Mild Hyperbaric Oxygen Therapy (mHBOT) and Covid

COVID-19 turned the world upside down in 2020 and now, in the aftermath, we are seeing many of those previously infected with symptoms that persist long after the acute infection resolves. 

These symptoms can vary widely but can include pulmonary and cardiac-focused symptoms such as chronic cough, shortness of breath, low oxygen levels, chest pain, and decreased exercise tolerance. Brain fog, fatigue, muscle aches, joint pains, and headaches that range from mild to severe are also common. 

There are several reasons why we believe these symptoms develop. Low oxygen levels during the infection may cause lasting damage to tissue. The infection may cause chronic inflammation and chronic immune overactivity akin to what would be seen in an autoimmune process. There also may be viral or other infection reactivity due to the initial immune suppression. In addition, there is also the possibility that in some cases the covid spike protein may continue to replicate long after acute infection. 

There is good news to share, though. Many different therapeutic options are becoming available for patients with long haul covid and one of the most promising is hyperbaric oxygen therapy.  

HBOT and COVID 

HBOT combines increased atmospheric pressure with increased inspired oxygen to drive more oxygen into circulation. Typically we carry oxygen on red blood cells but inside a hyperbaric chamber, oxygen gets diffused into the plasma or the liquid of our bloodstream to exponential levels. This significantly increases oxygen-carrying capacity. 

Early in the pandemic, the risk of dying of covid if intubated and put on a ventilator was  >80%. HBOT was used in several hospitals and, although it was difficult to get these patients in the chamber due to their critical status, intubation was averted in many. The primary mechanism here was simple: despite damaged lung tissue due to covid infection, HBOT was able to overcome the oxygen deficit and help increase oxygen levels. 

There were several second mechanisms at play here too. For example, HBOT works not only by driving oxygen into circulation but also by the downstream effects of this oxygen on the expression of various genes in the DNA (i.e. via epigenetic changes). HBOT also increases angiogenesis or the production of new blood vessels. It decreases inflammation immediately and downregulates inflammatory markers (many of which are elevated during and after covid infection, especially in long haulers), releases stem cells to go to tissues where there is inflammation and damage, and also enhances immune system function. 

We believe that all of these mechanisms are working to the benefit of long-haul covid patients. Clinics and patients using chambers in their homes all over the world are seeing amazing recoveries due to HBOT’s ability to decrease inflammation and rebuild damaged tissue.  

HBOT and Pulmonary/Cardiac Predominant Symptoms

In long-haul covid patients with pulmonary and cardiac predominant symptoms, there is no data yet but from my clinical experience and the experience of my colleagues, it seems that mild hyperbaric pressures are the safest and most effective. The lungs are sensitive to high oxygen levels. The heart is as well, especially when it (or the surrounding tissue) is inflamed or damaged. If hyperbaric treatment is titrated very slowly, sometimes starting at just 1.1 ATA and going down to 1.3 or 1.5 ATA as tolerated, and used with an integrative approach (see below), there is potential for these patients to improve dramatically. I have seen elite athletes with pericarditis or with chronic hypoxia rebound in as few as ten treatments at 1.3 ATA but in some, it does take considerably more HBOT. 

HBOT and Neurologic Symptoms 

Mild hyperbaric chambers are particularly helpful for those with long-haul covid symptoms of brain fog, fatigue, difficulty concentrating, headaches, and other neurologic symptoms. This is because mild hyperbaric pressures are optimized to enhance brain oxygenation and brain blood flow. 

There are several studies showing the benefit of mild pressures in the treatment of post-concussive syndrome and neuroinflammation. Although no studies have yet to be done at these pressures in COVID, again my clinical experience and the experience of many of my colleagues around the country using these pressures have been overwhelmingly positive. Treatment protocols of 1.3 to 1.75 ATA X 60-minute sessions for 20 to 60 sessions are the typical range where see the benefit. 

HBOT and COVID: An integrative approach: 

In my clinical practice, most long-haul covid patients–and by “most” I’d venture to say >95%--had underlying toxicities, deficiencies, or untreated infections prior to the covid infection. In some, these issues may have been subclinical (i.e. they had no symptoms).

The key to truly helping these patients is by using an integrative approach alongside HBOT that includes comprehensive laboratory analysis (ie. assessment of vitamin, mineral, nutrient, hormone, and gut status), and lab testing for possible infection reactivation (Lyme, mold, EBV etc). 

Depending on the findings, supplementation, prescribed medications, lifestyle measures (breathwork, cold exposure, etc), additional practitioners that specialize in the various organ systems or infections plus additional technology may be helpful. 

The good news is that all of these integrative interventions synergize well with HBOT and can be combined to accelerate healing and recovery. 

/ Dr. Scott Sherr