A 57-year-old african american man with severe COVID-19 pneumonia who responded to supportive photobiomodulation therapy (PBMT): First use of PBMT in COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) is associated with lung inflammation and cytokine storm. Photobiomodulation therapy (PBMT) is a safe, non-invasive therapy with significant anti-inflammatory effects. Adjunct PBMT has been employed in treating patients with lung conditions. Human studies and experimental models of respiratory disease suggest PBMT reduces inflammation and promotes lung healing. This is the first time supportive PBMT was used in a severe case of COVID-19 pneumonia.

A 57-year-old African American man with severe COVID-19 received 4 once-daily PBMT sessions by a laser scanner with pulsed 808 nm and super-pulsed 905 nm modes for 28 min. The patient was evaluated before and after treatment via radiological assessment of lung edema (RALE) by CXR, pulmonary severity indices, blood tests, oxygen requirements, and patient questionnaires. Oxygen saturation (SpO2 ) increased from 93–94% to 97–100%, while the oxygen requirement decreased from 2–4 L/min to 1 L/min. The RALE score improved from 8 to 5. The Pneumonia Severity Index improved from Class V (142) to Class II (67). Additional pulmonary indices (Brescia-COVID and SMART-COP) both decreased from 4 to 0. CRP normalized from 15.1 to 1.23. The patient reported substantial improvement in the Community-Acquired Pneumonia assessment tool.

This report has presented supportive PBMT in a patient with severe COVID-19 pneumonia. Respiratory indices, radiological findings, oxygen requirements, and patient outcomes improved over several days and without need for a ventilator. Future controlled clinical trials are required to evaluate the effects of PBMT on clinical outcomes in patients with COVID-19 pneumoni

Full text

Received: 2020.06.12
Accepted: 2020.07.31
Available online: 2020.08.07
Published: 2020.XX.XX
2353 2 3 35
A 57-Year-Old African American Man with
Severe COVID-19 Pneumonia Who Responded to
Supportive Photobiomodulation Therapy (PBMT):
First Use of PBMT in COVID-19
ABCDEF 1 Scott A. Sigman
ABCDEF 2 Soheila Mokmeli
A 3 Monica Monici
BCDEF 4 Mariana A. Vetrici
Corresponding Author: Scott A. Sigman, e-mail: sasigmanmd@icloud.com
Conflict of interest: None declared
Patient: Male, 57-year-old
Final Diagnosis: COVID -19
Symptoms: Shortnessofbreath•hypoxia
Medication: —
Clinical Procedure: Photobiomodulation therapy (PBMT)
Specialty: InfectiousDiseases•Pulmonology
Objective: Unusual or unexpected effect of treatment
Background: Coronavirus disease 2019 (COVID-19) is associated with lung inflammation and cytokine storm. Photobiomodulation
therapy (PBMT) is a safe, non-invasive therapy with significant anti-inflammatory effects. Adjunct PBMT has
been employed in treating patients with lung conditions. Human studies and experimental models of respira-
tory disease suggest PBMT reduces inflammation and promotes lung healing. This is the first time supportive
PBMT was used in a severe case of COVID-19 pneumonia.
Case Report: A 57-year-old African American man with severe COVID-19 received 4 once-daily PBMT sessions by a laser scan-
ner with pulsed 808 nm and super-pulsed 905 nm modes for 28 min. The patient was evaluated before and
after treatment via radiological assessment of lung edema (RALE) by CXR, pulmonary severity indices, blood
tests, oxygen requirements, and patient questionnaires. Oxygen saturation (SpO2) increased from 93–94% to
97–100%, while the oxygen requirement decreased from 2–4 L/min to 1 L/min. The RALE score improved from
8 to 5. The Pneumonia Severity Index improved from Class V (142) to Class II (67). Additional pulmonary indi-
ces (Brescia-COVID and SMART-COP) both decreased from 4 to 0. CRP normalized from 15.1 to 1.23. The pa-
tient reported substantial improvement in the Community-Acquired Pneumonia assessment tool.
Conclusions: This report has presented supportive PBMT in a patient with severe COVID-19 pneumonia. Respiratory indi-
ces, radiological findings, oxygen requirements, and patient outcomes improved over several days and with-
out need for a ventilator. Future controlled clinical trials are required to evaluate the effects of PBMT on clini-
cal outcomes in patients with COVID-19 pneumonia.
