Pentagon Health Leaders Speak on COVID-19 at Sea-Air-Space Exposition



Rear Adm. Dana Thomas, the Coast Guard’s director of health, safety and work-life; Rear Adm. Bruce Gillingham, Navy surgeon general; and Army Lt. Gen. Ronald J. Place, Defense Health Agency director, speak about the COVID-19 response and post-pandemic national security at the Sea-Air-Space Global Maritime Exposition in National Harbor, Maryland.

Transcript

think about organizing to get after this problem set after I give each of the panelists a few minutes to talk about the starting position, I’ll ask a few more questions to get the conversation started. My objective here is to really make it conversational. This is not just a straight Q and A. But hopefully we can have some back and forth because many of these folks work together regularly and collaborated and solving problems. So hearing some about that I think will be a great uh sort of addition to the conversation here. So I know that all the biographies of our speakers are in the package that you have and obviously these are well known senior experts, but I am really pleased to be able to have on the stage with me. Lieutenant General Ron place who is the director of the Defense Health Agency where he has responsibility for making sure that there is, you know, combat readiness amongst the services and across the force as well as directing the civilian component of the civilian military health team. I also have Bruce Gillingham, who is the Chief of the Bureau of Medicine and Surgery, the surgeon general of the Navy. Uh and in that role he is the chief medical advisor to the Secretary of the Navy, the commandant of the Marine Corps and the Chief of Naval operations. And I also have on this panel, uh Rear Admiral Dana thomas, who is the director of health Safety and work life at the U. S. Coast Guard, the chief medical officer, aka the surgeon general of the Coast Guard and like all physicians, dentists and pharmacists in the U. S. Coast Guard. She’s also by definition of US public health service officer. So with that I look forward to a robust conversation. There are question cards on your table available to you. So if you have questions you’d like to ask any of the panelists or potentially all the panelists, please write those down. There are people here from the Navy League, he will be circulating and picking up those questions and bring them up to me on the stage. And I want to make sure that I leave time for for plenty of Q and A. From the audience because you’re here to take full advantage of the team on the stage and I want to make sure that we leave enough space for that. So with that, let me turn it over to to general place for your perspective on how this all looked at the beginning and what the mission was that you were pursuing and how that got underway. Sure, thanks dr Thompson. So I think like any sort of a rising middle problem, you have to frame the problem itself shape and understand that, that sort of thing. So the things that we were talking about collectively so I’m going to talk about it but certainly conversations with Dr Willingham and the other surgeons general happened. But what is it Right? How do you diagnose it? How is it transmitted? How can you protect yourself from it? How can you treat it? How can you understand it? And then do we have the right systems in place to help us at an individual location or an individual person or collectively? Across the service or across the Department of Defense? How can we understand from a data perspective and as we looked around um what we thought we had and what we needed were not necessarily the right thing. So the initial elements of of what we tried to do was how can we better understand it? So what are the right diagnostic tools? I’ll give you a data point In pick a date middle of February of 2020, There were 11 laboratories In the Department of Defense that could diagnose COVID-11. I love it. And by the summer of last year was 130 by the fall of last year, 150 I think. As of today, it’s 177 something along those lines. So, I mean, the whole idea of do you even know what you know it was no, we didn’t. Information just wasn’t coming to us. And in a number of other things like All right, what do you do to protect yourselves? Doctor Gillingham has some great great comments on body armor and what that looks like. And I’m guessing he’s going to talk about so I’m not going to. But But what are the personal protective equipment that we have And how do we normally do that for biological agents? And what are in hospital or in clinic supplies of what are the stockpile supplies? What are the rules for getting them out of stockpiles? How do we share them across the the entire federal response? And what are the gates that we give as advice to the secretary defense when he decides what to do? So it’s all those sort of the skeleton of what’s the global plan for it. And then how do you understand it? And finally, you know, what’s the treatment strategy people are are being diagnosed with it. And in general, when you don’t know, we call it supportive care, in other words, to keep them alive. So I? Ve therapies, breathing machines, that sort of thing to try to help people. But intuitively, lots of great research, some of it done in the Department of Defense, some of it done in nonfederal organizations. Academic locations et cetera. Were constantly pushing forward what’s known what’s not known what we thought to be true. What can we prove? What was actually proven not to be true those sorts of things. Uh And so within about a month experts across the entire D. O. D. Workforce within the D. H. A. The service’s uniformed services University very rapidly developed a clinical practice guidelines to try to help us sort all that out. It took about five days to write at 70 pages for everyone to understand. This is the knowledge that we have now. We’re currently on version seven of those clinical practice guidelines that went from whatever. The first one was 60 70 pages to now. A little bit more than 200 pages. It’s not just for physicians it’s for respiratory therapists, iCU nurses, ward nurses, logistics, teammates, everything so that we can better understand. So really it’s it’s how do you go from a almost everything unknown to as many things as possible known and then at echelon, what you need to know throughout it to be able to get there and then we can talk more about where we’ve built from that. But that’s where we started. Excellent. Thanks very much. Admiral Gillingham. I welcome you to begin to tell us about the Navy perspective on this in the starting position. Obviously there was a lot of attention to what was going on in the Navy in the early days. So let me turn it over you to set the scene and help us understand what that looked like at the early stages. Okay, thank you dr, Thompson. And uh first of all, I’d just like to thank the Navy League for this invitation to be here with my esteemed colleagues to discuss. Really what was extremely challenging issue continues to be an extremely challenging issue. And really the response to COVID-19 has just been a continuous, high velocity learning both scientifically and operationally. Um and at its essence, all of us exists to