Health & Fitness

I have been saying for months now that hyperbaric oxygen therapy (HBOT) would be an excellent treatment adjunct against severe COVID-19 and a superior alternative to ventilators, which have been shown to cause harm in many patients and increase the risk of death.

Mechanical ventilation can easily damage the lungs for the fact that it's pushing air into the lungs with force in a disease where the alveoli are compromised and filled with fluid from inflammatory cytokines due to insulin resistance. HBOT bypasses this problem by supplying 100% oxygen in a pressurized chamber, which allows your body to bypass this defect and absorb oxygen directly into your tissues.

There's no airflow being forced directly into the lungs. HBOT also improves mitochondrial function, helps with detoxification, inhibits and controls inflammation and optimizes your body's innate healing capacity.

Louisiana Hospital Deploys HBOT for COVID-19

April 23, 2020, WGNO, a local Louisiana news station reported¹ Opelousas General Hospital in Louisiana, which has a hyperbaric center, has been deploying "off-label compassionate use" of HBOT as an alternative for patients that would otherwise have required ventilation. Dr. Kelly Thibodeaux told WGNO:

"The thing we see with severe COVID-19 patients is a complication with an inability to carry oxygen in addition to the problem to lungs itself. It's not just lung injury. The virus does something to the red blood cells of certain patients …

Being inside hyperbaric chambers won't cause injury. It's a less invasive way to deliver oxygen that doesn't require sticking a tube down the trachea."

HBOT in the Treatment of COVID-19

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Thibodeaux presented his case findings in a recent webinar held by the Association for the Advancement of Wound Care (AAWC). As explained in this webinar, HBOT can help treat COVID-19 by:

• Reversing hypoxia
• Reducing inflammation in the lungs
• Increasing viricidal reactive oxygen species
• Upregulating HIF-increasing host defense peptides
• Reducing proinflammatory cytokines such as IL-6, IL-1B, IL 18, TNF alpha and NF kappa B

Thibodeaux, who is board certified in general surgery and wound care, collaborated with Dr. Amer Raza, a doctor of pulmonology and critical care, to develop an inclusive treatment plan using HBOT once a day for 90 minutes.²

In the video above, Thibodeaux reviews the details for the first five cases. All saw rapid improvements in their respiratory rates and dramatic decreases in CRP (an inflammatory marker) and D-dimer (a measure of blood coagulation). The number of treatments required ranged between one and nine.

At the time this video was recorded, 11 patients had received HBOT. None of them required ventilation and five had been successfully discharged. As a result of these positive outcomes, Opelousas General Hospital is now using HBOT for all patients with oxygen-resistant hypoxemia.

Chinese Doctors Report Positive Results Using HBOT

Opelousas General Hospital's decision to deploy HBOT for compassionate use was in part supported by the findings of Chinese doctors who reported³ "promising results" after treating five COVID-19 patients with HBOT. Two were in critical condition and three were severe. As reported by the International Hyperbarics Association:⁴

"Hyperbaric oxygen was added to the current comprehensive treatments being performed at the hospital for COVID-19 affected patients, with a dose of 90-120 minutes at treatment pressures of 1.4 to 1 fi.ATA.

The results were very encouraging as these five patients received significant therapeutic benefits, including rapid relief of symptoms after the first session.

The rationale for adding this procedure is to help combat the progressive hypoxemia (low blood oxygen levels) that COVID-19 can cause. Hyperbaric oxygen has the ability to add a substantial supply of extra oxygen into the bloodstream …"

HBOT Has Many Benefits Over Alternatives

The report⁵ from China states patients with severe COVID-19 disease experienced rapid relief of hypoxic symptoms, rapid correction of hypoxemia, improved lung pathology and a general reversal of associated conditions, including gastrointestinal symptoms, appetite, headache and mental state.

The report also details some of the mechanics behind HBOT and why it benefits COVID-19. Importantly, delivering oxygen under pressure allows for greater oxygen uptake by inflamed lung tissue.

