For millions worldwide, Long COVID has become a persistent shadow—lingering fatigue, breathlessness, and cognitive fog that stubbornly resist conventional treatment. As researchers race to find effective interventions, a new pilot study from the United Kingdom suggests that hyperbaric oxygen therapy (HBOT), when delivered in community settings, may offer meaningful symptom relief for some patients struggling with the aftermath of COVID-19 infection.
The Study: Community-Based HBOT for Long COVID
Published in the British Journal of Nursing in 2026, the pilot study led by Gale and colleagues represents an important step in understanding how HBOT might be deployed outside traditional hospital settings to reach Long COVID patients where they live. Unlike earlier randomized controlled trials conducted in specialized medical centers, this investigation explored the feasibility and outcomes of delivering HBOT through community-based facilities.
The study enrolled participants experiencing persistent Long COVID symptoms, including the hallmark complaints that have defined the condition: debilitating fatigue, shortness of breath, and diminished quality of life. Over the course of four weeks, participants underwent a series of HBOT sessions in community hyperbaric facilities, with researchers tracking both objective measures and patient-reported outcomes.
What the Researchers Found
The results, while preliminary, point toward potential benefits that align with findings from larger controlled studies. Participants who completed the four-week HBOT protocol reported improvements across several key symptom domains. Fatigue levels decreased notably—a significant finding given that post-viral exhaustion is among the most treatment-resistant features of Long COVID and the symptom patients consistently rank as most disruptive to daily functioning.
Breathlessness, another common and distressing complaint, also showed improvement. This is particularly relevant because dyspnea in Long COVID often persists despite normal pulmonary imaging, suggesting a complex pathophysiology involving vascular dysfunction, autonomic dysregulation, or mitochondrial impairment rather than structural lung damage. The observed improvement hints that HBOT’s mechanism—delivering oxygen under pressure to enhance tissue oxygenation and reduce inflammation—may address these underlying biological processes.
Quality of life measures improved as well, suggesting that the symptom relief translated into meaningful functional gains for participants. This holistic improvement is crucial for a condition where the cumulative burden of multiple moderate symptoms often proves more disabling than any single complaint.
The Patient Experience: Promise and Practical Challenges
The study’s qualitative findings reveal a nuanced picture of the patient experience. Participants reported positive perceptions of the therapy itself, with many noting perceived improvements in significant symptoms that had persisted for months or even years. This subjective sense of benefit matters—not only as an outcome in its own right but as a factor that could influence adherence and engagement with treatment.
However, the research also illuminated substantial barriers to access. Attending regular HBOT sessions proved difficult for many participants, precisely because of the symptoms HBOT was intended to treat. The fatigue and functional limitations imposed by Long COVID made traveling to appointments, maintaining schedules, and completing the full protocol challenging for a subset of enrollees. This catch-22—needing treatment to overcome the barriers that prevent accessing treatment—highlights the importance of developing more flexible delivery models or supportive services to help patients complete therapeutic courses.
Context: Building on Earlier Evidence
The Gale pilot study arrives in a research landscape that has already produced promising signals about HBOT for Long COVID. A randomized controlled trial by Zilberman-Itskovich and colleagues, published in Scientific Reports, demonstrated that HBOT improved neurocognitive functions and symptoms in post-COVID patients compared to sham treatment. That study utilized 40 sessions over two months and found statistically significant improvements in cognitive function, fatigue, and quality of life measures.
Another recent randomized trial from Sweden, the HOT-LoCO study, presented a more mixed picture—finding no significant benefit over sham treatment with a shorter 10-session protocol. This divergence in outcomes suggests that dosing—both the number of sessions and the pressure protocols used—may be critical determinants of efficacy.
The UK pilot study contributes to this evolving evidence base by demonstrating that community delivery is feasible and that even in less controlled settings, patients appear to derive benefit. However, the absence of a control group means these findings should be interpreted cautiously. Improvements could reflect placebo effects, natural symptom fluctuation, or regression to the mean rather than specific HBOT effects.