provide force, health protection. And so this has been really an extreme example of protecting the force so that they can do their critically important job to defend our liberties. One of our one of our real secret weapons in that fight our preventive medicine teams, public health experts. They often toil in the shadows and don’t get the really the recognition that they deserve. So, so to give them some well deserved recognition and to help the audience understand the role they play on a daily basis. We have a short video for you. Mhm. On march 20th 2020 the Navy embarked a forward deployable preventive medicine unit F. D. P. M. You aboard ships of the seventh Fleet. Its mission To help combat the risk of and provide laboratory batch testing for COVID-19. The role of preventive medicine units, PMU. S in this pandemic is nothing new. As far back as World War Navy laboratory and sanitation units, forerunners of the PM US were deployed aboard ships and to shore facilities to perform a series of public health and preventive medicine duties such as fighting outbreaks of meningitis and influenza under the administrative control of the Navy and Marine Corps Public Health Center in Norfolk Virginia. The Navy operates four of these units in Norfolk san Diego, Pearl harbor and rhoda spain. These units work hard to identify evaluate and monitor diseases, injuries and hazards in environments that threaten the health of deployed US forces And to other countries when deployed on humanitarian missions. Whether the fight against COVID-19 or ensuring the Navy is prepared for the biosphere, the US Navy will remain all the more resilient and stronger because of the vital services that Navy medicines, preventive medicine units continue to play each and every day. Mhm. Yeah. Mhm. Yeah. Who? I hope you enjoy that? And I’d like to thank our uh you met historian Mr Andre So Bochenski and our visual information team for putting that together to help us kind of set the stage for the challenge that we faced. And you know that challenge extended beyond the Force health Protection mission because we were also involved in defence support of civilian authorities like the other services uh and and learn to learn quite a bit from that that were actually able to now blend in and we can talk about, you know, during the question session, some of the, some of the future future, you know, aspects of that. But in addition to providing that public health and scientific support to the, to the fleet in the marine Corps, you know, we’re doing also deploying teams actively. So certainly the marquis deployment was, you know, usns comfort pulling into the harbor and new york providing badly needed support initially intended to be a to offload the hospital so that they could focus on Covid just didn’t have that luxury given the extent of the infections at that time. And so comfort, which is designed as a combat casualty care platform, transformed itself literally overnight into an infectious disease hospital and did a remarkable job, you know, pitching in to take care of very critically ill Covid patients. Um, may also not be aware though that in addition we have our expeditionary medical facilities which is our contribution to roll three casually care. They have medical components. Uh, we were able early on to recognize that it wasn’t the equipment from that we needed, we needed the people and the expertise. And so are medical experts are infectious disease Doctors are critical care doctors, nurses are respiratory technicians assigned to those units were broken down into smaller units, went across the United States and then working with fema. After that initial response, we recognize that we had an opportunity to really kind of optimize those teams. And so that led to the development of 44 acute care team, which is critical care doctor and nurse heavy with supporting Corman including respiratory technicians. And then really the counterpart of our four deployed surgical teams. The rural rapid response team won Critical care doctor five critical care nurses and respiratory technician. And they actually went out to southeast texas, southwest texas rather on the border with Mexico and set up on the fly critical care units ICUs in community hospitals that did not previously have that capability. Uh Their model had been to transfer any critically ill patients. Uh Covid and the saturation of their referral centres didn’t allow that. And so they set up and and perform truly heroic work as did the other services in similar circumstances as you as you alluded to dr Thompson. Our wake up call was Theodore Roosevelt. Uh And that was that was, you know, the recognition that we had an outbreak aboard one of our capital ships or aircraft carrier. And it really helped us to understand because of one of the four deployed medical units that was deployed about aboard with research only S. A. At the time for Covid 19 or SARS-COV-2 really helped us understand the behavior of the virus, which as as general place mention is critically important, understand the adversary. And so it was from that work and from the investigation of that outbreak that we learned that really the role of pre and asymptomatic transmission of Covid and how critically important it was to understand that and prevent that. Um, so based on that experience and then a subsequent experience aboard uss Kidd, one of our destroyers. Uh, we were able to learn how to diagnose how to quarantine how to isolate and a shipboard environment and then how to actually step back and say, how do we create a bubble? To minimize the risk of Covid for our forward deploy hours. And that involved as many no restriction of movement for two weeks. Testing of those coming out of the restriction of movement. But at its heart, the success of the fleet and continuing to operate was really the resilience in the grid of our sailors and our marines embarked. That they were able to follow those very strict requirements and still keep their focus on their mission. So we can’t forget as much as we supplied in terms of public health and and infectious disease care at its heart. The navy response was based on the resilience of our sailors um as we moved out of that uh and we were operating forward uh and developed and developed uh you know the vaccine we I mean as the vaccine was developed, it was critically important for coordination and hats off to General Place and his team at the Defense Health Agency for really providing kind of the central coordination, establishing and leading the O. P. T. The planning team to say how are we going to distribute the vaccine and then working through the services to execute. And that really is I think a very effective model that I think we can leverage into the future. So that just gives you hopefully a flavor of what Navy medicine did. And the other thing was our scientist who actually did a prospective study on marine recruits at parris Island. And actually to really understand fundamentally at an immunological level the response to healthy young adults in a tightly controlled congregate setting to the virus and recognize just how relentless it is. Because even in that environment about 16 of the recruits still became infected. So and and both