Diving After COVID-19

[kitsap_diver]

Hopefully, I can do this without starting a firestorm. I'll start by saying that I appreciate that there is a lot of unknowns about COVID-19 and seeing as how Cave Diving is something I do for fun, I don't need to take any unnecessary risks, and have made the personal decision that I will get cleared by my physician with the partnership from DAN+ before returning to the water.



I received a positive COVID-19 test on 12/20, after my fiance was exposed at work (she is an essential employee). My fiance had tested positive on 12/10 and my effort to isolate from her in the house was apparently ineffective. I developed symptoms on 12/18 and they mostly cleared up by 12/23 although fatigue continued into the new year. I would say I"m 100% recovered now, and my personal physician gave me the all clear to return to physical activity like jogging.



My symptoms at the time were congestion, sore throat, cough, and high heart rate. I've found that a lot of people I talk to are nodding their head and saying "me too" when I mention high heart rate. I've talked to DAN+ and they said right now their recommendation is typically 6 months out of the water and then release from a physician. They have worked with some folks to get a physicians release after as little as 2-3 months, but cautioned me that involves some advanced imaging with primary concern being damaged tissues in the lungs and the integrity of the lungs structure.



Has anyone else elected to use the full DAN+ guidance to return to diving? Has anyone gone through the imaging and testing DAN+ is recommending? I'm just curious what's in store for me since I am electing to follow their guidance even though it is so impactful. I know a lot of people who are returning to diving sooner, and this impacts at least two planned trips to cave country, but I'd rather be safe than sorry.

[kensuf]

I'm not a doctor and I did not sleep at a Holiday Inn Express.

It seems the way that COVID-19 impacts people is highly variable, and while there are some things that may influence the way your body reacts, there may still be things that are unknown. A college basketball player, a guy that should be near the peak of his physical fitness, blacked out recently during a game. There has been speculation that it may have been influenced by myocardial infection left over from a COVID-19 infection.

The bottom line is really that how your body responds and recovers may be completely different from the way my body responds and recovers and completely different from the way Fred down the road responds and recovers. When it comes to a novel viral disease that impacts your cardiovascular system, I probably would seek guidance from real medical professionals that understand diving and have seen this disease in person rather than random people on the message boards.

BTW - there are several cave divers that may be able to provide some real feedback. Doug Ebersole is an obvious one to contact, he had COVID last summer and pretty much works on hearts for a living. Derek Covington at UF Health is another one that may be worth contacting.

Best of luck to you on your recovery

[twaldo]

I'm not a doctor and I did not sleep at a Holiday Inn Express.

It seems the way that COVID-19 impacts people is highly variable, and while there are some things that may influence the way your body reacts, there may still be things that are unknown. A college basketball player, a guy that should be near the peak of his physical fitness, blacked out recently during a game. There has been speculation that it may have been influenced by myocardial infection left over from a COVID-19 infection.

The bottom line is really that how your body responds and recovers may be completely different from the way my body responds and recovers and completely different from the way Fred down the road responds and recovers. When it comes to a novel viral disease that impacts your cardiovascular system, I probably would seek guidance from real medical professionals that understand diving and have seen this disease in person rather than random people on the message boards.

BTW - there are several cave divers that may be able to provide some real feedback. Doug Ebersole is an obvious one to contact, he had COVID last summer and pretty much works on hearts for a living. Derek Covington at UF Health is another one that may be worth contacting.

Best of luck to you on your recovery

I totally agree with Ken... except for that one small part... in this community I don't think any of us are "random people" and this is where I would start my research. Haven't had it or if I did, was unware... but the same for any diving, if I felt my cardiovascular status had changed I would definitely be speaking with someone more in the know, even if this is a great place to start that journey.

[kitsap_diver]

Thanks for the input. As I work with DAN+ and my physician I may certainly reach out to those folks you suggested.

