Symptomatic or asymptomatic SAR-CoV-2 positive divers should be medically evaluated before returning to scuba diving.

Introduction: In order to allow the resumption of diving activities after a COVID-19 infection, French military divers are required to undergo a medical fitness to dive (FTD) assessment. We present here the results of this medical evaluation performed 1 month after the infection. Methods: We retrospectively analyzed between April 2020 and February 2021 200 records of divers suspected of COVID-19 contamination. Data collected included physical examination, ECG, blood biochemistry, chest CT scan and spirometry. Results: 145 PCR-positive subjects were included, representing 8.5% of the total population of French military divers. Two divers were hospitalized, one for pericarditis and the other for non-hypoxemic pneumonia. For the other 143 divers, physical examination, electrocardiogram and blood biology showed no abnormalities. However 5 divers (3.4%) had persistent subjective symptoms including fatigability, exertional dyspnea, dysesthesias and anosmia. 41 subjects (29%) had significant decreases in forced expiratory flows at 25-75% and 50% on spirometry (n = 20) or bilateral ground-glass opacities on chest CT scan (n = 24). Only 3 subjects were affected on both spirometry and chest CT. 45% of these abnormalities were found in subjects who were initially asymptomatic or had non-respiratory symptoms. In case of abnormalities, normalization was obtained within 3 months. The median time to return to diving was 45 days (IQR 30, 64). Conclusion: Our study confirms the need for standardized follow-up in all divers after COVID-19 infection and for maintaining a rest period before resuming diving activities.

Factors Determining Tourists Motivation To Visit A Place for Adventure Tourism: A Systematic Review

India is a country with diversity. It is the gift of nature wherein different rivers, mountains, hill stations, forts, caves, historical places are in the country. It is the social, cultural, religious, and geographical diversity. All these conditions are favourable for travel, tourism and hospitality in India. The young generation, use of technology, expert guidance, safety tools have paved the ways to adventure tourism not only in India but also in the world. The ‘adventure tourism’ is a niche form of tourism which includes deep exploration and extensive travelling to far-flung areas. It is based on the principle of ‘expect the unexpected.’ This is because it is closely association with greater risk as compared to other kinds of tourism. Some of the best examples could be rock climbing, mountaineering expedition, trekking, river rafting, Scuba diving etc. The present study is a review article which examines the different trends, challenges, opportunities, and prospects of adventure tourism in India. The systematic literature review method is applied in this regard. The author has used “Indian Tourism”, “Adventure Tourism”, “Adventure Sports” “Trekking”, “Rock Climbing”, “River Rafting”, “Mountaineering” and other relevant keywords are used to search the existing literature. The study covers the period from 2000 to 2022 as selection criteria. It is applicable for the Indian region. The impact of COVID-19 on adventure tourism is also taken into consideration. The study is unique and significant as it deals with the regional balance, eco-tourism, sustainable development etc. It has historical, cultural, geographical, socio-economic importance from national and international perspectives.

No Diving! National Estimates and Characteristics of Diving-related Injuries in Children and Adolescents from 2008-2020

Background: Recreational swimming/diving is the most common physical activity among US children and a significant cause of preventable morbidity across the United States. There are an estimated 50 million Americans that participate in swimming per year, 16 million of whom are children. Despite the popularity of swimming and diving, there are few up-to-date national divingrelated injury analyses, and no comprehensive injury analysis has been performed since the institution of International Swimming Pool •Spa Code (ISPSC) in 2012, which regulate diving equipment and design. This study offers a much-needed update on the national epidemiology of diving-related orthopedic injuries. Methods: The Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) database was queried for patients aged 0-18 from 2008- 2020 who presented to any of the approximately 100 NEISSparticipating emergency departments (EDs) for a diving-related injury. The patient cohort was identified using a search for consumer product code-1278 (diving). Injuries involving diving accessories, running, hitting, or tripping over the diving board, and injuries resulting from contact between two or more divers, were excluded. Infections were excluded. Dive characteristics such as dive height, dive skill, dive direction, and dive sequence were determined from case narratives. Descriptive statistical analysis was performed using Stata 16. Results: From 2008-2020 there were 1,157 cases of diving-related injury corresponding to a national estimate of 35,648 injuries (CI=28,067 - 43,230;Table 1). Children aged 10-14 accounted for 42% of all injuries, while adolescents aged 15-19 accounted for 38%. Nearly twice as many injuries occurred in boys compared to girls (64.2% vs 35.8% of total injuries, respectively). From 2008-2012, there were an average estimated 3,191 injuries per year. From 2013-2019, the yearly average decreased to 2,633 injuries (Figure 1). Due to the COVID-19 pandemic, there were relatively few (1,261) injuries in 2020. Compared to 2012, there were an estimated 1,081 fewer diving injuries in 2013, the first year the ISPSC codes were widely adopted. Lacerations were the most reported diagnosis for all years (24.9% of injuries). The head and neck were the mostinjured body parts (46.4% of injuries), followed by the face (17.4% of injuries), and lower extremities (16.6% of injuries). Concussions and nerve injury accounted for 6.7% and 0.1% of injuries, respectively. When the mechanism of injury was reported, unintentional contact with the diving board or platform was the most common cause (27.2% of injuries). Conclusion: Diving injuries are common in children and adolescents, especially in boys aged 10-19. Since the 2012 adoption of international safety standards for swimming pool design and operation, the average number of yearly divingrelated injuries has fallen by nearly 600 injuries/year. There was a significant reduction in diving-related injury corresponding with the COVID-19 pandemic.