that article and the article describing the comprehensive uh you know, uh outbreak response and investigation of tr we’re both published in New England Journal. So I’m proud to say that our folks were able to contribute to the national discussion and national awareness of how to how to get after and and uh and defeat covid. Thank you. Thanks very much. I appreciate that perspective. I’m Alina thomas. Can you uh can you provide some insights on a um you know, what was the mission that the Coast Guard had and who were your primary sort of targets of concern? And how how how did you approach this problem? And how would you describe your mission as this unfolded last spring? Thank you Dr Thompson and thank you to the Navy League for inviting me to join you today. So initially again, the Coast Guards are very external, outward facing organization. And I found myself in january um beginning to address cruise ship passengers that were ill and how are we going to collaborate with the captains of the port and the division of global migration and quarantine from C. D. C. To help assess and remove patients. But you could see what was happening with the spread on these ships that this was like you know kind of Somebody else’s problem for a short time before you knew it was gonna be your problem because with the Coast Guard we have a lot of boats two and you know, learning what we did. I think just that was really uh you know long drawn out Maley many of you might remember there were a lot of like floating islands of disease out there that no one would remove the crew from even after we got all the passengers off. So just there was some diplomatic push. There was just trying to really do the right thing for people. But that’s sort of where you realize as the rest of the country was talking about, well, we need to protect the airports. The Coast Guard had to come back to the government and say, you need to think about the ships coming over because of this longer um Period of Kyrenia between someone being infected and someone being contagious. There are people that will land here coming from the far east within 14 days and may be asymptomatic. So really trying to put out enough notification for the, the maritime community, the marine information bulletins that just to keep people apprised of this is what you’re looking for. This, what you’re looking for if you’re ill. This is how this has to be reported. I think that that was your entree in the next steps were quick pivot to saying, how are we going to take care of our own people? Because it’s really easy to say, You know, well, when you pick up that person in the water or the migrant that, that that’s how you’re going to get infected. But I will tell you 100% of the cases of infections within the Coast Guard on a ship who did not come from the migrants, They came from blue suitors wearing blue suit, other blue suit friends because we never practiced that type of must stay away. You must keep this kind of space amongst ourselves. You just, we just didn’t have that. You know, in the early months, how aggressive asymptomatic spread was going to be with a nonstick person. So when we would have ever, you know, some ships would come into Baltimore and it would be like 13 people on the crew, 13 people positive go to Vegas, you’re gonna win. You know, they managed to get every single person sick. Um what you had to do that, it was really protect the workers at the Baltimore yard who are not, you know 20 and 30 year old kids, but 50 and 60 year old adults working on their ships. So just the testing and the contact facing then began. I think that we were much like the other services in understanding basic preventive medicine concepts, but like we had never as a service organized contact tracing teams and medical is so small, we said we’re not going to be everywhere four years. So we had to train the line how to establish their own contact tracing teams with medical guidance. Um I think that that PPE as you might remember, was really also challenged in the beginning, um from a different department, Department of Homeland Security. And we have been told for years maybe you heard something similar? Don’t buy anything, don’t store anything. Everything is just in time. We’re going to get it for you when you need it. Well, how does that work? Not so well, I mean thank goodness Defense Logistics Agency was able to look at us as part of the service and help us with some of the PPE we needed from masks, two gloves. So just to be able to do our regular medical job because I don’t know where we would have fallen on the DHS list but not high enough to get anything by now. I’d imagine so. I mean I think it really was looking at what do you have to protect yourself? What can you do? What is our plan since we have no tertiary care centers? What is our plan for mitigating sick people are of our own how where we’re gonna send them? and laboratory was another challenge for us because we do not have 11 labs that would do this. We had with a few labs that have a clear wave test, like a gene expert in them now and everything else we do by laboratory, whether we’re using Quest or Labcorp was all sent out Fast forward to today. We have established three um surveillance testing programs in large congregate settings. So our training center, Cape May Training Center, Petaluma and the academy. Because surveillance testing, it doesn’t have to have the same clear regulations and you can just test people that are unvaccinated, whomever your your parties are that you’re interested in on a regular basis as long as it’s anonymous testing. So I mean I think that we have had a lot of growth to do. Thanks. Excellent thank you very much. Um let me just get the conversation going a little and I’ll start with you general place. Can you from your perspective at D. H. A. Give us a sort of an overview from your your experience in the seat that you had in this. How ready were we for this kind of pandemic? You know, what had been the planning assumptions and training assumptions? How appropriate were they? And and one of the big things that have been learned about future readiness to respond. Sure, that’s a good question. So if I was going to give us a grade for the readiness to be able to handle this particular pandemic, I’d say I don’t know. Be depending on the subsets of the criteria. Be some routine B plus B minus. I don’t know. But a good solid B. I guess where I go. A lot of that is because of the way that we already handle are integrated system, are evacuations are casualty responses as Admiral William. Already mentioned with Roll Three facilities. So we even define a role one being, that health care that’s with you and its role to a sort of resuscitative surgical care. Roll three is a three theater hospital. And Roll for is what we have, um, perhaps in in Germany or Japan or other Coolants locations or here in the United States. So we already have a system in place that knows how to do it. We have a system, knows how to talk to each other. We have a system that has a centralized um, logistics arm, a centralized pharmacy arm we have on the shelf pandemic plans that were okay. I mean they weren’t terrible. That’s for sure. They weren’t perfect, but they were