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Lt. Gen. Place, Director, Defense Health Agency, and Rear Adm. Gillingham, Surgeon General of the Navy, Discuss COVID-19 Response

March 19, 2020
Army Lieutenant General Ronald Place, Director, Defense Health Agency; Navy Rear Admiral Bruce Gillingham, Surgeon General of the Navy

LIEUTENANT GENERAL RONALD PLACE:  Sure, thanks.  So today, I'll be giving an update on the Defense Health Agency and the military health system's support to the national COVID-19 response.  Thanks to the -- the team there for hosting this virtually, and for all the team that makes this possible, and thanks, Rear Admiral Gillingham, here with me today, for making himself available to talk about Navy medical issues, especially about the USNS Comfort and Mercy.  But mostly, thanks to -- to the reporters here and on the phone for your attendance and attention to the very important work that the Defense Health Agency is doing.  Whatever questions we can't answer now, we'll be sure to take for action.  We'll get back to you as soon as we can.

Now, for a little -- first, for a little context, the Defense Health Agency serves 9.5 million beneficiaries within the military's health care system.  That includes almost 1.5 million active-duty military personnel.  It also includes their families, activated reservists and the military retiree population.  The DHA is responsible for providing care through 51 hospitals and 424 military treatment clinics, and supporting deployable medical forces such as the USNS Comfort and Mercy.

Now, I won't go any further without noting that care in -- in these facilities for our beneficiaries is being significantly affected by our nationwide response.  The entire DHA staff appreciates the military community's positive attitude and resilience, even as they shoulder their burden of stress, inconvenience, and disruption to their healthcare during this pandemic.

Briefly, what we're talking about here is how DHA is providing support through the Department of Defense to the whole-of-government response.  We've put in place a Crisis Action Team that's working nights and weekends here at our headquarters on patient concerns, patient care, equipment, monitoring blood supply and sharing our capabilities for the greater cause, all while ensuring we maintain the readiness of our military forces.  And we're looking at issues that have become familiar to you by now:  bed space, military health capabilities and capacity, the trade-offs of shifting resources from one knee to another, assisting people with self-screening, triage, and testing of patients. 

One statistic that helps tell the story relates to the calls receiving on our military health system nurse advice line.  It's jumped almost 500 percent in just a few days to where we're now fielding at least 8,000 calls per day, and sometimes in excess of 10,000 calls per day. 

Within our system, we're evaluating reducing elective procedures to increase capacity, and I've directed doctors and nurses in staff positions to shift responsibilities to clinical patient care as much as possible.  We're looking at how our clinics and hospitals might be able to surge bed space that isn't currently being used for patient care.  The list goes on.

I think Rear Admiral Gillingham's description of the issues that arise in mobilizing the Comfort and Mercy will really be the most tangible way for you to get a sense of how we're approaching these complex issues in real time, so we're not just tossing around numbers and jargons.

With that, I'll pass it off to Admiral Gillingham.

REAR ADMIRAL BRUCE GILLINGHAM:  Thank you, General Place.

And good afternoon, everybody, and thank you for the opportunity to talk with you today about Navy medicine's contributions to help sailors, Marines, and our fellow citizens from Coronavirus-2019.

Since December of 2019, when the COVID-19 pandemic was first reported, Navy medicine has been on the forefront, actively mitigating the spread to its forces and their families -- deployed at sea, stationed overseas, and in the United States so that the Navy and the Marine Corps remain ready to protect our nation.

This global crisis demands the leadership, creativity, and commitment of our entire one-Navy medicine enterprise in partnership with the Defense Health Agency and the other services.  And we are up to this challenge.

In conjunction with the Department of Defense and our interagency partners, Navy public health professionals, scientists, researchers, emergency preparedness experts have all been actively monitoring the disease and providing direct support to ensure Navy and Marine Corps commanders have the latest information to ensure mission readiness and effectiveness.

In addition, our Navy physicians, nurses, corpsmen, clinical scientists and laboratory professionals are prepared to identify, diagnose and care for those who may contract the virus.