It also improves cellular oxygen uptake in general, and to a greater degree than extracorporeal membrane oxygenation (ECMO), which involves oxygenating the patient's blood outside the body and then pumping it back into circulation.

And, while ECMO is recommended^6,7 for relatively young patients with few comorbidities who are failing to respond to ventilator treatment, Opelousas General Hospital's work shows HBOT can successfully be used on older patients who have several comorbidities. Moreover, as noted in the Chinese report, HBOT does not conflict with other conventional means of critical treatment:⁸

"HBOT is not the etiological treatment of COVID-19, it is the symptomatic treatment of hypoxia in patients with COVID-19, and it is a supplement to the existing oxygen treatment technology …

In addition to HBOT, ICU clinicians are still responsible for the daily comprehensive treatment of the above-mentioned severe patients. There is no conflict in treatment technology. On the contrary, it can provide better support for other supportive treatments."

HBOT Trial for COVID-19 Underway

NYU Langone Health is also recruiting COVID-19 patients for a study using HBOT.⁹ The study was posted April 2, 2020 and is expected to end in July 2020. As detailed on ClinicalTrials.gov:¹⁰

"This is a single center prospective pilot cohort study to evaluate the safety and efficacy of hyperbaric oxygen therapy (HBOT) as an emergency investigational device for treating patients with a novel coronavirus, disease, COVID-19 …

The patient will receive 90 minutes of hyperbaric oxygen at 2.0 ATA with or without air breaks per the hyperbaric physician. Upon completion of the treatment the patient will then return to the medical unit and continue all standard of care …

After the intervention portion of this study, a chart review will be performed to compare the outcomes of intervention patients versus patients who received standard of care."

This study will also examine whether HBOT reduces the cytokine storm reaction that is so prevalent among patients with severe COVID-19 infection, and how this might impact the recovery process.¹¹ In all, 40 patients will be enrolled. To be eligible, patients must test positive for COVID-19 and be diagnosed with respiratory distress. All patients will be recruited from the NYU Winthrop Hospital.

Hypoxia Is the First Indication for HBOT

As mentioned, Opelousas General Hospital is now using HBOT for all patients with oxygen-resistant hypoxemia. Similarly, the Chinese report¹² states that "hypoxia is the first indication of HBOT." Another indication for HBOT is a diagnosis of anoxia, i.e., severe hypoxia where the patient is severely deprived of oxygen.

"The therapeutic effect of five patients was very significant, and both the subjective and objective clinical indexes showed that the deterioration of hypoxia was interrupted immediately and then the whole body recovered gradually after the first HBOT," the Chinese report states.¹³

"Such a consistent treatment response, according to the statistical law, cannot be explained by chance. The above mechanism demonstrated that the efficacy of HBOT in five patients was not accidental …

The relevant scientific papers, literature and works are endless. The superiority of HBOT in solving severe hypoxia in patients with COVID-19 is clearly scientific.

Unlike the newly developed treatment stage or the efficacy of medicine is still in the scientific hypothesis stage, HBOT don't need clinical trial verification and other methods of oxygen therapy that have been used clinically, such as mechanical ventilation or ECMO, it can be reasonably used."

Both Thibodeaux and the Chinese report also review the excellent safety record of HBOT. There really aren't any drawbacks to the treatment, aside from the fact that some patients may be too vulnerable to be transported to the chamber.

Overall, it seems clear that HBOT can be an extremely valuable adjunct in COVID-19 treatment and can help lower the mortality rate. You can learn more about HBOT — how it works and what its benefits are — in my previous article, "Hyperbaric Oxygen Therapy as an Adjunct Healing Modality."

Other Uses of HBOT

It is exciting to see this valuable intervention provide such promising results in COVID-19, which is precisely what I predicted. However, HBOT is also useful in a wide range of other disorders such as traumatic brain injury (TBI), stroke, wounds and even adjunctive cancer treatments.

There are primarily two different types of hyperbaric chambers, inexpensive soft shells that cost $5,000 to $30,000 or professional hospital grade hard shell chambers. Within the hard-shell chamber some use oxygen concentrators to provide the oxygen but the better ones use 100% liquid oxygen.