good. And so if you look at all the different elements that were there, we were pretty ready. But, but every, every pandemic, every biological disease is a little bit different. And so uh certainly updates had to be made. But I would be stunned to hear that that someone suffered. Someone that we are responsible suffered because we weren’t ready. We were ready and ready to learn along the way as more information came in. And would you, would you characterize the learning piece of this as being something that we need to bring forward in terms of being prepared to as you just described, everything is a little different. Each biological event is different. Are we doing enough to prepare critical thinking and and have the infrastructure to quickly do that experimentation learning track. So for all of you, one of the things that you should feel comfortable with is your the Department of Defense Medical Team has insatiable curiosity. So there’s no um there’s no deficit of man. How could how could we do this better? Are there better ways to diagnose the better ways to treat? Are there better ways to be organized? Is there better ways to do the logistics as animal thomas was just talking about? So yeah, it’s a continuous process of improvement within our organizations to be able to get better. Excellent. Um, and reflecting actually wanted, I’m getting a whole bunch of questions here. There are one or two things I want to make sure we cover before we go on. But this reflects one of the questions and I’ll ask you Admiral Gillingham, both D. A. J. And Coast Guard have a clearly interconnected civilian peace to this right with Tricare and the families and veterans for for for D. H. A. And obviously the migrants and the commercial communities that you interact with. But for the navy right as a military service you were pressed into this civilian support interacting with civilian officials. Um, what did that look and feel like? Um, what have you learned and how how prepared was the navy to be in direct support of really a wide array of civilian agencies and organizations that we’re confronting this challenge? Yeah, thank you know, I would say that I would say that certainly there was quite a bit of learning there, but but the interagency work, I cited the relationship with fema uh, and and and working through a health and human services. Uh, I think uh, to general places point framework was there? So the actual practice, the actual tactical execution was where we did some very early learning. I will say though, that the way that we were set up within the military health system lended itself that, you know, the Assistant Secretary of Defense for health affairs really was that node working with civilian agency and then and then we were we were kind of the next echelon down and working through Defense Health Agency. So early on we had really established a very good battle rhythm of an interagency coordination. So I think I think it it worked well. I think the, you know, the lesson for us was uh you know, to to um you know, admiral thomas point. We uh we have older people who work in our shipyards and that was a population that was a great risk. And so working very closely again, our scientific experts, public health experts working very closely with with nancy was able to establish protocols and things to be able to keep keep them safe yet continued the very necessary work of shipbuilding, ship repair and that sort of thing. So, and the other piece just kind of related is I think one of the greatest surprises for me was just how important the accession pipeline is, particularly for the Marine Corps. And uh and our Chief of new personnel and the Marine Corps made it very clear that we had to keep those recruit pipelines going. And so we’ve invested a lot of work to figure out how we could do that safely, recognizing that we had recruits coming from all parts of the United States. How do we, how do we ensure that we don’t have a major outbreak? That the charm study that I that I mentioned in the introduction was significant, significant help in that, but it was really sitting down and figuring out how do we maintain continuous operations of accession so that we can keep that pipeline going. That’s essential uh for us to the Navy and the Marine Corps. Thank you Admiral thomas. If I can ask you a perspective as a as a senior leader in a military organization, I can imagine there are several levels at which you needed to be operating yourself. There was the overseeing an integrating tactical execution. There was being able to step back and say, what are the broader trends? What are the policies, where does that coordination? And I suspect, um there was an insatiable demand for information for from people senior to you or people that the Coast Guard was supporting. How did you manage and balance those different sort of competing responsibilities for your time? Energy and bandwidth as this unfolded, I doubled my days 48 hours. 24. Just was not going to be enough. But I know I think that you’re absolutely the amount of explanation because our line leadership is very smart, but they’re not physicians, they’re not medical epidemiologist, they’re not laboratory ins and just trying to explain to them what the accuracy of some large testing iterations might be or how you would have these false positives or false negatives and that really getting them beyond. Like as soon as the day you had testing, once we had some testing available to us, it was like more cowbells please, you know like now I need more and I said well you need more but you need to be doing it took the Coast Guard and I’m not sure about other services. Um the better part of that first year into 20 to understand that restriction of movement Rahm it really means your family members from out of town can’t come to visit you while you’re in Rome. I mean they just, they did not want to be so harsh with people, but you can’t rahm people when they get to a school. And then every evening let people go out and have beers together in town because like you’re not gonna surely talk to some new people you don’t know. I think so. It was just it’s they understood it by the end, they understood. By the end of the first year we turned around national security cutters enough times with missing a positive person. And then if you remember how christmas was male was so incredibly slow because of our laboratory capacity or or lack of laboratory capacity. We used a saliva based test that and the fact that there was a lot of restrictions are short supply of swabs and things. So imagine a saliva based test that you’re spitting into a cup Like 23 and me it worked very well. They would do the test in 24-48 hours, but wherever I was I had to mail it to New Jersey. If anyone male was like at christmas, Not for love or money because you’ve gotten something across the country in less than eight or 12 days, which is part of why we said we’re going to have to stand up some surveillance testing on each coast for ourselves because it really begins the turnaround time. You’re holding a ship from going anywhere. So you see how many more people could be positive. I think that always keeping leadership informed, making sure that the C. D. C. Writes guidance. I