On August 4, 2021, COVID-19 was again front and center as top medical leaders of the Navy, Defense Health Agency (DHA) and Coast Guard took part in a robust conversation about the pandemic at the Sea-Air-Space Exposition in National Harbor, Maryland.Speakers included Rear Adm. Bruce Gillingham, Surgeon General of the Navy, Lt. Gen. Ronald Place,
On August 4, 2021, COVID-19 was again front and center as top medical leaders of the Navy, Defense Health Agency (DHA) and Coast Guard took part in a robust conversation about the pandemic at the Sea-Air-Space Exposition in National Harbor, Maryland.
Speakers included Rear Adm. Bruce Gillingham, Surgeon General of the Navy, Lt. Gen. Ronald Place, Director, DHA, and Rear Adm. Dana Thomas, Director of Health, Safety & Work-Life, U.S. Coast Guard. The panel was moderated by Dr. Eric V. Thompson, Vice President and Director of Strategy, Policy, Plans and Programs, Center for Naval Analysis (CNA).
COVID has undoubtedly changed the world and forever impacted the way the services operate. These medical leaders shared perspectives on the virus and the efforts taken over the last 19 months to mitigate its impact on their organizations.
General Place noted that early in the pandemic it was a challenge to frame the problem, determine how to better understand it and then identify the right diagnostic tools to use. He pointed to the fact that in February 2020—across the Department of Defense (DoD)—there were only 11 laboratories that had the capability to diagnose COVID. Today there are 177 DoD laboratories with this capability.
For Admiral Thomas it was a challenge to locate the “problem areas” in the Coast Guard, develop a program for testing and contract tracing, and then educate the service on basic preventive medicine concepts. As she stated, “There was a lot of growth to do.”
Lessons and application of this growing knowledge was a key theme for the discussion. “Your Department of Defense medical team has insatiable curiosity,” said Place. “There is no deficit of ‘How can we do this better?,’ ‘Are there better ways to treat?,’ ‘Are there better ways to organize?,’ ‘Are there better ways to do logistics?’ It is a continuous process of improvement within our organizations.”
“It has been a continuous high velocity learning, both scientifically and operationally,” said Admiral Gillingham. “At its essence all of us exist to provide Force Health Protection. And so this has been an extreme example of protecting the force so that they can do their critically important job of defending our liberty.”
Admiral Gillingham focused on many of the important hallmarks and achievements of Navy Medicine during the pandemic. This included the marquee deployment of USNS Comfort to New York where it was adapted from a combat casualty center to an infectious disease hospital; re-envisioning how we deployed the Expeditionary Medical Facility (EMF) platform, and working with FEMA on optimizing EMF personnel into teams; using our knowledge to develop and deploy new platforms like the Acute Care Team (ACT) and Rapid Rural Response Teams (RRRTs) which played vital roles in southwestern Texas and in the Navajo Nation; learning and applying the lessons from the USS Roosevelt and Kidd outbreaks and using that knowledge to better diagnose, quarantine, isolate on a shipboard environment and explore ways to minimize the risk of COVID on our forward deployers.
Gillingham lauded the work of the One Navy Medical Team, the ongoing interagency coordination, and the important contributions made to the national discussion about and awareness of COVID transmission. He also noted that the make-up of the warfighters ultimately proved indispensable in the fight against the virus. “We cannot forget, as much as we supply public health and infectious disease care, at its heart the Navy’s response was the resilience of our sailors.”
The three leaders remarked that meeting readiness requirements and continuity of operations were challenges. Chief among them for the Navy was the accession pipeline of recruits. “Our Chief of Naval Personnel and Marine Corps made it very clear that we had to keep those pipelines going,” said Gillingham. “We invested a lot of work to figure out how we could do that safely, recognizing that we have recruits coming in from all parts of the States, and how do we ensure that we don’t have a major outbreak.”
Communication, and specifically connecting to individuals serving outside of the medical realm, was also a key topic for the discussion. As Admiral Thomas stated, those serving on the line side are not necessarily physicians or epidemiologists and it was important to communicate the nature of “false positives” and “false negatives” of testing and breaking down the guidelines and implications of what a two-week Restriction of Movement (ROM) meant. To help address the communication hurdles, Admiral Thomas established open forums including holding regular town halls with those charged with implementing policy in the field.
At the end of the discussion Dr. Thompson asked panelists about the impact of the vaccine roll-out. Admiral Gillingham stated that the vaccine has been a “game changer” and has taken off some of the stress on warfighters. “I think if you are aboard ship you saw immediate impact in that our Navy and Marine Corps Public Health Center was able to model levels of vaccination and likelihood of outbreak . . .85 percent vaccination [aboard ships] gave skippers the opportunity to relax restrictions.”
Putting it in perspective, General Place noted that the COVID vaccines are based on sound, scientific research dating back years. “The reason we have such good vaccines isn’t because of some magical thinking by manufacturers in the spring of 2020,” said Place. “This is based on years, [and] some cases more than a decade of research.”
Leaders noted that getting the force vaccinated is still an ongoing fight, but one with a tangible operational value.
“If you are vaccinated you are much less likely to get very ill or be hospitalized and so you are going to be in the game,” said Gillingham. “You would not send folks into combat without flak and Kevlar. The enemy this time is a virus and it is biologic body armor for them to take and use to protect themselves.”