COVID-19 infection can lead to a wide range of persistent physical, neurocognitive, and neuropsychological symptoms. I have seen a lot of patients (and a few friends) suffer from “long haul COVID,” and personally, the possibility of living with long term cognitive problems from COVID scares me more than dying from it. I have been active in Undersea and Hyperbaric Medicine for many decades, and while hyperbaric oxygen therapy research has dwindled in this country over the decades, it has accelerated in Israel. The Israelis have found novel ways to approach hyperbaric research which have included allowing patients to help fund the carefully designed research trials in which they are enrolled as subjects. We should all be taking notes from the Israelis. The most recent paper in a long line of important research by the Israelis is entitled: Hyperbaric oxygen therapy improves neurocognitive functions and symptoms of post-COVID condition: randomized controlled trial.

The group performed a randomized, sham-control, double blind trial to evaluate the effect of hyperbaric oxygen therapy (HBOT) on post-COVID-19 patients with ongoing symptoms for at least 3 months after confirmed infection. Seventy-three patients were randomized to receive daily 40 session of HBOT (n = 37) or sham (n = 36) at 2ATA (atmospheres absolute) – the equivalent of 33 feet of sea water pressure, for 90 min with five-minute air breaks every 20 minutes. Follow-up assessments were performed at baseline and 1–3 weeks after the last treatment session. Following HBOT, there was a significant group-by-time interaction in global cognitive function, attention and executive function. Significant improvement was also demonstrated in the energy domain, sleep, psychiatric symptoms, and pain using the validated tools they employed. Clinical outcomes were associated with significant improvement in brain MRI perfusion and microstructural changes in specific areas of the brain. These results indicate that HBOT can induce neuroplasticity and improve cognitive, psychiatric, fatigue, sleep and pain symptoms of patients suffering from post-COVID-19 condition. Please read the full paper for the details.

This study, along with others published by the Israelis, likely represents the future of HBOT. It should be noted that this study was performed with 100% oxygen at two times sea level atmospheric pressure and not the low pressure achieved by nearly all inflatable chambers, which are increasingly available at health spas and chiropractic offices. Whether a lower oxygen partial pressure will be similarly beneficial I do not know, but given the generally poor understanding of physics by the average person, it will be challenging to make sure that the possible benefits shown in this study are not extrapolated to low-pressure inflatable chambers.

I will also emphasize that there is nothing unethical about a legitimate hyperbaric practitioner offering HBOT on a “case by case” basis for persistent COVID-19 symptoms, if the consent process for the patient includes the fact that the patient is likely going to pay cash since it is not covered by insurance, they are told the treatment it is still unproven, and no research data are being collected (since research requires an IRB approval while off-label clinical use of a device does not).

For more information about the math of HBOT and the ethics of off-label use of HBOT, see these previous blog articles: