What is Covid? What are the symptoms of the disease? What does Covid mean for you as a diver?
Covid is today very present in media. A lot of action is taken to prevent further spreading of the disease, but what does Covid mean for you as a diver?
Today, I want to explain to you simple rules to prevent an infection, and how to come back to diving after infection with Covid-19.
Hello together, my name is Doctor Manuela Schoch, I'm an anaesthesiologist & specialist for intensive care medicine, and I'm living in Germany.
The hospital I'm working at is a competence centre for patients with Covid-19, and my daily work is related to respiration, and respirators.
I'm a physician for diving medicine, and an active GUE diver. I'm as well an Instructor, and Instructor Trainer for DAN & GUE live support classes.
But what is Covid? First, let me explain what the disease, Covid, exactly is and what it does. Covid is an infection with the new Coronavirus SARS-Cov-2
This virus attacks primarily the respiration system & the lungs, and the main targets are the lung cells, and as you know,
there are more effects on other organs like the heart, the liver, the spleen, and the central nervous system (CNS) including the brain.
The mechanisms are various, and not completely understood, yet.
The main side effect is an inflammatory reaction of the body. It can cause direct damages like Myocarditis, and this is an inflammation of the heart muscle.
Other symptoms can be related to a higher probability to develop a Thrombosis. This can happen in various locations in the body
and occur with different severity. This Thrombosis can lead to clotting of blood vessels, and lead to damage the brain, the kidney, liver, and the CNS
by reduced circulation. In severe cases, patients can develop a septic shock when the inflammation gets out of control. We call this a "Cytokine Storm"
with an enormous risk of death. And what are the symptoms of the disease? General symptoms at the beginning of the disease
are flu-like symptoms, with fever, headache, and muscle pain. Additionally, people are complaining about the loss of taste,
and smell, stomach pain, with digestion problems and less appetite can occur. When the sickness gets more severe, you can have dry cough and dyspnea,
these are symptoms that contribute to the lung, with Pneumonia, and in later stages, the lung tissue can even be destroyed!
Other symptoms of Heart contribution are developing a cardiomyopathy, with loss of fitness, then there is a high risk of getting a heart attack.
And as I said before, all symptoms of Thrombosis or embolism are possible.
What do I see in the hospital I work in? I see a high a variety of symptoms and severeness. We have a definition of 3 stages of severeness,
at first, mild cases, they can cured at home, they are comparable to a strong flu. People with the medium stage, with medium to strong symptoms,
these patients are hospitalised, and often oxygen or medical treatment is needed. And the people with the heavy symptoms, the 3rd stage, these patients are at the IMC,
or ICU in the hospital. In these cases, respiratory support with a mask or tube ventilation is indicated, mostly because of the A.R.D.S, the Lung Failure.
It should be mentioned that about 10-20% of the hospitalised patients need an IMC or ICU, and sadly, up to 40% of these Covid patients on the ICU, they die..
And this is the reality I see in my hospital.
Next question is, what are he risk factors for developing a Covid disease? First, a higher age or/and pre-existing illnesses like Coronary sickness r other heart failures.
Diabetes & Obesity are also risk factors, and long term smoking, this is a risk factor for developing a Covid disease.
But how do you get infected? The spreading of the Covid happens by incorporating (inhaling) infectious drops. Mostly by aerosols in the air
coming into contact with mucosa. Aerosols are droplets that float in the air. They can exist for long time, depending on the situation, even longer than 30 minutes,
and in these droplets, the virus stays active. The big problem with this new disease is the prolonged incubation time of 5-7 days, and during this time, the virus can be spread.
That means the infected person can spread the virus without knowing that he/she(they) are infected. With this, the virus reaches a lot of people.
So, how can I prevent getting infected? First of all, protect myself from Aerosols & droplets. And how do I do this? Keep your distance, follow hygienic rules,
and WEAR A PROTECTION MASK!
Even easy ones help a lot. So, here you can see an FFP2 mask. This is very tight, seals well, and is used in hospitals.
And here, this one, this is a simple cotton mask, easy to breath, and still pretty effective in retaining aerosols and droplets
But, how does Covid affect us as divers? At first, the lung. The lung tissue gets mouldy, and this leads to auto-diffusion and reduced gas exchange in the lung.
This can br critical for CO2 retention and decompression behaviour. Also air trapping is possible, and the risk for Barotrauma and Pneumothorax is rising after Pneumonia.
For the Heart, a residual Heart failure reduces the fitness and increases the risk for heart attack. For the CNS (central nervous system), it is reported
that the cognitive deficiency can last for a long time (up to a month). Thrombosis, Embolism, because of the diver's Diuresis, the risk of these is already higher,
the additional affect from Covid infection increases the risk further.
What do I suggest to divers asking for medical advice after infection. So in this situation, it is individual, and depends on the symptoms.
Generally speaking, for Germany & Europe, the medical clearance for diving becomes invalid after Covid infection. In general, a detailed physical
exploration, with additional tests like Spirometry, ECG, is needed. There are international recommendations for returning (after a Covid infection) to diving.
They depend on the severeness of the illness. So, if you had mild symptoms, when the symptoms are gone, just one month no diving, and then you can ask for a medical
examination & clearance. If you had medium-strong symptoms, when the symptoms are gone, three months no diving and then you can go to the doctor
and ask for medical examination & clearance. If you were suffering from a severe sickness, when the symptoms are gone, after three to six months no diving, then,
medical examination & clearance is possible to ask for, and in this case, additional tests are needed. So what can I say for mild symptoms
which are the most common? For mild symptoms, in just one week recovery, the risk of permanent damage to the lung, to the heart, or to the brain is very low.
But after all, there are discussions going on (to see) if Covid is an absolute contra-indication for diving. But this is not clear yet.
So please, don't just go diving after Covid infection. First, see a doctor.
So to sum all this up, Covid can be a really dangerous illness that affects us as divers heavily. So please follow the rules to prevent an infection: distance, hygienic rules, wear a mask!
Take care of your general health, and once you've got infected, see a doctor before you return to diving. We are all still learning what this disease means for divers
and more evidence is needed. For this, DAN set up a study with divers who had a Covid infection where you can participate. For more information about the DAN study
please find the link in the comments, under this video. So that's in from my side, I hope you found this video helpful, please take care, stay healthy
hope to meet you all again somewhere in the world diving when the situation is back to normal, goodbye and see you soon!