Our Navy environmental preventative medicine units and their forward-deployed preventive medicine teams are fully engaged with the fleet and the Marine Corps to provide critical support.  Their work is vital in the maritime environment in which the Navy and the Marine Corps operate.

And ashore, we're working hard to provide services including establishing new processes at Naval Medical Center-Portsmouth in the Hampton Roads area of Virginia.  They're implementing a car triage screening process to allow patients with respiratory illness symptoms, fever, cough, and shortness of breath to be screened prior to entering the base emergency department.

And as you’re well aware -- and I'm sure of key interest to you -- is that -- as was announced by the president yesterday, the United States naval ships Comfort and Mercy are being prepared for deployment to assist overwhelming -- overwhelmed communities with acute patient care.

Comfort and Mercy are medical treatment facilities.  Their ships and their crew of medical professionals will help take some of the burden off of local hospitals so that they can focus on COVID-19 care.

The Navy is always ready to support defense support of civilian authorities or DSCA missions.  And Navy medicine stands ready to support the nation as directed by our civilian leadership.

Now, the preparations for the ships itself and the crew to run it fall under Fleet Forces Command.  But as the Navy surgeon general, I'm responsible for putting together the medical teams that will staff the ships and run the medical facilities aboard.  And I'll announce today that the critical core of the staff are actually reporting today, as we speak, to ready those ships for their mission.

We can adjust the staffing as we go, as we get a better sense from the local leadership of what they need.  We're going through and identifying exactly which military treatment facilities the staff will come from, and working with Lieutenant General Place and his team in the Defense Health Agency, who operate those facilities, to ensure that the beneficiaries at those medical treatment facilities can still be cared for.

We're honored to serve.  And although this is not our traditional medical mission, which typically involves combat casualty care, I believe these efforts demonstrate our agility and responsiveness to do what the country asks, wherever and whenever we're needed.

And of great importance of course is the requirement to protect the health of our force.  This is something that we do at all times, not just during a pandemic.  The Navy is ensuring that sailors who display COVID-19 symptoms are tested, isolated, and treated in accordance with Navy and Marine Corps Public Health Center and CDC guidelines.

While FDA approved at-sea testing for COVID-19 equipment isn't available at this point, samples can and are being sent to shore for testing to one of our DOD laboratories.  While awaiting results, symptomatic sailors live in separate quarters where they can maintain appropriate social distancing. 

Navy medical professionals are working with industry to improve and expand at-sea testing methods.  Navy remains focused on protecting all sailors, their families, and those they interact with from the spread of COVID-19.

We're also actively working to identify and acquire new testing platforms for shipboard diagnostics as they become available to get those onboard our ships.  As Secretary Esper has stated, our focus first and foremost is on people.  And that's not only our active and Reserve and our civilians but also those in the community in which they live.

At this point, I'd like to open -- open the forum to questions of myself and General Place.

Q:  All right.  This is Bob Burns from Associated Press.  A question for Admiral Gillingham on the two hospital ships.  Could you talk a little bit more about the staffing that you referred to in terms of the numbers for each ship and the capabilities?  Will it be just the typical capabilities or will you have some additional personnel or equipment?

ADM. GILLINGHAM:  Thank you for that question.  Yes, we -- we are preparing the ship for its thousand bed mission, which is the largest mission set that it's designed for.  The -- we are activating our usual call-out of individual professionals but as I said in the opening remarks, we're a high velocity organization, we believe in rapid cycle feedback, and we will adjust that manning as the situation on the ground dictates.

Q:  Thank you.

STAFF:  Meghann?

Q:  Meghann Myers, Military Times.  So there are more and more calls coming from public health experts outside of the government about widespread testing, that we can't really get a good idea of how far this has penetrated if everybody isn't getting tested, including in the military, as a population where everyone can get tested and there could be a better understanding of -- of who's a carrier – can you not hear?

Can you guys hear anything?

STAFF:  ... can you hear us?

Q:  Oh, well I can hear myself now.

