Coronavirus News: Italian Study Shows That Steam Inhalation Protocol Found To Inactivate SARS-CoV-2 In COVID-19 Patients

Coronavirus News: A new study by Italian researchers from Meyer Children's University Hospital-Florence, University of Florence and the Guglielmo da Saliceto Hospital-Piacenza have found that steam inhalation therapy was able to mitigate SARS-CoV-2 infection.

 This single-centered open label interventional study had the limited objective of enrolling up to 10 adults in whom RN-swab (eSwab, Copan, Italy) revealed a SARS-CoV-2 infection during a systematic screening of healthcare professionals (physicians, MD; pediatric nurses, PN) actively working at Meyer Children's University Hospital, Florence, consecutively screened between March–April 2020.
 
The study protocol consisted of exposure of airway mucosae to humidified steam through inhalation for at least 20 min (4 cycles of 5 min or 5 cycles of 4 min) within 1 h, with a temperature maintained between 55 and 65 °C in the first 4/5 min after initiation of water boiling (experimental measurements in triplicate). The patient was asked to drape the towel over the back of his/her head lowering toward the hot steam down to about 25 to 30 cm from the water.
 
The primary outcome was a reduction of viral shedding after 4 days (at least 6 Cycle Threshold Values measured with RT-PCR) and the secondary outcome complete virus elimination after the 4-day protocol.
 
Of 1292 screened healthcare professionals, the first 10 with a SARS-CoV-2 positive RN-swab were enrolled in the study. The mean age of the 7 patients (6 women) completing the protocol, was 44.4 (SD 12.1) years. One patient (no. 5) was asymptomatic before and after the protocol, five exhibited one or two mild symptoms including dry cough (1/5), sore throat (1/5), headache (1/5), anosmia (2/5), ageusia (2/5), tiredness (2/5), soreness/muscle pain (1/5), and nasal congestion (1/5). One patient (no. 4) reported moderate headache and generalized muscle pain. All 6 patients with symptoms reported clinical improvement at the end of protocol: three reported to have been cleared of all symptoms; 2 declared persisting anosmia and ageusia; one reported mild muscle pain and nasal congestion. All seven patients achieved both outcomes, testing negative after the first day of steam inhalation (4 consecutive RN-swabs). All were asked to evaluate their negativity 3–5 days after protocol conclusion
 
Patient 8 (PN, 39 years old, allergic) experienced mild headache and nasal congestion, both of which resolved at the end of the study, after three steam inhalations on day 1 (5 + 3 + 3 min), three on day 2 (5 + 5 + 3 min), two on day 3 (5 + 4 min), three on day 4 (3 + 3+ 3 min). A first negative swab after the first session was followed by a new weak positivity after 3 days. This patient stopped the protocol on day 5 and underwent an additional swab on day 10 , which resulted negative.
 
Patient 9 (MD, 36 years old) reported moderate tiredness, headache and mild muscle pain. On the third day of the protocol this patient started hydroxychlorochine (HC) and azytromicine (AZ) (for 9 days and 3 days, respectively), which resulted in her being dropped from our study. This lady continued the steam inhalati on protocol up to complete clearance on day 5, as she felt her symptoms had been eased. From day 6 she reported nasal congestion, muscle/bone pain, progressive anosmia and ageusia, which diminished till day 11. Steam inhalation was stopped on day 12. All swabs during the experimental protocol resulted positive, while further swabs on days 15 and 17 tested negative.
 
Patient 10 (PN, 38 years old) tested positive at first swab, 13 days after close contact with a known infected, symptomatic individual. When asked to participate to the study, this patient reported moderate muscle pain, tiredness, nasal congestion, sinusitis, anosmia, hypogeusia, and sore throat, with 4 days of fever (>38 °C) immediately prior to the official swab. All the swabs during the study protocol were positive. This lady continued the steam inhalation protocol, which she motivated with a beneficial effect on symptoms (complete clearance on day 10). Three additional swabs on days 8, 9 and 10 were negative).
 
The study findings were published in the peer reviewed journal: Life Sciences. https://www.sciencedirect.com/science/article/pii/S002432052031554X
 
To date, over 63 million individuals worldwide have been infected with SARS-CoV-2 virus, the agent that causes COVID-19 and over 1.46 million individuals have lost their lives. At present, there are no safe and effective antivirals to treat infection. Non-pharmaceutical interventions (NPIs) thus remain the order of the day, and these typically include wearing masks in public, social distancing and regular hand washing.
 
Eleven months after the virus was first detected, Italian researchers at the Biochemistry and Pharmacology Laboratory, Meyer Children's University Hospital, Florence, Italy, have published the first study on the efficacy of steam inhalations as another possible treatment to help mitigate SARS-CoV-2 infection.
 
