Transcript

Military Health System Press Briefing on Unified Response to Coronavirus

April 10, 2020
Assistant Secretary of Defense for Health Affairs Tom McCaffery; Surgeon General of the Army Lieutenant General R. Scott Dingle; Surgeon General of the Navy Rear Admiral Bruce L. Gillingham; Surgeon General of the Air Force Lieutenant General Dorothy A. Hogg; Lieutenant General Ronald J. Place, director, Defense Health Agency; Dr. Richard Thomas, president, Uniformed Services University of the Health Sciences

STAFF:  Hey, everybody, and to those on the phone.

So today we're here to discuss the military health system's unified response to coronavirus.  Our speakers today in the room, we have the Hon. Tom McCaffery, the assistant secretary of defense for health affairs.  And then we have Army Lt. Gen. Ronald Place, the director of the Defense Health Agency.

On the phone with us, we have the surgeon generals from the services: Army Lt. Gen. R. Scott Dingle, Air Force Lt. Gen. Dorothy Hogg and Navy Rear Adm. Bruce Gillingham.  And then also on the phone we have Dr. Richard Thomas, the president of the Uniformed Services University.

With that, I will turn it over to Mr. McCaffery for some opening remarks, and then we'll take some questions.

ASSISTANT SECRETARY OF DEFENSE TOM MCCAFFERY:  Thank you.

Ladies and gentlemen, thank you for joining us today.

I'm pleased to have here in the room with me Lt. Gen. Ron Place, the director of the Defense Health Agency; and on the phone, the senior leaders of the military health system, who are each leading significant efforts supporting the military's COVID-19 response:  Lt. Gen. Scott Dingle, the surgeon general of the United States Army; Rear Adm. Bruce Gillingham, the surgeon general of the U.S. Navy; Lt. Gen. Dot Hogg, the surgeon general of the U.S. Air Force; and Dr. Tom Thomas, the president of the Uniformed Services University of the Health Sciences.

We are doing this in part by phone because we felt it important that we engage with you as a team together, but also while maintaining appropriate social distancing.

As you know, Secretary Esper has set our priorities:  that we protect our service members, their families and our workforce, while maintaining military readiness and supporting the national COVID response.  Military medicine has been at the front lines of the national response, bringing unique and agile expertise and rapidly deployable resources to the fight.

Most importantly, we have marshalled medical staffing, getting them to the place where they can do the most good:  treating patients.  We're mobilizing doctors, nurses, medical technicians, both active duty and the Reserve component.

As you know, right now, DOD is executing a three-pronged effort in New York City through the high-end capability of the USNS Comfort, our large capacity within the Javits Center, and augmentation of medical professionals directly to 11 civilian local hospitals in the New York area.  The Comfort is accepting trauma, emergency and urgent care patients without regard to their COVID-19 status.

The department has also deployed our other hospital ship, and expeditionary field hospitals around the country to support hard-hit local health care systems.  Additionally, roughly 30,000 National Guard service members are offering front-line care to community-based testing, distributing personal protective equipment, medical supplies, food and water, all part of the concerted national response to serve and support hard-hit communities.

For the first time in its 48-year history, the Uniformed Services University has graduated nurses and doctors early so that even as we speak, those new nurses and doctors are on the front lines of the COVID response.

The military health system also is heavily involved, working to better understand this virus, how to treat and prevent it.  We are putting all the best brains in our military medical research facilities, working in partnership with other federal agencies on future treatments and vaccines.

Our research experts are focusing in on diagnostic testing, utilizing DOD's robust laboratory network to perform testing, and pursuing additional types of diagnostic capabilities, to include serologic testing to assess the patient's blood for the presence of COVID-19 antibodies.

The department has also invested $75 million to research three vaccine candidates.  We're collaborating closely with other federal research efforts on the promising antiviral therapeutic remdesivir through COVID-19 clinical trials, having previously funded the development of this antiviral for the treatment of Ebola and Marburg viruses.

