Hyperbaric Oxygen Therapy for Long COVID: What the Research Shows

Important: Hyperbaric oxygen therapy is not FDA-approved for long COVID. This is an investigational use. Evidence is preliminary. Insurance will not cover HBOT for this condition. All costs are out-of-pocket.

Long COVID is a persistent illness that can follow a COVID-19 infection, sometimes lasting months or years. Researchers are studying HBOT because several of its proposed mechanisms overlap with what’s going wrong in long COVID at the tissue level.

What Long COVID Is

Long COVID is defined as symptoms that persist four or more weeks after an acute COVID-19 infection. Common symptoms include fatigue, cognitive impairment (“brain fog”), shortness of breath, pain, and post-exertional malaise, meaning symptoms that get worse after activity.

Studies estimate 10-20% of people who had COVID-19 develop long COVID. That’s millions of people worldwide.

The cause isn’t fully understood. Leading theories include microclotting in small blood vessels, mitochondrial dysfunction, viral persistence in tissue, and neuroinflammation. Most patients have tried standard treatments without finding complete relief.

Why HBOT Is Being Studied

Several of the leading theories about long COVID involve problems with oxygen delivery at the tissue level. Microclotting in small blood vessels can reduce blood flow to organs, including the brain.

HBOT works by dissolving oxygen directly into blood plasma, independent of red blood cells. This means it can reach tissues even when small blood vessel circulation is impaired. It also has anti-inflammatory effects that may help with neuroinflammation.

HBOT promotes angiogenesis, which is the growth of new blood vessels. That could help repair damage from microclotting over time.

These are biological rationales for studying HBOT, not proof that it works. The research is ongoing.

What the Studies Have Found

The most significant study so far is Efrati et al. (2022), published in Nature Communications. This was a randomized controlled trial of 73 long COVID patients. Participants received either 40 HBOT sessions or a sham treatment. The HBOT group showed significant improvements in cognitive function, fatigue, and quality of life compared to the control group. The differences were measurable on brain imaging as well.

An RCT published in a peer-reviewed journal is meaningful evidence. But the sample size was moderate, and the study was conducted at a single center in Israel. Results from one center don’t always replicate across different populations and settings.

More trials are underway. The evidence is promising, but it’s not definitive yet. The standard protocol studied was 40 sessions at 2.0 ATA with 100% oxygen, five days per week.

What HBOT Won’t Do for Long COVID

Even the positive trial showed symptom improvement, not elimination. HBOT is not a cure for long COVID.

Insurance won’t cover HBOT for long COVID. A 40-session protocol at $250-450 per session comes to $10,000-18,000 out-of-pocket. That’s a significant financial commitment for a treatment with preliminary evidence.

HBOT is not FDA-approved for long COVID. Be cautious about clinics that claim to “treat” long COVID with HBOT without clearly disclosing that this is investigational. You deserve transparent information before spending that kind of money.

Ask your doctor whether HBOT is appropriate for your situation, and ask about clinical trials that may reduce the cost.

Frequently Asked Questions

Is HBOT covered by insurance for long COVID? No. Insurance won’t cover HBOT for long COVID. It is not FDA-approved for this use, and all costs are out-of-pocket.

How many HBOT sessions were used in the long COVID trial? The Efrati et al. (2022) trial used 40 sessions at 2.0 ATA with 100% oxygen, delivered five days per week.

Should I try HBOT for long COVID? That’s a question for your doctor. The research is promising, but the evidence is still preliminary and the costs are high. Ask your care team to review the current evidence with you.

Are there clinical trials for HBOT and long COVID? Yes. Multiple trials are ongoing. Ask your doctor about trial eligibility, which may reduce or eliminate cost. You can also search ClinicalTrials.gov for “hyperbaric oxygen long COVID.”

References

Efrati, S. et al. (2022). Hyperbaric oxygen therapy improves neurocognitive functions and symptoms of post-COVID condition: randomized controlled trial. Nature Communications. PMID: 36329021. https://pubmed.ncbi.nlm.nih.gov/36329021/

Explore other conditions on our conditions hub. For brain-related uses of HBOT, see our page on TBI and concussion. Learn what to expect in a session on the what is HBOT guide or see the cost guide for a breakdown of what clinics charge.

Medical Disclaimer: This page is for informational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before pursuing any medical treatment.