The Impact Of Covid-19 On The Development Of High-Performance Sports On The Example Of Underwater Sports

Goal. To investigate the impact of the new coronavirus infection on the development of underwater sports in Russia and the Krasnoyarsk Territory for the period 2020 - 2021. Materials and methods. The study involved men and women specializing in the discipline of underwater sports - swimming in fins. A comparative analysis of the results of the athletes' performance at the Russian Championship, the championship of the Krasnoyarsk Territory for the period 2020 - 2021 was carried out. Results. Our comparative analysis of the results of athletes who competed at the Russian Championship showed that during the pandemic there was a slight decline in results at certain distances for women. A comparative analysis of the results of the athletes' performance at the championship of the Krasnoyarsk Territory showed a decline in the results of men at 50% of the distances.

Health Management Challenges of the Pandemic - A Case Study from Recent Pipeline Repair Campaign

Avoiding an offshore COVID-19 outbreak while executing an urgent and intricate pipeline repair campaign is a significant challenge, especially in a country that is experiencing a COVID-19 positivity rate of more than 20% on daily basis. Any minor mismanagement of health management on the DSV (diving support vessel) may lead to a COVID-19 outbreak with the risk of shutting down the campaign and significantly impacting the business continuity objectives. Therefore, the major health management challenge is to avoid a COVID-19 outbreak on the DSV to ensure the well-being of personnel during campaign and to achieve the necessary pipeline repair. The approach taken was to deploy the DSV with team and tools/equipment as soon as possible to avoid a prolonged platform shutdown due to the pipeline leak event. In order to carry out the project, a detailed risk assessment taking account of medical, logistics and security considerations was undertaken in order avoid a COVID-19 outbreak on the vessel. The risk assessment enabled an adjustment to the quarantine requirements for the pipeline repair team before departure to the work location. A contingency plan was also developed to manage a scenario in which a member of the offshore team was infected with COVID-19, and in order to comply with applicable government regulation. Through the effective implementation of a detailed risk assessment, the company was able to complete the pipeline repair campaign without any offshore COVID-19 outbreaks. On the DSV there were 65 personnel working on multiple activities to execute the pipeline repair works on time and on budget. The site team made a diligent effort to follow the mitigations identified in the risk assessment, under the direction of company Business Continuity Management Team (BCMT). As a result of this effort, the company was able to resume production from the offshore platform in a timely manner. This paper discusses the effective implementation of detailed risk assessment on a DSV as part of company business continuity management amid COVID-19 pandemic in the country, including medical, logistics and security considerations. This project was implemented in a year-end period, beyond normal conditions and in a tight schedule. © Copyright 2021, Society of Petroleum Engineers

Post COVID-19 fitness to dive assessment findings in occupational and recreational divers.

INTRODUCTION: It is now known that COVID-19 has long term effects that may not correlate with clinical severity of disease. The known pulmonary and cardiovascular changes as well as thrombotic tendency could predispose to diving accidents. We aimed to investigate COVID-19 related changes that may cause disqualification from diving among divers who recovered from the disease. METHODS: Occupational and recreational divers who applied for fitness to dive (FTD) assessment after COVID-19 infection were included. Routine FTD assessments were performed. Details of COVID-19 history were evaluated. Lung computed tomography (CT) scans were advised if not previously performed or if there were COVID-19 related changes in previous scans. Divers with pathological findings were restrained from diving and followed prospectively. RESULTS: Forty-three divers were analysed. Thirteen divers were restrained from diving, all due to persistent COVID-19 related changes in lung CT. The prevalence of CT with at least one lung lesion was 68.2% at the time of diagnosis, 73.3% in the first three months after diagnosis and 19.2% later. The most common CT findings were glass ground opacities and fibrotic changes. Demographic characteristics and COVID-19 history of divers deemed 'unfit' were similar to those deemed 'fit'. CONCLUSIONS: Divers who recover from COVID-19 should undergo FTD assessments before resuming diving. A chest CT performed at least three months after diagnosis may be suggested.

