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Hyperbaric Oxygen Therapy (HBOT) and Long Covid

Mar 3rd 2023 | By Craig P. Tanio, MD, FACP, IFMCP

long covid image with hbot graphic

Long Covid, also known as post-acute sequelae of SARS-CoV-2 infection (PASC), is a condition that affects between 5 to 15% of people who have been infected with Covid-19. This condition is characterized by symptoms that can resemble myalgic encephalomyelitis/chronic fatigue syndrome. They can include but are not limited to persistent viral replication, inflammation of the blood vessels, hypercoagulability, neuroinflammation, fatigue, and other neurological and psychiatric symptoms. Unfortunately, there are currently no FDA-approved treatments for this condition, which has become a global challenge.

A recent randomized placebo-controlled study from Israel has shown that hyperbaric oxygen therapy (HBOT) may have potential utility in treating Long Covid. HBOT is a therapy that involves breathing pure oxygen while in a pressurized chamber and has been shown to help heal wounds and reduce inflammation, can have several neuroplasticity effects including improvement in mitochondrial function, increased blood flow via angiogenesis, migration of stem cells, and reduction of stem cells. Small studies in the past have also shown positive improvement in a small group of people.

long Covid syndrome and coronavirus pandemic symptoms

This recent study is unique because the researchers used a rigorous placebo control group in their design. Subjects were placed in a multi-person chamber and given air masks to wear while inside. The researchers increased the pressure for the first five minutes of the treatment, then reduced it to just above normal atmospheric pressure. Additionally, air was pumped into their masks instead of oxygen so subjects could not tell the difference between the placebo and real HBOT. The researchers included post-Covid patients who had symptoms for at least 3 months, with 37 patients in the treatment group and 36 in the control group. Patients in the treatment group received 40 sessions of HBOT at 2.0 ATM, utilizing air breaks with oxygen being delivered through the face mask.

The researchers found that the HBOT group improved in a statistically significant manner in several domains including physical limitation, energy, somatization, depression, anxiety, sleep, and pain.They also tested improvement in brain performance testing in the global cognitive score, executive function, and attention using computerized brain testing. In all of these areas, the treatment group improved more than the control group at a level that was found to be statistically significant. The researchers also found that the HBOT group showed significant improvement in brain perfusion seen by MRI in multiple areas that are associated with cognitive and emotional roles consistent with neuroplasticity. Patients who had the most improvement in brain perfusion also had the most improvement in symptoms.

This study is the first prospective randomized trial demonstrating significant improvement beyond expected clinical recovery for post-Covid.The researchers used a rigorous placebo control and used multiple methods of looking at improvements that were aligned with each other – brain performance, blood flow, and symptoms.  This study provides promising results for the potential use of hyperbaric oxygen therapy in the treatment of Long Covid, however, it is important to note that this is just one study and further research is needed to confirm its effectiveness and safety in a larger population. It is also crucial to consider the potential risks and side effects associated with hyperbaric oxygen therapy such as ear barotrauma, oxygen toxicity, and seizures.

Given that there are no approved treatments for Long Covid, the onus should be on regulators and insurance companies to look through this data and consider coverage for hyperbaric therapy for this condition, or at a minimum cover the therapy with the stipulations that patients enroll in a follow-up study.

Patients who are looking for options for Long Covid should consider discussing the utility of hyperbaric therapy with their physician. They should also discuss potential therapies to address other parts of the pathophysiology for Long Covid, including addressing blood vessel inflammation, micro clots, and persistent viral replication. It is essential for patients to work with their healthcare providers to develop a comprehensive treatment plan that addresses their individual needs and concerns. We will have further future blog posts to discuss the mechanisms of action of Long Covid and other potential therapies.

In addition to Hyperbaric Oxygen Therapy, we invite you to visit our website for more information on additional modalities we use to treat those suffering from Long Covid and other Brain Health issues.

If you have further questions, please call us at 1.866-REZILIR or send us an email at

long covid on wood cube

References: Zilberman‑Itskovich, S. Efrati S et al. Hyperbaric oxygen therapy improves neurocognitive functions and symptoms of post‑COVID condition: randomized controlled trial  Nature Scientific Reports | (2022) 12:11252

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