Q:  I don't think they heard it.

(CROSSTALK)

GEN. PLACE:  It -- it appears -- it appears we can hear you now.  We -- we -- we -- as Admiral Gillingham was talking, we lost all contact with you all for sound.

Q:  ... and my question is has there been any consideration to do more widespread testing within the military, knowing that a lot of these young, healthy service members could be carriers?

GEN. PLACE:  So one of the challenges with any infectious disease is when it becomes testable.  And as I'm -- I'm sure you've heard over time, we used the same guidelines as everyone else and that's the CDC guidelines.  So the first part that comes is screening, screening questions, does it appear that you're symptomatic at all?

What we found, at least the current information, is asymptomatic people, even if they eventually become a positive, wouldn't screen positive at that time.  So we use screening first.  If screening first, then testing, use that if they're a person under investigation, we quarantine them in the same sort of way as if they were positive until we get the results of the test, but that's the way that we're handling the testing. 

We're not individually testing everyone. 

STAFF:  All right, Jenn. 

Q:  General Place, Jennifer Griffin, Fox News.  I have a question for you, do you think it's a good idea to keep the Pentagon open as it is?  There are a lot of people in the hallways, it really is -- it sort of looks like a shopping mall right now in terms of numbers of people who are walking close together. 

And General -- or Admiral Gillingham, can you talk about onboard the Navy ships many of the -- how many sailors have tested positive?  And is it a good idea to continue port calls in various places around the world, given that you really don't know who could be a carrier at this point?  Wouldn't these Navy ships -- isn't the fear that they could really become like the civilian cruise ships? 

ADM. GILLINGHAM:  Certainly -- that's certainly a concern which is why several weeks ago fleet commanders instituted a policy that all who would come aboard the ship would be screened.  Those who appeared ill or met CDC criteria were not allowed aboard ship. 

They also took the step of once the ship left port they would not come back to a port for a period of 14 days or greater.  So this was not only to protect the health of the crew, but also to make sure that we were not inadvertently transmitting the virus. 

Q:  But do you think that is enough? 

ADM. GILLINGHAM:  Yes, ma'am, and I think you asked at the beginning, I would say that we've only had a very small handful of cases of sailors assigned to ships.  We are watching that very carefully, our environmental preventive medicine officers and medical officers aboard those ships are taking every measure recommended by the CDC to make sure that we limit the potential spread of the virus. 

Q:  And General Place, on the Pentagon? 

GEN. PLACE:  Yes ma'am, so I think you've likely seen that the situation at the Pentagon continues to evolve over time, as new information comes in the methodology by which the Pentagon staff work have changed.  Now, in general we continue to use the CDC guidelines which mandates distance apart, the social distancing, as well as how long people can be in contact with each other and still have a reasonably small risk. 

But the fact of the matter is that the risk that we have in the Department of Defense is really -- the defense of the entire world.  And so the mission that must be done, still must be done.  So we give advise -- medical advisers, we give advice to senior leaders about the potential risks and they weigh those risks in terms of then how they make decisions about where we meet, how we meet -- and what sort of collaboration we can have. 

So I believe we're in a good place still in the Pentagon, and as the situation evolves you'll likely see an evolution of decision-making about how the Pentagon is operated. 

Q:  Thank you. 

STAFF:  Tara. 

Q:  Hi, Admiral Gillingham, this is Tara Copp with McClatchy.  I wanted to get back to the ships, and with some of the sailors that have tested positive -- could you give us some very specific examples of how the ships are continuing to operate with social distancing?  As you know some of those bridge spaces are very small -- how do you social distance on a submarine?  Just give us an idea of what -- how life has changed for the sailors aboard these ships? 

And then secondly, when the Comfort and Mercy do deploy, will you be screening and taking the temperature of any patient you bring aboard to insure that the coronavirus doesn't spread on the ships?

ADM. GILLINGHAM:  Yes, thank you for that question.  Yes, we -- we have a protocol not only for any patient that would come aboard but for all of the crew.  So before the critical core reported today, they were all screened before they -- before they crossed the bow of the ship.