DOD's medical research teams continue to be at the forefront in support of the whole-of-government response to this pandemic.  What the service surgeons general, Lt. Place* and Dr. Thomas will be able to tell you more about today is the wide range of efforts they are involved in, from the surge to buttress our front-line clinical care, to running field hospitals and hospital ships, to lab testing, to aeromedical evacuations and movement of supplies and equipment to the areas most in need.

We're working hard to ensure our beneficiaries have continued access to the care they need, ramping up virtual health capabilities and offerings, establishing drive-up testing sites and putting the right protection measures in place to minimize exposure risks to both patients and our health care workers.

We've expanded our nurse advice line capacity to include implementing an over the phone screening tool to meet the surge we saw just weeks ago of up to 9,000 patient calls a day requiring medical consultation.

Our medical treatment facilities are implementing pharmacy drive-throughs and curbside delivery, in some cases servicing patients in up to 1,200 vehicles a day, demonstrating our ability to protect our people while also staying mission ready.

At the same time, we haven't let up supporting combat readiness for service members, even while we surge laboratory and research facilities to support national and international events.  This is an historic challenge for our nation, but the military health system is bringing it all has to bear on this fight, from highly trained medical providers in a world class health care system to cutting edge research and development expertise and a wide-ranging arsenal of military medical combat capabilities.

We are system trained to be agile and adaptable.  That's why we're here and that's what we do.  Across the military health system, that's what you see in action today.  The men and women serving the military medicine are delivering today on the front lines of hospitals and clinics and the labs and behind scenes, advancing the priorities of the department to protect our people, maintain our readiness and support the nation's needs.

The impressive MHS leadership team alongside me today, the Defense Health Agency director, the service surgeons general and the president of USU can describe for you the issues in a very tangible way so you can get a deeper understanding of how we are collectively addressing these complex issues in real time.

And with that, we are open to take your questions.

STAFF:  All right, let's go to the phones.  Bob Burns from AP?

Q:  Yes, thank you, this is Bob Burns.  My question is for the service surgeons general.

Separate from the work you're doing that's connected to supporting civilian agencies and communities, I'm wondering what your planning is, are you -- whether you're planning with the expectation that coronavirus will still be a challenge for the military, requiring extraordinary health protection measures into or beyond the summer?

MR. MCCAFFERY:  So let me just quickly, before the surgeons jump in, we are -- the department has been planning to put out guidance across the military departments, across the department, on force health protection measures that will be in place and be used as the situation adapts, unfolds.

Since January, we've put out about seven or eight different force health protection directives that, again, adapt to the evolving situation, aligning with CDC guidelines and everything to do with, you know, personal health measures you take, use of PPE, travel restrictions, guidance to local commanders with regard to, based upon their community, their mission, what they need to -- to take care of their force and keep them healthy and ready.

And we would anticipate we will have those in place and evolve those as the switch -- the situation merits.

Q:  But you see my question was about -- about how -- how far in the -- you know, into the summer or beyond the summer you anticipate having to -- to implement these measures and keep these measures in place?

MR. MCCAFFERY:  So we -- we work with the CDC in terms of their planning guidance, their projections, and I think what's unique for us, unlike many organizations, we are obviously in all 50 states, we're in over 100 countries around the world, so there's not one -- I think one way to say how long this is going to place in terms of our force health protection measures:  It's going to be contingent upon what environment, what mission and at what local community.

We are -- the -- the guidance we have put out is meant to be flexible, based upon the conditions of the mission command and of that local community.  And so things may be different in different parts of the country as we go forward.

STAFF:  All right --

(CROSSTALK)

Q:  -- service surgeons general?

REAR ADMIRAL BRUCE L. GILLINGHAM:  Hi, Mr. Burns, this is Admiral Gillingham from the Navy.

I think we are not -- we don't have a specific prediction.  We're certainly following the -- the -- the models very carefully but I'll tell you what we've learned, certainly in the Navy, is that with regard to COVID-19, we're learning that stealth in the form of asymptomatic transmission is this adversary's secret power.