These chambers typically are over $100,000. The most common one is made by Sechrist, which is what they use in the Opelousas General Hospital's hyperbaric center, which has six chambers.

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If you've ever gone on a road trip, you probably have memories of bugs littering your windshield and front bumper. If you think about it for a minute, you may realize it's been a while since this happened. While it may feel like a good thing since you don't have to clean up the mess, it's actually an ominous warning of changes to the environment.

The number of insects worldwide have been declining at a dramatic rate, and scientists believe modern-day agricultural practices are largely to blame.¹ Those at the greatest risk are Lepidoptera — insects that include butterflies and moths, as well as Hymenoptera, which include bees, and Coleoptera, which include dung beetles.

The total mass of insects has been falling by nearly 2.5% each year. Researchers believe that more than 40% of all insect species are threatened with extinction in the next few decades. Habitat loss and agrochemical pollutants are two of the most significant factors causing this.

Scientists have also noted that population declines are not only significant in number, but also represent more restricted geographical distribution. A study released in 2017 monitored insect population over 27 years and found a 76% decline in flying insects in several of Germany's protected areas.²

Giant Hornet Arrives in the US

While many insect populations are near extinction, the Asian Giant Hornet appears to be thriving. This insect, dubbed "the murder hornet," was first sighted in British Columbia in August 2019. By December, they were reported south of the Canadian border in Washington.³

The combination of COVID-19 and the appearance of murder hornets has taken Twitter by storm.⁴ Memes comparing the hornets to COVID-19, or comments hoping the murder hornets will encourage people to stay inside, are popping up in Twitter. The attention may be a result of the hornet's appearance, its painful sting or how small groups can decimate an entire honeybee hive.

The Asian Giant is the largest hornet species in the world,⁵ which a Washington State University bug expert calls "shockingly large."⁶ It measures 1.5 to 2 inches long with a wingspan of up to 3 inches.⁷ This hornet has a distinctive look with orange and black stripes down the body, large pincers and a stinger that stays attached after stinging.

Its life cycle starts in early spring when the queen awakens from hibernation to search for a den in which to build her nest. Once built, worker hornets are sent to find food during summer and autumn.

The giant hornets have sharp, spiked mandibles, which they use to tear the head off honeybees and then transport the bodies back to the nest to feed their young. Ted McFall from Blaine, Washington, has first-hand knowledge of the devastation these hornets can wreak on a hive.

His story is told in The New York Times.⁸ In November 2019, he was checking his hives near Custer, Washington, when he spotted a large group of bee carcasses on the ground. Taking a closer look, he could see the heads had been torn off thousands of bees on the ground and inside the hive.

In December, 2.5 miles away from McFall's property, another farmer found a dead hornet on his front porch. Jeff Kornelis suspected it could be a giant hornet and contacted the state, which confirmed it was an Asian Giant Hornet.

Don't Try This at Home

Seriously, do not try this. Nathaniel "Coyote" Peterson is the host of Brave the Wild on Animal Planet. In November 2018 he searched for days in the forests of Japan to find a Giant Hornet to do what he does — get bitten or stung.

The hornet he found, as shown in this video, was more than 2 inches long and not at all happy about being caught. While they don't normally attack humans,⁹ when cornered the hornets do defend themselves. Peterson discovered:¹⁰

"It sounds like an apache helicopter — you can definitely hear them before you see them. In Japan, they actually call them the great sparrow bee because when they're flying, they look like a bird."

The stingers on the hornets are long enough and strong enough to penetrate a beekeeper's suit, as Conrad Bérubé from Canada discovered when he was assigned to exterminate a nest.¹¹ Before letting the hornet sting him, Peterson expressed some concern the hornet may latch onto his arm with its pincers and sting him multiple times.

This would have been especially dangerous, as the insect injects venom that can be deadly. Multiple stings or anaphylactic shock from allergic reactions are how the insects kill up to 50 people a year in Japan.¹²

With the hornet grasped in a padded, tweezer-like instrument, Peterson placed the insect on his forearm and watched as it forced the stinger through his flesh. Thankfully, the hornet did not latch on, but crawled off after Peterson lost his grip on the insect.

