For the longest time I’ve wanted to write something on this topic but haven’t quite been able to drill down on it enough to decisively say anything concrete. I’m not sure I can yet but with that in mind, and in the absence of much citation its prudent to label this one a hypothesis. But certainly, a promising one if the doctors that are cited continue their good work.
After all, what is science without the process of hypothesis, followed by repeatable experimentation, studies and trials, followed by necessary questioning and peer challenges, and finally an agreed outcome based on empirical proof. A religion is what it would be. But that’s a discussion for another time.
Back in the 90’s, and again in 2000, and then yet again some years after that as well as in March last year, I have had occasion to experience what I had always been taught was “post viral fatigue” or “Post viral debility”.
The first time I experienced this was in the mid-nineties and I had been very ill for about a month or more with what I figured was a bad flu that year. After the high temperatures subsided though and the virus seemed to be passing, I found I hadn’t quite returned to normal. It took a further 2 months to achieve this and this was diagnosed as post viral debility. Characterized by fatigue, sleepiness, inability concentrate, brain fog, muscle weakness and just generally feeling like my get and go had just got up and went.
I suffered this again with malaria in 2000 when I endured a prolonged bout with malaria which I was told would kill me. It was months before I could dive again and function normally.
This happened again with flu around 2012 and then last year with what may well have been Covid. The timing was right, and the symptoms familiar. It too took a month to recover from after the infection subsided. This to my mind is post viral debility or fatigue. But this is not about how many times I nearly died. That’s also a story for another day, maybe over a braai (BBQ) with a drink among friends. It’s about all of those now suffering debilitating after effects of Covid.
Covid seems to be dealing some bad cards to some people and this post viral fatigue seems to be continuing longer than even the aforementioned time frames. Reports are common and it seems to be becoming a bigger and bigger problem as time wears on.
People that are coming forward are complaining of “brain fog” and physical debility coupled with chronic fatigue not dissimilar to Myalgic Encephalopathy or Myalgic Encephalomyelitis as it was formerly known by the ME association. Recall from previous articles that the “itis” generally refers to some form of inflammation.
The mechanism of post Covid debility or long Covid as its called are not known. It is not understood as yet and no conclusive explanations have been put forward, however it would seem that it could be coupled with perhaps the pre-existence of pathologies previously undetected or not considered serious, or simply that the virus itself is one of the more virulent ones that do the rounds from time to time and is leaving cell damage and consequent dysfunction in its path.
BBC breakfast recently showcased the use of hyperbaric oxygen therapy as a viable therapy to help with this. Dr Timothy Robbins in the clip explains the process at the Midlands Diving Chamber, an NHS funded chamber in Rugby Wales.
ITV also covered the progress made at the Midlands Diving Chamber in this regard and their Dr Michael Gonevski confirms progress in the ITV report.
Having had a handful of inquiries myself as to whether HBOT may help “Long Covid” I did some reading and went back to basics of what HBOT does and how it benefits other conditions. Having recently written a new module in the upcoming book, the cobwebs have been cleared out.
Most illness presents with some form of debility. That is a reduced capacity for work. Illness and injury compromises cell integrity, and this results in local hypoxia. For those inflicted with this, muscle performance just isn’t what it was, and the body is incapable of much. Constant fatigue seems to plague those inflicted. This can be severe in some cases. It almost seems that simply metabolising seems to be all the effort a body can muster.
I’ve written before about the underlying pathology of hypoxia in all illness and injury and with this in mind it follows that with debility following viral infection there may be a level of cellular hypoxia involved. Widely distributed cellular hypoxia affecting multiple systems simultaneously would almost definitely result in debility. Although this is not necessarily the only cause. Only further study will answer that question. But it is reasonable to hypothesise that Covid has left multiple widespread cellular and systemic dysfunctions in many.
We also must not dismiss the well established anti viral properties of oxygen, specifically hyperbaric oxygenation. Remaining persistent virus will certainly find perseverance challenging in a an oxygen rich environment as detailed in the article – Oxygen as an Anti-Bacterial & Anti-Viral Agent
We know that Covid compromises oxygen transport. And while long Covid is not considered a direct effect of the virus, it is likely the that it is a result of the cellular carnage left behind in some people. Compromised cells, blood vessel linings and membranes as well as lung tissue all compromise oxygen transport and inhibit oxygen delivery to cells. This also goes a ways to explaining why the overweight and unfit seem to suffer more. They, (And I include myself in these numbers), already suffer from impaired metabolic function with likely lower VO2 capability indicating metabolic dysfunction.
Intra cellular function relies on adequate oxygen transport. This function includes ribosomal function in the binding and production of signalling compounds and proteins, Adenosine triphosphate uptake, the use of food fuels such as glucose and the ability of mitochondria to perform work. Adenosine triphosphate (ATP) is the energy molecule found in every cell. It is cellular currency and enables mitochondria to metabolise and use glucose as fuel to perform work.
