To Editor, I read a recently published report by Masiero et al. (2020) in your reputed journal with great interest. I thank the authors for their important remarks that remind us of the benefits of balneotherapy on human immune function. I have a few doubts concerning their suggestion. First of all, I cannot fully support the advice that spas can be visited for balneotherapy purposes in COVID-19 days. While I share the view that balneotherapy hydrotherapy applications can alter the human immune system, I also think that they may have a yet unknown effect on the virus itself and virus transmission (Masiero et al. 2020). There are studies that examine the relationship between COVID-19 incidence and a number of meteorological factors worldwide. Absolute air temperature and humidity have been reported to affect COVID-19 transmission among patients. Unfortunately, the results of these recent studies are variable (Liu et al. 2020; Tosepu et al. 2020). Furthermore, it is well known that the viral transmission begins before symptoms arise. Close contact with someone during these asymptomatic but contagious periods raises the risk of infection and disease transmission (Siordia Jr 2020). So even though the precautions are taken, people will still come together around hot springs or in pools in these facilities. Also, it must be kept in mind that this spa population will mostly be older people and/or having chronic diseases and drug use. Last but not least, we know that balneotherapy has thermal effects on the body; hot water causes vasodilation (Nasermoaddeli and Kagamimori 2005). Acute inflammation exacerbates in the presence of heat-induced vasodilation (Ozturk 2004). Therefore, inflammation may accelerate in asymptomatic but infected people. Like many other health issues in these days, spa usage and balneotherapy may be a r isk for pat ients in the abovementioned points, so cons and pros must be carefully evaluated for each patient.

中文翻译：

---

COVID-19 时代的浴疗：应该推荐还是不推荐？

对于编辑，我阅读了 Masiero 等人最近发表的一份报告。（2020）在您的知名期刊上非常感兴趣。我感谢作者的重要评论，这些评论提醒我们浴疗对人体免疫功能的益处。我对他们的建议有些怀疑。首先，我不能完全支持在 COVID-19 天内可以去水疗中心进行浴疗的建议。虽然我同意浴疗水疗应用可以改变人体免疫系统的观点，但我也认为它们可能对病毒本身和病毒传播产生未知的影响（Masiero 等人，2020 年）。有研究检查了 COVID-19 发病率与全球许多气象因素之间的关系。据报道，绝对空气温度和湿度会影响 COVID-19 在患者中的传播。不幸的是，这些近期研究的结果各不相同（Liu 等人，2020 年；Tosepu 等人，2020 年）。此外，众所周知，病毒传播在症状出现之前就开始了。在这些无症状但具有传染性的时期与某人密切接触会增加感染和疾病传播的风险（Siordia Jr 2020）。因此，即使采取了预防措施，人们仍然会聚集在这些设施的温泉周围或游泳池中。此外，必须记住，这些温泉浴场的人群主要是老年人和/或患有慢性病和吸毒者。最后但并非最不重要的一点是，我们知道浴疗会对身体产生热效应；热水会导致血管舒张（Nasermoaddeli 和 Kagamimori 2005）。存在热诱导的血管舒张时，急性炎症会加剧（Ozturk 2004）。所以，在无症状但已感染的人群中，炎症可能会加速。像当今的许多其他健康问题一样，水疗使用和浴疗可能会在上述几点中为患者带来风险，因此必须仔细评估每位患者的利弊。