Doctors reject ‘tuob’: It pushes door wide open for coronavirus infection

DAVAO CITY—Medical doctors warned against the high risk of contagion that the practice of “tuob” (steam inhalation) could bring if patients resorting to it were infected with SARS CoV2, the virus that causes the novel coronavirus disease (COVID 19).

Dr. Magdalena Barcelon, president of the doctors’ group Community Medicine Practitioners and Advocates Association (Compass), said the steam being inhaled by a sick person could cause “aerosolization”, or virus particles turning into fine spray or invisible molecules.

This, according to Barcelon, increases the risk of transmission if the sick person had coronavirus.

“The spread through aerosols can be much more dangerous and widespread because these are very tiny particles that can travel farther and stay in the air much longer,” Dr. Barcelon said. “When inhaled, they can penetrate deeper into the respiratory chamber than ordinary droplets do.”

She said community doctors were no strangers to the benefits of steam inhalation, especially among patients suffering from respiratory ailment.

Doctors in the barrio used to encourage it among patients in many of the country’s poorest communities, especially when the people there could hardly afford to see a doctor.

But in the time of the COVID-19 pandemic, when all fever and flu-like symptoms could be possible signs of COVID-19, Barcelon said doctors would not recommend steam inhalation.

“With a highly contagious disease like COVID 19, the threat of a spread is real,” she said. “We are talking of a viral particle which are so tiny, they are measured in microns—equivalent to .001 of a millimeter—and can stay in the air for hours,” she said.

She said among the reasons that a large number of anaesthesiologists had contracted the virus, some of them even dying, could be the high viral load they usually encounter when they perform endotracheal intubation, a very painful medical procedure which exposes them both to the aerosol and droplets in the patient’s mouth.

Intubation requires inserting a tube into the windpipe (trachea) through the mouth or nose of the patient, exposing anaesthesiologists to a high risk of infection.

“Even if they’re wearing complete PPE, any procedure related to the airway, where there are droplets and aerosol, would really expose you to the risk of infection, and that’s the same way with steam inhalation,” said Dr. Jean Lindo, an anaesthesiologist at the Brokenshire Hospital here.

Even the World Health Organization (WHO) had earlier given a list of precautions, including the wearing of complete personnel protective equipment (PPE) for health care workers performing aerosol generating procedures which included, among others, the use of nebulizers among asthmatic patients.

Earlier, a medical doctor in Cebu, who reacted to Gov. Gwen Garcia’s endorsement of “tuob” as stress reliever among provincial government employees had been berated by the governor.

But it was not only Cebu province where steam inhalation had been encouraged. In Agusan del Sur, the provincial government treats its COVID-19 health workers and others on the frontline of the pandemic fight with aromatic steam inhalation supposedly as a reward for hard work.

The province has set up what it calls a “steam bath chamber,” where eight people, mostly health care workers, could inhale aromatic steam together.

Eight persons inhaling steam in one room can bring high risk of transmission since the aerosols generated by the breath of each person can travel fast and far and could be inhaled by other people in that room.

“There’s a high risk of contagion if one of them is infected,” Lindo said. “The strategy to avoid the virus has always been to avoid crowd, contact and closed spaces,” she said.

TSB