COVID recovery and high gas usage

[WS007]

Another thing to consider is potential for positive swab even months after resolution of symptoms, which could lead to everyone on your liveaboard getting quarantined. Might be better to take 6+ months to heal, then do a single dive locally to see how you do before any big travel.

Hi Nootfish,

I have never heard that someone who has recovered from Covid will produce a positive test afterwards. Here in Austria, where I live, one needs to pass a negative PCR test after Covid infection, in order to be released from quarantine...

Wolfgang

 

[WS007]

Just a short update of my recovery after Covid vaccination break through infection and diving, in case someone is interested:


On October 20th, I had a CT of the thorax. In comparison to pre Covid CTs, "minimal edema" could be found in both lung wings (maybe I should not have told the radiologist that I have had Corona previously). Both the diving physician from DAN (Dr. van Laak) and my local diving physician here checked the outcome of the CT and said it is not excluding fitness for diving, but in addition to the CT a new medical examination for diving fitness is required before I can scubadive again safely...

Yesterday (November 9th), I had my medical examination, including pulmonary function test, and passed it (although not with the best marks, that I have normally), so I can go for the diving holiday in Egypt (November 17th to December 8th), that I have booked before the corna infection...

I must however say that the pulmonary function test was not the optimum with only 88% and in pre Covid tests the performance was better...

Still I cannot say whether my air consumption will be higher, but I will be able to update in December, when I am back. I would be also interested to hear how Lucky is doing (did the air consumption already normalize?) and wish him the best...


Wolfgang

 

[uncfnp]

Hi Nootfish,

I have never heard that someone who has recovered from Covid will produce a positive test afterwards. Here in Austria, where I live, one needs to pass a negative PCR test after Covid infection, in order to be released from quarantine...

Wolfgang

Hi WS007. I am sure each country sets their own standards but the CDC in the US has recommended against standard retesting after covid. Antigen and PCR tests do not check for active infection but rather viral particles. Since the PCR test of the two is the most sensitive it is also the most likely to detect viral material when there is no live virus. So one can continue to test positive after one is no longer contagious, in some studies for up to 3 months though that is the extreme.

 

[WS007]

Hi WS007. I am sure each country sets their own standards but the CDC in the US has recommended against standard retesting after covid. Antigen and PCR tests do not check for active infection but rather viral particles. Since the PCR test of the two is the most sensitive it is also the most likely to detect viral material when there is no live virus. So one can continue to test positive after one is no longer contagious, in some studies for up to 3 months though that is the extreme.

This is interesting. Can you provide the link for this recommendation or is it just the CDC statement that testing of freshly recovered people just not regarded to be necessary ("People who have tested positive for COVID-19 within the past 3 months and recovered, as long as they do not develop new symptoms, do not need to get tested.")...

I had a quick look using Google and found that in fact some people have been found to be PCR positive many weeks after recovery from Covid. This is attributed to integration of at least part of the genetic information of the virus into the genome of the victim (documented to occur by a scientific publication in PNAS, but still enigmatic since Covid-19 is not a retrovirus). In these people the PCR test continues to give positive results, long after the end of active infection. I could not find an example where someone was PCR tested negative and later the PCR test was again positive (unless a second infection had occured). Here in Austria quarantine after infection is only over after negative PCR testing (I do not know, however, how they deal with the few people that continue to give positive PCR results, even long after the disease).
In my case I have been tested negative already on September 15th and unless I get infected again a positive PCR test is not expected (at least I hope so).
As far as I understand it, the potential troublemakers are the non-vaccinated divers: the current regulation in Egypt is that only non-vaccinated divers have to undergo a PCR test, when they leave a Safari boat. However if this guy is positive, all the others have to go to quarantine too...


Wolfgang

 

[uncfnp]

It’s been months since I have accessed the studies but I will link as I have time
(packing for my first Bonaire trip since covid ).

This is interesting. Can you provide the link for this recommendation or is it just the CDC statement that testing of freshly recovered people just not regarded to be necessary ("People who have tested positive for COVID-19 within the past 3 months and recovered, as long as they do not develop new symptoms, do not need to get tested.")...

It is actually based more on its lack of usefulness in the healthcare/public health setting from what is currently known about the virus and transmission. It is also among the reasons that US residents returning to the states after international travel are not required to present a negative covid test if recently infected. They do have to have documentation of an infection in the past 3 months and that end of isolation criteria has been met.

Some of the relevant information…

Healthcare Workers

COVID-19 guidance, tools, and resources for healthcare workers.

www.cdc.gov

Highlights…

“Patients who have recovered from COVID-19 can continue to have detectable SARS-CoV-2 RNA in upper respiratory specimens for up to 3 months after illness onset in concentrations considerably lower than during illness; however, replication-competent virus has not been reliably recovered and infectiousness is unlikely. The circumstances that result in persistently detectable SARS-CoV-2 RNA have yet to be determined. Studies have not found evidence that clinically recovered adults with persistence of viral RNA have transmitted SARS-CoV-2 to others. These findings strengthen the justification for relying on a symptom-based rather than test-based strategy for ending isolation of most patients.”

More detail…

“The likelihood of recovering replication-competent (infectious) virus is very low after 10 days from onset of symptoms, except in severely ill or immunocompromised people.