Carrying capacity studies of marine tourism during COVID-19 pandemic in Derawan Island, Berau, East Kalimantan

The COVID-19 pandemic has forced all sectors to adapt to new habits including the tourism sector. The research examines the carrying capacity of a particular area, especially marine tourism areas used for diving and snorkelling. Thus, the results can be used in the management of marine tourism in the new normal period. This research was conducted by survey and analyzed by the carrying capacity marine tourism formula. The research was carried out at six diving tourism and five snorkelling tourism sites scattered in the waters of Derawan Island. The carrying capacity of diving was 1,611 people/day with an area of 402,704.29 m2, and the carrying capacity of snorkelling was 1,126 people/day with an area of 281,453.29 m2. During the new normal period meaning the carrying capacity applied is 806 people/day for diving areas and 563 people/day for snorkelling areas. The utilization of marine tourism on Derawan Island is still sustainable because the number of tourist visits is smaller than the carrying capacity.

The economic marine tourism based on cleanliness health safety and environment (CHSE) protocol as covid-19 outbreak responses at Derawan Island, Indonesia

Popular tourism activities at Derawan Island are snorkelling and diving. The Covid-19 outbreak led these activities down and reduced visitors and income for restaurant, lodging, and diving center business units. The Ministry of Tourism and Creative Economic of Indonesia (KEMENPAREKRAFT) issued a new regulation to suppress the pandemic’s adverse impact specifically designed for New Normal Tourism with CHSE. They created new trouble in business units’ cash flow. It requires financial incentives and stimuli for its stability. This study assessed the tourists’ WTP, evaluation using the CVM, which covered the cash flow with three schemes. The value of the WTP substituted to financial analysis and looked at the number of BEP. WTP value for each person was US\( 2.97, or about US\) 190,636.28 - 288,677.80 in a year. If the cash flow did not reach the BEP, it would have proposed the financial stimuli to be submitted to related stakeholders. The restaurant was the most business unit that needed several financial incentives. Restaurants faced difficulties to reach BEP in three schemes, and they needed around US$ 170,422.54 - 247,323.94 in a year for over 20 restaurants.

Physiology of repeated mixed gas 100-m wreck dives using a closed-circuit rebreather: a field bubble study.

PURPOSE: Data regarding decompression stress after deep closed-circuit rebreather (CCR) dives are scarce. This study aimed to monitor technical divers during a wreck diving expedition and provide an insight in venous gas emboli (VGE) dynamics. METHODS: Diving practices of ten technical divers were observed. They performed a series of three consecutive daily dives around 100 m. VGE counts were measured 30 and 60 min after surfacing by both cardiac echography and subclavian Doppler graded according to categorical scores (Eftedal-Brubakk and Spencer scale, respectively) that were converted to simplified bubble grading system (BGS) for the purpose of analysis. Total body weight and fluids shift using bioimpedancemetry were also collected pre- and post-dive. RESULTS: Depth-time profiles of the 30 recorded man-dives were 97.3 ± 26.4 msw [range: 54-136] with a runtime of 160 ± 65 min [range: 59-270]. No clinical decompression sickness (DCS) was detected. The echographic frame-based bubble count par cardiac cycle was 14 ± 13 at 30 min and 13 ± 13 at 60 min. There is no statistical difference neither between dives, nor between time of measurements (P = 0.07). However, regardless of the level of conservatism used, a high incidence of high-grade VGE was detected. Doppler recordings with the O'dive were highly correlated with echographic recordings (Spearman r of 0.81, P = 0.008). CONCLUSION: Although preliminary, the present observation related to real CCR deep dives questions the precedence of decompression algorithm over individual risk factors and pleads for an individual approach of decompression.

Impact of the COVID-19 Pandemic on Marine Tourism Derawan Island, Berau Regency, East Kalimantan Province

The COVID-19 pandemic has had a tremendous impact on various aspects of life today. The tourism sector is one of the sectors affected by COVID-19, especially by the policy of social restrictions and foreign tourist visits. Derawan Island is one of the leading tourist destinations in East Kalimantan which has been affected by the COVID-19 infectious disease. The purpose of this research is to find out the impact of the COVID-19 pandemic on marine tourism on Derawan Island. The research was conducted in December 2020 – March 2021, using survey methods based on primary and secondary data. COVID-19 causes changes in habits, visit patterns, and the number of visits to Derawan Island marine tourism. The number of tourist visits decreased by 58% from the previous year, even as of December 2020, diving tourism actors are the parties most affected by COVID-19 due to the absence of diving tourists since the reopening of the leading tourist destination Derawan Island. The decline in tourist arrivals causes a decrease in income in the tourism sector, especially the income of tourism actors on Derawan Island.

