I researched Hyperbaric Oxygen Therapy to address my long COVID fatigue.
My long COVID doctor suggested I consider Hyperbaric Oxygen Therapy (HBOT) to alleviate the fatigue and post-exertional malaise I am still experiencing. He recommended 40 treatments at 2.0 ATM and said the treatment would most likely not be covered by health insurance and cost about $8000.
Below is the research I have done into this treatment.
FDA
The Food and Drug Administration (FDA) has an informative fact sheet about HBOT.
HBOT is approved for treating some illnesses. However, the fact sheet contains the following statement: “HBOT is being studied for other conditions, including COVID-19. However, at this time, the FDA has not cleared or authorized the use of any HBOT device to treat COVID-19 or any conditions beyond those listed above.”
Note that all the FDA information is for “hard shell” HBOT. They have a statement at the bottom of their page: “The FDA has also cleared a large, zippered bag that is intended to treat altitude sickness only.”
Based on FDA approval for some conditions, I believe that hard shell HBOT treatment does something to the body. The question is whether it will do something for long COVID fatigue.
Risks
Johns Hopkins has a list of possible complications which I recommend reading. Three of the complications I have seen in anecdotal reports.
Fatigue is a non-serious complication listed. A treatment that causes fatigue, but treats fatigue? Possible, but suspicious.
Ear or sinus problems are often listed in anecdotes. I don’t like the ear pressure swimming to the bottom of a 10 foot pool and I assume this is much worse, especially every day for 40 days.
Nearsightedness I have also seen in anecdotal reports and it freaks me out to think the treatment could change the shape of my eyeball, but it makes sense that the pressure could do that.
That page also says “To prevent oxygen poisoning, you may need to take short breaks during the therapy and breathe normal air. This can prevent tissues in the body from taking in too much oxygen.”
Research
There has been a small randomized controlled study of HBOT for long COVID: Hyperbaric oxygen therapy improves neurocognitive functions and symptoms of post-COVID condition: randomized controlled trial. This study gave 37 patients HBOT and 36 controls a sham treatment.
Then a year later the same team published a follow-up study: Long term outcomes of hyperbaric oxygen therapy in post covid condition: longitudinal follow-up of a randomized controlled trial
This team has a significant conflict of interest. In the second paper they disclose, “Amir Hadanny and Efrat Sasson work for AVIV Scientific LTD. Shai Efrati is a shareholder at AVIV Scientific LTD.”
- Shai Efrati is the “Founder and Chairman of the Medical Advisory Board” of Aviv Clinics.
- Amir Hadanny is the “Chief Medical Officer and Head of Research” of Aviv.
- Efrat Sasson is listed on LinkedIn as “Imaging Algorithm Developer at Arineta LTD.” The About section of her page starts, “Aviv Scientific Ltd, world leader in improving brain performance and treating the aging process.”
Aviv is setting up HBOT facilities in multiple locations around the world. Right now they list Florida and Dubai on their website, but I think they also have a facility in Tel Aviv. Their paper describes a randomized controlled trial (RCT), which is the gold standard for medical research, showing that HBOT works for long COVID. If the findings do not hold up, we will only know that once a much larger RCT has been completed, which will likely take years. These guys have a lot to gain financially in the short term. More on Aviv below.
A study like this of “long COVID” with only 36 participants is very difficult to evaluate because long COVID can present itself in many different ways. I noticed that 8 controls were hospitalized with COVID versus 4 in the HBOT group. Also, 4 controls have chronic liver disease versus none in the HBOT group. I take all the conclusions with a grain of salt.
In the one year follow-up study, they say the patients who received treatment remained improved, but they did not compare the patients who received HBOT to the controls a year later. Many long COVID patients get better on their own, so that would be important to know. They could not compare because the controls were offered HBOT after the first study completed.
As a caveat, I am not a medical professional or scientist and I did not understand everything in the papers.
Aviv Clinics
The homepage of Aviv Clinics says, “Our personalized, clinically proven program enables you to reset, retain and restore your youthful vitality at any age.” I am immediately suspicious of any company that claims to impact the aging process.
