CAN I GET COVID-19 EXPOSURE FROM A DIVE MISSION
By: James McKenzie
The ongoing pandemic with COVID-19, also known as SARS-CoV-2, has raised interest in the possibility of being infected as a result of exposure during a dive mission. Emergency response divers are very aware of the types of environments that they work in and they are always hazardous in some way. The procedures for the various exposures are very similar in terms of protection and decontamination but COVID-19 may require some additional modifications to procedures.
What we Know
Let us first look at the information we have on the virus and its transmission characteristics. The current version of coronavirus, SARS-CoV-2, the world is dealing with is much like other versions of coronavirus, the difference being the increased effect on the respiratory system. What we know for sure at this time is the virus is spread through droplets from the respiratory system (modes). The data also shows that transmission is more likely the closer contact individuals have with each other. Additionally, transmission can be achieved if the infectious substance is on surfaces and individuals contact and then introduce it into the eyes, mouth, or nose (Smith, 2020).
There are also methods of introduction that thankfully have been shown to not spread the infection and have a bearing on diving. One method is through consumption such as food “According to the European Food Safety Authority, the spreading of the virus is unrelated to what we eat.” (Southey, 2020).
Concerns of transmission for first responders and Emergency Response Divers (ERD) lies in the environments which we operate. These environments include sewage waters and the possible bodily fluids contained in such as blood. As you would expect the blood is infections and can carry the disease (Biologics Evaluation and Research). How long the blood may be infections in the water is hard to determine and no reliable data is available at this time.
The operating environment of an ERD can very much be considered as a sewage system in many cases and the CDC has advised that “SARS, a similar coronavirus, has been detected in untreated sewage for up to 14 days” (“Water Transmission and COVID-19: Questions and Answers”, 2020). This is concerning for the operation of dives and Coronavirus, however, this is not the only concern, many other organisms and viruses will likely be in untreated sewage waters.
The dive scene can be a very populated environment and as many know lots of people want to be there that may not need to be there. During this time of heightened awareness of virus, transmission teams should take extra precautions to protect their personnel and the associated agency personnel they work with.
The best practices at this time for team operation on the surface are going to be those advised by the CDC but will require some possible modification due to the nature of Emergency Response Diving.
The surface operations will require several precautions first being the N95 mask and should be appropriately fit tested for the team members to ensure protection. Due to the close nature of operations, the N95 mask is going to be one of the most important pieces of PPE (Personal Protective Equipment) utilized (“Using Personal Protective Equipment (PPE)”, 2020). This simple piece of equipment protects the primary entry point that COVID-19 prefers.
Following the mask, is appropriate Eye Protection. Considering the eyes are an excellent entryway due to the absorption properties and the entry through tear ducts it is especially important to protect them from contamination (Belser, Rota, & Tumpey, 2013). The use of properly fitting Z87 rated eye protection will not only stop objects entering the eyes but also prevent individuals from rubbing their eyes and possibly infecting themselves.
Finally, gloves should be used if the possibility exists, that the team could have contact with the virus or contaminated surfaces. The gloves should fit properly, and team members should be especially vigilant in proper procedures related to donning and doffing of gloves along with appropriate use precautions.
The equipment suggestions for the diver are no different from normal operation since the diver should be fully encapsulated for operation. Changes that should apply would include protecting the respiratory system and eyes with an N95 mask and eye protection as long as possible prior to donning the dive mask and regulator.
In terms of the actual operation and how teams should conduct the operation, there is room for little change except in proximity to each other. Team members should do their best to stay separated as much as possible along with ensuring their PPE stays in place. It is very tempting to pull a mask down to speak to one another or to take a gloved hand and scratch an itch, but team members need to control that impulse. It may also be necessary to set perimeter tape and post an watch to ensure that random visitors and spectators do not become a risk to your team. Spectators even from adjacent agencies could pose a risk as you begin the decontamination phase of the dive operation.
Upon completion of the dive operation the decontamination process will need to begin. If the environment was to have the possibility of a COVID-19 contamination, you will need to be especially thorough. A proper decontamination solution will need to be selected for the operation; a common selection is a sodium hypochlorite solution or bleach and water. The EPA has provided a comprehensive list of acceptable disinfectants for use against COVID-19 which can be found here. The process will be much the same as usual decontamination operations with the exception of the diver should be provided with N95, Eye protection, and gloves as soon as feasible once unmasked.
Upon the total completion of the operation, a final decontamination should take place of all personnel associated with the operation along with all the equipment utilized in the operation. Once again, the appropriate disinfectant should be used, and proper procedures followed to remove and dispose of PPE. All team members should also see the medical office and have records taken of the operation should there be an infection that develops after the operation is complete.
While the risk of getting the virus is there for first responders there are steps we can take to limit that risk. As responders, we don’t have the luxury of deciding we will just not go, so being vigilant in the application of the proper use of PPE and the adherence to procedures will hopefully ensure that everyone comes home safe after an operation.
Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations. (n.d.). Retrieved April 16, 2020, from https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations
Smith, M. W. (2020, April 13). How Long Does the Coronavirus Live on Surfaces? Retrieved April 16, 2020, from https://www.webmd.com/lung/how-long-covid-19-lives-on-surfaces
Southey, F. (2020, March 12). Spreading coronavirus: ‘There have been no reports of transmission through food’. Retrieved April 16, 2020, from https://www.foodnavigator.com/Article/2020/03/12/Spreading-coronavirus-There-have-been-no-reports-of-transmission-through-food#
Biologics Evaluation and Research. (n.d.). Updated info – to Blood Establishments Regarding COVID-19. Retrieved April 16, 2020, from https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/updated-information-blood-establishments-regarding-novel-coronavirus-outbreak
Water Transmission and COVID-19: Questions and Answers. (2020, April 3). Retrieved April 16, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/php/water.html
Using Personal Protective Equipment (PPE). (2020, April 3). Retrieved April 16, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html
Belser, J. A., Rota, P. A., & Tumpey, T. M. (2013, March). Ocular tropism of respiratory viruses. Retrieved April 16, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3591987/