The American Academy of Physical Medicine and Rehabilitation estimates more than 23 million Americans have been affected by long COVID, which is why it is being described as a “mass disabling event.” It’s officially a disability under the Americans with Disability Act (Section 504 and Section 1557). The few COVID clinics I know of in Texas have wait times of 7 – 9 months. However, there may be hope for the millions who suffer from Long COVID by using Hyperbaric Oxygen Therapy (HBOT).
Keep in mind that if you are treating patients on a case-by-case basis and not collecting data for research, it is not necessary to go through the process of obtaining approval from an Institutional Review Board (IRB). Patients still need to undergo the appropriate medical consent process and will probably have to pay cash for treatment, but it’s not unethical to charge patients for care that is not covered by their insurance as long as logical ethical practices are observed. I talked about this in a post related to the use of HBOT for COVID pneumonia, but the ethical principles are the same for Long COVID. Patients should be told that HBOT isn’t proven for Long COVID, and they need to be informed of the potential risks of treatment (which are few). Note that the treatment protocol described can’t be achieved with an inflatable chamber designed for altitude sickness, but must be delivered in an FDA approved (and safety certified) hyperbaric chamber.
My friend and colleague, Daphne Denham, MD has been treating Long COVID patients. She’s provided the guest article below, and you can also watch an interview with Dr. Denham.
Finally a Cure for Lingering COVID? A Recent Study Shows Dramatic Improvement with Hyperbaric Oxygen Treatments
Lingering symptoms of COVID, referred to as “long-haulers” by some, is reported to affect anywhere from 10-30%, with many saying it is closer to 50%. Complaints include memory issues, loss of executive function, anxiety, depression and even post-traumatic stress symptoms. Physical complaints include tiredness, shortness of breath when moving around, loss of taste and smell, sleep disturbances, headaches and total body pain. Until recently, the recommendations from the medical community have been to “wait and see,” a plan that is not comforting to millions of people who are unable to work or function normally.
An article published this past month, from a group in Israel gives us hope. Their study was a randomized controlled trial which is considered a gold standard for medical trials. According to their article in Nature (2022)12:11252, entitled “Hyperbaric Oxygen Therapy Improves Neurocognitive Functions and Symptoms of Post-COVID Condition: Randomized Controlled Trial,” patients were treated with 40 hyperbaric oxygen treatments [HBOT] and assessed at 1-3 weeks after they completed their treatment. Those who received HBOT had statistical improvements from baseline and in comparison to the control group who received the sham treatment.
The areas of improvement with HBOT included “global cognitive function, attention and executive function, energy domain, sleep, psychiatric symptoms, and pain interference.” Additionally, they were able to show improvement in brain MRI perfusion, meaning greater blood flow to areas of the brain after treatment. They concluded, “HBOT’s beneficial effect may be attributed to increased brain perfusion and neuroplasticity in regions associated with cognitive and emotional roles.” All this means, simply, there is hope for those suffering from long-COVID.
The treatment protocol tested by the Israelis involved 40 daily sessions of hyperbaric oxygen at a pressure of 2.0 Atmospheres Absolute (two times sea level atmospheric pressure) for 90 minutes with a 5 minute “air break” every 20 minutes. (Note that these treatment pressures can’t be achieved in “inflatable” chambers used for mountain sickness.) We have been treating long COVID patients for the past year and see dramatic improvements with as few as 5 treatments, although some severe cases do need 40 as in the Israeli study.
Hyperbaric oxygen therapy is an underutilized, very low risk, treatment that has been used for 100 years. The benefits of HBOT for lingering symptoms of COVID make intuitive sense. Inflammation is thought to be a main cause of the long-COVID issues, and HBOT has been well documented in other studies as being anti-inflammatory. Although COVID clinics are being set up to help patients manage the debilitating symptoms of Long COVID, so far, only HBOT is showing benefit as a way to actively treat long COVID.
–Daphne Denham, MD
- Zilberman-Itskovich et al; Hyperbaric oxygen therapy improves neurocognitive functions and symptoms of post-COVID condition: randomized controlled trial. Nature. 12:11252 (2022)
- Hyperbaric Oxygen Therapy Improves Neurocognitive Functions and Symptoms of Post-COVID Condition – the Results of a Randomized Controlled Trial
- How to Do the Right Thing Ethically Regarding HBOT for COVID-19 Pneumonia
- Portable (Inflatable) Hyperbaric Chambers – Where Unsafe Meets Unethical
- The AMA Adopts a Resolution Opposing the Unsafe Use of “Mild Hyperbaric Oxygen Therapy”
- Explaining The Math for Hyperbaric Oxygen