HBOT Therapy and Coronavirus Application
Alternative Therapies in Health and Medicine (ATHM): To start can you provide me a little bit about your background.
Dr. Harch: I went to college at the University of California Irvine and then medical school at Johns Hopkins. After medical school I went to the University of Colorado and did two years of general surgery training, an additional year of radiology training in New Orleans at LSU Charity Hospital and then while I was in New Orleans had a practice-based experience of emergency medicine. The second year I was in New Orleans, 1985, I joined a group that had a large hyperbaric chamber and received all of the diving medicine referrals for the Gulf of Mexico. Part of that practice also was wound care. So it was a hyperbaric medicine practice. I went and received training in hyperbaric medicine from the federal government and made a discovery treating our divers from the Gulf of Mexico that involved brain decompression illness, which was pretty much ignored for most of its existence or at least a hundred years in the diving medicine field.
Importantly, we found a way that we could image and treat brain decompression illness. It turns out 80% of decompression sickness is neurological, it’s not the joint “bends.” We found that we could treat these divers with brain involvement weeks, months, or long after it was considered treatable and capture the results on very illustrative brain blood flow scans. Prior to this discovery it was understood that you had to treat divers within 24 hours of the injury or it was permanent. Once we made that discovery in divers, we started treating some Louisiana boxers and then the first cerebral palsy children, autistic children, people with stroke, toxic brain injury, and over the years now, probably 90 different neurological diagnoses. I’ve done this in both formal animal and human studies and as a clinical application. The research studies included the first veterans with TBI and PTSD and in March we published a randomized trial of HBOT in the treatment of traumatic brain injury post-concussion syndrome in civilians and veterans. Also, in March I brought to the public’s attention that we very likely could treat dying patients with coronavirus which brings us up to today.
ATHM: Let’s talk a little bit about the Coronavirus because that’s the topic that’s hot right now. How does hyperbaric oxygen therapy relate to it?
Dr. Harch: Well, it corrects what people are dying of, which is low oxygen in the blood, and treats the underlying disease in the lungs. Patients who are in the process of deteriorating and going on a ventilator are the best candidates. If people get the infection and a certain percentage of them proceed to very serious lung infection, there’s a point in the process where, and it’s not clear why, the ones with the risk factors go downhill in a hurry. Generally it’s over about a 48 hour period and or even less. Sometimes it is in just an hour or so. And when they do deteriorate it is due to an intense inflammatory reaction in their lungs. Eventually, they die of low oxygen level s that cause end organ damage, such as heart, brain, kidney damage, and multiorgan failure.
Considering the problem in the lungs of COVID-19 patients I brought attention to the previous use of hyperbaric oxygen for the last great pandemic, which was the 1918 Spanish flu pandemic that killed 50 million people worldwide In early March I posted an announcement on the internet about COVID-19 and Spanish Flu, pointing out that the Spanish Flu patients died the exact same way as coronavirus patients. The very first introduction of hyperbaric medicine in the United States was directed at these patients. In 1918 in Kansas City there was a doctor named Orval Cunningham who was an anesthesiologist. He had recently been in the Rocky Mountains in Colorado. He started thinking about how the mortality of the Spanish flu patients was so much higher in the Rockies and he reasoned that it was the low atmospheric pressure and with it low oxygen pressure. So, he thought, “What if we gave increased atmospheric pressure and oxygen?” He hurried back to Kansas City, had a chamber built, and planned a whole series of animal experiments, but before he could even treat the first animal one of his colleagues at the medical school brought him a dying Spanish flu patient.
