Image description: The background shows red covid-19 spike proteins. The picture shows people sitting down with oxygen masks on. (bottom left)The title reads America: Treating Long Covid with Hyperbaric Oxygen Therapy. ME Association logo (bottom right)

America: Treating Long Covid with Hyperbaric Oxygen Therapy

‘A new long Covid treatment shows promise, but insurance won’t cover it and some doctors are skeptical: Here’s why' by Annika Constantino

For the roughly 23 million Americans suffering from long Covid symptoms, an assortment of options claim to bring some relief — from stem-cell treatments and naturopathic medicine to an obscure process called “blood-washing” only available in Cyprus. One in particular appears promising for some: hyperbaric oxygen therapy. It involves breathing 100% pure oxygen — up to three times higher than air’s normal oxygen levels — in a pressurized chamber to enable the body to repair cognitive and physical damage.

ME Association Comment

While the use of HBOT in Long Covid is relatively new, we have been aware of people with ME/CFS trying it for many years. However, there hasn't been a robust clinical trial to evaluate its use as a form of treatment. And although there are anecdotal reports from people with ME/CFS who have tried this approach, sometimes using a service for MS patients, the results are very mixed. It can also be quite expensive to try this therapy with no guarantee that it might help.

There has been 1 observational study in 2013: The efficacy of hyperbaric oxygen therapy in the management of chronic fatigue syndrome. But this only involved a small number of people (n=16) who knew they were receiving HBO – so no form of placebo – and no control group, and it did not involve any long-term follow up. It does not, therefore, have the status of a proper clinical trial.

There are theoretical reasons why HBO might be effective in ME/CFS and a clinical trial would be interesting to try and confirm them. However, even a small trial would probably cost around £100,000, and possibly much more, and this is not something that we could add to the MEA Ramsay Research Fund agenda as a high priority study at the moment.

Russell Fleming
Head of Communications. The ME Association.

Article Extracts

But hyperbaric oxygen therapy’s success in treating long Covid appears to be largely anecdotal — with limited data on why it works, how effective it is, how long its healing effects last, whether it alleviates some symptoms better than others or if it carries unforeseen consequences. That’s a huge stumbling block for many medical experts, who caution against viewing it as a universal remedy for long Covid. It’s an expensive bet to make, too: The therapy, when used to treat long Covid, is only available at private facilities, some of which charge more than $50,000 for the experience.

“We’re using a treatment that’s complex and not fully understood to treat a medical condition that’s also new and complex,” says Dr. Venita Chandra, a vascular surgery clinical professor at Stanford University. “The level of challenge that Covid brought onto society has left people reaching for anything, but a lot more data is needed before this becomes a well- established treatment for Long Covid.”

How hyperbaric oxygen therapy works 

Hyperbaric oxygen therapy is only new when it comes to long Covid: The U.S. Food and Drug Administration has previously cleared it for disorders like decompression sickness, carbon monoxide poisoning and radiation injuries. In pressurized medical-grade chambers, patients alternate between breathing pure oxygen through a mask and regular air. When you go from the former to the latter, your brain interprets the drop in pressure as a lack of oxygen, says Dr. Mohammed Elamir, a physician at The Villages, Florida-based Aviv Clinics. That triggers stem cell production and blood vessel growth in the brain, which helps the body repair itself in a variety of ways, Elamir says.

A lack of data leaves unanswered questions 

Lynette Milakovich, a retiree in The Villages, experienced a range of long Covid symptoms before starting hyperbaric oxygen therapy. She had insomnia, felt “electrical shocks” all over her body and experienced brain fog that made it difficult to process and remember things, among other symptoms. After completing three months’ worth of sessions at Aviv in December 2022, Milakovich experienced improvements in her cognitive function, breathing and sensitivity to light and sound, she says. There’s limited data on how long those benefits might last, but Milakovich says she hopes to keep healing post-therapy in the coming months.

Elamir points to a 2022 study from Tel Aviv University, which examined 72 long Covid patients with cognitive symptoms like brain fog that lasted for at least three months. Half underwent hyperbaric oxygen therapy for two months, while the other served as a control group. Patients in the first group reported reduced brain fog, improved memory and attention, more energy and less pain. Those in the control group didn’t report any significant improvements.

Why the new long Covid treatment is so expensive

Even if hyperbaric oxygen therapy proves effective, its cost is a huge barrier to entry – especially when long Covid symptoms make it difficult to work 40 hours per week. Nora Lieberman, a gallery coordinator in Washington D.C., says she’s had trouble breathing, fatigue and cognitive impairments that make it difficult to complete normal tasks. She paid nearly $3,000 for ten sessions at a Restore Hyper Wellness location in Richmond, Virginia, in June 2021. Her symptoms returned after she halted the treatment, she says. It’s unclear whether that would’ve happened if she’d undergone her full allotment of sessions.

“It won’t happen without positive data emerging from larger-scale studies,” says Dr. Jonathan Whiteson, an associate professor of rehabilitation medicine at NYU Langone Health. “A few ongoing studies exist, but there’s no concrete timeline for when they’ll yield data,” Horton adds.

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