By Peter A. McCullough, MD, MPH
Many followers have been clamoring for some approach to post-COVID-19 syndromes. I have tried many therapies in clinical practice and have been disappointed with my observations. Approximately 50% of patients hospitalized with severe respiratory COVID-19 suffer from post-COVID-19 syndromes including weakness, depression, muscle fatigue and loss of mass, hair loss, sleep disturbance, anosmia, tinnitus, headaches, and general inanition. The observational studies suggest these symptoms are transient and will resolve over time. However, patients are suffering now and want a pathway to prompt recovery. Several observational studies and one small randomized trial demonstrated salutary effects of hyperbaric oxygen therapy (HBOT) consisting of a series of treatments with the whole body in a HBOT chamber where the partial pressure of oxygen is modified to levels used to treat chronic wounds and other medical problems.
Zilberman‑Itskovich et al randomized 73 post-COVID syndrome patients to a very intense protocol of 40 daily sessions, five sessions per week within a two-month period. The HBOT procedure included breathing 100% oxygen by mask at 2ATA for 90 min with five-minute breaks every 20 min. Compression/decompression rates were 1.0 m/min. The results on brain imaging and quality of life were impressive, however, I doubt this would be practical in the real world.
Kjellberg and coworkers published the more practical HOT-LoCO clinical trial protocol which outlines the inclusion and exclusion criteria and the HBOT treatment schedule of 10 treatments over 6 weeks. As with acute COVID-19 therapies, it would be optimal if all patients could be in a randomized trial. However, many locations will have no access to clinical trials, thus the publication a protocol gives a standardized approach that other physicians and patients can review and if attempted, could be carried out in such a manner to be generalizable to the trial results when they become available in a few years.
In general HBOT is safe, however the main drawback is cost. In the US, the cost of hyperbaric oxygen therapy per individual treatment for patients can vary between more than $100 at a HBOT clinic, to more than a $1,000 for at a large medical center. In my practice, HBOT is the only form of treatment I have found in post COVID-19 syndromes (especially residual pulmonary disease) that appears to have a bone fide treatment effect. My observations await corroboration by large, definitive randomized trials.
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Zilberman-Itskovich, S., Catalogna, M., Sasson, E. et al. Hyperbaric oxygen therapy improves neurocognitive functions and symptoms of post-COVID condition: randomized controlled trial. Sci Rep 12, 11252 (2022). https://doi.org/10.1038/s41598-022-15565-0
Kjellberg A, Abdel-Halim L, Hassler A, El Gharbi S, Al-Ezerjawi S, Boström E, Sundberg CJ, Pernow J, Medson K, Kowalski JH, Rodriguez-Wallberg KA, Zheng X, Catrina S, Runold M, Ståhlberg M, Bruchfeld J, Nygren-Bonnier M, Lindholm P. Hyperbaric oxygen for treatment of long COVID-19 syndrome (HOT-LoCO): protocol for a randomised, placebo-controlled, double-blind, phase II clinical trial. BMJ Open. 2022 Nov 2;12(11):e061870. doi: 10.1136/bmjopen-2022-061870. PMID: 36323462; PMCID: PMC9638753.