And the remainder of the crew as they come aboard will also be similarly screened.  And then we'll be very careful in the development of our concept of operations of how to care for community patients, screening will be -- screening will be an essential part of that guidance.

Q: And then for on -- you know life aboard the ships now, how things have changed.

ADM. GILLINGHAM:  Yes, ma'am.  So again, our ships that are operating out at sea, we -- because of those enhanced measures that were undertaken weeks ago, we have not seen active transmission.  And so we believe they are essentially self quarantined in place as units.  We are -- the small handful of cases we have had, have -- are -- have been in ships that are in port. 

And so those individuals have been immediately identified, isolated, and if requiring treatment, they've been provided appropriate treatment for their condition.

Q:  So are you saying aboard the ships there aren't measures like social distancing going on?

ADM. GILLINGHAM:  Yes, to the maximum extent possible.  Yes, ma'am.

STAFF:  OK.  Barb.

Q:  I think my question's probably for the General.  Sir, the White House talked today about trying to test the use of chloroquine as a potential therapeutic.  And this is a drug of course the military has a lot of experience with.

So could you tell us what you have seen over the years in chloroquine in terms of side effects or efficacy of the drugs, how troops have reacted to the use of Chloroquine.  How it affects preexisting conditions, that sort of thing.

And then I wanted to ask both of you the latest data of course shows that younger population that originally expected has been in -- around the world is being impacted by coronavirus.  I am wondering if that's causing the military to rethink its initial assumption that it could relatively count on being a young healthy fit population.  Do you need to change your assessment now that you have this new data on the impact on younger people?

GEN. PLACE:  OK, ma'am.  I'll do my best on the chloroquine.  The specifics I don't have and we can get more information to you.  But speaking writ large about the Department of Defense’s utilization of -- of individual testing of medications for troops in combat, troops in deployable situations, the department takes that very seriously.

And every single element of the research and development phase I trials, phase II trials, phase III trials, et cetera; we take those all very seriously.  So if indeed we are doing this, and again, I don't have any information about that today, so if that was announced, and again, we'll get you more information.  But my suspicion is that we'll do it just like we do everything else with great care to preserve the -- the safety and security of the individual service members.

But find the greatest methodology possible to treat them and get them back to full duty as soon as possible.

Q:  OK.  And do you have any rethinking of your assumption on a young fit population being relatively secure from the disease.

ADM. GILLINGHAM:  Well, I would -- I would start by saying that we never made the assumption that we would lower the threshold for screening based on age.  So we have applied the CDC guidance across the board and have taken this very seriously.  Given - given the mission, you know, of our military forces, we felt that we had to provide the maximum possible protection for the force.

Q:  Who was speaking?  We can’t tell. 

STAFF:  That was -- that was the Admiral.

Q:  OK.

STAFF:  All right, Tom?

Q:  So, Tom Bowman with NPR.  I wanted to get back to the testing, if I could.  As you know, the Air Guard has flown a half million swabs from Italy to Memphis, Tennessee.  They'll be distributed by FedEx around the country.

I'm just wondering what role DHA will play in that whole effort, either analyzing the swabs at -- at your labs or if someone tests positive, providing maybe bed space with a DHA facility for those people?  If you could just walk us through that.

GEN. PLACE:  Sure.  You're -- you're right about that, the half million swabs are in fact swabs that were provided to Health and Human Services for distribution across the entire country.  Some of those will remain in the DOD, most of them will not remain in the DOD, they'll go to -- to healthcare organizations across the country.

We have approximately 15 labs that are available to perform the -- the appropriate assay to test for COVID-19.  At this time, we're only testing DOD beneficiaries.  Like everything else that the Secretary said, we stand ready to support the needs of the country and if we're asked for our labs to do that then we stand ready to do it, but at present we have not been asked to add our laboratories to the myriad of labs across the country that have that capability.