His reaction was immediate and intense. He yelled as the hornet stung him,¹³ "Oh, man, wave of dizziness really quick. When the stinger went into my arm, I had like this wave, this wave came over me … The pain was immediate, immediately searing."

Before being stung, Peterson said that the pain of the insect is reportedly a 2 on a pain scale of 1 to 4. However, from the personal experience of a man who has been stung and bitten by many creatures, Peterson said¹⁴ "I would definitely say it's up there at a 4."

The Goal Is to Track and Destroy

Since McFall's hives were attacked in Washington State, scientists have mounted a full-scale hunt for the hornet's nests. Should the insects become established, the hope of eradicating them would be lost. These invaders feed almost exclusively on honeybees and many beekeepers fear they could damage the currently sagging population of pollinators.

Chris Looney is an entomologist. He works at the Washington State Department of Agriculture and spoke to The New York Times, saying:¹⁵ "This is our window to keep it from establishing. If we can't do it in the next couple of years, it probably can't be done."

Since only two were found before the insects were expected to hibernate, Looney believes it is impossible to determine how many may have made their home in Washington. Before the hornet was found in November 2019 in Washington, another hive was discovered on Vancouver Island.

The Island is located across a strait that scientists think is too wide for the hornets to have independently flown from the mainland.¹⁶ The hive on Vancouver Island was located and bug expert and beekeeper Bérubé was sent to exterminate it.

However, as he quickly discovered, their stingers could penetrate the bee suit and sweatpants he was wearing. His wrists and ankles were protected by Kevlar braces. During his approach to the nest at night he woke the hornets. He said the sting "… was like having red-hot thumb tacks being driven into my flesh."

Bérubé managed to work through the pain to kill the nest and collect samples. He said this was the most painful sting he'd endured of the thousands he's had at work.

U.S. scientists began preparing over the 2019 and 2020 winter months to eradicate the insects. However, the region is extensively wooded, making their task challenging. Giant Hornets may make their nests underground and the queens can fly many miles before settling on a spot. Over the coming months Looney anticipates hundreds of traps will be set to capture the worker hornets.

Since the activity in a hive generates heat, some trackers may use thermal imaging to locate and kill a hive. Looney said the plan for those that are trapped is to attach either a small streamer or radio-frequency device to monitor their path and follow it back to the hive. The size and strength of the hornet enables them to handle the extra weight of these devices while flying.

What You Need to Know About the Giant Hornet

The murder hornet is the largest hornet species in the world,¹⁷ and identified by the size, yellow and black stripes along the body and large, shark-teeth like mouth pincers. Washington State University¹⁸ and the Washington Department of Agriculture¹⁹ have identified several more facts about the hornet:

Our Food Supply Depends on Honeybees

Much of the world's food supply depends on pollination, and pollination depends on insects. Insects do everything from providing food to cleaning up waste. National Geographic reports insects generate $57 billion a year to the U.S. economy.²⁰

Without insects that consume waste and return nutrients into the soil, the smell of decay would be overwhelming. Insects produce food, such as honey, pollinate plants, manufacture silk and provide natural biological control of parasites and predators.²¹

The BBC²² reports the population of pollinators has been falling in the past decades. From 1947 to 2017 the number of honeybee colonies has dropped more than 50% from 6 million to 2.5 million. In the winter of 2018 to 2019, the colonies suffered another 40% loss, which represents the largest so far.

Although murder hornets are not an immediate threat to human life, if they should become established, they will be a significant threat to the honeybee population and therefore the food supply. They currently prefer low altitude forest and mountain areas. Remember, if you spot an insect you believe may be a hornet, do not try to catch it or approach it, but report your sighting.

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Since the beginning of March, public life in Germany has been severely restricted due to the coronavirus pandemic. Following the encouraging decline in the number of new cases of COVID-19, the debate on the effectiveness of interventions taken to date and on further relaxation of the restrictions is meanwhile gaining momentum.