Modified snorkeling facemasks for safe application of non-invasive ventilation. A pilot study / Uso de máscaras de buceo modificadas para aplicación segura de ventilación no invasiva. Estudio piloto / Uso de máscaras de mergulho modificadas para aplicação segura de ventilação não invasiva. Estudo piloto

Resumen: Introducción: en el contexto de la pandemia de SARS-CoV-2, diferentes autores propusieron adaptaciones a máscaras de buceo comerciales (máscaras modificadas, MM) para proporcionar oxigenoterapia a pacientes con o sin presión positiva. Hasta la fecha, ninguno ha evaluado su desempeño como interfaz para la ventilación no invasiva (VNI) en el modo de soporte de presión inspiratoria (PSI). Objetivos: desarrollar una interfaz de VNI utilizando MM y evaluar su rendimiento en comparación con una máscara oronasal (MC) convencional. Métodos: las MM se adaptaron como interfaces VNI utilizando dos piezas creadas mediante impresión 3D. Se comparó su desempeño contra una MC en 10 voluntarios sanos en modo PSI (3 cmH2O) con dos niveles de presión positiva al final de la espiración (PEEP 4 y 8 cmH2O). Se compararon: fugas del sistema, frecuencia respiratoria, volumen corriente, oximetría de pulso, CO2 transcutáneo y comodidad. Resultados: con 4 cmH2O de PEEP no hubo diferencias significativas entre las máscaras en ninguna de las variables estudiadas. Con 8 cmH2O de PEEP, el uso de MM se asoció con un menor nivel de CO2tc (41,0±5,7 vs 43,5±8,1 mmHg; p=0,03) y un mayor confort (8,3±1,1 vs 6,5±1,4; p<0,01) que las MC. Conclusiones: el uso de MM para realizar VNI presenta, en voluntarios sanos, un rendimiento similar a las mascarillas oronasales estándar, con la ventaja de mayor comodidad y menor costo. Si bien restan estudios para avalar su utilización, en la emergencia sanitaria provocada por la pandemia SARS-CoV-2, la adaptación de máscaras de buceo podría representar una opción válida frente a la escasez de interfaces comerciales.

Abstract: Introduction: within the context of the SARS-CoV-2 pandemic, different authors proposed adaptations to snorkeling masks available in the market (modified masks: MM) to provide oxygen therapy with positive pressure ventilation or not. Until today, none of them has assessed its performance as an interface for non-invasive ventilation (NIV) in the inspiratory pressure support mode. Objective: to develop an interface of NIV using MM and assess its performance with a conventional full mask. Method: the MM were adapted as NIV interfaces using two pieces created by 3D printing. Their performance was compared to a that of a conventional mask in 10 healthy volunteers in inspiratory pressure support (3 cmH2O) mode with two levels of positive pressure towards the end of expiration (PEEP 4 and 8 cmH2O). The following were compared: system leaks, respiratory rate, normal volume, pulse oximetry, transcutaneous car bon dioxide and comfort. Results: with 4 cmH2O of PEEP, no significant differences were found between masks in none of the variables studied. With 8 cmH2O de PEEP, the use of MM were associated to a lower level of CO2tc (41.0±5.7 vs 43.5±8.1 mmHg; p=0.03) and greater comfort (8.3±1.1 vs 6.5±1.4; p<0.01) than conventional masks (CM). Conclusions: in healthy volunteers, MM for NIV evidence a similar performance than that of standard oronasal masks, and have a further advantage, as they are more comfortable and cheaper. Even if further studies are needed to support its use, modified snorkeling masks could represent a valid option during the health emergency caused by the SARS-CoV-2 pandemic in consideration of the scarce interfaces available in the market.

