation immediately. We continuously urge the public to observe practices that have been proven effective in mitigating virus spread like wearing of masks, handwashing, and physical distancing.” – ###