COVID-19
Navy Sets Rules for Lifting COVID-19 Travel Restrictions
Here’s a link to this article released yesterday:
COVID-Related Update – Travel and More
There have been a number of COVID-related updates in the last few days, and as a result this is a long post. Sorry.
Here are the summaries and links to more information:
Force Health Protection Guidance – Supplement 10
On Thursday, the department released the Force Health Protection Guidance – Supplement 10, which provides guidance on clinical and diagnostic COVID-19 testing for eligible persons with a DOD connection suspected of having contracted COVID-19, and applies Centers for Disease Control and Prevention (CDC) testing guidance to the DOD context. DOD Components will continue to employ clinical diagnostic testing in accordance with this guidance. This guidance does not prohibit or impede surveillance, screening, and asymptomatic testing conducted to decrease operational risk within DoD, consistent with applicable law.
Testing Considerations
- Healthcare providers will use their clinical judgment to guide diagnostic testing for COVID-19. See Attachment 1 for case management and disposition guidance. Providers are encouraged to test for other causes of respiratory illness as clinically indicated. The CDC testing priorities may be found at: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html
- In the clinical setting, asymptomatic individuals may be tested based on a clinician’s judgment and as deemed appropriate by public health professionals.
- DOD Components must ensure appropriate infection prevention and control procedures are followed throughout the entire testing process. This includes employing the appropriate biosafety precautions when collecting and handling specimens, consistent with CDC guidance.
Approved Diagnostic Laboratories and Tests
- DOD Components will conduct diagnostic testing at clinically approved laboratories.
- DOD Components must comply with U.S. Food and Drug Administration (FDA) regulations for diagnostic testing, including by complying with COVID-19 emergency use authorizations (EUAs). The FDA COVID-19 EUA list is at: https://www.fda.gov/medical-devices/emergency-situations-medical-devices/emergency-use-authorizations#covid19ivd
- COVID-19 testing capabilities are synchronized by the DoD COVID-19 Task Force Diagnostics and Testing Line of Effort, with input from the Defense Health Agency’s Center for Laboratory Medicine Services (CLMS). CLMS may be contacted at: dha.ncr.clinic-support.mbx.clms@mail.mil
Eligibility of DoD Personnel, Other Beneficiaries, and Other Populations for Testing
- DOD Components may test Service members (including the Reserve Component, which includes National Guard personnel when in a title 10 or title 32 duty status) in accordance with this guidance.
- DOD civilian employees (who are not otherwise DoD health care beneficiaries) may be offered testing in accordance with this guidance and reference (b) if their supervisor has determined that their presence is urgently required in the DoD workplace.
- DOD family members who are eligible Military Health System beneficiaries may be offered testing in accordance with this guidance.
- Employees of DOD contractors will use the processes for medical care to access testing as set forth in the terms of the contract under which they are performing. As necessary, existing contracts should be modified to set forth processes to provide access to testing.
- For testing of local national employees in locations outside the United States, DOD Components should refer to country-specific labor agreements or contracts and consult with supporting legal counsel for guidance and any limitations concerning such tests.
The guidance can be found here.
Force Health Protection Guidance – Supplement 11
On Thursday, the department released the Force Health Protection Guidance – Supplement 11, which provides guidance on the Department of Defense surveillance strategy for the coronavirus disease 2019 (COVID-19) pandemic response, including health surveillance activities, screening, asymptomatic testing, and sentinel surveillance testing. The DOD surveillance and screening strategy is designed to break the chain of disease transmission to reduce risk to the force and to DOD missions.
The guidance details information on the following:
- Health Surveillance Activities
- Screening, Restriction of Movement, and Asymptomatic Testing for Operational Risk Reduction
- COVID-19 Sentinel Surveillance
- COVID-19 Contact Tracing and Testing
- Guidance for Specific DOD Populations
The guidance can be found here.
Navy Mitigation Measures in Response to Coronavirus Outbreak Update 5
This NAVADMIN is long and can be seen here. Reading it, the topic it addresses is:
This NAVADMIN...transitions the stop movement approach to domestic and overseas personnel travel to a conditions-based, phased approach to lifting of travel restrictions.
