Protocols and self-checking plans for the safety of post-COVID-19 balneotherapy

Main Article Content

Massimo Clementi
Carlo Signorelli
Vincenzo Romano Spica
Matteo Vitali
Marco Conti
Marco Vitale

Keywords

balneotherapy, COVID-19, Phase-2

Abstract

During the COVID-19 pandemics, balneotherapic establishments were closed in Italy like in the rest of Europe. The Italian Foundation for Research in balneotherapy (FoRST) was asked to prepare a safety protocol to be proposed to the National Health Authorities to allow the establishments to restart their activity when possible, under safe conditions (the so-called Phase-2). The group of experts proposed the following hygienic and sanitary protocols of risk management for the initial reopening of the balneology settings in Italy. The plan aims to define the operating procedures to be implemented at the balneology establishments for the beginning of Phase-2 and to keep them constantly updated in the different periods that will characterize Phase-2 in relation to the trends of the disease. To this end the procedures, defined on the basis of the scientific state-of-the-art available today, will be updated and revised from time to time whenever further scientific evidence and directives from the Health Authorities make it necessary and/or useful.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...
Abstract 146 | PDF Downloads 66

References

1. Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DKW, Bleicker T, Brünink S, Schneider J, Schmidt ML, Mulders DGJC, Haagmans BL, van der Veer B,van den Brink S, Wijsman L, Goderski G, Romette JL, Ellis J, Zambon M, Peiris M, Goossens H, Reusken C, Koopmans MPG, Drosten C. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill. 2020 Jan ;25(3).
2. Fehr AR, Channappanavar R, Perlman S. Middle East Respiratory Syndrome: Emergence of a Pathogenic Human Coronavirus. Annu Rev Med. 2017 Jan 14;68:387-399.

3. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, Zhao X, Huang B, Shi W, Lu R, Niu P, Zhan F, Ma X, Wang D, Xu W, Wu G, Gao GF, Tan W; China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020 Feb 20;382(8):727

4. Gutenbrunner C, Bender T, Cantista P, Karagülle Z.: “A proposal for a worldwide definition of health resort medicine, balneology, medical hydrology and climatology”. Int J Biometeorol. 2010 Sep;54(5):495-507. doi: 10.1007/s00484-010-0321-5.

5. Kwiatkowski F, Mouret-Reynier MA, Duclos M, et al. Long-term improvement of breast cancer survivors' quality of life by a 2-week group physical and educational intervention: 5-year update of the 'PACThe' trial. Br J Cancer. 2017;116(11):1389-1393. doi:10.1038/bjc.2017.112

6. Morer C, Roques CF, Françon A, Forestier R, Maraver F. The role of mineral elements and other chemical compounds used in balneology: data from double-blind randomized clinical trials. Int J Biometeorol. 2017;61(12):2159-2173. doi:10.1007/s00484-017-1421-2

7. Valeriani F, Margarucci LM, Romano Spica V. Recreational Use of Spa Thermal Waters: Criticisms and Perspectives for Innovative Treatments. Int J Environ Res Public Health. 2018;15(12):2675. Published 2018 Nov 28. doi:10.3390/ijerph15122675

8. Margarucci LM, Romano Spica V, Gianfranceschi G, Valeriani F. Untouchability of natural spa waters: Perspectives for treatments within a personalized water safety plan. Environ Int. 2019;133(Pt A):105095. doi:10.1016/j.envint.2019.105095

9. Guida M, Di Onofrio V, Gallè F, et al. Pseudomonas aeruginosa in Swimming Pool Water: Evidences and Perspectives for a New Control Strategy. Int J Environ Res Public Health. 2016;13(9):919. Published 2016 Sep 15. doi:10.3390/ijerph13090919

10. Romano Spica V, Gallè F, Baldelli G, et al. Swimming Pool safety and prevention at the time of Covid-19: a consensus document from GSMS-SItI. Ann Ig. 2020;32(5):439-448. doi:10.7416/ai.2020.2368

11. Pasquarella, C., Veronesi, L., Napoli, C., Castaldi, S., Pasquarella, M.L., Saccani, E., Colucci, M.E., Auxilia, F., Galle, F., Di Onofrio, V., Tafuri, S., Signorelli, C., Liguori, G., 2014. What about behaviours in swimming pools? Results of an Italian multicentre study. Microchem. J. 112, 190–195. https://doi.org/10.1016/j.microc.2013. 09.024. 