MeSH Keywords: Anti-InammatoryAgents•COVID-19•LaserTherapy•RespiratoryDistressSyndrome,Adult
Full-text PDF: https://www.amjcaserep.com/abstract/index/idArt/926779
Authors’ Contribution:
Study Design A
Data Collection B
Statistical Analysis C
Data Interpretation D
Manuscript Preparation E
Literature Search F
Funds Collection G
1 Team Physician, UMASS Lowell, Fellow of the World Society of Sports and
Exercise Medicine, Fellow of the Royal College of Surgeons in Ireland, Chelmsford,
MA, U.S.A.
2 Training Institute, Canadian Optic and Laser Center, Victoria, BC, Canada
3 Department of Experimental and Clinical Biomedical Sciences, University of
Florence, Florence, Italy
4 Department of Biological Sciences, University of Lethbridge, Lethbridge,
AB, Canada
e-ISSN 1941-5923
© Am J Case Rep, 2020; 21: e926779
DOI: 10.12659/AJCR.926779
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Background
Coronavirus disease 2019 (COVID-19) is caused by Severe
Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).
The presentation of COVID-19 includes dyspnea, lung edema,
and pneumonia. Morbidity and mortality are associated with
Acute Respiratory Distress Syndrome (ARDS) and cytokine
storm. Hospitalized COVID-19 patients are classified as severe
if they require intensive care unit (ICU) admission [1,2]. Here,
we report the first case of the use of supportive or adjunctive
photobiomodulation therapy (PBMT) in a patient with severe
COVID-19 pneumonia.
PBMT is an emerging alternative modality with demonstrated
anti-inflammatory effects in pain management, lymphedema,
wound healing, and musculoskeletal injuries. Additional terms
for PBMT include low-level laser (or light) therapy (LLLT), cold
laser, and photobiostimulation [3]. The effects of PBMT differ
from the thermal effects produced by the high-power lasers
used in cosmetic and surgical procedures to destroy the tis-
sue [4,5]. PBMT utilizes non-ionizing, non-thermal light sources
in the visible and infrared spectra (400–1000 nm) [3]. In PBMT,
light is applied over damaged tissues and the light energy ab-
sorbed by intracellular chromophores or biomolecules starts a
cascade of molecular reactions that improve cell function and
enhance the body’s healing process [4]. In effect, light stimu-
lates healing, modulates the immune system, and reduces in-
flammation, edema, and pain [4]. PBMT is non-invasive, cost-
effective, and has no known adverse effects.
Empirical use of PBMT in children, adults, and elderly patients
with pneumonia, asthma, chronic bronchitis, or pulmonary fi-
brosis resulted in reduced chest pain and heaviness, normal-
ization of respiratory function, shortened recovery times, and
improved immunological and radiological parameters. In these
patients, PBMT used in combination with conventional med-
ical treatment was safe and appeared to produce a synergis-
tic effect in healing [6–10]. Recent publications recommend
the use of supportive PBMT in COVID-19 patients [11–13].
ARDS is a critical complication of COVID-19 infection and sup-
portive PBMT can ameliorate ARDS and promote lung heal-
ing [11,13–18]. Animal models of acute inflammation of the
respiratory system suggest that transcutaneous PBMT over
the lungs is effective against cytokine storm and ARDS via its
anti-inflammatory action at multiple levels [14–18].
The theory of supportive PBMT for COVID-19 is based on la-
ser light reaching lung tissue, which relieves inflammation and
promotes healing. The World Association for Laser Therapy
recommended treatment doses for low-level laser therapy, or
PBMT for superficial to deep tissue lesions in musculoskeletal
disorders in 2010 [19].
The minimum observed therapeutic dose for a bio-stimulatory
effect of red and near-infrared (NIR) lasers is 0.01 J/cm2 [20].
NIR Laser light at a power of 1 W/cm2 projected through bo-
vine tissue ranging in thickness from 1.8 to 9.5 cm resulted
in effective power densities at 3.4 cm and 6.0 cm [21]. In vet-
erinary practice, feline and canine pneumonia is frequent
-
ly treated with laser doses of 6–10 J/cm2 [22]. These animals
have a thicker chest wall and furry skin, making penetration
more challenging than in humans. Therefore, the range used
in cats and dogs approximates an effective dose for humans.
