The CoviD-19 saga: Tuob and the Dunning Kruger effect

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CoviD-19 continues to ravage the country, and with this pandemic is another outbreak – misinformation, aptly called the “infodemic” by health authorities. People are distraught that the contagion is seemingly not contained in our country because, as of this writing, June 28, 2020, the number of cases are 35,455, with 9,686 recovered and 1,244 deaths.

While there are some countries like Vietnam and New Zealand that seem to have controlled the spread of the virus within their borders, many are still struggling, like us, the Philippines. And in that struggle comes desperation for a solution, some feasible but a long way from happening, like a drug or a vaccine. Some we may have missed, like early lockdowns, and some are unproven, like alternative medicine, most especially the recent hot topic, “tuob” or steam inhalation.

But people’s desperation and fear sometimes get the better of them, making them throw logic and caution to the winds. It may be attributed to our cultural beliefs, but whatever the reason, it’s very dangerous to spew out misinformation when people are dying of the disease. But there’s a couple of public figures who recently drew ire for climbing on the pandemic’s effects on the masses. One, an influencer, took stances in mass testing and clinical trials with misinformed sentiments. His statements can be described as anti-science, bordering on conspiracy theories. Mr. Influencer has almost 4 million followers, and if even just a fraction of that believe him, the results would be catastrophic. (READ: Mass testing vs clinical trials: Of media influencers, celebrities, and the viral phenomena)

Then there’s the Governor from Cebu, a public servant, who refused to wear face masks and even announced publicly that face masks are detrimental to health (which is obviously wrong if you still don’t get it). The governor proceeded to shame healthcare professionals on a Facebook Livestream and subsequently released a memorandum that “tuob” or steam inhalation is a must not just for CoviD-19 patients but everyone, sparking a debate between medical communities and netizens alike.

It is in these people that the fight against the raging contagion becomes harder.

What is “tuob” or Steam Inhalation

According to Dr. Jaime Bernadas, DOH-7 director, “tuob” is the practice of steam inhalation where one covers his/her head with a towel, blanket or large piece of cloth to inhale steam from a small basin containing boiled water infused with lemon, ginger, or eucalyptus. She added that DOH is not promoting tuob but also prohibits its use.

In the Journal of Family Practice, many people believe that steam inhalation reduces cold symptoms. There is no evidence suggesting that steam inhalation is effective for treating the common cold. Also, according to the International Rhinologic society, evidence does not support a relationship between cold temperature exposure or a “chill” (feeling of coldness) and the common cold, because these are some of the reasons why steam inhalation is used – they claim the hot temperature reduces the “cold” of common cold.

Another study by Singh M. and coauthors about heated and humidified air for the common cold states that steam inhalation is traditionally used as a home remedy for common colds and upper respiratory tract infections but the evidence base on the practice is weak, with unproven theories that the steam loosens mucus, opens nasal passages, and reduces mucosal inflammation, or that the heat inhibits replication of viruses.

Tuob for CoviD-19?

There’s no evidence of its benefit against CoviD-19 or any respiratory illness whatsoever, that’s it. The common misconception is that steam inhalation is beneficial in preventing and treating respiratory tract symptoms. It remains as that, a misconception.

In the advent of a pandemic however, this traditional form of medicine’s usage has spiraled up, and with it came its other effects: injuries. The Burns Centre at Birmingham Children’s Hospital, UK, received a 30-fold increase in the number of scalds directly resulting from steam inhalation. A study published on the Lancet about steam inhalation and paediatric burns during the CoviD-19 pandemic states that Social media and home-made tutorials from unverified sources have a role in misleading parents into practicing this habit.

Unfortunately, in a survey of general practitioners in 2016, it showed that 80% of general practitioners have recommended steam inhalation as a home remedy to their patients. Which means that there’s doctors have and are probably still endorsing it.

The Dunning Kruger Effect in Public Figures

There’s currently a rise in influencers or people in power overestimating their knowledge. This probably comes from a false sense of superiority due to their myriad followers and supporters. This makes them think most of the things they can come up with is true and correct, even to the point that if they are corrected they will retaliate. This is the Dunning Kruger effect in psychology, and is a very dangerous cognitive bias in the context of public figures amidst the pandemic.

Steam inhalation has been an alternative medical treatment for common colds and cough and has been passed down from generations, which is why it may be culturally significant for some and writing against it is irritates them. While a huge number of people claim that steam inhalation soothes them, this is also not true for all, and there is no evidence that steam inhalation cures colds and other respiratory illnesses.

A soothing feeling or relief is not equitable to a cured state. And this might lead to another event where people have a false sense of security because they’ve done steam inhalation or “tuob”. And proceed to recklessly go out in the virus-filled world unprotected.

Most of the arguments that can be seen supporting tuob ranges from claims that the heat kills the virus or it promotes the multiplication of white blood cells which boosts the immune system. These claims we can’t actually find any evidence of. The only actual effects of steam inhalation that has been recognized and have a good amount of data is scald and burn injuries on its misuse, especially in pediatric patients.

In defense of tuob, if it is as helpful because it provides subjective relief for some people then by all means, there’s absolutely no harm in its correct use. What people must understand is that it is neither a cure for SARS-CoV-2 (nor any bugs for the matter) nor a better alternative for any of the proven preventive measures against CoviD-19, like handwashing, social distancing, and face masks.

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