In both a scientific journal article in 1960 and then a book on hyperbaric oxygen therapy in 1973 the authors described the dying Spanish Flu patients just like the patients with Corona virus today. The first patient was obtunded, just a breath or two shy of coma, and blue (cyanotic). They put this man in the chamber and within minutes he was aroused, not to normalcy, but had improved mental status, breathing, oxygen level, et cetera. Over the course of the next four days, they treated him just once a day in this chamber and managed to bridge him over the most severe part of the illness. And he survived. The next thing you know, there was a stream of patients he was treating. My post on the internet was that history bears remembering, that this therapy, hyperbaric oxygen therapy, was used in the most severely ill Spanish flu patients dying of the same pathophysiologic type of problem that the coronavirus patients had. My post on the internet said that in the absence of any effective treatment for this disease, “We really ought to try this.”
Within 24h of that post my research nurse, Juliette Lucarini, who had been the source of discussions on HBOT and coronavirus for a few months, found an article on the internet that had circulated pretty much just in China. Nobody had really seen this or reacted to it. It was a report of five patients who were deteriorating on mask oxygen and they put them in a hyperbaric chamber and gave them the identical number of treatments that Dr. Cunningham did for the Spanish Flu victims in 1918. But these Chinese doctors were completely unaware of the application of hyperbaric therapy to Spanish flu. Regardless, all five of these patients survived. Within probably 48 hours through contacts in China, I was in touch with these doctors and had an hour long interview through a translator where they verified exactly what they had done. We spent six weeks or more of intensive, frequent exchanges where they related their experience, what they were doing, their procedures, infection control, and I tried to help them get their information published in an English language journal. They finally published two of the articles in Chinese. Another one had already been published, a case report, of a patient on a ventilator who survived.
Meanwhile, a number of places in the United States picked up on this information. In fact, we had over 20000 visits to our website on this. I subsequently organized the information from the Chinese doctors and submitted it to Governor Cuomo of New York and Governor Edwards of Louisiana, the two states that at the time had the highest infection rates and moralities. As the information was disseminated and more people accessed the Chinese article on the internet studies were initiated in New York, Louisiana, Sweden, and elsewhere.
ATHM: Can you describe the HBOT treatment that you’re talking about?
Dr. Harch: Yes. It is simply going in an enclosed chamber in which you increase the pressure and oxygen. There are two types of chamber in which you can do this hard shell and softshell chambers, and they differ in the pressure they can achieve and in their operational characteristics. The hard shell chambers made of acrylic and steel can go to 3 atmospheres or 66 feet of seawater pressure. Most of the portable chambers, go to 1.3 atmospheres, or about 10 feet of seawater. If you look at the Chinese experience and Dr. Cunningham’s experience, the minimum pressure that they treated them at was 1.6 atmospheres or about 20 feet of seawater pressure. So it’s double the actual increased pressure that those portable chambers go to.
In general, you need a hard shell chamber to treat the coronavirus patients. The hard shell chambers also solve bigger problems which are logistical and operational. These patients are very short of breath, bedbound pretty much, such that they cannot climb into a portable chamber, thru the zipper, etc. The exertion alone drops their oxygen levels. They are also coming from the ICUs, so you end up having to continue their EKG monitoring and IVs, both of which need to be done in a hard shell chamber.
With the less sick patients we have the possibility of intervening early. If you look at what the Chinese did, at least at the one hospital in Wuhan, they treated 35 patients. The first six were the very, very serious ones that were in the ICU. One of them, as I just mentioned, was on a ventilator. But with the other 29, what happened was the other patients in the hospital who were less ill with coronavirus saw these very sick patients being treated and getting better so quickly that they went to the hospital administration and demanded hyperbaric treatments. The Chinese hyperbaric doctors told me, “Well we thought they would probably all have improved on their own, but we treated all of them and they did well.” Essentially, all 35 have been discharged from the hospital well. If you wanted to treat lesser ill patients early in the disease process, you could easily do so in any type of chamber, but no one has shown that treatment of these lesser ill patients with HBOT is necessary and nobody has shown that the much lower pressure range in the portable chambers has benefit.