Our previous experience in treating asthma [23] and musculo-
skeletal pain and injuries suggested that the anti-inflammato-
ry effects of PBMT could benefit the severe inflammatory con
-
dition in COVID-19 patients. The laser machine used in this
case is an US Food and Drug Administration (FDA)-cleared sys-
tem for pain management and inflammation reduction in deep
joints of the body. The combination of 808 and 905 nm, both
NIR wavelengths, provides penetration to depths of 4–5.4 cm.
This laser machine is used for deeper tissues like hips and pel-
vic joints that are surrounded by thick muscles. The therapeu-
tic dose with this machine is 4.5 J/cm2 over the skin to reach
these deep targets of the pelvis. Based on our calculations, we
used 7.2 J/cm2 over the skin to deliver just over 0.01 J/cm2 of
laser energy to the lung. The 7.2 J/cm2 dosage penetrates the
chest wall (1.6 to 6 cm in humans) and reaches the lung tis-
sue with sufficient energy for bio-stimulation. Scapular pro-
traction in the prone position reduces the bone and muscle
tissue the laser must penetrate, thereby increasing laser en-
ergy to the lung fields.
Here, we report the first use of PBMT as a supportive treat-
ment in a severe case of COVID-19 pneumonia.
CaseReport
A 57-year-old African American man with a history of hyperten-
sion and asthma presented with shortness of breath, severe de-
hydration, acute renal failure, and C. difficile-positive diarrhea.
A physical examination revealed labored breathing, weakness,
and fatigue. Chest X-rays demonstrated worsening bilateral lung
infiltrates. Oxygen requirements in the hospital ranged from 2
to 6 L/min oxygen. The patient had been in the ICU for respi-
ratory depression with SpO
2
of 80% requiring 48 h on 6 L/min
oxygen. The diagnosis of SARS-CoV-2 was confirmed for this
patient by reverse transcription-polymerase chain reaction by
nasopharyngeal swab on an Abbott ID system. Patient con-
sent was obtained for an FDA-guided and International Review
Board-approved trial of laser treatment for COVID-19 (Lowell
General Hospital Federal-wide Assurance number 0001427).
The inclusion criteria consisted of a positive COVID-19 test,
the ability to self-prone, and requiring at least 1 L/min oxygen.
Sigman S.A. et al.:
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The patient was treated with an FDA-cleared Multiwave Locked
System (MLS) Therapy Laser (ASA Laser, Italy.) The MLS laser
utilizes a mobile scanner with 2 synchronized laser diodes, one
in pulse mode (adjustable to 1–2000 Hz), emitting at 905 nm,
and another in pulsed mode emitting at 808 nm. The 2 laser
beams work simultaneously and synchronously. This laser is
used in pain centers for treatment of musculoskeletal pain
and inflammation. Laser parameters were set as outlined in
Table 1 and Figure 1. The laser scanner was adjusted to 20 cm
above the skin, as recommended by the manufacturer. Each
lung was scanned for 14 min from apex to base over 250 cm2
of the posterior thorax (Table 1, Figures 1, 2).
Specific prone positioning was used with the patient’s hands
under his head for maximal scapular protraction. The laser field
was focused to the medial border of the scapula opening the
lung fields, thereby minimizing the chest wall thickness for
theoretical improvement of laser penetration to lung tissue.
Prior to laser treatment, the patient was bedridden, with SpO
2
92–95% on 2–4 L/min oxygen. He had completed his antibiotic
course and was not receiving any pharmacotherapeutic or IV
support. He experienced severe paroxysmal coughing episodes
and had failed a physical therapy trial. The patient tolerated
the prone position for laser treatment for a total of 28 min.
Within 5 min of laser treatment, his oxygen saturation rose
from 94% to 100% in the first session. Following treatment,
he returned to his bed and resumed the semi-sitting position
and SpO2 remained at 98% for the rest of the day.
The patient tolerated all 4 daily treatments and noted significant
improvement in breathing immediately after each treatment.
Paroxysmal coughing spells resolved after the third treatment.
Upon completion of the fourth treatment, the patient was able
Table 1. Laser parameters for COVID-19 pneumonia patients.
