As the novel coronavirus (COVID19) outbreak upends virtually every aspect of American life, we are constantly reminded of the devastation wrought by the 1918 Influenza pandemic. It also offers a sobering reminder of how quickly a virus can hobble a military force without effective countermeasures. During WWI, influenza and pneumonia sickened between 20 to 40 percent of U.S. Army and Navy service members in a matter of months.1 However, it is not 1918; modern biotechnology is already making dramatic gains in testing, therapeutics, and immunization in ways unimaginable in 1918, or even a few decades ago.2 Here we describe just one biotechnology solution – a test that could determine who has been exposed but not sickened - that could mitigate the impact to the U.S. military’s readiness. While America’s response to date has been very much steered by the virus itself, this tool could give us leverage and control to better manage the military’s readiness and protect our ability to deliver the defense mission.
COVID19: A unique threat to US Military Readiness
Within the growing landscape of advanced technology and weaponry, a key point of readiness in the US military remains the individual service member. COVID19’s threat to the force is that it unexpectedly takes individuals out of the fight even with current protective and distancing protocols. Unlike 1918’s virus which selectively harmed young healthy individuals, what we know about COVID19 suggests that average service members should experience minimal symptoms, and those that do require hospitalization will likely recover. But like 1918 our service members still operate within highly skilled, interwoven teams and in some cases, tight workspaces.3 Thus, most military jobs are not conducive to social distancing. Moreover, an entire unit that is either mildly or moderately suffering from this disease will be ineffective until the disease runs its course with the unit.
A prime example happened at sea; when a number of sailors on the USS Theodore Roosevelt aircraft carrier deployed in the Pacific tested positive for COVID19. In response, the Navy is undertaking the long process of testing each members of the 5000 person crew to determine if they’ve been infected.4 Within a few days, the Roosevelt went from a mission ready and potent symbol of American power and commitment to peace in the Indo-Pacific, to a health impaired boat docked in Guam, sidelined from its mission.5
What happened on the Roosevelt represents an alarming example of the virus’ potential to complicate ongoing United States operations, deterrence missions, and our response to any opportunistic aggressor. The virus’s impact on military readiness is subtle but real. For example, some large-scale exercises have been reduced or canceled6, and a global 60-day stop movement order impacting individual and unit travel and deployments remains in effect7.The Marine Corps paused sending recruits to Marine Corps Recruit Depot Parris Island, and the Army just halted movement of new recruits to basic training sites.8 These delays in individual and unit training are especially important today because the Services had only just begun making headway in regaining the high-end capabilities lost while we focused for nearly two decades on counterinsurgency-type operations.9. Although Secretary Esper directed the Services to look for ways to process and train new recruits while minimizing the spread of the disease,10 practical difficulties with this edict remain. Although the military can identify those sickened by the virus, they cannot reliably identify which service member is a carrier or who is immune.
Under these conditions, the Department’s force management and deployments are vulnerable to surprise outbreaks of the disease either within operational units or within the equipment, personnel and training pipelines that feed those units. Without more pro-active disease management tools, the effects we see on ongoing operations11 as well as on the ability to maintain a credible deterrence, will episodically increase. Luckily such tools are possible.
Focus on Rapid Antibody Testing
The most urgent tool at the onset of any outbreak is diagnostic testing, that is, the ability to rapidly and reliably detect the virus in people who are infected, and to track the spread of the virus through populations. These are commonly developed based on the unique genetic code of individual viruses (PCR-type tests). Although the U.S. had a slow start on reliable and scalable tests diagnostic tests12, there are now a suite of virus tests approved by the FDA for use in a variety of settings, including military health facilities and labs13. However, not everyone exposed to the virus contracts disease14, and moreover, some have very mild symptoms and quickly recover. These recovered individuals no longer test positive for the COVID19 virus, but they have antibodies against the virus in their blood serum. They are believed to be no longer a risk of infection, or spreading disease to others. Most importantly, recovered individuals can more safely operate in the current infectious disease environment. If we knew which individuals on the Roosevelt were in this category, the crew would have been in a very different situation - only those infected or at risk would disembark, and those already immune to COVID19 could have continued the mission and decontaminated the ship.