ATHM: And I think that’s the part that got my interest in this and that the Corona virus is something that once we get through this peak that we have right now, it doesn’t mean it’s going to go away. I mean this thing is going to … They expect it could be here for another two years. And so if we could educate people and practitioners that when they get somebody who is … Has a disease and is starting to get worse, then those patients be put on the treatment. And if you do touch them at the right time, maybe you could eliminate them even needing to go into the hospital.
Dr. Harch: True, it is likely it will be here for a while, especially since we are seeing resurgences of cases in previously quarantine locations and it was just reported that patients previously infected with COVID-19 can get re-infected. Part of the HBOT treatment of coronavirus patients is safety for other patients and staff. That was a key part of the information that the Chinese hyperbaric doctors provided and one that became a huge concern shortly after my encouraging post on the internet. Within 24 hours of that post only did we find the Chinese article, but we got called by the CEO of a wound care company who falsely identified himself as a doctor and wanted me to become involved with “doing a study” with them. In reality, all he was looking to do was capitalize on my announcement and increase his market share by treating coronavirus patients. He had no idea what was entailed in a “study” nor the great precautions the Chinese took to prevent cross-infection of their staff and other patients
Simultaneously, a hyperbaric center in California put on their website that according to what I had posted and a colleague of mine on use of a powerful antiviral anti-oxidant, they were now going to offer coronavirus immune booster treatments in their hyperbaric chambers. Essentially, here was another reckless attempt to attract coronavirus patients without any knowledge of the precautions necessary to do so. I was so alarmed that I immediately followed my post with a secondary post that called attention to the fact that we’ve seen this kind of opportunism in hyperbaric medicine before and that this could destroy the hyperbaric medicine field if clinics became not the treatment centers, but the vectors for dissemination of infection.
The central problem was that if this treatment of COVID-19 patients is not done right, and I put a picture on my website of the Chinese staff and how they were dressed up/protected (they looked like they were in astronauts suits with personal protection from head to toe) to prevent transmission of the virus, hyperbaric chambers/centers could easily spread the virus. Neither of these facilities had any concept of this and the one facility had no medical professionals on their staff. Given the contagiousness of the virus, you would be inviting known infected, unknown infected, and non-infected patients into your clinic, inadvertently contaminate your facility and chambers, and infected everyone in your facility.
So, what I said was to take a look at what the Chinese hyperbaric physicians did. In one hospital, 29% of their inpatients with coronavirus infection were healthcare workers, that is, hospital employees who got cross-infected with coronavirus from taking care of coronavirus patients. Due to the precautions the Chinese hyperbaric physicians employed no one in the hyperbaric department became cross-infected. Overall, they safely treated 35 coronavirus patients without cross-infection. So the point is, yes, you could treat people and even treat them early in the infectious process, but you’ve got to do it right and you’ve got to really have attention to prevention of disease transmission. You have to convert your department or clinic to an exclusive coronavirus treating facility or use extreme sanitation measures to treat coronavirus and other patients while you protect the other patients and your staff. Recently, I received the information from the Chinese that we are putting on the internet to show all of the infection procedures that they used to prevent anybody else from getting infected. So to sum up, yes, you could safely use HBOT to treat coronavirus patients, and yes, HBOT could possibly be used as an early treatment. You just have to gear up and do it right.
ATHM: Well, and one of the big issues would be making sure that after a patient was in the chamber, it is cleaned properly so that you don’t end up spreading the disease A could transfer something different to patient B because we just don’t know enough about it right now. But I think it’s a great opportunity.
Dr. Harch: Exactly. This is also one of the operational issues I was mentioning above with the different types of chambers. The portable chambers are more difficult to clean; the hard shell chambers are easier. The hard shell chambers are like cleaning a gun barrel. I mean, you can get a mop with a disinfectant and clean the whole inside of it very, very easily. But the portable chambers, they’ve got a wire internal frame and it’s just difficult and tedious when you get in them to try to wipe them down. When we have had to “sanitize” these chambers to recycle them we send them back to the manufacturers to be sterilized first.