• For patients with mild-to-moderate COVID-19, replication-competent virus has not been recovered after 10 days following symptom onset for most patients.(8, 9, 20- 24) Outliers exist; in one case report, an adult with mild illness provided specimens that yielded replication-competent virus for up to 18 days after symptom onset.(25)
• Recovery of replication-competent virus between 10 and 20 days after symptom onset has been reported in some adults with severe COVID-19; some of these individuals were immunocompromised.(7)However, in this series of patients, it was estimated that 88% and 95% of their specimens no longer yielded replication-competent virus after 10 and 15 days, respectively, following symptom onset.
• Detection of sub-genomic SARS-CoV-2 RNA or recovery of replication-competent virus has been reported in severely ill or severely immunocompromisedpatients beyond 20 days, and as long as 144 days after a positive SARS-CoV-2 test result.(1-5)
• Prolonged detection of replication-competent virus may be associated with other factors. For example, a 13-year-old immunocompetent male was hospitalized for injuries received in a motor vehicle crash. He required intubation, developed pulmonary infiltrates, and tested positive for SARS-CoV-2. Viral cultures of upper and lower respiratory tract specimens were positive for SARS-CoV-2 on days 47 and 54 of his hospitalization.(26)”

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had a quick look using Google and found that in fact some people have been found to be PCR positive many weeks after recovery from Covid. This is attributed to integration of at least part of the genetic information of the virus into the genome of the victim (documented to occur by a scientific publication in PNAS, but still enigmatic since Covid-19 is not a retrovirus).

I am aware of the study you referenced but it is not commonly used among my colleagues so know little about it, it’s validity or the extent, if any, it has impacted current policy.

I could not find an example where someone was PCR tested negative and later the PCR test was again positive (unless a second infection had occured).

This happened very early on in the pandemic. Individuals previously cleared retested positive and it raised an alarm about reinfection. I believe much of it was from Korea. I will try and find the relevant info.

 

[Tracy]

From the experience with similar cases, I do not see any suitability for diving for you in the coming months, if only because all restrictions must be resolved before a positive decision is made, so there is no "post-covid" or even "long covid syndrome" developed.

Best regards - Dr. U. van Laak"

I will keep people here updated, since I believe that this is of potential interest for many and the number of affected, vaccinated, divers will increase...
Wolfgang

I am in no way discounting DAN's advice or usefulness. They are a wonderful organization doing good things for diving.
That said, their blanket answer to most issues has been "you should stop diving" in my experience.
It is an easy answer that is always correct. Only a physician experience with dive medicine that physically examines you in person can give a better answer.

 

[tursiops]

That said, their blanket answer to most issues has been "you should stop diving" in my experience.

Other experience seems to vary. You must ask the really hard questions!

 

[Tracy]

Other experience seems to vary. You must ask the really hard questions!

I always say, if you are going to screw up, do it big, take notes, and try to help others avoid it.

 

[rddvet]

I am in no way discounting DAN's advice or usefulness. They are a wonderful organization doing good things for diving.
That said, their blanket answer to most issues has been "you should stop diving" in my experience.
It is an easy answer that is always correct. Only a physician experience with dive medicine that physically examines you in person can give a better answer.

Agree. I find more than in the past you get blanker answers of "consult your physician", go to the ER to be transferred to a chamber (after calling for a minor question related to minor skin bends), and "stop diving"

 

[Catito]

I have more information regarding my recovery, but it does not sound good: I contacted DAN for advise and they say that diving fitness is no longer given after a Corona infection, even after mild symptoms. I am now in contact with my diving physician and will proceed with examinations as he will suggest...
=> I strongly suggest Lucky to go for a diving doctor for advise (in case you are not already in treatment anyhow)...

Here is what I have written to DAN Europe (translated from german via Google):
"I ask for medical advice: During a diving holiday at Fernsteinsee / Smarangersee I was infected with the Delta Mutant, although I was vaccinated with Biontech / Pfizer in February and March 21, I am 65 years old. Mild symptoms (headache, sore throat, cough, dry eyes, after 1 week massive diarrhea (- 5kg; 2/3 of it dehydration), no fever, lungs little affected (occasional stinging)). Illness from 1.9. - 15.9 - rather tedious; on September 15 PCR test negative and official ordered quarantine was cancelled on September 17th). I feel better every day (yesterday, September 20th, I went to the sauna for the first time). I also booked a three-week diving holiday in Egypt (Nov / Dec 21) even before the corona disease. Now it is a matter of carefully returning to normal again. I am reluctant to cancel my diving vacation, my plan is as follows: # 1 .: At the end of the week (September 17th), carefully restart sporting activities (cycling and swimming with fins). # 2 .: Depending on the course of recovery, another fitness test or not (last was July 21st). # 3 .: If recovery is sluggish, what imaging of the lungs is recommended to get to the bottom (CT, NMR) in order to decide on a diving vacation? Thank you, LG, WS"

Here is the answer from DAN Europe (translated from German via Google):
"Dear Mr. Scheibmayer,

But you have had to experience great bad luck, which unfortunately does not allow any other answer than this:

After a Covid-19 illness, as you have experienced it, there is no longer any fitness to dive as long as it has not been confirmed by a diving doctor. The severity of your illness, the fact that it was most likely the more dangerous Delta variant and that pulmonary involvement cannot be ruled out, but is even probable, makes a pulmonary examination necessary (at least a large pulmonary function examination, possibly also a CT) must include. With these results, your diving doctor will have to make further decisions.

From the experience with similar cases, I do not see any suitability for diving for you in the coming months, if only because all restrictions must be resolved before a positive decision is made, so there is no "post-covid" or even "long covid syndrome" developed.

Best regards - Dr. U. van Laak"

I will keep people here updated, since I believe that this is of potential interest for many and the number of affected, vaccinated, divers will increase...
Wolfgang

Oh wow. Sorry.