Major Ozone Autohaemotherapy in Post-COVID Syndrome: A Records Review of 40 Patients (2026)

September 22, 2026

Background

Post-COVID syndrome describes symptoms that emerge within twelve weeks of a COVID-19 infection and cannot be explained by anything else. The author notes that it has been reported in anywhere from a third to nearly nine in ten people discharged from hospital, that fatigue is its most common feature at around 64 per cent, and that there are few medicines with any evidence behind them, which is why complementary approaches are being studied.

Dr Ozlem Kuculmez, of the Department of Physical Medicine and Rehabilitation at Baskent University Alanya Hospital in Türkiye, had been treating post-COVID patients with major autohaemotherapy - the procedure in which blood is drawn, mixed with a measured oxygen-ozone gas mixture and returned by drip. The paper reviews what happened to them. It builds on the earlier Italian series by Tirelli and colleagues, which the author cites as its precedent.

Study design

This was a retrospective review of medical records, approved by the university's ethics committee. Forty-five patients with post-COVID syndrome and musculoskeletal symptoms - fatigue, joint pain, weakness - had completed the treatment course; five were excluded for missing data, leaving 40 (32 women, 8 men, average age 55). People with other systemic diseases, contraindications to ozone, or irregular attendance were excluded.

Each patient had ten sessions of major autohaemotherapy, two or three a week, with the ozone concentration stepped up over the first three sessions and then held. Four validated questionnaires were completed before the first session and immediately after the tenth: the FACIT Fatigue Scale, the Beck Anxiety Inventory, the Beck Depression Inventory, the Pittsburgh Sleep Quality Index, and the SF-36 quality-of-life survey. There was no control group and no follow-up after the course ended.

This was a supervised clinical procedure delivered in a hospital department. It is a description of what was studied, not a set of instructions.

Findings

At baseline, 90 per cent of patients reported fatigue, 30 per cent joint pain, 10 per cent brain fog and 5 per cent muscle weakness.

Fatigue fell. The median FACIT fatigue score dropped from 31.0 to 9.5 (p = 0.001). On the scoring used in this paper, a higher score means more fatigue.

Anxiety and depression fell. Median Beck Anxiety Inventory went from 7.5 to 4.0 (p = 0.001) and Beck Depression Inventory from 5.5 to 1.0 (p = 0.002). Both starting medians were in the minimal-to-mild range.

Sleep improved on most measures. The global Pittsburgh score improved from 15 to 13 (p = 0.016), with significant gains in subjective sleep quality, sleep duration, sleep disturbance and daytime function. Time to fall asleep, sleep efficiency and use of sleep medication did not change significantly.

Quality of life improved on eight of nine SF-36 domains - physical functioning, physical and emotional role limitations, energy, social functioning, pain, general health and reported health change. Emotional wellbeing was the one domain that did not change significantly.

Safety. No adverse events were reported.

What the authors concluded

The author concludes that "the patients suffering from post-COVID syndrome may benefit from major blood ozonation" and that "the treatment may be one of the complementary treatments after COVID-19 infection". The paper presents its results as consistent with Tirelli's earlier finding of improved fatigue in two-thirds of post-COVID patients, and recommends larger randomised controlled trials in outpatient populations.

Limitations of this study

The author lists the limitations directly: a small sample; a retrospective rather than prospective design; no control group; no formal cognitive testing for brain fog; no objective biomarkers; the lack of standardised ozone dosing and session protocols in the literature; and the still-unclear pathogenesis of post-COVID syndrome, including any effect of vaccination.

Two points for readers. Because scores were taken immediately after the tenth session, nothing is known about whether the improvements lasted. And the paper scores the FACIT fatigue scale with higher numbers meaning more fatigue, which is the reverse of the scale's usual convention, so its figures should not be set directly against other studies that use the standard scoring.

Post-COVID symptoms should be assessed and managed with a doctor. Anyone considering ozone therapy alongside their care should discuss it with their own GP or specialist.