808 nm (GaAlAs)
diode
905 nm (GaAs)
diode
Mode of
radiation Pulsed Pulsed
Frequency
1500 Hz,
(Duty Cycle 50%)
(1 Hz÷2 kHz)
1500 Hz
(90 kHz Modulated
at 1 Hz÷2 kHz)
Pulse duration 333 μs
(500 ms÷250 μs) 100 ns
Peak power 3 W 75W×3
Average power 1.5 W 11.25×3=33.75 mW
Spot size 19.625 cm2
Area On each lung
25×10=250 cm2
Dose 7.1–7.2 J/cm2
Distance from
the skin 20 cm
Treatment time 14 minutes each lung
Total energy 3600 J
1794.24 each lung
Total time 28 minutes
Sessions Once daily for 4 days
The table explains the technical parameters for the dosage
of laser energy and treatment time used in this case report.
GaAlAs – Gallium Aluminum Arsenide Diode; GaAs – Gallium
Arsenide Diode. The two diodes are part of a single laser system,
the Multiwave Locked System (MLS). For patients with dark skin
color, there is a pigment adjustment selection button on the
laser console. When the pigment selection is activated, laser
intensity is reduced by 50% and the software automatically
recalculates the required dose.
Figure 1. Orientation of the laser beams during laser treatment
while in the prone position. The apex of the lung lies
above the first rib. The lungs extend from the C7 to
T10 vertebra, which is also from the apex of the lung
to the inferior border. Laser parameters with both
diodes operating synchronously and simultaneously,
and the propagation axes are coincident. 1) 808 nm
(GaAlAs) diode: Peak Power: 3 W, Laser Mode: Pulsed,
Frequency: 1500 Hz, Pulse Duration: 333 μs,
Scanning Area: 25×10=250 cm2, Dose: 7.2 J/cm2;
2) 905 nm (GaAs) diode: Peak Power: 75 W×3, Laser
Mode: Pulsed, Frequency: 1500 Hz, Pulse Duration:
100 ns, Area: 25×10=250 cm2, Dose: 113.4 mJ/cm2;
Total Energy: 3600 J. Treatment Time: (28 minutes),
14 minutes each lung, Sessions: Once daily for 4
days. Therapeutic Protocol: PBMT-COVID-19 By
Dr. S. Mokmeli.
Sigman S.A. et al.:
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to ambulate in the room with physical therapy. On the day fol-
lowing his final treatment, the patient was discharged to an
acute rehabilitation facility on 1 L/min oxygen. On the day af
-
ter arrival to the acute rehabilitation facility, the patient was
able to complete 2 trials of stair climbing with physical thera-
py and was in the process of weaning to room air.
The patient’s response to PBMT was evaluated by comparing
different scoring tools before and after laser therapy. The pa-
tient showed improvement in all evaluation criteria (Table 2).
The Pneumonia Severity Index (PSI) [24] calculates the prob-
ability of morbidity and mortality among patients with com-
munity-acquired pneumonia (CAP). Prior to treatment, the pa-
tient’s PSI score was Class V (142), which requires ICU treatment
and predicts intubation and ventilator use. After PBMT, PSI de-
creased to Class II (67), which signifies outpatient treatment.
The SMART-COP score [25], which is an acronym for Systolic
blood pressure, Multilobar infiltrates, Albumin, Respiratory rate,
Tachycardia, Confusion, Oxygen, and pH, evaluates pneumo-
nia severity and predicts the need for intensive respiratory or
vasopressor support (IRVS) in CAP. The pretreatment SMART-
COP score was 5, placing him in the high-risk group, and sig-
nifying a 1 in 3 chance of needing IRVS. Following PBMT, the
SMART-COP decreased to 2, implying minimal risk for need-
ing IRVS.
The Brescia-COVID Respiratory Severity Scale [26] is a stepwise
algorithm for managing patients with confirmed COVID-19.
Before treatment, the patient’s score was 4 out of 4, which
requires a trial of high-flow nasal cannula (HFNC), reassess-
ment, and intubation if the score remains >2. Following PBMT,
the patient’s Brescia-COVID score was 0, which simply requires
patient monitoring.
The CAP tool score [27] is a short and sensitive question-
naire evaluating changes in respiratory symptoms and well-
being during the treatment of community-acquired pneumo-
nia. Scores <75% indicate symptomatic distress. The patient’s
pretreatment CAP score was 36.68% and increased to 82.84%
after treatment. His CAP Respiratory Score improved from
67.52%, before treatment to 87.17% at the time of discharge.
The CAP Well-Being score increased from 0% before treatment
to 73.07% after treatment. This patient demonstrated substan-
tial improvement in all 3 measures of respiratory symptoms.
