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Exploring the rationale for thermotherapy in COVID-19

Mancilla-Galindo et al., International Journal of Hyperthermia, doi:10.1080/02656736.2021.1883127
Jan 2021  
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Review of thermotherapy (mild heat treatment) as a potential therapy for COVID-19. Authors review evidence showing SARS-CoV-2 is heat-sensitive, with reduced viral replication efficiency at body temperature compared to cooler upper airway temperatures. Several mechanisms are proposed by which mild hyperthermia could aid viral clearance and immunity in early stage COVID-19, including enhanced interferon responses, inhibition of viral enzymes/replication, increased antigen presentation, and effects on RNA interference.
Reviews covering thermotherapy for COVID-19 include Cohen, Kunutsor, Larenas-Linnemann, Mancilla-Galindo, Ramirez.
Mancilla-Galindo et al., 1 Jan 2021, peer-reviewed, 2 authors. Contact:
This PaperThermotherapyAll
Exploring the rationale for thermotherapy in COVID-19
Javier Mancilla-Galindo, Norma Galindo-Sevilla
International Journal of Hyperthermia, doi:10.1080/02656736.2021.1883127
Increased transmissibility of the pandemic severe acute respiratory coronavirus 2 (SARS-CoV-2) has been noted to occur at lower ambient temperatures. This is seemingly related to a better replication of most respiratory viruses, including SARS-CoV-2, at lower-than-core body temperatures (i.e., 33 C vs 37 C). Also, intrinsic characteristics of SARS-CoV-2 make it a heat-susceptible pathogen. Thermotherapy has successfully been used to combat viral infections in plants which could otherwise result in great economic losses; 90% of viruses causing infections in plants are positive-sense singlestranded ribonucleic acid (þssRNA) viruses, a characteristic shared by SARS-CoV-2. Thus, it is possible to envision the use of heat-based interventions (thermotherapy or mild-temperature hyperthermia) in patients with COVID-19 for which moderate cycles (every 8-12 h) of mild-temperature hyperthermia (1-2 h) have been proposed. However, there are potential safety and mechanistic concerns which could limit the use of thermotherapy only to patients with mild-to-moderate COVID-19 to prevent disease progression rather than to treat patients who have already progressed to severe-to-critical COVID-19. Here, we review the characteristics of SARS-CoV-2 which make it a heat-susceptible virus, potential host mechanisms which could be enhanced at higher temperatures to aid viral clearance, and how thermotherapy could be investigated as a modality of treatment in patients with COVID-19 while taking into consideration potential risks.
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