Severe Long COVID: Endothelial Dysfunction and Microthrombosis
Severe post-COVID has multiple pathological mechanisms. One of the most important: endothelial dysfunction.
The endothelium (cells lining blood vessels) is damaged by COVID-19. Result: vasoconstriction, microthrombosis (small clots), poor tissue perfusion. Organs don't receive enough blood. Tissue hypoxia. Additional oxidative stress.
Nitric oxide is a substance produced by the healthy endothelium. It dilates vessels, prevents clots, improves flow. COVID-19 reduces NO production. Result: a downward spiral.
If you could: 1. Restore NO production (inhaled nitric oxide) 2. Reduce oxidative stress (H₂)
You could break the spiral.
The Study: Pozdnyakova 2026 — NO + H₂ in Post-COVID Syndrome
Clinical trial. Patients with confirmed post-COVID-19 syndrome (persistence of symptoms >12 weeks post-infection). Some received a combined protocol: nitric oxide inhalations + H₂ inhalations. Others received standard care.
Duration: 4–6 weeks of sessions (typically 3 times per week).
Measurements: clinical severity scores, vascular-function parameters (endothelial function tests), tissue oxygen saturation, fatigue, dyspnea.
What They Found
Primary finding: clinical outcomes improved significantly in the NO+H₂ group versus control. The improvement was pronounced.
Secondary finding: endothelial function improved in the NO+H₂ group. Measures of vasodilation and blood flow improved.
Tertiary finding: symptoms (fatigue, dyspnea) reported as better in the NO+H₂ group.
Interpretation: the combination of nitric oxide + H₂ produces a synergistic effect in severe post-COVID syndrome.
Why NO + H₂ Works Better Than Either Alone
Nitric oxide alone: restores vasodilation, improves flow. But NO is an unstable molecule. It degrades rapidly in the presence of free radicals. If there is high oxidative stress, NO burns out without being effective.
H₂ alone: reduces free radicals. But it does not restore vasodilation. Insufficient for severe Post-COVID.
NO + H₂: inhaled NO restores vasodilation. Inhaled H₂ reduces the radicals that degrade NO. Synergy.
How to Use It: Combined Protocol (Requires a Doctor)
Specialized Medical Evaluation
This protocol is complex. It requires a specialist with experience in severe Post-COVID and gas therapies. It is not a DIY protocol.
Nitric Oxide Inhalation
Typically: sessions of 20–40 minutes of inhaled NO, 3 times per week.
Molecular Hydrogen Inhalation
Typically: sessions of 30–60 minutes of inhaled H₂, immediately after NO or in a separate session on the same days.
Continuous Monitoring
Frequent clinical evaluation. Adjustment of dose/duration based on response.
For those without access to specialized clinics, a complementary and accessible route is to incorporate hydrogen-rich water into daily consumption, which can also provide related benefits.
What to Expect: Recovery Timeline
Weeks 1–2
Possible slight improvement of symptoms. Fatigue perhaps slightly less. Less dyspnea.
Weeks 3–4
More noticeable improvement. Improved functional capacity. Some patients notice the ability to do activities that were previously impossible.
Weeks 5–6
Accumulation of benefits. Improved overall function.
The Reality: Expensive Protocol Not Available Everywhere
Inhaled nitric oxide + inhaled H₂ is an advanced protocol. It is not available in most places. Cost probably 500–1500 USD per session. Requires a specialist.
For patients with severe Post-COVID who have failed other therapies, it could be an option. For mild-moderate Post-COVID, simpler options (oral H₂, rehabilitation) are sufficient.