The U.S. Army is involved in conducting a change of mission to focus on combating the COVID-19 virus. The main emphasis is protection of the Army force through maintaining global operational readiness and supporting the national effort to combat COVID-19. This will result in the best defense for soldiers, civilians, retirees and their families.
The Army is engaged in all aspects of COVID-19 management, from prevention through vaccination, diagnosis and treatment of this devastating virus. The Walter Reed Army Institute of Research continues its work on COVID-19. The Army provides medical facilities to support COVID-19 efforts and supports vaccine development. The Walter Reed institute through its research also supports the health of soldiers and civilians across all installations.
While daily cases and deaths have drastically declined since the coronavirus surfaced in China in December 2019, and COVID deaths hit more than 3,000 per day in January in the U.S., the new and dangerous delta variant could set back America’s progress on the pandemic.
In a cohort study of over 27,000 veterans who received a positive test result for COVID-19, no association between social and behavioral risk factors and death from COVID-19 was found in an integrated health system such as the Department of Veterans Affairs, according to a June article in JAMA, The Journal of the American Medical Association. Interestingly, the diagnosis and treatment of post-COVID conditions (or so-called long COVID-19) can be managed by primary care physicians. There are a lot of unknowns about post-COVID symptoms and recovery. However, distinguishing between post-COVID and other chronic conditions is necessary.
Vaccinations Required
Defense Secretary Lloyd Austin in late August ordered that all service members be vaccinated against COVID-19. Soldiers could request an exemption from receiving the vaccine for legitimate medical, religious or administrative reasons, the Army said. Those who refuse to be vaccinated could face reprimand, administrative action and even discharge.
“This is quite literally a matter of life and death for our soldiers, their families and the communities in which we live,” Army Surgeon General Lt. Gen. R. Scott Dingle said in a statement.
As of Sept. 22, the total number of Army COVID-19 cases was 84,072. By mid-September, about 80% of active-duty soldiers had received at least one vaccine dose, according to the Army.
According to the Centers for Disease Control and Prevention, the U.S. was not prepared for COVID-19, due to years of insufficient investment in public health infrastructure. By working more closely with public health organizations, the Army can help prepare for future pandemics. The World Health Assembly of the World Health Organization has proposed nine steps to end COVID-19 and prevent the next pandemic. These serve as a blueprint for action that the world could follow for future pandemic responses.
Standards must be developed to prepare for the next viral threat. The COVID-19 pandemic drew attention to the need for the health care system to be more receptive to changes in medical science. COVID-19 testing provides a descriptive illustration of how fast medical practice changed during the pandemic.
Actions to take in case of the next incident include updating electronic health records to include additional questions to ask patients to ensure an accurate medical history, and making progress on ensuring the nation’s Strategic National Stockpile is equipped to handle a sudden demand for personal protective equipment and ventilator supplies. This was learned the hard way during the COVID-19 pandemic.
Additional investigations are required to bolster vaccine research and manufacturing. Improvements to tracking and alerting the world to new diseases are needed. For example, a recent project at the University of California, Davis, predicts what animal viruses might spill over to humans. There is little existing research on identifying threats from viruses that occur only in animals but are also found in viral families that probably can cause disease in humans. More research is needed.
Medical personnel who treat and care for COVID-19 patients on a long-term basis may need additional support in caring for their patients. Telementoring is a method of providing extra assistance for medical personnel. It offers a proven standard for social learning for doctors, uses the cases of real patients and helps determine how to best care for these patients. This method would be advantageous to doctors who practice in rural areas.
Innovative Ideas
From $1 million cash prizes to dinner with a governor, states and cities offered incentives as part of their efforts to boost vaccination rates. These incentives are a relatively novel topic in public policy. It is unknown to what extent incentives can affect increases in vaccinations, however, there are some early indicators that the right incentives can help.
Supporting new ideas is a way to address threats from novel strains of viruses. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, in June announced that the U.S. was investing $3.2 billion to advance the development of antiviral pills to treat COVID-19 as well as future virus outbreaks. The Antiviral Program for Pandemics also will support research into new drugs. A number of other viruses, including influenza, HIV and hepatitis C, can be treated with a simple pill. However, no such pill exists to treat COVID-19.
Target Missed
When we think of combating COVID-19 in the U.S., we must remember that this is a global situation. Many countries have been hit with the pandemic, and none of them is finished with this virus. In the U.S., as of Sept. 26, there was a seven-day average of 1,996 COVID-19 deaths. The White House formed “surge response” teams to combat the delta variant. President Joe Biden had set a target of July 4 to get 160 million U.S. adults fully vaccinated, and at least 70% of U.S. adults partially vaccinated. However, the number of people getting vaccinated dropped considerably. As a result, this target was not achieved.
Vaccine mandates are most effective if high vaccination coverage cannot be achieved through other public health interventions. Public health and mobile efforts, pharmacists and primary care doctors, faith-based leaders and others are bringing the vaccine to where the people are and making it relatively easy for people to have confidence in the vaccine.
COVID-19 vaccination of health care personnel as a condition of employment may become a requirement to protect patients and other health care providers. The question of whether to implement this vaccination policy as a condition of employment is becoming clearer. It may be necessary.
Soldiers who are unvaccinated are strongly encouraged to get vaccinated. By doing so, they will be better prepared to defend the nation and protect their families and their communities from COVID-19. By getting vaccinated, a soldier may ultimately save their life or that of a family member. Understanding this recommendation may prevent or alleviate the next virus pandemic.
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Maj. Gen. George Alexander, M.D., U.S. Army retired, served as assistant surgeon general and deputy surgeon general for the Army National Guard in the Office of the U.S. Army Surgeon General, Falls Church, Virginia. He earned his medical degree from Howard University College of Medicine, Washington, D.C., and completed postgraduate medical specialty training at the University of Texas MD Anderson Cancer Center, Houston.