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Development, design and experience of the UK Military’s return to diving pathway following SARS-CoV-2 infection
  1. Stuart McPhail1,2,
  2. D Steed1,
  3. D Holdsworth3,4,
  4. E Nicol5,6,
  5. A Bennett7,8 and
  6. S Phillips1
  1. 1Underwater Medicine Division, Institute of Naval Medicine, Alverstoke, UK
  2. 2Department of Anaesthesia, University Hospitals Plymouth NHS Trust, Plymouth, Devon, UK
  3. 3Academic Department of Military Medicine, Royal Centre for Defence Medicine (Research and Clinical Innovation), Birmingham, UK
  4. 4Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  5. 5Royal Brompton Hospital, London, UK
  6. 6King's College London School of Biomedical Engineering and Imaging Sciences, London, UK
  7. 7Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre Headley Court, Epsom, UK
  8. 8National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
  1. Correspondence to Dr Stuart McPhail, Underwater Medicine Division, Institute of Naval Medicine, Alverstoke PO12, UK; s.mcphail{at}


After the emergence of the SARS-CoV-2 virus in early 2020, it quickly became clear that symptomatic or asymptomatic infection had the potential to negatively impact on an individual’s fitness to dive through effects on the respiratory, cardiovascular or neurological systems. The significance of these effects in the military diving environment was initially unclear due to an absence of data concerning incidence, chronology or severity. In order to safely return divers to the water and maintain operational capability, the UK Military developed a pathway for SARS-CoV-2 positive divers that stratified risk of sequelae and extent of required clinical investigation, while minimising reliance on viral testing and hospital-based investigations. We present this process, provide rationale and support for its design and detail the number of SARS-CoV-2 positive divers who have been returned to full diving fitness following infection of varying degrees of severity.

  • Respiratory infections
  • COVID-19

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  • Contributors SMcP was the primary author and contributed to data collection and analysis. DS was the primary data collector and assisted in the initial drafting of the article. SP was primarily responsible for the development and design of the UK Military COVID-19 Return to Diving Fitness Pathway. The expertise and contributions of ANB, DAH and EN were critical to the pathway’s conception and development. All authors were involved in the revision and approval of the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.