Aviv is extremely expensive. The early 2023 price was $36,000 to $51,000, while my doctor said treatment with his provider would be about $8000.
The Aviv YouTube channel has multiple testimonials, including one in which a woman claims to be better off than before long COVID. I’m happy for her, but this sure sounds like a boutique medical company over selling their services.
I also found users like u/lynettemilo on Reddit who seem to only post and comment about Aviv and how great it is. This also made me very suspicious.
Anecdotes
Long COVID patients are very eager to share treatments that worked for them. On Reddit I see people saying all manner of things helped them heal. Given that context, there are surprising few stories of, “I got HBOT for long COVID and it was the best $8000 I ever spent.” If it really was dramatically effective, then $8000 would be a small price to pay after months or years of suffering.
Instead, the “positive” anecdotes I see are more like this. “This was mega expensive and I’m not advertising it as I’m pretty sure my recovery trajectory would’ve been similar without it.”
I also keep running into accounts like u/Shot_Good4918, who sound positive, but when I look at the comment history, it’s a new account that posted the exact same pro-HBOT comment on four different HBOT threads (one in Chinese).
On the other hand, there are several accounts of adverse effects.
This thread has a discussion about how going to the HBOT treatment itself causes fatigue. It’s very easy for me to believe that traveling to a facility 5 days a week for 8 weeks to go sit in a pressurized chamber is fatiguing. Remember that fatigue was one of the side effects listed by Johns Hopkins.
Another recent thread has a lot of accounts of people who tried HBOT, but it didn’t help. This comment from u/inseend1 was very enlightening: “My wife did 60 sessions and no improvement. She is still in contact with some 30 patients she met there, in a text chat group for support for each other, and the other ones also say the hbot did nothing for the their symptoms. Some think it might have alleviated some, but arent sure what to pin it on.”
YouTuber NjoyLiving shared her HBOT experience and at the end said it helped some, but she had to discontinue treatment because it was too hard on her body.
My biggest concern with these anecdotes is that HBOT doesn’t seem great for fatigue.
ME/CFS
The first Aviv paper says, “Post-COVID-19 fatigue has many overlaps with chronic fatigue syndrome (CFS). Symptoms common to CFS and post-COVID-19 condition include fatigue, pain, neurocognitive/psychiatric symptoms, reduced daily activity, and post-exertional malaise. Previous studies have demonstrated the efficacy of HBOT in CFS, in reducing symptom severity and increasing quality of life.”
One study they listed to support that sentence is “The efficacy of hyperbaric oxygen therapy in the management of chronic fatigue syndrome”, a 2013 study that gave 16 CFS patients HBOT treatments. It was very small with no controls.
The second study is “Reversible widespread brain 18F-FDG PET hypometabolism in chronic fatigue syndrome treated by hyperbaric oxygen therapy”. It’s from 2022, also small, and I’m not sure what to make of it.
On the other hand, the Bateman Horne Center is a non-profit that has been treating ME/CFS patients for a long time. Their mission is to communicate effective treatment strategies to medical providers. I cannot find any reference to HBOT on their website or in any of their YouTube videos.
Likewise, the U.S. ME/CFS Clinician Coalition is a group of doctors with vast experience with ME/CFS. They spent several years developing a consensus treatment plan for ME/CFS and their plan doesn’t mention HBOT anywhere.
On the r/cfs subreddit, which is for ME/CFS, I found no positive anecdotes about HBOT.
HBOT and ME/CFS have both been around for a long time. I think it’s safe to say that HBOT is not an effective treatment for ME/CFS.
My Conclusion
My conclusion is that HBOT is not right for me. The long COVID research of HBOT has too many conflicts of interest and slimy marketing strategies. The treatment itself can cause fatigue or worse. And finally, it is not effective for ME/CFS, which is very similar to the condition I have.
Someone asked me if I thought my doctor had a financial interest in recommending HBOT. The answer is, “No.” He works in academic medicine, which makes a financial interest unlikely. He was recommending one of the only long COVID treatments that has an RCT.