Q:  And -- and how many have you tested now at your 15 labs and how much can you ramp up at those labs to deal with a -- a huge volume of these swabs?

GEN. PLACE:  Well sure.  The -- I mean, so now you're talking about microbiology testing.  They typically come in batches and so it -- it's a batch type event.  Based on current methodology, which is a reverse transcriptase polymerase chain reaction, that test isn't actually -- takes -- depending on the -- the -- the analyzer that's used, somewhere between four and six hours to do, so depending on the size of the batch, that's your -- your rate limitation.

The CDC, working with industry, is looking at other methodologies for testing this particular virus.  That would take much less time and being able to do it in much greater batches.  So at present, we are relatively limited, all labs are relatively limited in the speed.

That said, we are far from being overwhelmed in our laboratories.  In terms of your first question on the number, we've tested a little bit more than 1,000 across DOD laboratories and have the capability to do way more than that.  And I'll just leave it at that.

Q:  Ballpark, way more, 10,000, 15?

GEN. PLACE:  We have the capability, if we had to -- and -- and right now, we haven't -- we have the capability to do tens of thousands per day.

STAFF:  All right, we're going to go out to the phone lines.  Kristina Wong from Breitbart?

Q:  Thank you so much for doing this.  What kind of non-coronavirus patients will be taken on the hospital ships and could you go into a little bit of how it will -- will work?  Will patients be taken as they're admitted to the hospital or will they be transferred from civilian hospitals onto the ship?  And will the ships be stationary or will they go from place to place as needed?  Thanks.

ADM. GILLINGHAM:  Thank you, that's a great question.  That concept of operations, that process is still being developed.  What worked very well in Puerto Rico when Comfort was activated for Hurricane Maria is that the -- that the ship functioned as a referral center, so essentially a tertiary care center.

And so a network was set up with the local health officials to -- to decide and prioritize the care based on our capabilities and the -- the areas where they needed the most support.  So as I said, we will -- we will engage with the local health officials at -- at the site -- the sites that are chosen and we will work through that process.

I do envision, though, that it will be -- it will be patients who are already hospitalized or who would have come into an emergency room and that they would be transported to the hospital ship so that that would open up capacity at the civilian hospital for treatment of COVID-19 patients.

STAFF:  Paul McLeary, Breaking Defense?

Q:  Hi, thanks for doing this.  I just wanted to follow up on the ships at sea.  Are there any sailors who are currently being isolated or monitored on the ships and what's the status on giving test kits out to the ships?

GEN. PLACE:  I'm sorry, we've lost audio again. 

STAFF:  Sir, the question was for the Admiral, what's the status of getting test kits out to the ships and -- you remember the first part?

Q:  Are any people being isolated aboard ships?

STAFF:  And -- and are there any people being isolated aboard ships now?

ADM. GILLINGHAM:  OK, we -- I -- I believe I caught the essence of your question.  I think we -- we had a little technical difficulty there but in -- right now, as I said, the sailors that were identified were shore-based, were -- or the ship was in -- in port, and so they have been removed from the ship.

In terms of testing kits, as I said in my opening remarks, we -- we are able to test, that is perform the test, aboard the -- or the -- the swab aboard the ship but that is sent to our Naval Health Research Center or our Naval Medical Research Center for -- for the actual performance of the test result.

STAFF:  All right.  Phil?

Q:  I had a couple of housekeeping questions that I wanted to ask you, something about what -- but first my -- my -- my main question is there going to be a point for the General -- is there going to be a point at which you start limiting non-essential medical visits at base hospitals throughout the country?  That's -- that's my -- my first question but I had a couple of housekeeping questions on things you said, if I could just get to those after your answer.

GEN. PLACE:  Sure.  So the -- the exact words that you used give me a little bit of pause.  I'd like to think that everything that we do is essential inside of our healthcare facilities.  But really, now what you're talking about is the concept of triage and we wholeheartedly believe in the concept of triage within the military health system.

