Cebu Governor Gwendolyn Garcia earned the ire of netizens and health experts for publicly shaming doctors who criticized a local memorandum urging provincial officials and employees to perform “tuob” or steam inhalation as means to help contain the coronavirus disease (COVID-19).

In Memorandum No. 36-2020, signed on June 18 by Provincial Administrator Noli Vincent Valencia, department heads and employees were “enjoined” to have hot steam inhalation twice a day, between 8 and 9 a.m. and 4 and 5 p.m., at their work stations.

This is in line with Executive Order No. 17 or general community quarantine guidelines the Cebu governor issued in May, which includes tuob as part of a “health regimen” to boost the immune system in combating COVID-19.

Garcia, who lashed out at doctors for at least an hour during her June 23 online presser, claimed that the COVID-19 virus “does not survive beyond 27 degrees Celsius.” She added that when one inhales hot steam and it reaches the respiratory tract, “it will melt the fat surrounding the virus, thus killing it.”

To lend credibility to her “wellness” directive, Garcia previewed a video testimonial of Interior Secretary Eduardo Año, who said he practiced tuob when he tested positive for COVID in late March and felt better after. He said Education Secretary Leonor Briones did the same.

What is tuob or steam inhalation? Does it cure or prevent COVID-19?

Here are three things you need to know:

1. What is steam inhalation therapy?

Steam therapy entails wrapping one’s head in a towel or any thick cloth with a basin or pot of steaming water with salt or mixture of herbs underneath to make one sweat while inhaling the vapor for five to 10 minutes, according to health information site Healthline.

Commonly practiced as a home-based therapy, steam inhalation helps loosen the mucus secretions, clearing up nasal and respiratory passages -- relieving symptoms of common colds and dry cough.

A "stuffy" or congested nose "occurs when the tissues lining it become swollen" due to "inflamed blood vessels," according to the U.S. online medical encyclopedia.

At least two Filipino studies published in 2015 and 2016 in different scientific journals showed that “tuob” (suob in Tagalog) or boiling ritual has been used by traditional healers accompanied by other healing methods, such as “hilot” or massage therapy.

2. Can it be used to cure or prevent COVID-19?

Health Undersecretary Maria Rosario Vergeire said in a June 25 virtual presser that there is “no scientific evidence that steam inhalation kills the SARS-CoV-2 (the virus causing COVID-19).”

“While some western, traditional, or home remedies may provide comfort and alleviate symptoms of mild COVID-19, there are no medicines that have been shown to prevent or cure the disease,” the World Health Organization said in its Q&A on coronaviruses (COVID-19).

The Philippine Medical Association (PMA), an umbrella organization of physicians in the country, denounced Garcia for her “dangerous claims and insults” to medical members who disagreed with her advocacy for tuob.

In a three-page statement issued on June 24, PMA said the Cebu governor’s claim may “foster a false sense of security and well being,” and may facilitate transmission of the virus by aerosols and contamination of nearby persons, objects, or surfaces.

Likewise, WHO said it “does not recommend self medication with any medicines, including antibiotics, as prevention or cure for COVID-19.”

It added that exposure to high temperatures will not prevent a person from getting the disease.

When one still wants to proceed with the steam therapy, it should be done with caution, Vergeire said. Should COVID-19 symptoms persist, one should immediately seek medical help, she added.

WHO Representative in the Philippines Rabindra Abeyasinghe, in an earlier interview with VERA Files, also reiterated that water steam mixed with other concoctions such as salt “will not prevent you from catching COVID-19.” (See VERA FILES FACT CHECK: Salt water steam DOES NOT kill coronavirus and VERA FILES FACT CHECK: FB posts claiming 2019-nCoV only survives in ‘cold weather,’ salabat a cure NOT TRUE )

The only clear indication if someone already recovered from COVID-19 is through a series of negative testing results. (See VERA FILES FACT SHEET: Five things you need to know about COVID-19 antibodies and The science behind COVID-19 testing)

3. What are the risks and benefits of steam therapy?

Steam therapy may help alleviate symptoms of colds and sinus blockage of the respiratory tract.

However, it will not eliminate any virus still present in the body, according to a 1994 study published in the United States National Institutes of Health.

Several studies which assessed steam inhalation as treatment, such as a 2016 paper conducted in the United Kingdom, a 2013 research that evaluated six trials in different countries, and a 2013 study also in the U.K., said it has no proven or significant benefit.

WHO, DOH, and PMA are one in reminding the public that extremely hot steam can be harmful as there is risk of burn injury in the respiratory tract and scalds from hot water accidents.

Protecting oneself from COVID-19 through frequent hand washing, social distancing, practicing cough etiquette, and wearing masks still remain the most effective ways to prevent getting the virus.