Resumo: Introdução: no contexto da pandemia de SARS-CoV2, diferentes autores propuseram adaptações às máscaras de mergulho comerciais (máscaras modificadas, MM) para fornecer oxigenoterapia a pacientes com ou sem pressão positiva. Até o momento, nenhum avaliou seu desempenho como interface para ventilação não invasiva (VNI) no modo de suporte de pressão inspiratória (PSI). Objetivos: desenvolver uma interface de VNI usando MM e avaliar seu desempenho em comparação com uma máscara oronasal convencional (MC). Métodos: as MMs foram adaptadas como interfaces VNI usando duas peças criadas por impressão 3D. Seu desempenho contra uma MC foi comparado em 10 voluntários saudáveis no modo PSI (3 cmH2O) com dois níveis de pressão positiva no final da expiração (PEEP 4 e 8 cmH2O). Vazamentos do sistema, frequência respiratória, volume corrente, oximetria de pulso, CO2 transcutâneo e conforto foram comparados. Resultados: com 4 cmH2O de PEEP, não se observaram diferenças significativas entre as máscaras em nenhuma das variáveis estudadas. Com PEEP de 8 cmH2O, o uso de MM foi associado a um menor nível de CO2tc (41,0 ± 5,7 vs 43,5 ± 8,1 mmHg; p = 0,03) e maior conforto (8,3 ± 1,1 vs 6,5 ± 1,4; p <0,01) do que a MC. Conclusões: o uso do MM para a realização da VNI apresenta, em voluntários saudáveis, desempenho semelhante às máscaras oronasais padrão, com a vantagem de maior conforto e menor custo. Embora ainda sejam necessários mais estudos que embasem seu uso, na emergência sanitária ocasionada pela pandemia do SARS-CoV-2, a adaptação de máscaras de mergulho pode representar uma opção válida diante da escassez de interfaces comerciais.

Medical assessment of fitness to dive after COVID-19.

Since the global pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the etiological agent of a coronavirus disease 2019 (COVID-19) infection started, millions of people globally have become infected. It must not be forgotten that thousands of those affected are commercial or recreational divers. A severe COVID-19 seriously affects the respiratory system and the pulmonary parenchyma but it may also involve the cardiovascular and the blood coagulation system. For this reason, many divers and hyperbaric medicine specialists are becoming increasingly concerned about a diver's ability to safely return to diving after a SARS-CoV-2 infection. The article presents current guidelines for diving fitness health assessment after a COVID-19 both for active and prospective divers, with particular emphasis on the types of diagnostic procedures and tests to be performed in cases of asymptomatic infection with SARS-CoV-2 as well as in patients who have recovered from a symptomatic COVID-19.

Considerations for scuba and breath-hold divers during the COVID-19 pandemic: A call for awareness.

In late 2019, a highly pathogenic novel coronavirus (CoV), severe acute respiratory syndrome (SARS)-CoV-2 emerged from Wuhan, China and led to a global pandemic. SARS-CoV-2 has a predilection for the pulmonary system and can result in serious pneumonia necessitating hospitalisation. Computed tomography (CT) chest scans of patients with severe symptoms, show signs of multifocal bilateral ground or ground-glass opacities (GGO) associated with consolidation areas with patchy distribution. However, it is less well known that both asymptomatic and mild symptomatic patients may exhibit similar lung changes. Presumably, the various pathological changes in the lungs may increase the risk of adverse events during diving (e.g., lung barotrauma, pulmonary oedema, etc.), thus these lung manifestations need to be considered prior to allowing resumption of diving. Presently, it is not known how the structural changes in the lungs develop and to what extent they resolve, in particular in asymptomatic carriers and patients with mild disease. However, current evidence indicates that a month of recovery may be too short an interval to guarantee complete pulmonary restitution even after COVID-19 infections not demanding hospital care.

Diving after SARS-CoV-2 (COVID-19) infection: Fitness to dive assessment and medical guidance.

Scuba diving is a critical activity for commercial industry, military activities, research, and public safety, as well as a passion for many recreational divers. Physicians are expected to provide return-to-diving recommendations after SARS-CoV-2 (COVID-19) infection based upon the best available evidence, often drawn from experience with other, similar diseases. Scuba diving presents unique physiologic challenges to the body secondary to immersion, increased pressure and increased work of breathing. The long-term sequelae of COVID-19 are still unknown, but if they are proven to be similar to other coronaviruses (such as Middle East respiratory syndrome or SARS-CoV-1) they may result in long-term pulmonary and cardiac sequelae that impact divers' ability to safely return to scuba diving. This review considers available literature and the pathophysiology of COVID-19 as it relates to diving fitness, including current recommendations for similar illnesses, and proposes guidelines for evaluation of divers after COVID-19. The guidelines are based upon best available evidence about COVID-19, as well as past experience with determination of diving fitness. It is likely that all divers who have contracted COVID-19 will require a medical evaluation prior to return to diving with emphasis upon pulmonary and cardiac function as well as exercise capacity.