Diving after COVID19 disease

There is now a statement dated April 21, 2020 on the Wetnotes article „Diving after Covid19 disease“ by Head of Medicine of the DLRG.

Diving after COVID19 disease

Statement by the Head of Medicine of the German Life Saving Association (DLRG) e.V. on „Diving after COVID19 disease“

This statement is based on the knowledge available on April 19, 2020. In such a dynamic situation, with existing gaps in knowledge, changes in the assessment can naturally occur. A future assessment / statement by the Society for Diving and Hyperbaric Medicine (GTÜM), as a medical and scientific society, would replace the corresponding sections of this statement.

preamble

In the last few days, an article by colleague Dr. Frank Hartig (senior physician at the Joint Institution for Internal Emergency and Intensive Care Medicine at the Medical University of Innsbruck) has attracted a lot of attention, especially on social media. Mission divers from the DLRG have also turned to us, unsure, which is why we would like to classify the current state of knowledge at this point.

The article itself represents an observation of the author from his professional activity, it is not a scientific study. Due to the work in a university clinic, the question may be raised as to whether the patients seen are really representative or whether predominantly severe / complicated cases are seen.

Oxygen administration in COVID19 disease

To date, no causal (causal) connection between the administration of oxygen and an increased severity of a COVID19 disease or obligation to intubate is known. Oxygen should therefore continue to be administered according to emergency and intensive medical standards. The current position paper of the German Society for Pneumology and Respiratory Medicine e.V. (DGP) ii expressly recommends an oxygen therapy as an escalation level in connection with COVID19 as long as there is no indication for endotracheal intubation.

Due to the risk of aerosol formation, adequate personal protective equipment (eye protection, N95, FFP2 or FFP-3 mask, gown) must be ensured when oxygen is applied.

COVID19 disease and subsequent suitability for diving

COVID19 is a disease with a very wide range of disease severity, asymptomatic courses are known as well as severe respiratory insufficiency with subsequent patient death. The vast majority of patients have mild courses. Against this background, a differentiated assessment of the question of fitness for diving is necessary.

From the SARS epidemic 2002 (SARS-CoV) it is known that after viral pneumonia, pulmonary changes (mostly post-infectious infiltrates in imaging or the like) last for a long time, but decreased continuously in the follow-up over two to three years and in most cases completely disappeared. Significant functional restrictions were rarely associated with it. The most common limitation of CO diffusion capacity also normalized in most cases.

Therefore, at the present time, the following procedure is recommended regarding the question of fitness for diving:

  1. With the detection of SARS-CoV2 or diagnosis COVID19, an existing suitability for diving expires. The (re) issue of fitness for diving should only be carried out by a physician qualified in diving medicine. The mere resolution of the symptoms, as with a flu infection, is not sufficient.
  1. In the case of mild illness (outpatient treatment or inpatient treatment without oxygen requirement / without signs of respiratory insufficiency), the suitability for diving can be assessed after one month without symptoms. Unless there are any other contraindications, due to the impact on organ systems or functions (e.g. cardiac and thromboembolic complications), diving suitability can be given in the case of normal lung function (spirometry). If the suitability for diving was re-issued, the initial findings of the spirometry should be used for the comparison during the initial suitability test.

[Personal observation in Robin Engert’s pneumological practice: Patients who have undergone SARS-CoV-2 infection and are symptom-free practically never show any abnormalities in body plethysmography / lung function examination, blood gas analysis or CO diffusion capacity]

  1. In the case of a serious illness with respiratory insufficiency (ventilation, COVID19 pneumonia, significant changes in thoracic imaging), a check diagnosis recommended in the inpatient discharge report should be completed first. After severe courses, there should be a symptom-free interval of at least three months, or rather six months due to the not yet fully known pathophysiology, before the fitness for diving is checked.

With regard to suitability for diving, special attention should be paid to post-infectious scars, in particular pleural adhesions, pulmonary cavities after tissue destruction and / or fibrotic changes. If there are indications of these changes, e.g. Previous findings of inpatient treatment, the additional implementation of an HR-CT of the lungs is required for further assessment.

Otherwise, the suitability for diving, after excluding other contraindications, if organ systems or functions are affected (e.g. cardiac and thromboembolic complications), if the pulmonary function is normal (spirometry).

If the suitability for diving was re-issued, the initial findings of the spirometry should be used for the comparison during the initial suitability test.

If there are still complaints more than three months after discharge, a further medical examination (pneumology, cardiology, etc.) is indicated regardless of the question of fitness for diving.

COVID19 disease and hyperbaric oxygen therapy (HBO)

Studies have been registered regarding a possible therapeutic indication for hyperbaric oxygen therapy. There are currently no meaningful and reliable results.

Authors for the management of medicine (in alphabetical order):

  • Robin Engert (specialist for internal medicine and pneumology, doctor for diving fitness examinations GTÜM)
  • Professor Dr. Björn Jüttner (specialist for anesthesiology / intensive care medicine, diving and hyperbaric medicine GTÜM)
  • Professor Dr. Kay Tetzlaff (specialist in internal medicine and pneumology, diving and hyperbaric medicine GTÜM)
  • Karsten Theiß (specialist for pediatric and adolescent medicine, diving doctor GTÜM)

 

i https://www.wetnotes.eu/tauchen-nach-covid-19-erkrankung/

ii https://pneumologie.de/aktuelles-service/covid-19/?L=0