spent seven years with C. D. C. So I will never say a bad word about them. C. D C. Writes guidance for the general population. We have operational missions that we have to meet that may not allow us every day to do everything that CDC would want for the general population to be done. There’s going to be some risk that you take. The idea of like that 14 day quarantine. Then coming down to maybe we’ll attend or seven day if you could test out was very helpful. And that’s just how you have two more pragmatically think about the missions that have to do the taxpayers money. We have to patrol shores and fly planes and everything else. So I think that the two things I did I’m most proud of in terms of field communications and I don’t want to miss stop talking about this one. So the first one I will say I established very early on wellness Wednesday, which is an hour panel when we talk about um how are you doing with various types of stress or anxiety you might be feeling in your life, It could be a chaplain and um e a p. It could be a doctor and you know, a member that’s had a tough time but basically humanizing and letting everyone know these are apparent conditions. And if you did not feel some level of stress anxiety out of your comfort zone, depression, for some of the things that you’re losing or finding yourself losing, it would be I’d be more concerned about you. So bringing that conversation into the the wardroom or the workplace for if I said, hey, how are you doing? I’m doing? And he says fine. I can say how are you really doing and have that? How are you really doing conversation whether I’m the boss or the pier because people weren’t fine last year and they’re just barely not even fine now. But I think that giving that space, so every every week it’s a different topic. And I mean these range from now from you know via transition issues and long covid to they’re not all covid related but to pt things physical therapy things as well as again a lot of the psycho social dynamics, that was one thing that we will continue as a best practice. The other thing we did was we took every um well as we printed all this guidance, this community of practice guidance, all this dynamically changing safety guidance, we decided to have town halls on Tuesdays and Thursdays and we would do them in like two week blocks cycles because you would want the people that were interested in area level or district level, thinking about the platforms and what was going to have to have our one level, the next people might be all your countrymen, they’re on a different call, your small boat stations on a different call, your aviators on another call. But like basically having the conversations with the communities who we’re going to go, we’re going to go over what we’ve said this policy means. And now we want to hear your questions as to how you’re going to struggle with or it’s going to be super easy to implement, but let’s make sure we’re talking about the same policy. So I think that was really helpful. Thank you very much. Uh general place. I have a question from the audience here that gets to the broader context in which you all are trying to do your jobs and and meet these challenges. And and obviously during this period of time the social media environment, the news coverage environment, the sort of broader political environment in the country meant that information and the information space um was was not simple or unified and there wasn’t one story that was getting out there. What was it like to operate in that environment? You know, what, what did you learn from it? And how do you think about the the information component of pandemic response going forward based on the experience you had? Yeah. Thanks for the question. And I think it’s a uniquely important thing to at least consider. There’s, You know, hundreds of millions of Americans. We each have our own individual story. We’ve many of us at least have been impacted either personally or or someone close to us in some form or fashion over the last 18 months or so. And that information is true for me or for you or whose ever experiencing it, but it may not be statistically true. And so balancing the the life and the experiences that people have or the desires that they have for a particular outcome that they want to have happen. And is there information that supports whatever it is that they want to have happen that then gets into uh the social media environment? On the other hand, I have my own personal desires for many things as well, But but I’m most interested in putting information out in the space that’s scientifically accurate. At least as much as that we know. Uh and in fact, it’s even better if it’s balanced scientific information, Right? It’s not all sunshine and unicorns. Everything that we want is not perfect. It’s what’s the balance of what do we know? What do we not know? What do we think? Why do we think it so it’s all those things put together. And, and quite frankly, I think that’s it’s terribly important for all of us and irrespective of whether you wanna talk about Covid or or any other thing in life. Social media is an interesting concept and it has huge value to it, but it also has huge risk to it and we have to be able to all of us. I mean, this is my advice to everybody to include my kids. Uh, make sure you balance whatever it is that you’re reading on social media post and make sure that if it’s a story that you want to read, that’s fine. There’s all kinds of books or articles or all kinds of things that we can do to bring joy or entertainment or whatever into our lives that doesn’t necessarily make them scientifically true. Um, and so try to balance those things out and then balance the emotion of what we may feel about what’s happening somewhere against what we know to be as true as possible based on real data and real information. So how to balance those things. And then from our perspective within the DHS, at least for the diode beneficiaries, how do you provide useful information in general? We as physicians, we tend to talk in a different language, just like aviators talking a different language or tankers talking a different language. And we often think that what we’re saying is absolutely accurate and it is and it makes absolutely no sense to those that were saying it too. And so just because we’ve said, it doesn’t mean that it’s received in the way that we intended it for it to be received. The last part of it is we’ve had to adjust in some ways. Just like admiral thomas was talking about, uh, when she mentioned that our line leaders aren’t physicians, they’re not epidemiologists. And yet in many cases I think we’re speaking a language different than them and what we thought was very easy to understand because we were speaking in our code wasn’t very easy for other people to understand. So changing it to be able to be understood by the intended recipient. All those things are my best advice. Yeah. If I could just build on the, you know, the two previous questions, um, absolutely. The information, you know, requirement, the requests for information flooding into our headquarters was astounding. I could guarantee that if there had been a story about some advance or some finding on CNN