SDBA Medicals Ltd
40 Royal Avenue
Worcester Park
Surrey
KT4 7JU

 

email: mhdowns@btinternet.com
telephone: +44 (0) 7802 895853
www.ukoffshoremedicals.co.uk
www.scuba4fun.org.uk

Recreational Diving after having Covid-19

What are the issues with Covid-19 and safe diving?

The coronavirus pandemic has been sweeping around the world since early 2020, which has changed the way many of us live. Leisure pursuits were largely suspended, people were encouraged to keep at least 2m apart and to avoid physical contact wherever possible. The usual behaviour for recreational diving is in buddy pairs and both rely on each other to assist when needed and therefore should maintain close contact with each other. Therefore, recreational scuba diving was not advised for most of the lockdowns. Recently many areas in the world are trying to resume more normality and the recreational diving industry is beginning to recover.

 

It is now well known that Covid-19 can seriously damage the lungs and heart. For those that survive Covid-19 (probably 98% of those infected) we do not know yet how many will have permanent significant damage and how many will only have temporary damage, but for an unknown duration.

 

Lung damage is a significant risk factor for pulmonary barotrauma on ascent in the water. The lung damage may also increase the risk of developing a right-to-left heart shunt leading to decompression illness in a similar manner to those with a Patent Foramen Ovale (PFO.)

 

Heart damage may increase the risk of developing cardiac arrhythmias and myocardial infarction underwater. It may also lead to a decompensation with exercise induced hypoxia.

  

Dr Frank Hartig, an Austrian physician reported on Wetnotes that of the many patients that he had treated 6 were divers. None were admitted to hospital and were sent home to self-treat. He reviewed them 6 weeks later when all reported that they were well, clinical examination was normal. However, he referred them for CT scans and 4 had serious lung damage. 2 had developed a reactive airways disease (asthma like) and 2 became hypoxic on exercising. This tells us that even though with supposed mild illness, that does not require hospital treatment, significant lung and heart disease may develop which would be dangerous for diving.

 

How many people have had Covid-19?

We are unlikely to ever know exactly how many will have had Covid-19. Tests were not available in the early months of the pandemic. Many people with symptoms either did not have access to testing or for some reason chose not to be tested, even when tests were freely available. Some who had a positive self-test chose not to report this result. Therefore even the 'official' figures are considered to be a gross underestimate.

 

 

As of the end of December 2021 nearly 13 million people have officially tested positive in the UK. Estimates of the true number range between double and triple that number. Therefore the potential number of divers who have been infected is likely to be very high.

 

Guidelines for the medical assessment of divers post Covid-19

 Significant online reports relating to this are available at:

1)      Dr Frank Hartig’s case series - https://www.wetnotes.eu/tauchen-nach-covid-19-erkrankung/

2)      Belgium Society of Diving’s guidance on assessing divers – 12th April 2020 http://www.eubs.org/wp-content/uploads/2020/04/2020-0412-Position-of-the-BVOOG.pdf

3)      UC San Diego Guidelines for Evaluation of Divers during COVID-19 pandemic – 8th May 2020
https://health.ucsd.edu/coronavirus/Documents/UC%20San%20Diego%20Guidelines%20for%20Evaluation%20of%20Divers%20during%20COVID-19%20pandemic.pdf

4)      European Underwater & Baromedical Society’s guidance on assessing divers – 21st May 2020
http://www.eubs.org/wp-content/uploads/2020/05/English-EUBS-ECHM-position-on-diving-and-COVID-19-21st-May-2020.pdf

5)     UKDMC guidance - 30th June 2020.  http://www.ukdmc.org/medical-conditions/coronavirus-covid-19/
The UKDMC have decided to take a cautious approach to recommending fitness to dive in relation to proven, suspected or symptoms compatible with Covid-19 infection. They recommend using a scorecard to assess risk, but even with a score of Zero they believe the risk of lung changes to be 5% due to having had an asymptomatic infection. Therefore, all divers will need to accept this potential risk. Diving abroad will, therefore, be of considerable risk as many, if not all, of the insurers may not provide assistance for Covid-19 related problems. Any diver who has needed hospitalisation for Covid-19 symptoms is rated as very high risk and should not return to diving for at least one year, and then only after full assessment. Anyone else who has had one or more of the potential symptoms of Covid-19 since January 2020 (fever, cough, shortness of breath, loss of taste or smell) should not dive for at least 3 months following return to full health and exercise capacity, and after full assessment by a diving doctor. Hence all divers need to review their need to see a diving doctor for assessment and what level of risk they find acceptable.