Tests for antibodies, commonly called serological tests, are now crucially needed in response to this outbreak. As of this writing, the Defense Department does not have such serological antibody tests available. The FDA has now approved the first clinical serological test for the civilian population of the United States15, to understand who among that population can safely return to work. However implementing this test for broad use at point of care, that is in doctor’s offices, will take time will be further complicated because Americans receive their health care in tremendously diverse health care settings.
The U.S. military, however is under less constraints than the general population; all active duty military members are within the same health system, so individuals could be rapidly tested and those who are safe from COVID19 could be given a readiness “green light”. While traditional antibody tests have been expensive and constrained to containment laboratories, newer methods for rapid point of care testing such as “test on a chip”, are becoming mainstream. A number of such tests have already been developed, some which could even be used in home settings. Further, the military services could serve as a test bed for these tests. With accelerated fielding in the military and real-world application of these tests to critical service men and women in the next couple of months, the US military could do as it has done in many past crises – pioneered the use of new medical procedures of great use to the general public . A point-of-care rapid antibody test should be fielded across the military as a priority. It would allow military commanders to identify the key units and individuals who are going to be reliably capable during the many months before a vaccine is available. It can also identify critical leaders who are immune, and thus better able to lead critical units and missions in the pre-immunization era, including those being sent to assist with the wider US response to COVID19.16 A reliable COVID19 antibody test will help our services identify those no longer at risk, and can be counted on when called.
Putting military leadership, not the virus, back in control of the force
The COVID19 pandemic has critically shaken the health, civil society, and economic security of the United States. It also has tested the readiness management processes of the U.S. Defense Department. The only option currently available to combat the spread has been social distancing and the highest quality of care by our medical providers. While we wait for treatments, the Department of Defense needs to maintain readiness of the force in the interim. Force readiness and management will be improved by rapidly deploying a point of care serological test to all in the U.S. military. While not a complete solution, it is the first step to assuring that the Department can both continue its mission and continue the fight against the pandemic. This simple, science-based course of action could ensure that during this dangerous pandemic, the U.S. armed forces stay in charge, not the virus.
1 Carol R. Byerly, The U.S. Military and the Influenza Pandemic of 1918–1919, Public Health Rep. 2010; 125(Suppl 3): 82–91. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337/
4 Navy docks USS Theodore Roosevelt to test crew for COVID-19. https://www.cnn.com/2020/04/01/politics/roosevelt-quarantine-guam/index.html
10 SECDEF April 3 memo on “Policy on Accessions and Accessions Training During the COVID-19 Outbreak”
12 The CDC’s rocky effort to get Americans tested for coronavirus, explained. https://www.vox.com/science-and-health/2020/3/6/21168087/cdc-coronavirus-test-kits-covid-19
14 Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180
15 FDA approves first antibody test in the US to detect the coronavirus. https://www.livescience.com/first-coronavirus-antibody-test-approved-us.html
16 DOD Mounts Multifaceted Response to COVID-19 Pandemic. https://www.defense.gov/Explore/News/Article/Article/2132534/dod-mounts-multifaceted-response-to-covid-19-pandemic/
Dr. Diane DiEuliis, is a Senior Research Fellow responsible for biothreat research in the Center for the Study of Weapons of Mass Destruction at the National Defense University, U.S. Department of Defense. Dr. Laura Junor is the Director of the Institute for National Strategic Studies at the National Defense University. Prior to that she was the Deputy Undersecretary of Defense for Personnel and Readiness, U.S. Department of Defense.
The views expressed in this op-ed are the authors’ own and do not reflect the official policy or position of NDU, the Department of Defense, or the U.S. government.
This was originally published by Insitute for National Strategic Studies