Anyone PCSing will want to give it a read. Any questions should be directed to your Detailer. My Detailing hat is too old to give you an official answer.
Navy Prioritizes PCS Moves
Here’s a link to this Navy article summarizing the PCS changes.
Permanent Change of Station Post Stop Movement Priority Plan
Here’s what this NAVADMIN, which is also long, deals with:
This NAVADMIN details how Navy Personnel Command (NPC) will work to eliminate the temporary backlog of five months of Sailors due to transfer as locations and installations achieve the conditions outlined in reference (b). There are 42,000 Sailors with Permanent Change of Station (PCS) orders delayed due to COVID- 19. As conditions allow for the easing of stop movement orders, household goods (HHG) and transportation logistics will initially limit the number of Sailors that can be moved at one time.
Again, anyone PCSing will want to give it a read. Any questions should be directed to your Detailer. My Detailing hat is too old to give you an official answer.
Travel Restrictions: Green Locations, June 12, 2020
The Secretary of Defense recently signed a memo, moving to a conditions-based, phased approach to personnel movement and travel. As of today, the following locations meet the conditions to lift travel restrictions, subject to the assessment of conditions at individual military installations within these areas. These criteria are: 1) removal of shelter-in-place orders or other travel restrictions 2) 14-day downward trajectory of flu-like and COVID-19-like symptoms; and 3) 14-day downward trajectory of new COVID-19 cases or positive tests. The secretaries of the military departments, commanders of the combatant commands, and the chief management officer will assess specific DOD installations, facilities, or locations under their purview.
U. S. (39)
- Alabama
- Alaska
- Arizona
- Arkansas
- Colorado
- Connecticut
- Delaware
- District of Columbia
- Georgia
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Mexico
- New York
- North Dakota
- Oklahoma
- Oregon
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Washington
- West Virginia
- Wyoming
Host Nations (7)
- Bahrain
- Belgium
- Germany
- Guam
- Japan
- South Korea
- United Kingdom
More information on the update to the travel restrictions can be found here.
Updated Guidance on COVID Travel Restrictions
Lots of info…
- Here is a Military Times article that summarizes it – DoD’s travel ban is lifting, with some restrictions still in place
- Here is a DoD press release with a video you can watch – DOD Officials Unveil COVID-Related Personnel, Move Guidance
- Here is a DoD press release that contains the actual memo and a fact sheet – Update to Personnel Movement and Travel Restrictions
- Here is the DoD release on Force Health Protection Guidance – Force Health Protection Guidance – Supplement 9
- Here is a release for those that work on the Pentagon or one of its affiliated sites (like me) – Pentagon Reservation Plan for Resilience and ‘Aligning With National Guidelines for Opening Up America Again’
Interesting COVID Research Idea Up for the Taking
This is an interesting idea from a brilliant friend that I’m passing along for the consideration of researchers out there. Take it or leave it:
I’m circulating this email in the hopes of networking my way through you to someone conducting a COVID-19 vaccine trial, or able to influence one. So far, advancing such a novel idea via emails to anyone I can think of, mid-pandemic, is not working. I’m sure the inboxes of the vaccine developers and immunologists competing to save the world are full. Among a couple dozen others, Bill Gates, Sanjay Gupta, and Dr. Fauci have yet to get back to me. If my proposal makes any sense to you, please pass it on to anyone you know who might be able to put it in front of someone who could make it happen.
I have been researching the intersection of my psychology PhD and my concerns, as a physician, regarding the challenges of implementing a Covid-19 vaccine. There is sound, supportive, but limited research suggesting that a distinctive taste stimulus paired with vaccine doses can later, and by itself, become immuno-enhancing via Pavlovian conditioning. The taste alone can then supplement or replace vaccine boosters, multiplying the availability and dramatically reducing the cost of successfully vaccinating billions worldwide against COVID-19. It would be easy and almost without additional cost to safely integrate the definitive experiment proving this concept into phase II or III trials of any prospective COVID-19 vaccine (one suggested protocol below). A major limitation is the lack of incentives for vaccine developers to pursue a paradigm that could cut their vaccine sales in half. Supporting data is in the attached brief proposal and included more extensively in a recently accepted paper of mine, also attached. I, of course, have no financial interest in the outcome of this; just trying to be helpful to the effort.