The WHO declared the global spread of COVID-19 a pandemic on March 11, 2020. It has been one of the largest public health problems in recent memory. It has overwhelmed healthcare systems in many parts of the world, and its knock-on effects have crippled the global economy. The authors of the study write that before the availability of effective vaccines to prevent infection, or antivirals to treat it, upholding NPIs remain crucial.
 
The SARS-CoV-2 is an RNA virus with a capsid and a peri-capsid envelope, which is crossed by glycoprotein structures. The virus has an external protein structure namely, its spike proteins – that can bind onto human cells to facilitate viral entry. Most therapeutic agents being developed are being targeted towards these proteins and the process by which they allow the virus to infiltrate the host cell.
 
Initially during the start of the pandemic, it was found that soapy water could help break down the viral envelope and thus denature it. Researchers added that heat has also been seen to denature the proteins that lead to loss of infectivity of the SARS-CoV that caused the 2002 SARS outbreak. The researchers have shown that heat can also denature the SARS-CoV-2 virion's proteins.
 
It was found that temperatures of 56 °C for 15 and 30 minutes in liquid environments, respectively, were enough to breakdown SARS-CoV and SARS-CoV-2, the study team wrote. https://downloads.hindawi.com/journals/av/2011/734690.pdf?fbclid=iwar2f7-4os677_oeqfau9uu3aus1taa2vlmcp8rg5kzmyfpi-imsva40jnom
 
https://www.medrxiv.org/content/10.1101/2020.03.15.20036673v2
 
Hence steam inhalation cycles were considered to be useful in damaging the capsid of the SARS-CoV-2 envelope and prevent infection, write the researchers.
 
Already past studies have shown that steam inhalation was also good at eradicating other respiratory viruses. https://www.pnas.org/content/79/15/4766.short
 
https://pubmed.ncbi.nlm.nih.gov/6784948/
 
The study team wrote that the European Pharmacopoeia VI edition has recommended steam inhalations as a procedure to treat respiratory diseases. https://www.uspbpep.com/ep60/preparations%20for%20inhalation%200671e.pdf
 
The study was a small single-center study, including 10 asymptomatic or paucisymptomatic healthcare professionals (including physicians and pediatric nurses). Paucisymptomatic individuals were those with mild symptoms. All 10 individuals had tested positive for the SARS-CoV-2 via real-time polymerase chain reaction reverse transcription (RT-PCR) tests.
 
The patients were administered humidified steam through inhalation for at least 20 minutes (5 cycles of 4 minutes) within 1 hour for at least 4 consecutive days. Their airway mucosal membranes were exposed to the steam. The temperature of the steam was maintained at 55 and 65 °C in the first 4 to 5 min after the initiation of water boiling. The patient had a towel draped over his over her back, lowering toward the hot steam down to about 25 to 30 cm from the water.
 
At the end 24 hours after each cycle of treatment, viral shedding was measured by RT-PCR after collecting swabs from the nose and pharynx (rhino pharyngeal swabs). Viral load was measured using at least 6 Cycle Threshold Values.


Viral shedding diagram from patients 2, 3, 5, 6 and 7. All five patients performed the protocol (4 cycles/5 min each) on days 1, 2, 3 and 4 measuring the effect of treatment on days 2, 3, 4 and 5. A new swab on day 10 confirmed short term negativity.

However 3 participants dropped out of the intervention; 1 due to allergy, 1 started on hydroxychloroquine and azithromycin treatment since day 1, and 1 manifested more than three symptoms, which were moderate to severe.
 
The average age of the participants was 44.4 years.
 
The Overall results were as follows:
 
-6 patients with symptoms reported clinical improvement at the end of the intervention
-2 patients showed persistent symptoms of loss of smell and taste
-1 patient complained of persisting muscle pain and nasal congestion
-All 7 patients tested negative after the first day of steam inhalation on four consecutive swab samples.
 
Interestingly all 7 remained low viral shedders 3 to 5 days after following the protocol
 
The allergic patient who had stopped the study on day 5 had showed a negative swab on inhalation on day 1. They showed a weak positive 3 days later. An additional swab on day 10 showed negative
 
Also the patient that had also started on hydroxychloroquine and azithromycin (for 9 days and 3 days, respectively) continued the steam inhalation till day 5 when their swab tested negative The third dropped out patient with moderate to severe symptoms continued the steam inhalation protocol tested negative on swabs on days 8, 9 and 10.
 
This new study, although a small one, shows the beneficial effects of steam inhalation in reducing viral shedding from infected patients. The team writes that this could be an "easily accessible, non-invasive and inexpensive procedure" which has been proven to be effective. It should be subjected to larger clinical trials, the team wrote.
 
The study team concluded, "Should our preliminary observations be confirmed, the protocol could be used against COVID19 or other viral infections using vapotherm masks, where temperature, time of exposure and size of steam particles can be set and monitored."
 
The study team is working with researchers from other institutions in the United States, South America and India to further explore steam inhalation therapy to help treat COVID-19.
 
For more on the latest Coronavirus News, keep on logging to Thailand Medical News.