  

This is my review and is for information only. All divers should read the guidance for themselves and decide what is applicable to them. Divers presenting to myself for advice will have individual medical and risk assessments.

 

Covid-19 screening algorithm:

 

 

NO

YES

Q1

Since January 2020 have you had any symptoms suggestive of Covid-19 infection?

(See below for symptoms)

Go to Q2

Go to Q3

Q2

Have you had a positive test for Covid-19?

Go to A

Go to Q3

Q3

Have you been admitted to hospital or been treated with supplemental oxygen?

Go to B

Go to Q4

Q4

Have you needed respiratory support e.g. ventilation?

Go to C

Go to D

Possible symptoms of Covid-19:

·         Fever / chills

·         Loss of appetite

·         Fatigue

·         Cough / shortness of breath / sore throat

·         Muscle pain / aches

·         New loss of smell or taste

 

Advice of when to resume diving and what tests may be needed:

A – Although you are at low risk you may have had an asymptomatic infection. Whether you choose to have a medical assessment or not will depend on your view on personal risk.

B – Refrain from diving for 1 month from date of diagnosis or from full resolution of all symptoms, whichever is the latest date. Spirometry and exercise tolerance test with oxygen saturation monitoring recommended. Those that have had a positive test but absolutely no symptoms may like to consider medical evaluation after 2 weeks from the test date and return to diving if the assessment is satisfactory.

C – Refrain from diving for at least 3 months after resolution of all symptoms. Spirometry, High resolution CT of lungs and exercise tolerance test with oxygen saturation monitoring recommended.

D – Refrain from diving for at least 3 months after full recovery. Advised full assessment by both Respiratory and Cardiology specialists.

 

Only spirometry was included in my Pre Covid-19 medicals, all other tests will be at additional cost.

Medical assessments require close contact. Spirometry and exercise testing result in powerful exhalations that will allow respiratory droplets potentially infected with coronavirus to be spread rapidly. Therefore these assessments are high risk. These medicals will still need to be conducted with PPE and disinfection protocols. More information on having a medical with Covid-19 protocols.

 

Official statistics show that there have been over 12 million, and rising, Covid-19 cases in the UK. This is noted to be an underestimate as testing was not widely available for the first wave of the pandemic and even now if people aren’t getting much in the way of symptoms they may not bother to get tested. So a large number of recreational divers are likely to have been infected.

Depending on which dive agency you dive with you will probably need to complete either the RSTC medical statement (commercial agencies such as PADI) or the UKDMC medical form (club based such as BSAC.) Both have been updated to include questions on Covid-19 infection and a positive response requiring an assessment by a doctor.

Those required to complete the UKDMC form will need to see a UKDMC medical referee, those using the RSTC medical form can technically be assessed by any doctor, although in reality most UK GPs no longer provide recreational diving medicals. There are not many approved diving doctors in the UK and most have other posts within the NHS keeping them very busy dealing with the pandemic. It is not likely to be easy to access diving medical consultations for the foreseeable future and even harder to access lung and heart investigations if needed.

All divers should be encouraged to complete medical screening forms honestly and accurately. If indicated medical assessment should be completed before any in water activity. Remember that a diving accident can have serious effects on family members, rescuers and bystanders as well.

My provision of a medical assessment service is not an endorsement that it is safe to dive, you should only resume diving if your risk assessment is satisfactory and acceptable to all concerned.

Updated 30th December 2021