What's interesting to me is that both of you triggered to the cardiovascular system (just like I did), and don't get me wrong that is significantly important; however, it is also I think what most people are pretty familiar with related to COVID. What surprised me was the concern DAN+ had for undiagnosed pulmonary concerns even though I never had any indications of COVID pneumonia or blood clots. DAN+ seemed very concerned about damaged lung tissue that may be asymptomatic on the surface, but problematic when breathing at pressure.

[twaldo]

Thanks for the input. As I work with DAN+ and my physician I may certainly reach out to those folks you suggested.

What's interesting to me is that both of you triggered to the cardiovascular system (just like I did), and don't get me wrong that is significantly important; however, it is also I think what most people are pretty familiar with related to COVID. What surprised me was the concern DAN+ had for undiagnosed pulmonary concerns even though I never had any indications of COVID pneumonia or blood clots. DAN+ seemed very concerned about damaged lung tissue that may be asymptomatic on the surface, but problematic when breathing at pressure.

Well we keyed on it because the two major systems that Covid seems to attack are pulmonary and cardiovascular (even though a major hint at having covid is loss of taste/smell and that really has nothing to do with either) and well... shortness of breath in a strenuous sport such as diving could be from either.... I could say more but I'd open myself up to a major flame war for ultimately suggesting you do EXACTLY what you are doing... getting checked out by an actual MD.

[TotDoc]

So I'm a doc who does hyperbaric medicine as a side gig. I'm curious...What imaging and testing are they recommending?
I've absolutely seen patients with lung changes that persist after covid infections, including fibrosis and even cavitation in the lungs, which would certainly be problematic. I've also seen a fair bit of heart inflammation (myocarditis) associated with infections, though the long term clinical significance of this isn't really known yet.
Eval by a doc familiar with dive medicine after symptomatic covid is absolutely a good idea before returning to diving.

[debersole]

Kitsap_diver -- PM me with your contact info. It is not a "cookie cutter" approach to returning to diving after COVID-19. When to return to diving is based on a multitude of factors -- your age, your other medical conditions, how sick you got with COVID-19 (asymptomatic but positive test, mildly sick, moderately sick but not hospitalized, or hospitalized), how you are currently feeling, and what your exercise capacity is now and compared to prior to getting sick. I am currently working on a manuscript with a PhD and several other diving medicine physicians (pulmonary, critical care, radiology, emergency medicine) to address a lot of the issues of how long to stay out of the water and what testing to consider before returning to diving based on all of the factors I mentioned above. Hopefully, we will be submitting it soon.

[Diverlee]

Some good info from the 2 doctors. Thank you.


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[kitsap_diver]

So I'm a doc who does hyperbaric medicine as a side gig. I'm curious...What imaging and testing are they recommending?
I've absolutely seen patients with lung changes that persist after covid infections, including fibrosis and even cavitation in the lungs, which would certainly be problematic. I've also seen a fair bit of heart inflammation (myocarditis) associated with infections, though the long term clinical significance of this isn't really known yet.
Eval by a doc familiar with dive medicine after symptomatic covid is absolutely a good idea before returning to diving.

I'm not sure at this point, they recommended that we start working on that process no sooner than 3 months after symptoms improve. I plan on talking to my physician this week and setting up an appointment for late February and ask my doctor to consult with DAN+ ahead of that appointment. However, from my short conversation it seems like what you've seen (fibrosis and cavitation) would be among their concerns. I'm not a doctor so I don't have the expertise required to talk fluently on this topic, but their two principle concerns seemed to be the integrity of the lungs. Would that be associated with fibrosis? And potential pockets for trapping gas that would result in some type of barotrauma. Would that be associated with the cavitation?


I plan to update this thread as I go through the process. My plan is to be transparent with the community so that others can have the see. The caveat to that plan is that this will be a slow process so I may go weeks without updates.

[mrki]

If a person has had a lung x-ray done after a covid infection, would that show any potential issues? Would a general physician notice them?

My girlfriend had an unusually long sickness a month or two after covid infection, had an x-ray done and was told that her lungs were ok. I'm wondering if that's a good enough diagnosis.

Thanks.