I had to translate this German article to English. It's a bit spotty in places but readable.

April 15, 2020

Diving after Covid 19 disease?

by editorial staff, wetnotes.eu

Target organ lung - diving after Covid 19 disease?

Dr. Frank Hartig heads the emergency department in Innsbruck (Tyrol) and is there in a hot spot of the corona pandemic. His team is confronted with many puzzles, especially regarding the massive changes in the lungs. The first six recovered divers received a preliminary bad news when it came to their routine fitness to dive.

In order to keep you up to date, the article from June issue 36 is already available as a free download: Diving to Covid-19 Disease_WETNOTES-36

And here to read directly:

Dear WETNOTES readers,

The corona pandemic is now part of everyday life and efforts to normalize as quickly as possible at all levels are becoming increasingly impatient. For us divers, however, I would like to branch off a few important observations from reality and the research pipeline. As you may know, I am not responsible as a diving doctor, but as an intensive care and emergency doctor for many weeks in the middle of the front line. I don't want to jump on the train of so-called experts. I'm just writing so much that the so-called Corona experts don't exist at all, because we all learn new things every day and many books have to be rewritten. The virologists or epidemiologists can currently only help us a little, even if they are quoted daily in interviews and articles. At the moment we are all only smarter afterwards. The countless reports reflect the entire spectrum from serious reporting to conspiracy theories.

Disturbing facts However, as a COVID-19 doctor who is definitely not an expert, I would like to draw your attention to a few exciting but also disturbing facts that will affect us divers.

In the past few weeks we have had COVID-19 patients of all ages from symptom-free spreader to intensive care patients on the heart-lung machine. The lungs are one of several target organs, and that clearly interests us divers.

Six active divers were among the sufferers. After we had to wait up to 32 hours for the test results in the first few days (so-called PCR test), the radiologists observed that a CT scan of the lungs showed such typical changes. So they quickly went on to do this chest CT in addition to the PCR test. CT was successful even in patients without cough or shortness of breath with only fever and suspicious COVID contacts. In the case of typical changes, the patient with corona pneumonia was admitted to the suspect station until the test result. In the meantime, this knowledge has also been published and the diagnosis does not always require a positive PCR test in the smear, but nowadays the typical CT image is often sufficient.

It was and is interesting that there is a remarkable discrepancy between the findings and the patient's feeling. Young people in their prime of age come to the emergency department on foot, have normal vital signs and subjectively do not require oxygen. And then they have these impressive bilateral infiltrates in their lungs that look like putting a wipe or two in a bucket of oil and pulling it out and hanging it up. Other patients have the same picture and come to the outpatient clinic with reduced oxygen saturation. Except for an increased breathing rate, which the patients hardly notice themselves, they are fine according to the circumstances, even though they have such bad blood gases that, according to the textbook, one should immediately think of intubation. If you give them 2 liters of oxygen, oxygen saturation will improve somewhat, but a few hours later many of them are in the intensive care unit with intubation and severe lung failure. Many colleagues have the feeling that the oxygen triggers a cascade. None of us know exactly what's going on here. It often looks scary. But let's not forget about 80% of the patients who put it all away as if it were nothing.

One of the triggers for this interim report is a contribution by one of the world's most recognized divers / diving medicine experts and grand engineers, who claims that you can cure Corona if you treat people with HBO / pressure chamber therapy. This proves how far away those colleagues from the front are brooding at their desks thousands of miles from the patient and want only the best for us.

The first controls of these six divers, who came to the controls clinically healthy after 5 to 6 weeks, are now exciting. In two of them, we saw significant oxygen deficiency when under stress as a typical sign of a persistent lung shunt. In two bronchial tubes, which are still very excitable during exercise, as in an asthmatics. Four of the six divers in the control CT still had impressive lung changes.

How it goes on is completely unclear, but for the WETNOTES reader it is now clear what I want to achieve:

None of the six divers can be released for diving for the time being despite their well-being.

Young, COVID-healthy people who want to dive again quickly and appear healthy at first could get through our hands.

Noticeable lung shunts from the lung consolidations are not good for diving.

Bronchial hyperexcitability / asthma are not good for diving.

Exercise hypoxemia is not good for diving.

An increased susceptibility to pulmonary oxygen toxicity is not good for diving.

And infiltrates / consolidations (lung areas that are not properly ventilated) are strict contraindications for diving of any kind anyway.

Of course, these effects also apply to freediving and scuba diving.

Consequential damage?

The extent to which long-term effects remain on the lungs is unclear and is currently speculative. We don't know how much of the changes will last. When looking at the findings, it is often difficult to believe in complete healing. What is certain is that those divers who, on the whole, feel healthy again, obviously still have serious findings even after many weeks, which in no way lead to suitability for diving.

Within the next few months, these examinations will also have to be discussed controversially within the diving doctors, namely whether divers should be examined differently or in more detail after a COVID infection. With this small number of cases, everything is still hypothetical and further studies will bring more clarity next year. But we are very vigilant.

Don't be reckless

My personal assessment is that the active diver after a surviving COVID infection should be examined very thoroughly by an experienced diving doctor from a diving medical point of view. And even better: a diving professional should do everything possible to avoid becoming carelessly sick with COVID-19, so group dives / diving excursions with the comment »everything, just no out-of-gas maneuver training« are in no way recommended and not really professional.

Unfortunately, we in Tyrol also have a large number of young patients in the intensive care unit. This is by no means about diving, but primarily about survival.

Our observations are currently in line with the publications, and we will certainly find out more about this from other research groups next year. The WETNOTES reader stays on the ball here.

Perhaps the idea that the hard withdrawal from diving or even financial ruin through these measures can ultimately save us from an even bigger catastrophe will help us.

Good air wherever you are,

Frank Hartig
Dr. Frank Hartig is a senior consultant at the Innsbruck University Hospital (emergency room, emergency room) and responsible crisis coordinator / disaster officer for SARS-Covid-19 patients.

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

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