And so we recognize despite, you know, really our best efforts, we're going to have to learn how to learn to operate with the virus, as Gen. Hyten said yesterday.  And so in coordination with our fleet commanders, we've developed a COVID-19 mitigation framework.  The essence, the goal is to protect the force and, of course, to preserve our war fighting readiness.

The four elements are -- are to identify, and that -- that involves screening, evaluating and testing as appropriate; isolating those who are positive; containing with numerous measures aboard our ships, to include enhanced cleaning up to three times per day; sequestering into small cohorts; mandatory use of cloth facial coverings; meticulous hygiene; and one at a time up and down ladders aboard ships.  The other elements, of course, are -- are to appropriately treat as those individuals develop symptoms.

STAFF:  All right.  Coming back to the room -- Ryan, did you have a question?

Q:  I did, yes.  Just two -- I -- two -- two quick questions.

The first, you -- you mentioned the -- this kind of recent development of surging military medical personnel into hospitals themselves.  We understand another updated -- another tranche has gone today.  Can you talk about, what is the capacity to keep doing that?  I mean obviously you've been deploying a lot of your military medical personnel in response to this.  New York seems to be the focus.  How many more personnel in theory could you deploy on that type of mission before you start exhausting your capacity?

And what does this say about -- you have the Comfort and -- and Javits, which both have about a thousand military personnel between them.  They're basically empty and not really -- the capacity doesn't seem to be much of an issue as much as personnel.  Do you plan on deploying more personnel from Javits and from the Comfort into the hospitals, or are you going to leave them there?

MR. MCCAFFERY:  So in terms of your first question, the shift in terms of actually utilizing our military medical capabilities around personnel and staffing, you mentioned in New York.  So along with managing the Javits Center and the Comfort -- and the original purpose of the Comfort was really to be another safety valve for E.R. and trauma that could arise in the -- the -- the city health care system, but what we found is, while the civilian hospitals are getting to capacity, what they really need is they need that extra manpower, that extra staffing.

And so, to date, we've already put in close to 400 doctors, nurses, respiratory therapists in New York City hospitals.  As you mentioned, we've got another tranche going.

So we are now looking and working with CDC in terms of whether those future hotspots -- you know, New Orleans, Texas, Detroit -- looking at doing the same thing, where can we really partner with a local hospital that may have capacity, but what they're out of is -- is that manpower.  So that's, again, I think a good example of how we're trying to adapt and be flexible based upon the need.

With regard to your other question of, how is that affecting our own DOD health care system; well, we put in a number of -- of measures that we think are helping to reduce the demand on our system, that would allow, then, us to be able to deploy out of our hospitals and clinics to help the domestic response.

So for example, we, like the rest of the country, adhere to the guidance of HHS and we have delayed elective non-urgent procedures in our facilities for a 60-day period.

Gen. Place can add into this, but we have seen that has had an effect in terms of reduced demand, so we are able to serve our, you know, kind of regular patients.  We also have seen that our -- our beneficiaries are likely, like other citizens, self-selecting not to necessarily go to a health care facility if they don't need to.

And so right now, we're not seeing that we cannot maintain our capacity for our beneficiaries and are able to support these missions.  But that's something that we will need to continue to evaluate as we balance what we do for the national response support, as well as maintaining our system. But that -- that -- we'll have to be doing that on a regular basis.

I don't know if you have anything to add in terms of MTFs?

LIEUTENANT GENERAL RONALD J. PLACE:  Sure.

So -- so much of our function has changed as well, as Hon. McCaffery mentioned.  Some folks are choosing to delay some routine care-type things, which means that staff is now available to do other things.  So as they're deployed out of our facilities, then we're reusing them inside of our facilities for other different things, for example, for our inpatient uses.

Further, many of our patients have decided that virtual health is a better way, at least at present, to handle their current health care needs, and it takes a different kind of staffing to handle virtual health appointments than it does in-person health appointments.  And in general, it takes less people.