that I would, my email would be explode would explode. So almost as self preservation. But it turned out to be extremely helpful and effective. Was uh, I said, listen, I need a I need to pull our experts. I need to defer to expertise here. I need to leverage these remarkable scientists and public health experts and virologists that we have in uniform and in our laboratories, are civilians who are in our laboratories as well. And so we put together scientific panel and we would meet weekly. They would, they would come to me with really the latest greatest, you know, latest, most definite information they could with an interpretation to get past that barrier of language. And we put that together as essentially a newsletter that went out weakly, uh you know, to senior leadership, but also all of our Fleet Marine Corps surgeons. And so there was there was the take home message implications for operations. And then for those more scientifically inclined, there was the actual article or uh, so that team really continues to this day. Now we’re at every two weeks continues to put that information out and we have found that to be very valuable. And that same scientific panel meets weekly verbally virtually with all of our senior caregivers surgeons and both Fleet Marine Corps. And that has turned out to be enormously valuable to stay ahead of that information. That you know, that relentless demand for information. Excellent. Thank you very much. I have several questions that relate to industry and the partnership between the military and industry. And so let me let me try to bring three of them together at at once. And then I’ll open up to any of the panelists who would like to speak to that one is sort of the what question? You know, what kinds of things should industry be be providing, investing in thinking about their capacity going forward, partnerships for future development to be prepared for the next one. The second question is sort of for what is you think about the future operational force and what it requires and how it’s going to operate. For example, the Navy and dynamic maneuver or thinking about high end combat coming back into the field or other things like that. You know, how do we think about that operating environment and what do we need? And then the third area is so, so how how does industry partner better more effectively, particularly small businesses? Are those that have not been in the field of medical response, medical support preparedness begin to develop that partnership with the uniformed services and the defense Health agency. So I just open that up too to any of our panelists. Yeah. Thanks. I’ll take a stab. I think, you know, the, the information and uh, you know, providing ideas to us was very valuable. So what, what I did, I would get, I would get a number of, hey, we have this to help you diagnose covid, for example, or we have this, uh, to help you sterilize, you know, workspace. And so what we did is that was the other real value of the scientific panels. I was able to have our scientific panel evaluate that. So I think we need a, a faster way to take those cutting edge things being developed in industry and be able to be able to analyze them and see if they fit our environment. But it’s beyond covid. Uh, the challenge that we face, uh, as we look at distributed maritime operations, expeditionary, advanced basing operations for the Marine Corps is uh, you know, the, when I was in Fallujah in 2000 and four, many of the casualties I treated I got within 10 minutes, certainly rarely more than the golden hour of 60 minutes. And we certainly saw the value of that in Afghanistan as well. In this demo environment, we talk about the brass 96 we talk about the vast distances, you know, and how we, how are we going to provide medical care in that environment? And so while while damage control surgery and immediate resuscitation has definitely proved its value. How do we replicate that and recognize that many of those patients probably will not come to surgical care? Resuscitative care within that, you know, then that vaunted golden hours. So I think prolonged resuscitative care, prolonged combat casualty care prior to roll to as as a general place to find. It is an area where we need tremendous assistance. And we have to recognize too. When you look at, when you look at the survival curves in any conflict, there’s a ramp up and we’re working on that in terms of making sure our folks are absolutely at the top of their game before they deploy. But the other side of that is just understanding the new complex of injuries. And so in the maritime environment, the things that keep me up at night are what happens if a missile hits the ship and I’ve got close base inhalation injury, I’ve got burned, uh, and something we haven’t treated in large numbers since World War two immersion injury. If I’ve got sailors that are in the water for long periods of time. And so that’s an area as we look to the future where tremendous help is required from industry as to what do we know, what are some of the tools that we can develop to get after that problem said, if I could add to what animal going home just mentioned. I mean, the way that I think about it is uh, the 1st 1st order of business is always prevention and that prevention can be something done to the human body or something done around the human body. And so for us, we’re most worried, we’re interested in taking care of everybody. Service members, family members, retirees, retiring family members. But the military health system exists for the military, that’s our purpose. And so we think about service members. What can we do to keep them healthy? What can we help them inside their own body or what, what piece of kit? What piece of gear? What piece of anything can we do to prevent anything bad from happening to them? It can be an infectious thing. It can be a cold. I am a Gillingham’s talking about immersion injuries. It can be directed energy is if you think about it, I mean right now we’re both surgeons, Admiral Willingham and I, most of the issues that we saw in Afghanistan or Iraq or Syria where projectile injuries of some sort and the challenge with the projectile injuries, what it does to tissue and how it lets the most important liquid inside of you leak out. Right? That’s the issue that we dealt with. How do you stop the bleeding and then how do you prepare for the greatest degree possible? The tissues the way they’re supposed to be so that the body can heal itself. That’s what we do. But but those are relatively recent challenges. I mean, in the history of mankind with high velocity injuries. So what’s the next, what’s the next injury type? And how are we getting ahead of that? Were preventing it or how we’re preparing to take care of it? But if the first part is prevention, then the second part is diagnosis. If you look at diagnostic capabilities, in particular diagnostic capabilities on the battlefield, it’s difficult to hell around an MRI scanner in a platoon, right? It’s just you can’t do it. And so if you look at diagnostic imaging 50 years ago is X rays. That’s all we have now. We got CT scans and pet scans and mris and ultrasounds and and nuclear medicine. All kinds of different