Long COVID affects an estimated 25 to 50 million people in the United States (US) and up to one billion worldwide. Symptom severity varies from mild to profoundly disabling. In its most severe form, Long COVID can force individuals out of the workforce, place strain on personal relationships, and require around-the-clock care. The annual economic burden is estimated at around $100 billion in the U.S. and up to $2 trillion globally.

To date, there is not a widely accepted and effective treatment for all the symptoms of Long COVID.  

Emerging clinical data indicate that hyperbaric oxygen therapy (HBOT) is both effective and well tolerated in the treatment of Long COVID. The effectiveness of HBOT appears to be correlated with its ability to target the likely underlying pathophysiology of Long COVID. International clinical trials and case series have demonstrated that HBOT can improve - or even reverse - diverse symptoms across organ systems. Importantly, these benefits have been maintained in long-term follow-up. For an overview on the use of HBOT for Long COVID, including epidemiology, risk factors, etiology, pathophysiology, history, diagnosis, current treatment alternatives, and current evidence on the use of HBOT for Long COVID, See topic "HBO Treatment Emerging Indication: Long COVID". 

Despite compelling clinical evidence, HBOT for Long COVID has not been fully adopted in practice yet. In this post, we explore the primary barriers that limit broader adoption. By overcoming these hurdles, HBOT could become the standard of care for Long COVID recovery.

Why is HBOT not the standard of care for Long COVID? 

Considering that the emerging evidence has been supporting the use of HBOT as a treatment for the multiple symptoms of Long COVID, it is surprising that HBOT treatment of Long COVID has not been recognized or widely accepted by the general medical community or the HBOT medical community.  What then, could be the possible reasons that HBOT is not yet the standard treatment for Long COVID? 

There are several factors that are likely responsible for the lack of acceptance of HBOT as a standard treatment for Long COVID. A few are listed below: 

Limited clinical exposure to HBOT during medical training

• Hyperbaric medicine is a niche area of medicine and is not routinely part of general medical education, training or residency programs.  As a result, most providers entering medical practice have little or no experience or background in hyperbaric medicine.  It is perhaps of little surprise then, that to many clinicians, the physiologic effects of HBOT or its relevance to the pathophysiology of Long COVID are not immediately obvious. By contrast, HBOT providers can more readily appreciate both the safety profile and the multiple mechanisms (e.g. anti-inflammation, microvascular repair, stem-cell mobilization, and neuro-autonomic support) that make HBOT an ideal candidate for treatment of Long COVID.

Long COVID is not yet an indication approved by the Undersea and Hyperbaric Medical Society (UHMS)

• Trained and experienced HBOT providers may be familiar with the literature on HBOT for Long COVID but are limited in being able to offer this treatment as it is not (yet) approved by their professional society, the UHMS. The UHMS is the society that approves indications for HBOT and that Medicare (CMS) and private insurance companies generally support. As a result, most hospital-based HBOT centers are not currently accepting Long COVID patients for HBOT. 

Insurance challenges

• UHMS registry data show that Long COVID is the fastest-growing non-UHMS indication, with a 300 percent increase in cases at registry-participating centers. Yet without insurance coverage, most patients face out-of-pocket costs that may be prohibitive or outright treatment denial by their insurance company. [1][2]
• The relative lack of awareness and acceptance of HBOT of Long COVID by regulatory and insurance agencies is, unfortunately, only one of several barriers preventing routine access of Long COVID patients to HBOT.   

These regulatory, educational, and financial obstacles represent some of challenges. Addressing them - alongside capacity constraints, referral, and protocol‐standardization issues - will be critical to making HBOT an accessible, frontline option for Long COVID recovery. Even if HBOT were covered by insurance and approved by UHMS, the current number of open chambers is not sufficient to treat the 35 million people living with Long COVID in a meaningful timeframe.