The FDA Position: What Patients Should Know
While the research trajectory is encouraging, the regulatory reality remains clear: the U.S. Food and Drug Administration has not cleared HBOT for Long COVID treatment. The agency’s approved indications for HBOT include decompression sickness, carbon monoxide poisoning, certain non-healing wounds, gas gangrene, and late radiation tissue injury—conditions where the evidence base meets regulatory standards for safety and efficacy.
Long COVID, despite its devastating impact on millions of patients, does not currently appear on this list. The FDA has explicitly warned that claims suggesting HBOT is proven effective for conditions not on the cleared list—including various post-viral syndromes—are not supported by sufficient evidence to meet regulatory standards.
This regulatory status has practical implications. Insurance coverage for HBOT in Long COVID cases is inconsistent at best, and patients seeking treatment may face substantial out-of-pocket costs. The community-based model explored in the Gale study could potentially improve accessibility, but without FDA clearance and established reimbursement pathways, financial barriers will remain significant.
Safety Considerations
The 2025 FDA letter to healthcare providers emphasized important safety considerations for HBOT devices, including fire risks and the importance of proper training for operators. While HBOT is generally well-tolerated, it is not without risks. Barotrauma to ears or sinuses, oxygen toxicity seizures (rare but serious), and claustrophobia-related anxiety are documented complications.
Community-delivered HBOT, as studied by Gale and colleagues, introduces additional considerations about facility standards, staff training, and emergency preparedness. The study’s successful completion without serious adverse events suggests that community delivery can be safe when appropriate protocols are followed, but patients should verify that any facility they consider meets professional standards for hyperbaric medicine practice.
The Path Forward: From Pilot to Practice
The researchers themselves emphasize what their study cannot definitively establish. As a pilot investigation without a control group, it provides proof-of-concept for community delivery and generates hypotheses about efficacy—but it cannot determine whether HBOT specifically causes the observed improvements. Larger randomized controlled trials, conducted in community settings to mirror real-world delivery, will be necessary to establish efficacy with confidence.
Such studies are urgently needed. With estimates suggesting that 16 percent of Americans who had COVID-19 developed Long COVID—far higher than earlier estimates—the population affected by this condition numbers in the tens of millions globally. Effective treatments could transform quality of life for this patient population and reduce the substantial economic burden of ongoing disability.
The community-delivered model may prove particularly valuable if efficacy is confirmed. Traditional hospital-based HBOT programs have limited capacity and geographic reach. Community facilities, if they can maintain safety standards and appropriate oversight, could dramatically expand access—particularly important for a condition where patients may struggle with travel and mobility.
Conclusion
The Gale pilot study adds a meaningful data point to the growing literature on HBOT for Long COVID, demonstrating that community-based delivery is feasible and suggesting symptomatic benefits for fatigue, breathlessness, and quality of life. For patients desperate for relief from persistent post-COVID symptoms, these findings offer cautious hope.
Yet the gap between promising pilot data and established clinical practice remains substantial. The FDA’s position—that HBOT is not cleared for Long COVID—reflects the absence of definitive evidence, not a judgment on the therapy’s potential. Patients considering HBOT should understand this regulatory reality, weigh the costs and benefits carefully, and ideally seek enrollment in clinical trials that will help answer the questions this pilot study has raised.
As research continues, the goal remains clear: transforming Long COVID from a life-altering chronic condition into a treatable, manageable aftermath of infection. Whether HBOT will play a central role in that transformation remains to be determined—but studies like this one keep the possibility alive.
Sources
- Gale et al. — Community-delivered hyperbaric oxygen therapy for people affected by long COVID: a pilot study (British Journal of Nursing, 2026)
- Zilberman-Itskovich et al. — Hyperbaric oxygen therapy improves neurocognitive functions and symptoms of post-COVID condition: randomized controlled trial (Scientific Reports)
- FDA — Hyperbaric Oxygen Therapy: Get the Facts
- FDA — Follow Instructions for Safe Use of HBOT Devices (2025 Letter to Health Care Providers)
- Science for ME — Discussion of Gale et al. pilot study