So, HBOT for coronavirus infection has to be done right, it can be done right, and the ideal way would be to try to treat larger numbers of patients in big chambers earlier. And especially if you can identify the ones that are going to go on to have a problem. We know who those people are in general: The elderly, anybody with immune compromises, high blood pressure, heart disease, diabetes, lung disease, and the obese. Possibly, the most efficient way to treat large numbers of patients would be to use the suggestion of one of my career-long colleagues, Professor Emeritus Dr. Phillip James of Dundee, Scotland who proposed years ago that we use the largest most available multi-person chambers to treat mass numbers of COVID-19 patients, commercial airlines. Each one is a pressure vessel that can be taken to the pressure used by Dr. Cunningham and the Chinese and they are already equipped with oxygen administration outlets above each seat. Towed, pulled up, and parked right next to a hospital, or isolated at a special section of each airport as little as five daily HBOTs could possibly impact this coronavirus pandemic in a significant way. But, that is the subject of another discussion.
ATHM: How does HBOT Therapy work
Dr. Harch: The process is that the oxygen gets dissolved from our lungs in the liquid of the blood and then it goes into the red blood cells where it’s stored like a battery. When the blood finally delivers these batteries to all of the tiniest blood vessels in all of the tissue in our bodies, the oxygen comes out of the liquid portion of the blood (plasma) first and then the red blood cells continually supply it to the plasma to deliver to our tissue. So there are two things that are happening in hyperbaric medicine and nobody realized this until about 10 years ago. Even though all the science was there, it had been ignored. There are two components to hyperbaric oxygen therapy. One is pressure. The other is increased oxygen. The hydrostatic pressure is mostly separate from the increase in oxygen. And it turns out that besides supplying extra oxygen, both the oxygen and the pressure influence the expression of our genes. Essentially, hyperbaric oxygen therapy is a gene therapy.
What’s been shown now is that with a single hyperbaric treatment, we turn on and turn off up to 40% of all the protein coding genes in our DNA in every cell. That’s 8,101 genes. This was shown with human cells. So, what we’re really doing with that pulse of oxygen and pressure, i.e., each hyperbaric treatment, is affecting gene expression. This is part of what I wrote about in that Medical Gas Research Commentary. If you look at what’s going on with Corona virus in the lungs, it’s an intense inflammatory reaction with eventually increased fluid or swelling in the lung tissue itself. That increased swelling in the lung tissue and the liquid that leaks out into the air sacs is a barrier to diffusion of oxygen. The result is inadequate oxygen levels in the blood in the lungs. HBOT is able to dissolve large amount of oxygen in the inflamed lung tissue and this is able to diffuse into the tiny blood vessels that cover the alveoli (air sacs) in the lungs. This oxygen delivered to the lungs and then the body is able to decrease some of the oxygen debt that has accrued as a result of the previously low blood oxygen levels and allow our body’s defense mechanisms to gain the upper hand. These are the “temporary” effects of HBOT.
However, each HBOT is also decreasing the fluid content of the lungs, something that has been demonstrated in multiple different animal and human HBOT-treated diseases and seen on the CT scans of the lungs of the Chinese coronavirus patients. And, equally important, when you look at those 8,101 genes that are turned on or turned off by HBOT, the largest groups of the turned-on genes are the growth and repair hormone genes and the anti-inflammatory genes. The largest clusters of the suppressed genes are the ones that cause inflammation and the ones that cause cell death. With the effect on the fluid content of the lungs and the anti-inflammatory gene effects HBOT is able to have cumulative day to day “permanent” effects.
So, every time you do a hyperbaric treatment, we are oxygenating, reducing oxygen debt, improving fluid balance in the lungs, inhibiting inflammation, and turning off cell death. In coronavirus patients, what we appear to be doing is suppressing that huge inflammatory reaction in the lungs. It also seems to be helping to resolve some of the fluid that’s the barrier to diffusion of oxygen. The net result is increased oxygen and the body’s able to fight back. If you can deliver as few as five treatments you can tide people over this severe part of the illness where their body’s defenses are on the losing side. The hyperbaric treatments appear to put things back in balance and according to what the Chinese did and what the Spanish flu experience was, it appeared to salvage these patients.