The Radiographic Assessment of Lung Edema (RALE)
score [28,29] evaluates lung edema on CXR in ARDS patients.
To quantify the extent of infection, a severity score was calcu-
lated [29]. A score of 0 to 4 was assigned to each lung depend-
ing on the percent lung consolidation or ground-glass opacity,
with 0 signifying no lung involvement, 1 indicating <25% lung
involvement, 2 indicating 25–50% lung involvement, 3 indicat-
ing 50–75% lung involvement, and 4 indicating >75% involve-
ment. The scores for each lung were added together to pro-
duce the final severity score [29]. The RALE score was 8 (>75%
involvement of both lungs) and improved to 5 upon treatment
completion (Figure 3).
His white blood cell count decreased from 10.7 to 6.5 and his
C-reactive protein decreased from 15.1 to 1.23 after treatment.
The oxygen requirement before treatment was 2–4 L/min with
an oxygen saturation (SpO2) of 93–94%. The oxygen require-
ment after treatment improved to 1 L/min with an SpO2 of
97–100% at the time of discharge.
Discussion
This case report showed that 4 daily sessions of adjunct PBMT
were beneficial in a patient with severe COVID-19 symptoms.
The patient’s positive response to treatment was supported
by radiological findings, pulmonary severity scores, oxygen
requirements, blood and inflammatory markers, and patient
questionnaires. On follow-up, his clinical recovery in total was
3 weeks, whereas the median time for COVID-19 is typical-
ly 6–8 weeks [30].
Figure 2. Laser scanner configuration while the patient is in the
prone position with scapular protraction. The laser
scanner was adjusted 20 cm above the skin as per
manufacturer’s guidelines. The patient is shown here
with his hands under his head for maximum scapular
protraction. The red light is the laser machine’s guide
beam on the skin. Infrared lasers with wavelengths of
808 and 905 nm are not visible to human eyes. The 2
sources are coupled in a single system in the MLS laser
system.
Sigman S.A. et al.:
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The therapeutic effects of PBMT on pneumonia are thought
to occur via local and systemic effects that reduce inflamma-
tory cytokines, cellular infiltrates, edema and fibrosis, and in-
crease anti-inflammatory cytokines and processes, and promote
healing. Local PBMT affects the entire body when photoprod-
ucts are distributed via the vasculature to reach distant tar-
gets. Activated photoproducts lead to alleviation of inflam-
mation and immunomodulatory effects, and stimulate wound
healing and tissue regeneration [4]. Animal studies illustrate
the potency of PBMT.
Transcutaneous PBMT in murine models for pulmonary fibrosis
and ARDS significantly reduced pro-inflammatory cytokines,
inflammatory cells, and collagen fiber deposition in lung pa-
renchyma [14–18]. In contrast, the anti-inflammatory cytokine
interleukin-10, serum monocytes, and lung macrophages were
significantly increased following PBMT [15,17]. The molecular
basis of MLS laser anti-inflammatory effects has been demon-
strated in murine and in vitro models [31–33]. In particular, it
has been shown to inhibit inflammasome activation, inhibit-
ing interleukin-1b and interleukin-18, whose downstream sig-
naling induces the production of interleukin-6, interleukin-8,
tumor necrosis factor a (TNF-a), and interferon-g, which are im-
plicated in ARDS caused by COVID-19 infection [14–18,31–33].
Table 2. Evaluation criteria before and after photobiomodulation therapy in a COVID-19 patient.
Parameters Before
treatment
After
treatment Normal range or evaluation criteria
PSI Class V
(142)
Class II
(67)
Risk Class (Points): Disposition
Class I (<50): Outpatient
Class II (51–70): Outpatient
Class III (71–90): Outpatient/brief Inpatient
Class IV (91–130): Inpatient
Class V (>130): Inpatient
SMART-COP 5 2
0 points: Very low risk of needing IRVS
1 point: Low risk (1 in 20) of needing IRVS
2 points: Moderate risk (1 in 10) of needing IRVS
3 points: High risk (1 in 6) of needing IRVS
³4 points: High risk (1 in 3) of needing IRVS; Consider ICU admission
Brescia-COVID 4 0
0 – monitor
1 – add O2 and monitor
2 – CXR, ABG, O2 therapy, monitor
>2 – HFNC and reassess. If still >2, intubate.
