Did nasal rinsing help ASEAN control pandemic or swift action?

Though not validated by the WHO, a method traditionally prevalent in Southeast Asia is being credited for the region's impressively low number of coronavirus cases. This method has its roots in Hatha Yoga, a classical form of yoga that aims to prepare the human body for higher possibilities.

Pedestrians wearing masks to prevent contracting the coronavirus walk on a zebra crossing in Seoul, South Korea. (File representative image: Reuters)

By Saikiran Kannan: Correlation, as scientists often say, does not imply causation. In other words, a cause-and-effect relationship between two variables is anecdotal if not validated conclusively.

Though not validated by the WHO, a method traditionally prevalent in Southeast Asia is being credited for the region's impressively low number of coronavirus cases.

This method has its roots in Hatha Yoga, a classical form of yoga that aims to prepare the human body for higher possibilities.

The Yogic Nasal Rinsing

A nasal-rinsing technique linked to Hatha is hugely popular in some of the ten-nation ASEAN grouping of Thailand, Indonesia, Malaysia, the Philippines, Singapore, Brunei, Laos, Vietnam, Myanmar and Cambodia.

Jala Neti is one of the six purification procedures or Shatkarmas or Shatkriyas, a set of yogic "purifications" for the body.

The other five practices, outlined by Yogi Swatmarama, a 15th/16th-century sage compiler of Hatha, are Dhauti, Nauli, Basti, Kapalabhati, and Traka.

Neti with Jala, or water, also known as nasal irrigation is especially common in countries like Thailand, Vietnam, Cambodia and Laos.

A vast majority of their populations is rural and most use this technique to ease sinusitis.

The process involves pouring water, usually saline, in one nostril and flushing it out from the other in order to keep the nasal passage clean.

A 2019 report by Thai ENT specialists, which tracked the efficacy of nasal-irrigation devices in Thailand, found that almost 80 per cent of country's citizens regularly use the yogic technique to clear their nostrils.

Dr. Amy Baxter, a pain-management expert and founder of the Atlanta-based Pain Care Labs, believes that nasal irrigation held the key to the low Covid caseload in countries like Thailand, Laos, and Vietnam.

"SARS-CoV2's viral load is heaviest in sinuses/nasal cavity," she told a US luxury magazine, Best Life, in an interview in May. "Yes, they wear masks, and yes, they bow and don't shake hands, but the biggest difference between them and places like South Korea or Japan is that nasal irrigation is practiced by 80 per cent of people."

Some non-Covid-19-related studies have in the past found nasal irrigation effective in treating common cold.

A report published in 2019 by Nature concluded that 93 per cent of patients, who participated in the nasal-rinsing trials, reported considerable improvement in their viral symptoms.

A report by America's National Center for Biotechnology Information underscored the effectiveness of nasal irrigation in treating acute upper-respiratory conditions.

"Saline nasal irrigation (SNI), a therapy with roots in ayurvedic medicine that bathes the nasal mucosa with in spray or liquid saline, has been used as adjunctive care for upper-respiratory conditions. In liquid form, SNI has been found to be effective adjunctive care by the Cochrane Collaboration for symptoms associated with chronic rhinosinusitis," noted the 2009 report.

Nasal Rinsing and Covid-19

Tennessee's Vanderbilt University Medical Center is holding clinical trials of nasal saline irrigations on viral load in Covid-19 patients.

This study is expected to release its primary results in June 2021.

Meantime, the WHO has ruled out nose rinsing as a proven protection against the new coronavirus.

"There is no evidence that regularly rinsing the nose with saline has protected people from infection with the new coronavirus," said the WHO in a statement.

"There is some limited evidence that regularly rinsing the nose with saline can help people recover more quickly from the common cold. However, regularly rinsing the nose has not been shown to prevent respiratory infections," it added.

How ASEAN Managed Covid-19?

Nevertheless, ASEAN nations are appreciated for efforts and policies that have led to controlling the spread of the pandemic in the Southeast Asian region.

Indonesia has the maximum number of cases, the country being the most populous in the ASEAN grouping.

Singapore has the maximum per-million ratio because of its migrant labour dormitory clusters.

There are different dynamics attached to the way these countries have been seeing case numbers.

But four countries have stood out from the rest of the pack -- Thailand, Vietnam, Cambodia and Laos.

Thailand and Vietnam feature in the world's 20 most populous countries.

Secondly, each of these four ASEAN nations shares borders with at least two other countries.

Besides, all four countries rely heavily on tourism, with a vast number of visitors coming in from China, the initial epicentre of the pandemic.

That said, the four ASEAN nations have managed to have less than 4,000 cases combined.

Thailand

Thailand has 3,261 cases and 58 Covid-related deaths, per the latest tally.

This puts them at a healthy position owing to which they are actually looking at opening up the country for tourists as early as August 1.

Thailand has at its disposal some multitasking village health representatives, who were in charge of families in their communities.

Their primary task was to visit households and apprise them of the dos and don'ts.

They basically performed extensive door-to-door check-ups and follow-ups.

It's a typical age-old village setup where outsiders coming into their communities and towns are easily identified and monitored with respect to symptoms and temperature checks.

These health representatives were well trained.

Thailand has 77 provinces, with each having a communicable disease control unit. This bottoms-up approach greatly helped Thailand control the pandemic up to its last village.

Thailand was also one of the first to implement the mandatory-mask rule.

Vietnam

Vietnam has zero deaths from Covid-19 in spite of sharing the border with China.

Now, with just 43 cases, Vietnam was among the first to lift most domestic containment measures.

Like any other nation in ASEAN, it too had a lot of learning from the 2003 SARS outbreak.

Vietnam enforced early containment measures, such as airport screenings, physical distancing, ban on incoming international flights, school closures, and so forth.

Masks were mandated for the general public even before the WHO came out with a recommendation.

They had a strict three-week nationwide lockdown.

The key aspect being attributed here are the cost-effective measures undertaken by Vietnam. It only tested high-risk and suspected cases leading to a lower number of tests. But where it stood out was that around 1,000 people per a confirmed case were tested, one of the highest ratios in the world.

Vietnam's contact-tracing and quarantining measures went as far as third-tier contacts.

Sometimes, streets or even entire villages were quarantined and isolated in case there was a positive nearby.

Cambodia

Cambodia again has zero deaths. Only 197 cases.

Cambodia has one of the weakest healthcare systems in the region. But its success story is once again attributed to quick containment measures.

The country received a shot in its arm when the World Bank approved a $20 million credit line for Cambodia's fight against Covid-19.

Numerous other international partners have pitched in with medical supplies, with the EU offering a $61 million help to support the economy.

Cambodia's biggest advantage is seen in the fact that 80 per cent of its population lives in rural areas with very low densities.

This makes it very difficult for the virus to spread as fast as what has been seen in countries with a high population density.

The mandatory mask regulations were easily enforced.

Laos

Laos only has a total of 19 cases with zero deaths.

An important factor for the success of Laos and the three other ASEAN countries can be found in the effective collaboration amongst these four countries.

Be it at border controls or in the supply chain of masks and the PPEs, the neighbours helped each other to better handle the pandemic.

(The writer is a Singapore-based open-source intelligence analyst)

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