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When it comes to health concerns, the COVID-19 pandemic is top of mind for most people right now. And that’s for good reason.

But there is some very good non-COVID health news that may not be getting the attention it deserves. According to the CDC, the rates of six of the top 10 causes of death in this country, which account for about three-quarters of all deaths, have been declining. That’s remarkable. And these improvements are occurring despite an aging population and an obesity epidemic that affects several health conditions.

Six positive health trends

Let’s look at the trends in these conditions and their rank as causes of death in the US:

• Heart disease (#1) and stroke (#5): Deaths due to cardiovascular disease, including heart attacks and stroke, fell by about 36% between 2000 and 2014. The decline for heart disease since 2014 appears to have continued through 2018. After leveling off for several years, stroke-related deaths dropped again (by 1.3%) from 2017 to 2018.
• Cancer (#2): The drop in cancer deaths was about 2% between 2017 and 2018. Over the last 25 years it has dropped by 29%.
• Unintentional injuries (#3), including drug overdoses, and chronic lower respiratory diseases (#4), such as emphysema and asthma: Each of these categories dropped by nearly 3% from 2017 to 2018.
• Alzheimer’s disease (#6): Deaths fell 1.6%, even though the prevalence of this devastating illness is increasing.

The cholesterol connection

Another positive trend is that cholesterol levels across the US population have been moving in the right direction over the last 20 years. About 18% of Americans had a high total cholesterol in 1999; as of 2018, just 10.5% had high levels. Meanwhile, about 22% of the population had low HDL (“good”) cholesterol; that number fell to 16% in 2018. Because high total cholesterol and low HDL cholesterol are risk factors for cardiovascular disease, these improvements may at least partly explain why cardiovascular disease mortality rates are falling.

And fewer people are smoking

There’s also good news with respect to the popularity of cigarette smoking. According to the CDC, the percent of the population that smokes cigarettes is dropping significantly. In 2017 it fell to 14%, an all-time low since such statistics have been collected. This represents a steady drop from 2006, when nearly 21% of people were smokers.

Over time, fewer smokers means lower rates of smoking-related illness, including several of the top 10 causes of death like chronic lung disease, lung cancer, and cardiovascular disease.

Notably, this survey did not include vaping, which has been rapidly gaining popularity in recent years. Some former cigarette smokers are now vaping, as are many adolescents and young adults. So the good news about falling smoking rates could be at least partially offset by potential negative health consequences of vaping, including e-cigarette or vaping-associated lung injury (EVALI).

What about life expectancy?

Life expectancy in the US was estimated to be 78.7 years in 2018, a small increase from 78.6 years in 2017. Between 2014 and 2017 life expectancy had been falling in the US, largely due to suicide and unintentional injury (especially drug overdoses). While the improvement in 2018 is small, it’s still welcome news to see estimated longevity tick upward.

Some caveats

It’s worth emphasizing that the data that demonstrate these positive health trends are at least a year or two old. And, importantly, improvements in life expectancy and certain causes of death are not shared equally among all groups of people: those living in poverty and a number of ethnic and racial groups have experienced less health improvement than the population as a whole.

In addition, these trends preceded the COVID-19 pandemic, a disease that has quickly become a leading cause of death. In fact, as of April 7th, 2020, COVID-19 was the number one cause of death in the US when the number of deaths per day (rather than the yearly number) were considered.

And of course, focusing only on causes of death does not provide a complete picture of a nation’s health. Disability and quality of life are essential measures of health as well, and for many people these are more important than longevity.

The bottom line

The good news is real and reason to celebrate. Yet there is plenty of room for improvement in the health of Americans, especially for four causes of death that are not falling: influenza and pneumonia, suicide, diabetes, and kidney disease. And there is no guarantee that the positive trends will continue. My hope is that we can figure out how to make even more progress more quickly, and to extend that progress more evenly throughout the population.

Follow me on Twitter @RobShmerling

The post And now for some good news on health appeared first on Harvard Health Blog.

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