The military’s ability to pivot quickly to fight enemies doesn’t just apply to air, sea, ground and space forces. The military medical system has been in a unique position to respond to the urgency of COVID-19 on a number of fronts, defense health officials said.
It’s not just about quickly deploying hospital ships to New York and California. It’s about quickly moving to vaccine research, gathering data on COVID cases in the military community, and other innovations to improve care for patients. Military health officials work with many federal agencies in the pandemic fight, and they work with civilian health officials around the country and around the world where their numerous military hospitals and clinics are located, including many COVID-19 hot spots.
As far as DoD-specific numbers, there have been a total of 36,659 COVID-19 cases reported as of Monday. Of those, 25,590 were military; 3,417 were dependents; 5,373 were civilians; and 2,279 were contractors. There have been 960 hospitalizations; 15,122 have recovered. There have been 56 deaths, including 33 civilians, 13 contractors, seven dependents, and three service members.
Many of the innovations and lessons learned during the wars in Iraq and Afghanistan have been helpful in the COVID-19 fight, Defense health officials said during a call with reporters Monday.
One is the Joint Trauma System, which includes a registry of clinical information on the thousands of service members injured during the wars. Officials used the lessons from the wars and from that registry early on to develop their COVID-19 registry, said Dr. Paul Cordts, chief medical officer for the Defense Health Agency. Part of the power of the COVID-19 registry, he said, is its “real-time information,” so officials can evaluate the effectiveness of therapies being used, such as remdesivir, convalescent plasma, and dexamethasone. “We can adjust our clinical practice guidelines, if need be, towards those therapies that appear to be the most effective,” Cordt said.
That mirrors one striking change during the wars, with their “rapid cycle innovation.” If military doctors did surgery on a patient in Baghdad or Afghanistan, for example, they subsequently got information about how the patient was doing at each node of the evacuation chain, he said. With that feedback, Cordts said, “We rapidly learned how to adjust our practices when caring for patients with injuries as a result of combat.”
In the civilian world, there’s most likely to be a randomized, controlled trial, a rigorous, multi-year process before innovations are approved.
“In certain clinical situations, that’s not feasible,” such as in the case of combat injuries, said Air Force doctor Col. Todd Rasmussen, professor of surgery and associate dean of research at the Uniformed Services University of the Health Sciences. The alternative is the rapid cycle innovation, a real time assessment, based on real world data.
“We all want randomized control trials, but in certain situations, we don’t have the time to plan and conduct a five-year [trial] because the issue is just too urgent,” Rasmussen said.
Just as the military shifted its research priorities in the early 2000s to some specific combat care issues such as hemorrhage control, resuscitation and limb salvage, they’ve shifted priorities to a variety of research efforts during COVID-19, including their vaccine research which began early on in the pandemic. Researchers in the military realm are also conducting a variety of other COVID-19 studies, such as why some people with the virus have no symptoms while others get very sick.
Researchers are also finding ways other ways to improve patient care. They’ve invented a device that provides an extra layer of personal protective equipment for medical providers as they’re performing procedures. It uses PVC piping for tent frame that can be placed over the patient’s head and chest, lined with a polyethylene bag to seal in any possible COVID-19 particles that could endanger medical providers as they perform procedures. The COVID-19 Airway Management Isolation Chamber, or CAMIC, has a negative-pressure vacuum that contains and reduces aerosols and airborne particles.
The CAMIC is being used by the military around the world and on the battlefield, said Army doctor Maj. Steven Hong, assistant professor of surgery at USUHS, and chief of Head and Neck Surgical Oncology and Reconstructive Surgery at Walter Reed National Military Medical Center. He came up with the idea of the three-dimensional airway tent after watching the COVID-19 crisis unfold in New York City in mid-March, he said, noting the shortage of protective equipment, and realizing the vulnerability of health care workers to the contagious virus, especially those within his specialty of head and neck surgery.
He pulled together a team who designed, built and tested the CAMIC, and received approval from the FDA for emergency use, within six weeks.