26 May 2020
Dr Doug Watts, Medical Director DDRC:
Back in March the doctor team at DDRC wrote an article about why we thought that it was sensible to put our recreational diving plans on hold. After the British Diving Safety Group released their statement suggesting a cautious return to shore diving many of us are thinking about our next dive. So now seems like a good time to think about the issues surrounding safety and returning to diving.
A quick disclaimer – this is a new illness which the medical community is learning about. As such we have no long term data and our understanding is poor compared to most other medical problems. This is very much a well intentioned opinion based on the little that we do know and extrapolating data from other diseases. As our understanding increases I’m sure that recommendations will change.
Why return to diving?
I think for most of us this doesn’t need to be explored in too much detail! However, I think that it does need to be said that diving brings many people a lot of joy and this shouldn’t be underestimated. As doctors, we spend a lot of time minimizing risk and it’s easy to lose sight of the many positives that diving brings to our general wellbeing, in addition to our fitness and mental health.
Another consideration is the economic cost to the dive industry. The dive industry in the UK has also been hit hard by the Coronavirus epidemic and many of us want to support the dive charters and shops who have supported us in the past.
An argument which we made in March was that a diving accident would place unnecessary strain on the Emergency services and on hospitals which might be overwhelmed with patients with Covid-19. Thankfully here in the South West hospital admissions for patients with Covid-19 remained low in comparison to the rest of the country and our local hospitals were not overwhelmed. Some hospitals are still under a lot of pressure however and things may change quickly.
Here at DDRC, we have put a lot of plans in place to ensure that we maintain our emergency capability and have done so 24 hours a day for this whole period. This is not just for recreational divers who might not have heeded our advice – but for essential commercial diving workers and cases of Arterial Gas Embolism (AGE) which can occur in non-divers.
Practically, I think that we all recognise that the NHS is still under some unique pressure and that the last thing any of us want is a diver needing to be rescued or requiring hospital or hyperbaric treatment. Therefore, we’d encourage everyone to follow the advice of the BDSG with regards to adding conservatism and extra caution into their plans.
Social distancing and diving
There is a huge challenge for all of us to maintain social distancing whilst returning to normal activities. I think that the diving industry in some ways has a head start here – divers are trained to consider risk objectively and to find ways to mitigate those risks. There is clearly lots of work to be done by training organisations, clubs, dive shops and individuals to finds ways to implement government guidelines. For the time being, shore diving seems like a reasonable activity to do with one person from another household, respecting social distancing and therefore staying within the government guidance and law.
General fitness following lockdown
Some divers will have made the best of being furloughed and may be emerging from lockdown fitter than when they entered. Many of us however have not been so diligent and are less fit and perhaps a bit fatter.
Obesity and poor levels of fitness are real risks for divers. For most dives that go to plan you don’t need to be fit. It’s when things don’t go to plan that your levels of fitness will make a difference between a close shave and a serious incident. Studies repeatedly show that the exertion required to rescue a diver is substantial.
So I would urge divers who are considering going back to diving this summer to firstly work on your fitness, and not to return until you can demonstrate to yourself and your buddy that you are fitter than when lockdown started.
What if I’ve had Covid – 19? Fitness to dive.
This is a topic of great debate at the moment within diving medicine. As this is a new illness we do not know what the long term consequences are and whether there are particular risks to divers. There is early evidence suggesting that even in those with relatively minor symptoms lung damage can persist. This kind of lung damage can be a significant danger for divers and may increase the risk of pulmonary barotrauma (pressure damage to the lungs), pulmonary oxygen toxicity or DCI. There is also concern about the heart and that damage to the heart may lead to immersion pulmonary oedema (IPO – fluid on the lungs from immersion).
For this reason I would strongly advise anyone who had symptoms of possible Covid-19, even if those symptoms were mild, to not return to diving for the moment. Get in touch with your local diving referee (check www.ukdmc.org) or book a telephone consultation with one of our doctors.
We hope to be starting research soon to investigate Covid-19 and the impact on divers lung function – if you have had Covid-19 and are a diver who wants to be involved then please follow us on social media for when we start recruiting!
Many of us might not have been diving since last summer or are considering UK diving after our usual overseas trip has been cancelled. I would urge people to get fit, be cautious and to ease themselves back to diving gradually and conservatively. Slowly build up to the kind of dives which you have previously been doing. I realise that there may be a sense of needing to make up lost time – but I think 2020 is not the year to break depth records and push exposure limits.
The right time to get back in the water is going to be an individual decision. Whenever that might be please stay safe. Although our emergency team is on standby we sincerely hope we don’t need to see you!
Best wishes from the whole doctor team.