ATHM: How do you educate practitioners about that?
Dr. Harch: It’s by what we’re doing right now, namely, getting this information out and published, getting into public forums with large audiences where people can see this information, understand it, and make choices. This is a therapy that’s really been misunderstood for 358 years and not better understood until the first major article on gene expression of HBOT was published in 2009. There are now many articles showing that hyperbaric therapy is one of the oldest and the most extensive gene therapies known to man and it’s pretty natural. It turns out every living creature is sensitive to changes in atmospheric pressure and oxygen levels. If you are an evolutionist our human ancestors crawled out of the oceans. It is well documented that different plants and animals live at different sea levels and oxygen levels, in other words, at different pressures, and some periodically surface to breathe the higher levels of oxygen in the air. All land-based living organisms have retained this sensitivity to pressure and oxygen. This is what we’re exploiting with hyperbaric oxygen. So, the answer to your question is that the best way to educate practitioners about the possibility of HBOT in coronavirus infection is by disseminating the information just like we’re doing right now.
ATHM: This Coronavirus is not something that’s going to be short term. I think people are looking for alternative ways on how to treat it and I think this is just one more example.
Dr. Harch: I agree. It’s so natural and the side effects are really minimal if you do this right. Although it’s not antiviral, it treats the underlying disease process. This is a provocative statement, but if we look at the definition of Evidence-Based Medicine, which is the best medical science and evidence combined with the doctor’s experience and the patient’s preference, hyperbaric oxygen therapy for hypoxic Spanish flu patients or coronavirus patients in respiratory distress may be evidence based medicine in terms of treatment.
In support of this statement it is important to note that hyperbaric oxygen therapy has been previously successfully used in patients with the non-infectious but same severe form of respiratory distress from which coronavirus patients die, the acute respiratory distress syndrome (ARDS). You’ve seen the term ARDS, which is the mostly terminal condition of the lungs that many of the coronavirus patients end up with and die from. This same condition occurs as a complication of trauma, sepsis, shock, etc. Nearly 20 years ago an article was published on severe blunt chest trauma patients who developed ARDS (Rogatsky GG, Shifrin EG, Mayevsky A. Adv Exp Med Biol. Oxyen
Transport to Tissue XXV, Chapter 12. Thorniley, Harrison and James, eds., Kluwer Academic/Plenum Publishers, 2003). Doctor’s in Russia applied the near-identical pressure of hyperbaric oxygen therapy that both the Chinese used in coronavirus patients and that Dr. Cunningham used in Spanish Flu patients. The ARDS patients who received hyperbaric oxygen had 100% survival, similar to the Chinese coronavirus patients with ARDS, and the patients who did not get HBOT had a 77% death rate. The point is that ARDS is a generic terminal lung condition with a variety of causes that is characterized by intense inflammation in the lungs that causes hypoxemia. Hyperbaric oxygen therapy is the ultimate treatment for hypoxemia and has now shown benefit in three separate conditions in which ARDS is manifest, Spanish Flu, COVID-19, and blunt chest trauma patients. This suggests that HBOT may be Evidence-Based Medicine for ARDS and derivatively the conditions that cause ARDS.
To confirm this provocative statement we need more evidence and more experience and that’s happening as we talked today.
For more information, please view the recent webinar:
In this short talk Dr. Harch reviews COVID-19 infection, the virus, the clinical course, deterioration of patients, laboratory findings, and the pathology in the lungs. He characterizes the lung injury as a wound in the lungs with primary problems of inflammation and low oxygen levels. He then shows how similar infection/wound diagnoses with inflammation and low oxygen levels have been successfully treated with hyperbaric oxygen.