ways. So what’s the what’s the best diagnostic capability that’s actually effective in an operational environment? And how can we get it there? So that’s about waiting cube? Or if it’s got it’s got radiation associated with protection from all involved with the radiation capability that it has And then treatment sort of thing. So if you look at what we had from a pharmaceutical intervention capability 50 years ago or 100 years ago compared to now it’s been an explosion of that. And so what are the types of things that we’re really not even considering now for the most common reasons that service members can’t be at work? And over the last year the number one reason that service members weren’t at work was because of covid. Number one. Now, a lot of that’s because this Admiral thomas said the restriction of movement, right? You can’t come to work because you got to be somewhere else, just doing nothing, not infecting yourself or other people. But the most common reasons for not being at work and the most common reason for not being work is Natural pregnancy. I think we’re okay with that one or musculoskeletal injuries. And so what are we doing on the prevention side of the musculoskeletal injuries? What are we doing on the intense rehabilitation of them or what are we doing on the pharmaceutical part of musculoskeletal injuries. So when we think about where we’re going, those are the things that we need help with. How do we prevent? How do we diagnose in particular? How do we diagnosed at McGill in Hampstead and distributed maritime operations? How about distributed military operations? Because we don’t want to I don’t want to fight at home. These are away games that we’re talking about. So how do we take it with us and then should something bad happen, how do we very rapidly bring people back to full capability wherever industry happens to have your niche that may interject into one of those areas? That’s where we’re interested. Excellent. Thank you. Please. Right. I really appreciated that discussion. The I am a I started off as a general surgeon. I did my first year, my internship here in that and I am a prevention ist now. And one of the reasons why people spent so much time at home because of Covid this year is because as soon as you were a contact and I might have had Covid I’m waiting for my test. But you have my contact, You’re in, you’re in the box for 14 days and there’s no way to get people out of that. Well, one of the things that that Detroit had worked on previously with two other companies was a way to alert the member to how their physiological state may have changed And it’s a score and it’s a score using two pieces of equipment. one is this watch and one is this ring because people can’t understand that concept. I think very easily. What do you mean? I have to say six ft away. I’ve got a mask all the time but you probably can’t understand. Look at your phone, you have an app, Check your rate score every day. My score is normally one, sometimes it’s five, But if it’s up to 100, my score was 25 tomorrow. Guess what I would not do would not go to work because the risk and the epidemic, a pandemic of me having Covid and then all the tail chasing that has to occur with all the different people. I’ve got to go find and swab and put them in in, in in the whole while we wait for those tests. The amount of wasted testing and time I spent on that would have been worth alone a watch and a ring for every person because it gives them the personal feedback on their sleep data on their heart rate, variability on their respiratory rates. It was actually tested, was actually tested on several other illnesses prior to Covid coming out and they said, but doesn’t work for Covid. And it does your lead times usually 48 hours from the time. You will feel a symptom while I’m still able to spread. But I would be completely unaware that I was infected. So to me, I mean, I would really also move us further upstream in everything we do with prevention. Well, I can’t I can’t let us uh, get off the stage here without talking about the vaccine and the vaccine rollout. Um, and there are many, many questions about it. And obviously there are lots of I have several questions from the panel about when and where and how much and and mandatory and authorized and all sorts of things like that. But let me make it an open ended question. Um, What was the what was the what was the impact of the vaccine rollout on the force? And what is the potential impact going forward of the suite of vaccines that we have for COVID-19? And I see you nodding your head, killing him. So I’ll ask you the question. Yeah. I think I think if you’re aboard ship, um, you saw an immediate impact in that our Navy Marine Corps Public Health Center was able to model levels of vaccination and likelihood of outbreaks, uh, and and they hit on a number uh, in that environment. I, you know, want to make very sure that that’s in that environment. About 85% vaccination gave skippers the opportunity to relax restrictions. So if that crew got aboard and were 85% affected pretty quickly, we were safe. We said with it, you know, continue the non pharmaceutical interventions for two weeks. But at that point, if no one’s no one’s developed, Covid, you can relax restrictions. So that really reduced some of the burden aboard ship board. So, so a very tangible operational value, I think also just, you know, sunday intangibles. The idea that folks could go to the gym and blow off steam and not not be restricted are very important to get to some of the the stress issues. That this is one more thing. One more outlet that I’m restricting you from doing and the social interaction which we know is critical. So so game changer, you know, and and we continue to push for our force to get vaccinated. It is a readiness issue first and foremost for us. And if you’re vaccinated, you’re much less likely to, you know, to get very ill or be hospitalized. And so you’re going to keep, you’re going to be in the game general place hinted at it. But I look at it very simply, we would not send our folks into combat without flak and Kevlar. The enemy this time is a virus and we have a biologic body armor for them to take and use to protect them. And so that’s how I that’s how I really a phrase that this is biologic body armor, put it on, be protected. Cool. And before we finish up this panel light, I do note that the title of this panel is Covid response and post pandemic National Security. And I got a question from the audience about how do we how do we how do we place what we have learned and what we need to do in the context of broader strategic competition? Right. The military has to play a role across the spectrum of conflict. And we are adversaries are are looking at us and and learning and they’re going through their own pandemic experience. Um, I’ll ask you general place, um, how should we think about covid response? Pandemic response, disease control and management in the context of great power competition. And how would you rate us? How are we doing in that regard of getting ready for that? Well, if you look at it um, from a scientific perspective, uh military scientific perspective with the B and C. Burn being biologic, I mean, this