Corona crisis: Joint statement by the Society for Diving and Hyperbaric Medicine (GTÜM), the medical director of the German Life Rescue Society (DLRG) and the medical department of the Association of German Sports Divers (VDST) on “diving after COVID19 disease”
In the last few days, an article by his colleague Dr. Frank Hartig (Senior Consultant at the Joint Facility for Internal Emergency and Intensive Care Medicine at the Medical University of Innsbruck), especially on social media. Unsettled divers and doctors have turned to us, which is why we want to classify the current state of knowledge at this point. The article itself is an observation of the author from his professional activity, it is not a scientific study. Due to the work in a university hospital, the question may be raised as to whether the patients seen are really representative or whether predominantly severe / complicated cases are not seen.
To date, there is no known causal relationship between the administration of oxygen and an increased severity of COVID19 disease or the need for intubation. The administration of oxygen should therefore continue to follow emergency and intensive care standards. The current position paper of the German Society for Pneumology and Respiratory Medicine e.V. (DGP) ii expressly recommends 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, sufficient personal protective equipment (eye protection, FFP2 or FFP-3 mask, gown) must be ensured when oxygen is applied.
COVID19 is a disease with a very wide range of disease severity; asymptomatic courses are just as well known as severe respiratory insufficiency with subsequent death of the patient. The vast majority of patients show mild courses. Against this background, a differentiated assessment of the question of suitability for diving is necessary.
From the SARS epidemic 2002 (SARS-CoV) it is known that pulmonary changes (mostly post-infectious infiltrates in the imaging or similar) persist for a long time after a virus pneumonia, but decreased constantly in the follow-up over two to three years and in most cases Cases completely disappeared. Significant functional restrictions were rarely associated with it. The most common limitation of the CO diffusion capacity also normalized in the course of most cases.
The following procedure is therefore recommended at the present time with regard to the question of suitability for diving:
If there is evidence of COVID19, any existing diving fitness will expire.
If there is evidence of SARS-CoV2 or a COVID-19 diagnosis, any existing diving fitness will expire. The reassignment of diving fitness should only be carried out by a doctor who is qualified for diving medicine. Simply subsiding the symptoms, as with a flu-like infection, is not sufficient.
In the case of mild illness (outpatient treatment or inpatient treatment without oxygen requirement without signs of respiratory insufficiency), fitness for diving can be assessed after one month of symptom-free treatment. Unless there are any other contraindications due to organ systems or functions being affected (e.g. cardiac and thromboembolic complications), fitness for diving can be granted with normal lung function (spirometry). In the event of a reassignment of the fitness to dive, the initial findings of the spirometry should be used for comparison during the initial fitness test.
Personal observation in Robin Engert’s pneumology practice: Patients who have been infected with SARS-CoV-2 and who are free of symptoms practically never show any abnormalities in body plethysmography / lung function tests, blood gas analysis or the CO diffusion capacity.
In the case of severe illness with respiratory insufficiency (ventilation, COVID19 pneumonia, significant changes in the thoracic imaging), a check-up diagnosis recommended in the inpatient discharge report should first be completed. After severe courses, there should be at least a three-month, symptom-free interval, due to the not yet fully known pathophysiology, before the suitability 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. When there are indications of these changes, e.g. Preliminary findings of the inpatient treatment, an additional HR-CT of the lungs is required for further assessment.
Otherwise, after excluding other contraindications, if organ systems or functions are affected (e.g. cardiac and thromboembolic complications), if the lung function is normal (spirometry), fitness for diving can be granted. In the event of a reassignment of the fitness to dive, the initial findings of the spirometry should be used for comparison during the initial fitness test.
If there are still complaints more than three months after discharge, further medical clarification (pulmonology, cardiology, etc.) is indicated regardless of the question of suitability for diving.
Studies have been announced regarding a possible therapy indication for hyperbaric oxygen therapy. Meaningful and reliable results are currently not available.