Every time we're deployed in general, we don't have enough capability to take care of everything that's happening around us.  In general, we do end up taking care of local nationals, for example, but there are sometimes where we don't have enough resources to do that and we can only take care of U.S. military beneficiaries, for example.  So we understand the concept of triage.

So based on the way that -- that you've said it, I'll tell you that we do it every single day.  We manage, based on the requirements that we have with the resources that we have, to do the most good with the capabilities that we have.

Now as the -- the needs of the -- of the organization change and the needs of the population change, then we'll triage and we'll utilize our -- our personnel to the greatest degree possible to make -- make sure that the most important, the most critical, the most urgent get this care first.

Q:  I know, I guess what I'm trying to find out is if I have a non-urgent medical appointment at a base hospital that's also screening COVID cases, are you going to cancel those visits or are people going to keep going to work for - you know, in the same numbers at the pharmacy, or at other labs that are not involved with the most serious cases?  Or even - is everyone at the hospital still going to go to work all across all the hospitals that you operate? 

(OFF-MIKE -- VTC AUDIO DELAY)

GEN. PLACE:  Yes - no, sure, so that's a great question.  Again, it's about triage. So based on the requirements we'll change the way that we do our business.  So if we're currently seeing 95 percent, or 98 percent of patients face-to-face in a clinical environment but we determined that the care still needs to happen.  But the risk of being in person rises, then we'll use other technologies like video teleconferencing - understanding that there's risks with using video teleconferencing, that maybe you can't make the point that you wanted to make as well as you could make if you were there in person, just as an example. 

Now when it comes to routine care like the care of hypertension, there needs to be management of that to include what's happening with blood pressures and what's happening with use of the medication.  But there's other things that are higher risks. 

I mean, we're still diagnosing patients with cancer, and there are risks associated with not treating cancer, and so in those cases we have to figure out the way to minimize, to mitigate the risks to the patients still coming in to the facility where that expert cancer care can be delivered. 

So depending on the - the answer to your question is yes, we will be determining what comes in the facility and what doesn't come in the facility based on the risk to the disease process, and based upon the risk of the environment within the facility. 

Q:  So then - and then just my quick housekeeping question was you said that you're following all CDC guidance when people are tested positive.  We got a release today saying that none of the more than 50 service members who are positive for COVID-19 are in the hospital that they are all offsite. 

So I'm just trying to figure out how does that work, how is it that all of the service members who are positive according to CDC guidance, are, I'm assuming at their residences or other places - not under supervision - full time supervision of medical professionals. 

(OFF-MIKE -- VTC AUDIO DELAY)

GEN. PLACE:  So I don't know if you picked it up or not, but we're getting this on a significant delay, so if it looks like we're just ignoring your question for a long period of time, that's what it is. 

If based on the clinical criteria someone meets in-patient requirements then we admit them, but you may well be right that all of them are out of the hospital now, but that's not to say that we haven't admitted active duty service members for their care, because we have.  I'm aware of at least two between both the continental United States and outside the continental United States who've required in-patient admission for their care. 

But the bottom-line is, wherever is the right place for their care, that's where they'll be.  The medical supervision doesn't end just because you're not an in-patient anymore, they're still being evaluated, they're still being cared for as an out-patient by that same healthcare team. 

STAFF:  All right, we're going to have time for one or two more questions? 

Q:  OK, thank you.  This is Fadi Mansour with Al Jazeera.  I had two questions, one for the Admiral and one for the General.  Admiral, had final destination been designed for the USNS Mercy, and how long is it going to take for it to be ready to be deployed? 

And the second question, thinking about long-term, should we think about this outbreak as once in a lifetime, or based on whatever information you have so far?  Maybe we should think about if that's something that's going to be more recurring in the future?  Thank you. 

ADM. GILLINGHAM:  Yes, thank you, so the location for Mercy has not been determined, but I can tell you that the goal is to have Mercy sailing out of San Diego harbor next week.  So they're working very quickly and hard to get the ship ready to go, but of course to be able to provide care in a very safe manner, consistent with the care that we deliver everyday at our medical treatment facilities. 

