ROLE OF OZONE THERAPY IN MANAGEMENT OF COVID-19 ILLNESS: A SYSTEMATIC REVIEW AND POOLED ANALYSIS OF PRELIMINARY EVIDENCE USING META-ANALYTICAL APPROACH

COVID-19 is a pandemic related with reduced immunity, high inflammatory activity and high oxidative stress activity. With its anti-microbial, immunity promoting, and oxidative balance modulating efficacy ozone seems to have a promising role in the management of COVID-19. This systematic review of experimental and clinical studies was done to assess the role of ozone in the treatment of COVID-19 patients and to bring out gaps in research design, methodology and patient selection in order to provide basis for further research using more standardized methodologies to build homogeneous evidence. We carried out adatabase search of PubMed using “Ozone therapy in Covid-19”, “ozone in covid-19 case control”, “Treatment of COVID-19 using ozone” as the search words. PRISMA guidelines for systematic review were followed. A total of 14 relevant articles were selected. The studies were grouped according to the type of study. Pooled rates for different outcomes were noted using a Meta-analytical approach using Microsoft Excel software. Odds ratios for pooled data were calculated. The experimental studies showed the feasibility of ozone in COVID-19 disinfection/viral load reduction. The case studies together included a total of 9 cases. All the cases showed symptomatic improvement and there was no mortality. In a prospective interventional study, the major promising outcome was ~10% increase in SpO2 level. In six randomized controlled trials that included 134 cases (where ozone was used as part of treatment) and 115 controls (where ozone was not used as part of the treatment), the pooled mortality rate was significantly lower in cases (3.7%) as compared to that in controls (10.4%) (OR=0.33; 95% CI=0.11-0.97; p=0.045). A promising role of ozonation was also seen for Intensive Care/Orotracheal intubation. The findings of study suggest that ozone therapy seems to have a promising impact on COVID-19 treatment.