And so based on the choices that our -- our beneficiaries are making, we're evaluating locally, local commanders are making decisions about where those people can -- can best be utilized inside those treatment facilities to continue to optimally care for the local -- the local population.

And because it is taking less, more is available.  So that total number of more, I don't know what the answer is, but more is available, should the -- the department decide that -- that we need to take further action.

Q:  Do you have a rough estimate?  Hundreds, thousands?

GEN. PLACE:  I'm sorry, I don't, sir.

Q:  And any -- any plans to take all the personnel that are kind of sitting unused at Javits, and -- and at Comfort, and have them go into the hospitals, where that -- because that seems to be where the need is?

MR. MCCAFFERY  That would be one of the things we look at, both in terms of New York City, but also now kind of prepositioning any staff we have and being agile enough to say, working with HHS and FEMA, where is the next priority area for the nation, and how do we balance, you know, what we do in New York, other areas, and do we have staff -- and also using the National Guard and the Reserves to help augment that ability and our -- our ability to kind of allocate resources, real-time, where they're -- where they're needed.

Q:  Quick follow-up on that?

STAFF:  Sure.

Q:  Did the states get it wrong?  This Army field hospital in Seattle, now had to pack up after not treating one patient for the past three days; Mercy and Comfort only treating just a small number of patients right now despite all this capacity; Javits Center, treating a few hundred patients, but, you know, there's about 2,000 empty beds right now.  Is the problem a shortage of docs and not beds?

MCCAFFERY:  I -- right now -- and you see in different communities -- it is likely more a shortage of -- of the docs and nurses and the staff you need to run a facility.  I wouldn't say that the states got it wrong.  I would say that the states were doing good due diligence in planning and anticipating.

And rather than being in a situation where they need that capacity, and it's not there, I'd much rather have it ready to go and if we need to reposition it somewhere else, I think that's a far superior position to be in than not have the capacity and there be an extreme need for it.

STAFF:  Right, let's go to the phone lines.

Phil from Reuters?

Q:  Hey there.  Thanks very much.

Can you talk a little bit about how the -- the virus' ability to infect people but have them be asymptomatic, was it sort of its superpower.  I wanted -- I wondered if you could elaborate a little bit on what that means for -- for you exactly.

And does that mean -- I know that, you know, there's been some debate about the extent to which the virus is -- is actually in kind of stealth mode.  Do you believe that it's a quarter of service members maybe been, you know, have been infected?  Or there's a very -- a bunch -- what does this mean as far as your perception of how many service members may be infected, how many of our partner nations' forces may be infected, and then what are you going to do about it?

Thanks.

MR. MCCAFFERY:  So I believe what Adm. Gillingham was referring to is, you know, based upon what we've seen, data here, and in the United States and elsewhere is, the testing technology we currently have, obviously, is good for identifying a positive, someone who is COVID-19 positive.  And so the value here is, you identify that person and you know what to do to -- to treat them, what you need to do to isolate them, prevent further transmission.

The issue -- the constraint of the current testing technology is, you may test negative, but the testing is not so accurate to say that you know that that person is negative.  So you -- we do know that we have folks who are asymptomatic who may have tested negative, who are infected.

And so the combination of our current testing, again, is good for identifying those we know are positive, deal with them, and then for those that may have been in contact with someone who has been positive, you know, we do all of the CDC guidelines in terms of what they must do, in terms of self-isolation, care, that sort of thing.

But that's one of the things that the Department of Defense and other entities are looking at in terms of, as we get more testing capability and we do more research about, you know, what is the prevalence of those asymptomatic positive folks, then how would that inform our own testing strategy, as well as, you know, nationwide testing strategy?

STAFF:  Let's stay on the phones --

(CROSSTALK)

Q:  Does that mean that the new number we have today is 2,000 forces tested positive -- a little over that -- does that -- is it fair to assume, then, that the assumption within -- within your agency is that there are hundreds or maybe thousands more who -- who are positive as well, but not -- not testing positive?