Q:  The second question, please? 

GEN. PLACE:  Yes, sir, if this is a once in a lifetime or not - that's pure projection that I would hate to step in to.  I think if you look across history, and you can read about it on the CDC website about different infectious disease over time that they come when they come, and the difference in the mutations of the particular virus tend to lead to different outcomes. 

And so I would very much discourage the idea of being able to project when's the next mutation that will have significant concern to the human race happens.  That said, I think it does give us reason to pause about the complacency that we as people - in particular, we as Americans, have. 

We're very used to our water being safe, we're very used to our food being safe - we're very used to walking around in all kinds of different areas and not worry about it. In fact, as Americans we're not very good at washing our hands - we're not very good at covering our mouths with our sleeve, or with a tissue and throwing the tissue away. 

We have bad habits, and if - despite all the tragedy that's coming from this, if it teaches us what our mom and our dad tried to teach us when we were kids about how you interact with people, and how you turn your head away and cover it, and how you wash your hands - and not just splash a little water on it but actually use soap and put it all around on every part of it.  If it teaches us good habits and at least something comes out of this, that's good.  So that when the next thing does happen we're better prepared for it. 

STAFF:  All right, let’s go to Jenny... 

Q:  Thank you very much.  Jenny Kum, USA Journal.  General, about the coronavirus '19 treatment of the United States servicemen in overseas is the treatment performed locally, or you send back to U.S.?  How would you consider this servicemen treatment in locally, or U.S.? 

GEN. PLACE:  So in general for our U.S. service members the type of care that we're giving them is minimally supportive.  Most of them are requiring almost no care, but if the local community whether it's U.S. military care, or even on the local economy, if that's – if they have the capability to care for them then we'll care for them there.

If it doesn't have the capability to care for them, then as all of you I think are aware, we have a very effective casualty evacuation -- strategic evacuation process to include infected patients.

And I believe that Lieutenant General Hogg spoke about the capabilities of doing that just a little bit yesterday.  So from the expertise of doing that that's certainly within the Air Force medicine services. 

But it depends on the capabilities, it depends on the requirements.  But in general, they'll be treated at the location.

STAFF:  Right.  We have time for one more question.  Jen?

Q:  General Place, how many presumptive cases have you had at Walter Reed?

GEN. PLACE:  Confirmed positive or ones that we've evaluated?

Q:  Confirmed positive and those that you have evaluated but -- and presume to have it.

GEN. PLACE:  Well, the -- ma'am, the turnover of the tests, since we have the capability within Walter Reed, is very fast.  And so the time difference between presumptive and ruled in or ruled out is very fast.

So the -- the number of positive -- I don't know the exact number, the last I saw was a handful.  So I'm presuming that it's still less than 10 from Walter Reed that we've -- we've tested well more than 100 within Walter Reed.

Again, I don't have the most recent numbers that we've tested but I'm guessing it's close to 250 or so at Walter Reed.

STAFF:  All right.

Q:  Thank you.

STAFF:  Yes, thank you, General Place.  And thank you, Admiral Gillingham.  Do you have any final comments you'd like to make to the reporters?

ADM. GILLINGHAM:  I would just add that it -- you know it's one of the reasons, and I can't speak for General Place but I'm sure he feels the same way.  One of the reasons that I'm still in uniform is to be in a position to be able to provide this type of support to our country.  And I will tell you that the men and women of, not only Navy medicine, but all of military -- the military health system are standing by.  And are -- are anxious to dive in and assist to the extent that we can and still maintain a health of our force and health of our -- and the readiness of our mission.

GEN. PLACE:  Is that while this is a huge challenge, the -- the things that -- that are challenging for us in the military for us as Americans also tend to bring us together.  And I'll tell you this, if you're worried about it, the men and women in uniform are thrilled to work together and they're thrilled to be able to support the rest of America.

So when asked by the president of by the secretary, we stand ready to do whatever is asked to serve you.

STAFF:  All right, gentlemen, thank you very much for your time.

Q:  Thank you.