Feature   Partnerships

Combined U.S.-German COVID-19 Efforts Make a Difference

May 1, 2020 | BY STEFAN ALFORD

With more than 50,000 Americans and nearly 200,000 of its own citizens, the Kaiserslautern area in Germany has long been recognized as being the largest U.S. military community overseas. It's no surprise that over the decades, many residents of both nationalities have come to speak each other's language and build lasting partnerships — the kind of well-established communication and friendship that has been integral in the joint effort to mitigate the spread of coronavirus in the area.

I am thankful for the good communication between U.S. and German health authorities."
Deputy County Commissioner Peter Schmidt, lead for the county's COVID-19 crisis response team

In fact, shortly after U.S. Army Garrison Rheinland-Pfalz Commander Col. Jason Edwards arrived in July 2018, he met with the Kaiserslautern county commissioner and his emergency response chief to discuss mutual capabilities for a joint response to a crisis. One of the initial discussion topics was preventing and responding to the African swine fever virus — a concern coming across European borders at that time.

Since then, Edwards has emphasized regular contact and sharing of crisis response planning ideas with the county and city's emergency management teams, thereby strengthening interoperability between the U.S. forces and its host nation counterparts.

Medical technician takes man’s temperature at clinic entry point.
Temperature Check
Air Force Airman 1st Class Sharmayne Campbell, 86th Medical Group aerospace medical technician, takes a patient’s temperature at the Ramstein Medical Clinic, Ramstein Air Base, Germany, March 19, 2020. To enter the clinic, each patient receives fever assessments. The 86th MDG transformed operations on the medical campus to prevent the spread of COVID-19.
Photo By: Air Force Airman 1st Class Taylor Slater
VIRIN: 200319-F-PJ020-1045M

While none at the time could have foreseen the current global pandemic, that groundwork has been key during the local COVID-19 response effort, with defined relationships, established communications channels and a team identity to work together to keep the number of positive cases to a minimum.

"I am thankful for the good communication between U.S. and German health authorities," said Deputy County Commissioner Peter Schmidt, the lead for the county's COVID-19 crisis response team and part of the 2018 meeting between Edwards and County Commissioner Ralf Lessmeister. "Everything is running smoothly for coordination. We appreciate the successful execution of what was actually promised."

During the most recent touch point, an April 24 conference call among Edwards, Lessmeister, Schmidt and Air Force Brig. Gen. Mark August, 86th Airlift Wing commander at nearby Ramstein Air Base, the county's roll-up of positive case numbers not only had stabilized, but also had decreased over the previous week — mirroring the Kaiserslautern Military Community.

Schmidt reported 203 total positive cases for the city and county, which includes the U.S. numbers being reported to them daily. With the aforementioned combined population exceeding 150,000, the spread of the virus has been statistically low as compared to other areas.

Thank you to the host nation team for how we've tackled this together. Credit the reduction in cases to restrictions placed from both the DOD and our host nation."
Air Force Brig. Gen. Mark August, 86th Airlift Wing commander

"The U.S. forces are following [country and state of Rheinland-Palatinate] restrictions appropriately," Lessmeister said, thanking Army and Air Force leaders. "We appreciate the messaging of [host nation restrictions] to help conform with [our rules] and help keep our numbers down."

"We are doing very well in adhering to every host-nation requirement for both information sharing and following of restrictions," concurred Edwards. "We remain overt about synchronizing across the board and staying in line with the guidance our host nation puts forth, as evidenced by our [senior responsible officer's] General Order No. 1 restrictions that mirrored German Chancellor [Angela] Merkel's guidance."

The Army's senior responsible officer for the Kaiserslautern Military Community, Army Maj. Gen. Christopher Mohan, commanding general of 21st Theater Sustainment Command, has released several videos and conducted livestreams along with Edwards' weekly virtual town hall meetings as they have pushed pertinent information on restrictions affecting the U.S. forces community.

Nurses put on personal protective equipment.
Protective Equipment
Dorothy Hall, critical care nurse at Landstuhl Regional Medical Center in Germany, dons personnel protective equipment during COVID-19 operations in the intensive care unit, April 1, 2020.
Photo By: Marcy Sanchez, Army
VIRIN: 200415-A-EK666-0119M
A woman dressed in personal protective equipment takes information from a motorist through a car window.
Patient Information
Air Force Staff Sgt. Maxime Copley, 86th Medical Group independent duty medical technician, writes down patient information in the Ramstein Medical Clinic’s coronavirus disease 2019 screening drive-thru at Ramstein Air Base, Germany, March 31, 2020. The 86th MDG transformed its main parking lot into a drive-thru to expedite testing and prevent the spread of COVID-19.
Photo By: Air Force Airman 1st Class Taylor Slater
VIRIN: 200331-F-PJ020-1030M

From the Air Force side, August also lauded the joint U.S.-German effort in the region: "Thank you to the host nation team for how we've tackled this together. Credit the reduction in cases to restrictions placed from both the DOD and our host nation," he said.

Two of the primary factors in flattening the curve locally have been proper data sharing between U.S. and German health officials and successful preventive efforts in identifying close contacts of confirmed positive cases via trace teams.

"Cooperation has been absolutely fantastic," Edwards said. "We recently had a joint Army-Air Force-Host Nation trace team discussion, and there are no seams or gaps in our accounting, down to all of the individual calls being made to contacts."

That assessment is echoed by all involved.