MR. MCCAFFERY:  Yeah.  So where I don't want to go is give you a sense that we have a precision, that it's hundreds or thousands.  What we -- what we do know and what we do anticipate or assume is that there are others, not just within DOD, but across the country, who are indeed positive, yet they have not been tested or confirmed as positive.

STAFF:  Okay, let's go to Tara Copp from McClatchy.

Q:  Hi.  Thanks for doing this.

I wanted to follow up on the Mercy question and Comfort question that Ryan asked.  So the Mercy, I think a current count only has 15 patients at -- at the, not only cost, you know, in taxpayer dollars, but in personnel.  Are you all evaluating whether the Mercy should be moved or if those doctors should be flown into possibly an -- an area with greater needs, such as New Orleans?  And at what point does it just become not cost effective to have the Mercy lingering there?

Thank you.

MR. MCCAFFERY:  Yep.

So as you know, the -- the secretary has designated the -- the NORTHCOM combatant command, Gen. – Gen. O'Shaughnessy, to be our lead on how we respond to FEMA and HHS requests for support.  And he basically is looking at, whether it is the -- the Comfort in New York, the Mercy in California, our field hospitals, you know, based upon the data we're receiving, the experience, what's happening in those local communities, he will be making those decisions in terms of the best way to deploy both our physical infrastructure and our staffing.  And so I don't want to, you know, get out in front and say that we -- we have a decision with what next for the Comfort or the Mercy.  That is all going to be reviewed and considered as part of the all-of-nation effort, where the next hotspots are, what are the priorities, and what would be the priorities for our military medical capabilities.

Q:  Okay, but in hindsight, does it make sense to send the ship, since there are so many limitations about -- or were initially about bringing coronavirus patients onboard, and maybe instead, just sending that medical expertise directly into the communities of need?

MR. MCCAFFERY:  So -- so again, when we first responded to -- to requests from FEMA and HHS, there was a concern and a desire that the capabilities of the Comfort, trauma and E.R., could very well be needed if, indeed, the civilian sector in New York was overwhelmed and did not have the capacity to be able to take on those patients.  And so it very much made sense that at the epicenter of the nation's, you know, pandemic outbreak, that was a very real threat.  And I believe that is why we -- the request for the hospital ship, that's why -- that's why it went -- went up there.  That was the original intent.

The experience has changed.  It could very well be because of the experience in New York City, the directives about staying at home -- have less trauma, have less E.R.  And now we are looking at, how would we make better use of that facility.  As you know, last week, you know, we made a decision that as necessary, if we need to treat COVID patients in some of our infrastructure, you know, with all the appropriate precautions and protocols, that is something that we will be doing.

STAFF:  Now let's come back to the room.  Meghann?

Q:  How many service members have been tested so far for COVID-19?  And given -- we've talked about how many -- how many sailors on T.R. have tested positive and have been asymptomatic, have you given any thought to the plan in terms of widespread testing, especially if there has been a service member in a unit who's tested positive, even if nobody else has symptoms?

MR. MCCAFFERY:  I don't have the most current in terms of total number tested.  We obviously have the total number of cases for DOD.  I'll let Adm. Gillingham speak to the specific Roosevelt situation.

But let me back up.  One of our approaches as DOD -- not just DOD, but across the country -- on testing is, again, keeping in mind that the current testing technology is good to test you in, meaning you know you're positive, but there are -- there's an element of false negatives, so you can't be sure if you test negative that you don't have the virus.  And there are right now, there's a finite amount of lab-testing capabilities, in terms of kits and the reagents and supplies you need.  And so in that environment, we want to make sure we devote those finite resources to the highest priority, and that is to, indeed, test those who are showing symptoms who we need to immediately treat and immediately isolate.  And so that's -- has been our approach.  It's consistent with the CDC approach over -- overall.

Now, if new testing technology comes on -- online where you're able to do a lot more tests, a lot more volume rapidly, then we probably can rethink our strategy.  But based upon supply and demand, priorities and the efficacy of the current tests, we believe that's a -- a prudent approach.