12. Liguori, G ., Castaldi, S., Signorelli, C., Auxilia, F., Pasquarella, C., Alfano, V., Saccani, E., Visciano, A., Fanti, M., Spinelli, A., Pasquarella, M.L. Hygienic Risks in Swimming Pool: Knowledge and Behaviours of Consumers of Three Structures in Crema, Parma and Naples. Ann Ig. Jul-Aug 2007;19(4):325-35

13. Valeriani F, Gianfranceschi G, Romano Spica V. The microbiota as a candidate biomarker for SPA pools and SPA thermal spring stability after seismic events. Environ Int. 2020;137:105595. doi:10.1016/j.envint.2020.105595

14. Karagülle MZ, Karagülle M, Kılıç S, Sevinç H, Dündar C, Türkoğlu M.: “ In vitro evaluation of natural thermal mineral waters in human keratinocyte cells: a preliminary study. Int J Biometeorol. 2018 Sep;62(9):1657-1661. doi:10.1007/s00484-018-1565-8. Epub 2018 Jun 2. PubMed PMID: 29860536.

15. Carbajo JM, Maraver F.:”Salt water and skin interactions: new lines of evidence”. Int J Biometeorol. 2018 Aug;62(8):1345-1360. doi: 10.1007/s00484-018-1545-z.

16. Zöller N, Valesky E, Hofmann M, Bereiter-Hahn J, Bernd A, Kaufmann R, Meissner M, Kippenberger S. “Impact of Different Spa Waters on Inflammation Parameters in Human Keratinocyte HaCaT Cells”. Ann Dermatol. 2015 Dec;27(6):709-14. doi:10.5021/ad.2015.27.6.709. Epub 2015 Dec 7. PubMed PMID: 26719640.

17. Mirandola P, Gobbi G, Micheloni C, et al. Hydrogen sulfide inhibits IL-8 expression in human keratinocytes via MAP kinase signaling. Lab Invest. 2011;91(8):1188-1194. doi:10.1038/labinvest.2011.76

18. Gobbi G, Ricci F, Malinverno C, et al. Hydrogen sulfide impairs keratinocyte cell growth and adhesion inhibiting mitogen-activated protein kinase signaling. Lab Invest. 2009;89(9):994-1006. doi:10.1038/labinvest.2009.61

19. Antonelli, M.,Donelli, D, Fioravanti, A.: “ Effects of balneotherapy and spa therapy on quality of life of patients with knee osteoarthritis: a systematic review and meta-analysis”. Rheumatology International, 2018; Vol 38, (10):1807-1824

20. Cozzi F., Ciprian L., Carrara M., Galozzi P., Zanatta E., Scanu A., Sfriso P., Punzi L.: “Balneotherapy in chronic inflammatory rheumatic diesases-a narrative review”. International Journal of Biometeorology. Doi: 10.1007/s00484-018-1618-z.

21. Forestier R, Desfour H, Tessier JM, et al. Spa therapy in the treatment of knee osteoarthritis: a large randomised multicentre trial. Ann Rheum Dis. 2010;69(4):660-665. doi:10.1136/ard.2009.113209

22. Forestier R, Genty C, Waller B, et al. Crenobalneotherapy (spa therapy) in patients with knee and generalized osteoarthritis: a post-hoc subgroup analysis of a large multicentre randomized trial. Ann Phys Rehabil Med. 2014;57(4):213-227. doi:10.1016/j.rehab.2014.03.001
23. Magrone T, Galantino M, Di Bitonto N, Borraccino L, Chiaromonte G, Jirillo E. : “Effects of thermal water inhalation in chronic upper respiratory tract infections in elderly and young patients. Immun Ageing. 2016 May 5;13:18. doi: 10.1186/s12979-016-0073-0. eCollection 2016.

24. Simonetta Baldi, Gian Domenico Pinna, Claudio Bruschi, Fabrizio Caldara, Roberto Maestri, Elena Dacosto, Antonella Rezzani, Ermanno Popovich, Ezio Bellinzona, Paola Crotti, Silvia Montemartini, Claudio Fracchia. “Medicinal clays improve the endurance of loaded inspiratory muscles in COPD: a randomized clinical trial of nonpharmacological treatment”: International Journal of COPD 2015: 10 2235-2248.

25. Viegas J, Esteves AF, Cardoso EM, Arosa FA, Vitale M, Taborda-Barata L. Biological Effects of Thermal Water-Associated Hydrogen Sulfide on Human Airways and Associated Immune Cells: Implications for Respiratory Diseases. Front Public Health. 2019;7:128. Published 2019 Jun 5. doi:10.3389/fpubh.2019.00128

26. Carubbi C, Masselli E, Calabrò E, et al. Sulphurous thermal water inhalation impacts respiratory metabolic parameters in heavy smokers. Int J Biometeorol. 2019;63(9):1209-1216. doi:10.1007/s00484-019-01737-7

27. Thea Magrone, Mauro Galantino, Nunzio di Bitonto, Luisella Borraccino, Gerardo Chiaromonte, Emilio Jirillo. “Effects of thermal water inhalation in chronic upper respiratory tract infections in elderly and young patients” Immunity & Ageing (2016) 13:18 DOI 10.1186/s12979-016-0073-0.