In the presence of cellular oxygen debt, brought about by oxygen transport dysfunction and its “supply chain” failure, it follows that ATP production and uptake may become compromised leading to low levels of intracellular energy leading to perceivable fatigue.
When muscles work, they consume glycogen, a multibranched polysaccharide of glucose which is stored in the muscles and liver as an immediate fuel source. This glycogen is then replaced by glucose in the blood stream as part of the overall glucose cycle and that is replaced by energy stored in white adipose tissue. Use of glycogen is closely linked to base metabolic function and metabolic function depends on sufficient oxidation to occur optimally. This is discussed in more detail in the diabetes hypothesis.
In theory, a failure to metabolise oxygen efficiently results in poor positive energy production and poor energy use by cells.
Other causes of the syndrome could be related to neurological effects, continued inflammatory syndrome and the ongoing cytokine response consuming the bulk of what energy is produced by cells, persistence of a viral presence, endothelial dysfunction (dysfunction of the cells lining the walls of blood vessels), and even theories surround mitochondrial defence states reducing the production and uptake of ATP.
Covid is known to attack the endothelial cells. It’s one of the mechanism thought to cause the blood clotting (thrombosis) which has been observed in Covid patients. Damaged endothelial cells will compromise oxygen transport from the blood stream to cells and tissues. HBOT is well known as an up-regulator of the repair and rebuilding process of endothelial tissue and is known to promote vascular growth.
How is it that HBOT might be helping those people who claim to be experiencing good results?
Good question. And I think many of the mechanical reasons have been covered before. In many of the other articles previously published, the above cellular function is discussed at some length and it is well established that hyperbaric oxygenation upregulates the following:
- Intra cellular functions such as mitochondrial function
- ATP uptake
- Oxidative metabolism of food fuels
- Improvement of insulin sensitivity allowing glycogen and glucose to enter cells
- Upregulation of the glucose cycle improving dry of glycogen from the liver to muscles
- Improved neurological function
- Amelioration of excessive inflammatory and cytokine response
- Transcription upregulation including the vascular endothelial growth factor (VEGF and HIF1A – Hypoxia inducible factor one alpha)
- The release of collagen which aids in the repair of damaged tissue
A good read of previous articles can provide more detailed discussions of these points.
In addition to this, the increased oxygen optimises energy output of cells. This can hopefully become a source of relief for those suffering. Its important to note however, that not everyone benefits it seems. The same applies to any therapy or intervention. Seldom is there a ‘one size fits all’ solution.
So, when I’m asked if HBOT will help. I have no other choice but to say that I believe it will. I would be remiss to think otherwise. It checks a lot of boxes. I cannot promise it will help, but I can tell you it is unlikely to make things any worse.
There is a caveat, however. As is generally the case, fatigue following a HBOT session is not unheard of. It is entirely possible to feel a little worse after the cellular workout the body receives during a session. This will pass and over the course of several treatments improvement should be forthcoming.
This theory also checks some of the boxes for ME and chronic fatigue syndrome. The truth is no one knows for sure what mechanisms and pathologies are involved, or exactly where the dysfunction exists. Although I have come across theories which involve lactate build-up. HBOT greatly improves lactic acidosis, and case studies and anecdotal reports indicate that HBOT is a good complementary therapy for these conditions.
This quote explains:
“Lactic acidosis is a medical condition characterized by the build-up of lactate (especially L-lactate) in the body, with formation of an excessively low pH in the bloodstream. It is a form of metabolic acidosis, in which excessive acid accumulates due to a problem with the body’s oxidative metabolism. Lactic acidosis is typically the result of an underlying acute or chronic medical condition, medication, or poisoning. The symptoms are generally attributable to these underlying causes, but may include nausea, vomiting, Kussmaul breathing (laboured and deep), and generalised weakness.”
Attention is drawn to the mention of oxidative metabolism which is know to benefit greatly from hyperbaric oxygenation.
Perhaps it’s in more than one place. And with more than one pathology. Either way, if its neurological like we see in PTSD and fibromyalgia, or in the muscles and tissues following poor cellular function, metabolic dysfunction, inflammation, or any other hypoxic state, HBOT could be a management tool for some.
Since the origin is yet unknown, it is impossible to say that HBOT is a cure for Long Covid. So, to err on the conservative side of the theory. It will not cure in all likelihood, but may very well relieve some of the symptoms experienced by a growing number of people. Only time, and continued use of the modality will provide a solid tested answer. Quality of life is everything and HBOT can certainly be a tool in the toolbox of therapies designed to improve quality of life.
Feel free to not take my word for it though. Watch the doctors in the video inserts on the links above. For those desperately seeking a solution, this may be it.
Stay safe everyone
Hayden.
© Hayden Dunstan
cumbria-hyperbaric.org 