Q:  But knowing that you can't really get the full scope of everything because the testing isn't powerful enough, would it be better to maybe meet it halfway in the middle and just test as many people as you can and hope that that gives you a better number than what you obviously have now?

MR. MCCAFFERY:  Not necessarily, because if you were to take that approach either across the DOD or -- or across the country, you may very well be allocating or diverting that finite amount of testing capacity to folks who maybe are perhaps not the highest priority, meaning those that are symptomatic.  That's the -- our first priority.

Q: Small follow up to that?

Q:  Mr. Secretary, why can't you test every sailor before he or she goes to sea?

MR. MCCAFFERY:  Again, with the -- with the -- the limited capacity in terms of testing -- and it's not just the DOD who want to -- wants to utilize testing, but the -- the entire civilian sector -- and knowing that the -- the current test will -- will show up a considerable amount of -- of false negatives, we don't believe that is the best way to allocate testing resources.  And so again, our focus is on those who are -- who are symptomatic and those that we -- we believe if you focus on that and you can isolate them, that's the most effective way to -- to kind of stop the progress of the --  of the virus.

Q:  Aren't you worried that the -- when the Nimitz Strike Group deploys this summer, this same thing's going to happen aboard Nimitz that we just saw happen aboard Theodore Roosevelt?

MR. MCCAFFERY:  We obviously are -- are very concerned, and that's why we have issued a series of -- of guidance to the force of all of the things consistent with CDC guidelines that we can do to prevent from -- that from occurring.  Is testing part of that?  Yes, testing can be part of that, in terms of the ability to, before a sailor gets on a ship, you know, is there a period of time before that, that we both do screening, we do the test and wait a 14-day period?  That is something that -- that we are looking at, that that could be a good approach going forward.

Q:  …social distancing does not… (inaudible)

(CROSSTALK)

STAFF:  I’ve got to get to the last question.  So we have time for one more question.  Let's go to Jeff on the phones, Jeff Schogol.

Q:  Thank you very much.

DOD has been putting out a lot of information on the coronavirus, and in the spirit of that transparency, I'm wondering if DOD would reconsider its policy of not saying how many service members are infected per installation.  Wouldn't that give the American public at large, and specifically the internal audience, a better idea of the scope of the problem and how DOD is rising to meet it?

Thank you.

MR. MCCAFFERY:  So I -- I will take that.  It's somewhat out of my -- out of my lane.

We obviously -- I would agree, we have been putting out a lot of information about the virus, what we're doing to, you know, mitigate its impact on our force and our employees.  We do provide, you know, daily numbers in terms of total cases broken down by active duty, civilians, contractors.  We're going to continue to do that.

I know from the operational standpoint and a national security standpoint, there is a discomfort for us to identify, you know, down to a particular base, down to a particular aircraft, or -- or naval vessel, what the cases are because it does then get into what is the impact on readiness on that particular mission or location, which we don't think is helpful to be sharing in a public way while we -- we recognize we still have adversaries in the world.

And so that is the rationale as to why we want to give the information, but we don't want to break it down to -- to particular missions or installations.

Q:  OK, so is it really a threat to OPSEC to say, for example, how many Marines and sailors at Camp Pendleton, California, have COVID-19.  I don't think DOD is saying -- is that would prompt the Chinese to invade the West Coast.  Am I wrong?

MR. MCCAFFERY:  Well, I don't know where you -- where you would stop in terms of going down that path.  You may be able to pick out a -- an installation or a base and -- and not tie it directly to a national security concern, but I -- I don't think it makes a lot of sense, I don't think that it's -- it's bringing a lot more value in terms of information if we're sharing with you by demographic, by active duty, by service.  I think it's giving you a sense of where we're finding cases and what the disposition of those cases are, so the American public is fully aware of that.

STAFF:  All right, thank you, everybody.  That's all the time we have for today.  Send me any follow up questions you may have, OK?

Thank you.

[*Eds. Note:  Lt. Gen. Place]