CAP total 36.68 82.82 Calculated based on (CAP) score questionnaire:
75–100%
CAP respiratory 67.52 87.17 75–100%
CAP well-being 0.0 73.07 75–100%
RALE 8 5
Lungs score dependent on extent of involvement based on consolidation or
ground-glass opacities for each lung, total score is the sum of the score of
the lungs: 0 – no involvement; 1 – <25% of lung involved; 2 – 25–50% of lung
involved; 3 – 50–75% of lung involved; 4 – >75% of lung involved.
WBC 10.7 6.5 4.5–11
CRP 15.1 1.23 3 mg/mL
O2 Requirement 2–3 L/min 1 L/min 0 L/min
SpO293–94% 100% ³94%
PSI – Pneumonia Severity Index; SMART-COP – Systolic blood pressure, Multilobar infiltrates, Albumin, Respiratory rate, Tachycardia,
Confusion, Oxygen, and pH; CAP – Community-Acquired Pneumonia; RALE – Radiographic Assessment of Lung Edema; SpO2 – Oxygen
saturation; WBC – White Blood Cells; CRP – C-Reactive Protein; IRVS – Intensive Respiratory or Vasopressor Support; CXR – Chest x-ray;
ABG – Arterial Blood Gas; HFNC – High-Flow Nasal Cannula.
Sigman S.A. et al.:
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Figure 3. Radiographic Assessment of Lung Edema (RALE) by CXR showed reduced ground-glass opacities and consolidation following
PBMT. Lung radiographic score is dependent on extent of involvement based on consolidation or ground-glass opacities
for each lung. Total score is the sum of both lungs. Scores classification: 0 – no involvement; 1 – <25% of lung involved;
2 – 25–50% of lung involved; 3 – 50–75% of lung involved; 4 – >75% of lung involved. RALE score before laser therapy
(04-27-2020)=8. Laser therapy started on (04-29-2020). RALE score after laser therapy (05-03-2020)=5.
Human trials have shown local and systemic effects of PBMT
when applied to quadriceps muscle in patients with chron-
ic obstructive pulmonary disease [10]. Beneficial effects ex-
tended beyond improved muscular performance, to statisti-
cally significant reductions in dyspnea and fatigue [10]. Our
patient also reported subjective feelings of improved respira-
tory function and strength.
Our patient was only placed in the prone position for the du-
ration of laser treatment. Treatments lasted exactly 28 min
for each of the 4 days. Physiological evidence and clinical tri-
al data support the use of prone position ventilation in se-
lected patients with moderate-to-severe ARDS. For patients
to benefit, the use of long prone positioning sessions of 12 h
to 18 h per session are necessary [34,35]. An increase in SpO
2
from 94% to 100% occurred within the first 5 min of treat-
ment, and the patient maintained good saturation thereaf-
ter. This finding shows the rapid effect of PBMT treatment on
oxygen saturation. It is unlikely that prone positioning alone
was the reason for improved oxygenation, given the minimal
time in that position.
A strength of this case report is that we collected patient symp-
tom data before and after treatment. All 4 pulmonary scor-
ing tools and the 3 patient questionnaires demonstrated the
benefit of treatment. To the best of our knowledge, this was
the first time that PBMT was used as adjunctive treatment for
pneumonia in a COVID-19 patient. Irradiation over the posteri-
or projection of the lungs, using the scanning method, has no
risk of contamination since the scanning laser does not phys-
ically touch the patient. A deficiency of our study is the lack of
inflammatory markers and blood tests. Future studies should
include measurements before and after treatment of interleu-
kin-6, interleukin-10, TNF-a, as well as additional inflammatory
markers. A limitation of this case report is that this is a single
patient and we were unable to carry out any statistical analysis.
Conclusions
This report has presented a patient with severe COVID-19 pneu-
monia associated with ARDS who was given supportive treat-
ment with PBMT. Based on this case report, as well as clinical
experience of PBMT in respiratory tract diseases in humans,
we consider PBMT to be a feasible adjunct modality for the
treatment of COVID-19. There is published experimental work
demonstrating the anti-inflammatory effect of PBMT on lung
tissue. We suggest that the use of adjunct PBMT in the early
stages of severe ARDS seen in COVID-19 patients can enhance
healing and reduce the need for prolonged ventilator support
and ICU stay. The urgent current medical situation calls for
PMBT pilot studies and clinical trials to evaluate its effect on
COVID-19 pneumonia. This patient is part of an ongoing in-
vestigational randomized controlled trial.
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