is a biological event, right? And I’m not going to get any sort of conspiracy theories about purposeful or not purposeful. Is this a wild type or not? I’m not going to get to that in large part because I don’t know. Um, but make no mistake about it. It has had a biological effect. That’s why you heard Admiral Willingham just mentioned this is biological, body armor. It is what it is. And so where are we? I think we’re in a, we’re in an okay place. We’re not in a great place for an okay place. But I think one of the, the things that many of us believe is a fallacy and that is, it’s going to go away. It’s not going away, just like influenza is not going away. It is. And the thing about many viruses is they tend to mutate and they tend to do things that keep them alive. And I think for all of us, you know, when it comes to influenza, we just, okay, either we get the flu shot or we don’t, we know that the flu affects people. The reason that influenza tends to stay outside of most of our, um, our ways of thinking about except for, Yeah, okay. I got it this year and I’ve, you know, I feel terrible and maybe have to stay home for a few days. But in general, those of us who are who are adults and healthy, yeah, maybe we get a little sick but otherwise don’t really worry about it. But ladies and gentlemen, tens of thousands of americans die every year from influenza every year every year. And what most of you likely don’t know is we have a tri valent vaccine every year because influenza subtypes a sometimes be always mutate and mutates in the northern hemisphere and it goes to the southern hemisphere, mutates more. It goes back to the northern hemisphere seasonally. It does all those sorts of things and we manage it with the public health things that Admiral thomas was talking about. And while most of us in the uniformed services get vaccinated, most americans actually don’t. That’s a problem for us. So I don’t see covid is a thing that’s going to go away or coronavirus is I I actually see it sticking around and continuing to mutate and and and we’re going to have to deal with it. And and the great thing about ingenuity and I’ll talk about the ingenuity of the human species, but specifically within the environment. That is the United States. The reasons that we have such good vaccines, A suite of vaccines right now Isn’t because the magical thinking happened by some manufacturers in the spring of 2020. This is based on years in some cases, more than a decade of research and how to take the the vaccination methodology to a new level. And so whether it’s M. R N. A. Or nanoparticle or whatever it is, there is huge improvements in the way that we’re looking at how vaccines work. And and I believe that that we will get to a place where we’re not talking about covid all the time. And we’re not worried about how is Covid affecting this, that or the other thing that likely that will be in the relatively near future, but not this week, not this month and maybe not even this year, but we will get to a place where it’s going to be another infectious disease that we worry about. And we think about much like influenza or measles or tetanus or another thing that Yeah, Okay. All right. I’ll get my vaccination. It’s going to be part of our reality for a long time. Excellent. Great. Thank you Apple Times. Um from your perspective, working across the inter agency and coordination, um, in terms of the lessons we’ve learned and how we’ve evolved, um, how how how can we do you think we can best prepare for collaborative responses between civilian and military going forward between the Coast Guard and industry, between us and our international partners? What would be the sort of foundational things that we would need to think about to make sure that that collaboration and coordination and shared learning and preparedness can happen, not just within the uniform services where there’s a lot of ability to control and direct, but in partnership with others. Thank you dr Thompson. So it’s interesting. I mean the CDC really does have a pretty good playbook for highly transmissible respiratory viruses. We didn’t kind of pull it down right away and start using it. But other countries that did really well in the beginning, they didn’t have a lot of testing or they didn’t have a lot of anything but what they had, they put into contact tracing, they put into quarantine and isolation and when they had testing and they stood that up and they really kept their numbers. So I think you having that national will regardless, regardless of politics, to sort of do the right thing in public health will save lives. The idea that because I don’t think anyone tries to look at, how do we not partner with because all of us have civilian members of our family, Right? So we want the same good health for ourselves as we do for our family members. Um and I think there’s just, I think there’s been great progress on a real openness. This to me, what was amazing was seeing something um MRNA vaccines in particular brought to fruition in such a short time because the the globe was a tremendous threat. Every population was a tremendous threat if we did not have vaccine. And it’s been great. I mean, we’re over 70% of our active duty and reserve forces are vaccinated right now. But that’s not enough. And almost like where we are right now is since you’re seeing all the breakthrough, um, cases Do I go back to Rome and testing people before they’re getting underway for 90 days and my back exactly where I was rather than rather than at the wonderful modeling that was done. If you have this level of vaccination, don’t worry about the other 15% because I am a little bit more worried about them now and I’m worried about the spread to other people even if it’s a milder disease. So I think the the game changes which keeps it interesting for us. But like, um, general place that I I have no expectation that Covid will go away. There won’t be another coronavirus or a similar viruses. This will mutate, I think. But I think we’re smart enough to figure out how to protect ourselves. Excellent. Well, unfortunately, we’ve, we’ve quickly reached the end of the time. We have a lot and for this, I have a couple of thank you. So I’d like to say before we finish up this panel. And first and foremost I’d like to thank the audience for being interested participating. I had a huge stack of questions. I’m sorry. I didn’t get to all of them, but I think we had a really substantive conversation. Um, and and that was driven by the questions from the audience. I’d like to thank the Navy League for inviting the panelists and drawing them together and creating this venue for this important conversation. And it also very much like to thank the services, the Defense Department and these individuals here that represent that for taking your time and energy for thinking about these issues for the contributions and learning that you made over the last year and a half, and your willingness to come and share that today. So so Admiral thomas at will killing him a general place. Thank you very much for your participation in this panel. It’s been a real pleasure, uh, and thank you all for being here today.

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