"The coordination with our German Public Health Department — the Kaiserslautern Gesundheitsamt — is very good," said Army Lt. Col. Laura Ricardo, chief of the preventive medicine division at Landstuhl Regional Medical Center. "We have been corresponding and speaking with our counterparts throughout this pandemic on a weekly basis, sometimes daily, when we need clarification on synching our processes. [The Army and the Air Force] have been providing them the reports as they have requested to be in compliance with the [Status of Forces Agreement].

"They receive the information of every positive COVID case," she continued, "and we provide them information of close contacts who live outside the base to reassure we are maintaining their protocols in protecting their German community."

Ricardo also said the Army and Air Force trace teams work very closely, as many of the COVID-positive cases are integrated, such as joint families and co-workers. "We share our reports on a daily basis and basically work as a unified Team Trace," she added.

Two people dressed head to toe in personal protective equipment hold up their gloved hands.
Critical Care
Army Lt. Col. Janet Glenn, left, and Dorothy Hall, both critical care nurses at Landstuhl Regional Medical Center in Germany, don personal protective equipment during COVID-19 operations in the intensive care unit, April 1, 2020.
Photo By: Marcy Sanchez, Army
VIRIN: 200415-A-EK666-0121M

The Army and Air Force track every positive patient in the Kaiserslautern Military Community through their entire infection period to their release date as approved by designated medical professionals, explained Air Force Capt. Patricia Baker, public health officer at Ramstein.

"These efforts are crucial and increasingly important in the global effort to combat the COVID-19 pandemic," Baker said. "Every infection we prevent, in turn, could mitigate a complication or severe case from manifesting. As we have seen, some people acquire the infection and are able to stay at home and recover with no issues. On the other hand; we have seen COVID cause serious complications, especially in communities where caseloads have been high."

In addition to the aggressive joint service follow-up on cases, Baker said the teams also work hand in hand with German health officials in situations where household members are empaneled off post and are tracked and medically managed by the host nation.

"We are in constant communication with the local public health department to ensure that our protocol for quarantine and isolation match their host-nation goals," she added. "The Robert Koch Institute is the overarching recommendation and regulation authority for disease control and mitigation within Germany, so it's paramount that we have a good flow of communication between the local public health office and our offices all year round, and especially during our COVID pandemic response.

I am incredibly grateful for the excellent cooperation and teamwork we have established between our local Air Force, Army and host-nation counterparts."
Air Force Capt. Patricia Baker, public health officer at Ramstein

"Our interactions have been consistently strong and constructive throughout the COVID-19 mitigation efforts," she continued, "[and] our public health emergency officers from the Army and Air Force have very good working relationships with the doctors and professionals at the Kaiserslautern Public Health Department."

One of those PHEOs is Dr. Robert Weien, normally the chief of occupational medicine and deputy chief of preventive medicine at Landstuhl Regional Medical Center, but currently tasked as the garrison PHEO to assist Edwards and his Emergency Operations Center staff with Team Trace and other functions. Weien reemphasized the strong partnership between U.S. forces leadership and German officials, both on the political and health-related fronts, as being vital to overall efforts in the Kaiserslautern area.

"The relationship has been open and productive," he said. "We have met with our counterparts at their offices downtown, and we are in daily contact to ensure cooperation is thorough and ongoing. A common goal is that no cases get missed and duplication of efforts is minimized. Our communication with our direct counterparts is good, and our joint communities are benefiting from that."

The chief of Kaiserslautern's public health department agrees.

"Close communication is essential in order to reach all affected people in overlapping situations," said Dr. Christiane Steinebrei. "Each new case is a good example that the procedures developed with regard to [COVID-19] require specific coordination, which is achieved through intensive and constructive inquiries on both sides."

She added that while "infectious diseases know no borders, the proposed response of the RKI and the U.S. Centers for Disease Control and Prevention mirror each other."

A man wearing personal protective equipment holds a sealed plastic bag.
Medical Supplies
Air Force Tech. Sgt. Daryl Agni, 86th Medical Group medical technician, handles medical supplies in the Ramstein Medical Clinic’s coronavirus disease 2019 screening drive-thru at Ramstein Air Base, Germany, March 31, 2020. The drive-thru testing process limits exposure of patients to others, saves on protective equipment and gives patients the convenience of testing from their personal vehicles.
Photo By: Air Force Airman 1st Class Taylor Slater
VIRIN: 200331-F-PJ020-2078M

Even with a unified front against a common adversary, it hasn't been easy.

"There have definitely been times of too much stress and too little sleep, trying to maintain the health and safety of our community members," Baker said. "I am incredibly grateful for the excellent cooperation and teamwork we have established between our local Air Force, Army and host-nation counterparts."

That teamwork is not something Edwards takes for granted, despite longstanding history, current mutual efforts and shared hardships.

On April 27, he and Mohan sent a co-signed letter to all of the mayors and host nation emergency services chiefs whose communities are adjacent to the 29 sites and installations in the garrison's Germany footprint — which stretches more than 100 miles from Baumholder over to Mannheim and down to Germersheim.

The letter stated in part: "As we all deal with this situation, we would like to take the opportunity to thank you for your friendship and support. It is very reassuring to have a trusted and reliable partner like you and we value the strong relationship we've built over decades that will get us through this together… we want to ensure we stay in contact and let you know that we are thinking of you as we all fight this virus together. We look forward to seeing you again soon. Until then, stay safe and stay healthy."

(Stefan Alford is assigned to U.S. Army Garrison Rheinland-Pfalz.)