Sources

Rappler, Netizens slam Cebu governor for shaming critics of steam inhalation, June 24, 2020

Interaksyon, Gwen Garcia and steam therapy: Why #NotoDoctorShaming gains traction on Twitter, June 24, 2020

Cebu Daily News-Inquirer, PH’s largest medical society denounces Gwen on tuob, calling out doctors, July 25, 2020

Inquirer, Provincial gov’t memo: Make time for ‘tuob’, June 24, 2020

Rappler, Cebu province memo encourages employees to practice steam inhalation vs COVID-19, June 24, 2020

Cebu Daily News-Inquirer, Capitol memos employees to ‘strictly’ practice tuob, June 23, 2020

Local Government Unit of Compostela, Cebu Facebook, Cebu Province GCQ Guidelines, May 21, 2020

Sugbo News Facebook, Daily updates from Gov. Gwendolyn Garcia on the Covid-19 situation in Cebu Province, June 23, 2020

Steam inhalation therapy

• Healthline, Steam Inhalation: What Are the Benefits?, March 17, 2019
• Healthline, Can Essential Oils Treat Sinus Congestion?, March 17, 2019
• WebMD, How do I use steam for congestion?, Oct. 30, 2017
• Medline Plus, Stuffy or runny nose – adult, July 11, 2019
• Naclerio, R. M., Bachert, C., & Baraniuk, J. N. (2010). Pathophysiology of nasal congestion. International journal of general medicine, 3, 47–57. Retrieved on June 29, 2020
• Allado-Ombat, L. A., Teves, F. G. (2015), Anti-angiogenic and non-cytotoxic potentials of aqueous and acetone extracts of the stem of Philippine Forest Liana, Bauhinia integrifolia Roxb, pg. 185. Retrieved on June 29, 2020
• Berdon, Z. S., Ragosta, E. L. et al. (2016). Unveiling Cebuano Traditional Healing Practices. Asia Pacific Journal of Multidisciplinary Research Vol. 4 No.1, 51-59 February 2016. Retrieved on June 29, 2020

Not COVID-19 cure nor prevention

• Department of Health Facebook, DOH Presscon, June 25, 2020
• World Health Organization, Q&A on coronaviruses: Is there a vaccine, drug or treatment for COVID-19?, April 17, 2020
• Philippine Medical Association website, PMA statement on the June 23, 2020 video of Cebu Gov. Gwendolyn F. Garcia, June 24, 2020
• World Health Organization, Coronavirus disease (COVID-19) advice for the public: Myth busters: Exposing yourself to the sun or to temperatures higher than 25C degrees DOES NOT prevent the coronavirus disease (COVID-19), April 27, 2020

Steam inhalation risks and benefits

• Ophir D, Elad Y. Effects of steam inhalation on nasal patency and nasal symptoms in patients with the common cold. Am J Otolaryngol. 1987;8(3):149-153. Retrieved on June 29, 2020
• World Health Organization, Respiratory infections in children: management in small hospitals: A manual for doctors, 1988
• World Health Organization, Cough and Cold Remedies for the treatment of Acute Respiratory Infections in Young Children, 2001
• Hendley, J. O., Abbott, R. D., Beasley, P. P., & Gwaltney, J. M., Jr (1994). Effect of inhalation of hot humidified air on experimental rhinovirus infection. Retrieved on June 29, 2020
• Baartmans, M., Kerkhof, E., et al. (2012). Steam inhalation therapy: severe scalds as an adverse side effect. The British journal of general practice : the journal of the Royal College of General Practitioners, 62(600), e473–e477. Retrieved on June 29, 2020
• Little P, Stuart B, Mullee M, et al. Effectiveness of steam inhalation and nasal irrigation for chronic or recurrent sinus symptoms in primary care: a pragmatic randomized controlled trial (2016). CMAJ. 188(13):940-949. Retrieved on June 29, 2020
• Singh, M., & Singh, M. (2013). Heated, humidified air for the common cold. The Cochrane database of systematic reviews, (6). Retrieved on June 30, 2020
• Little, P., Moore, M., et al. (2013). Ibuprofen, paracetamol, and steam for patients with respiratory tract infections in primary care: pragmatic randomised factorial trial. BMJ (Clinical research ed.), 347, f6041. Retrieved on June 29, 2020
• Centers for Disease Control and Prevention, Coronavirus Disease 2019: Protect Yourself
• Department of Health, What can I do to prevent the spread of COVID-19?, March 2, 2020
• World Health Organization, Coronavirus disease (COVID-19) advice for the public

(Guided by the code of principles of the International Fact-Checking Network at Poynter, VERA Files tracks the false claims, flip-flops, misleading statements of public officials and figures, and debunks them with factual evidence. Find out more about this initiative and our methodology.)