28. Monica Neri, Luigi Sansone, Luisa Pietrasanta, Aliaksei Kisialiou, elosia Cabano, Marina Martini, Matteo A. Russo, Donatella Ugolini, Marco Tafani, Stefano Bonassi. “ Gene and protein expression of CXCR4 in adult and elderly patients with chronic rhinitis, pharyngitis or sinusitis undergoing thermal water nasal inhalations” Immunity & Ageing (2018) 15:10.

29. Antonelli M, Donelli D. : “Effects of balneotherapy and spa therapy on levels of cortisol as a stress biomarker: a systematic review”. Int J Biometeorol. 2018 Jun;62(6):913-924. doi: 10.1007/s00484-018-1504-8.

30. Francesca Benedetti, Sabrina Curreli, Selvi Krishnan, Sergio Davinelli, Fiorenza Cocchi, Giovanni Scapagnini, Robert Gallo, Davide Zella. “Anti-inflammatory effects of H2S during acute bacterial infection: a review”. Benedetti et al. J Transl Med (2017) 15:100 DOI 10.1186/s12967-017-1206-8.
31. Rinaldi L, Gobbi G, Pambianco M, Micheloni C, Mirandola P, Vitale M. : “Hydrogen sulfide prevents apoptosis of human PMN via inhibition of p38 and caspase 3”. Lab Invest. 2006 Apr;86(4):391-7. PubMed PMID: 16446703.

32. Mirandola P, Gobbi G, Sponzilli I, Pambianco M, Malinverno C, Cacchioli A, De Panfilis G, Vitale M. : “Exogenous hydrogen sulfide induces functional inhibition and cell death of cytotoxic lymphocytes subsets”. J Cell Physiol. 2007 Dec;213(3):826-33. PubMed PMID: 17516567. 13

33. Bucci M, Papapetropoulos A, Vellecco V, Zhou Z, Pyriochou A, Roussos C, Roviezzo F, Brancaleone V, Cirino G. “Hydrogen sulfide is an endogenous inhibitor of phosphodiesterase activity”: Arteriosclerosis, Thrombosis, and Vascular Biology, 2010; DOI: 10.1161/atvbaha.110.209783.

34. Carpentier PH, Blaise S, Satger B, et al. A multicenter randomized controlled trial evaluating balneotherapy in patients with advanced chronic venous insufficiency. J Vasc Surg. 2014;59(2):447-454.e1. doi:10.1016/j.jvs.2013.08.002

35. Bothe G, Coh A, Auinger A.: “Efficacy and safety of a natural mineral water rich in magnesium and sulphate for bowel function: a double-blind, randomized, placebo-controlled study”. Eur J Nutr. 2017 Mar;56(2):491-499. doi:10.1007/s00394-015-1094-8.

36. Nouvenne A, Meschi T, Prati B, Guerra A, Allegri F, Vezzoli G, Soldati L, Gambaro G, Maggiore U, Borghi L. “Effects of a low-salt diet on idiopathic hypercalciuria in calcium-oxalate stone formers: a 3-mo randomized controlled trial”: Am J Clin Nutr 2010; 91:565-70.

37. Schnebelen-Berthier C, Negro N, Jaruga A, Roques CF, Lecerf JM. Long term effect of spa therapy combined with patient education program on subjects with overweight and obesity - A controlled study. Obes Res Clin Pract. 2019;13(5):492-498. doi:10.1016/j.orcp.2019.06.005

38. Chary-Valckenaere I, Loeuille D, Jay N, et al. Spa therapy together with supervised self-mobilisation improves pain, function and quality of life in patients with chronic shoulder pain: a single-blind randomised controlled trial. Int J Biometeorol. 2018;62(6):1003-1014. doi:10.1007/s00484-018-1502-x

39. Signorelli C, Scognamiglio T, Odone A. COVID-19 in Italy: impact of containment measures and prevalence estimates of infection in the general population. Acta Biomed. 2020 Apr 10;91(3-S):175-179. doi: 10.23750/abm.v91i3-S.9511 

40. Odone A, Delmonte D, Scognamiglio T, Signorelli C. COVID-19 deaths in Lombardy, Italy: data in context. Lancet Public Health. 2020 Apr 24. pii: S2468-2667(20)30099-2. doi: 10.1016/S2468-2667(20)30099-2. 

41. Signorelli C, Odone A, Gianfredi V, Bossi E, Bucci D, Oradini-Alacreu A, Frascella B, Capraro M, Chiappa F, Blandi L, Ciceri F. The spread of COVID-19 in six western metropolitan regions: a false myth on the excess of mortality in Lombardy and the defense of the city of Milan. Acta Biomed. 2020; 91(2) doi 10.23750/abm.v91i2.9600 

42. Boccia S, Ricciardi W, Ioannidis JPA. What Other Countries Can Learn From Italy During the COVID-19 Pandemic. JAMA Intern Med. 2020 Apr 7. doi: 10.1001/jamainternmed.2020.1447. [Epub ahead of print]