Be safe, be well.
All the best.
Kenneth Frumkin, PhD, MD, FACEP
Kenneth dot Frumkin at gmail dot com
www.linkedin.com/in/KennethFrumkinPhDMD
Retired civil servant on a pension
Consolidated PDF with COVID Resources
The flow of information on COVID-19 is overwhelming, but this PDF is a pretty good consolidated reference so I wanted to share it:
SG’s Message – Of These Things Miracles Are Made
Dear Esteemed Navy Medicine Colleagues,
Naval superiority means fighting and winning against enemies on the sea, on land, and as is the case with COVID-19, even in the Biosphere. This is where we truly see the real Power of Navy Medicine in action and the impact our incredible high-performing teams are having in combating this invisible adversary. Because of YOUR significant, selfless and incredible efforts, we are having dramatic effects on mitigating the spread of this disease, protecting our Navy and Marine Corps team, and maintaining mission readiness. Together, WE have deployed the largest force of medical personnel since Operations DESERT SHIELD/DESERT STORM, nearly 30 years ago. WE have deployed almost 4,000 Sailors on our hospital ships and in civilian medical facilities around the country, working shoulder-to-shoulder with local health care providers during this crisis, and we remain committed to sustaining this effort for as long as our nation requires. WE are flat out making a difference!
Last week the Chief of Naval Operations commended our speed and professionalism when a Sailor suffering respiratory issues was medically evacuated off the USS KIDD (DDG 100). Within hours of the Sailor’s test coming back positive for COVID-19, NMRTC Jacksonville deployed a special seven person medical team to conduct contact tracing, do onsite testing aboard the ship and to support the Independent Duty Corpsman in caring for his patients. Although the medical team didn’t expect to find themselves on a DDG in the Eastern Pacific when they went to work that morning, their rapid response provided critical support to the ship and demonstrates why we all need to maintain a high state of personal and unit readiness.
USS MAKIN ISLAND (LHD 8) rendezvoused with KIDD to establish a COVID-19 afloat medical response. MAKIN ISLAND embarked a fleet surgical team to provide intensive care unit capability, ventilators, and additional testing. Together, providers from the KIDD and MAKIN ISLAND worked tirelessly to test and care for patients who tested positive. The KIDD is now in San Diego where NEPMU-5, NHRC, and NMRTC San Diego are fully supporting her return with pier side testing and follow on health surveillance screening services for Sailors placed in quarantine or isolation. Fortunately, none of the sailors are currently hospitalized.
The coronavirus is a new pathogen and we are rapidly implementing lessons learned through operationalized mitigation and prevention efforts. Sailors and Marines aboard the DDG and LHD have directly benefited from the logistical and medical experiences we have gained in our support of the USS THEODORE ROOSEVELT (CVN-71). From our research scientists and public health experts, to our medical professionals deployed forward and serving at home, we are collecting, analyzing, and leveraging data to prepare our warfighters to operate in this new warfighting domain.
Our staff at U.S. Naval Hospital Guam has been doing much of the “heavy lifting” in providing twice daily health surveillance screenings, administering nasal swab testing, and delivering daily medical support and care to those in need. Importantly, they continue to collaborate with other medical assets on Guam (3rd Medical Battalion, USAF’s 36th Medical Group, a SPRINT from NMRTC San Diego, and TR’s medical department) to ensure the TR is ready to execute its mission. Similarly, I know commands across Navy Medicine are working hard each day to provide nasal swab testing and health surveillance support to units across enterprise, including Carrier Strike Groups and Marine Corps Recruit Depots.
Although we are far from defeating this virus, the Navy is aggressively applying COVID-19 lessons learned. As a prudent measure, every Sailor deploying in our next Carrier Strike Group aboard the USS NIMITZ (CVN 68) was placed in a pre-underway restriction of movement and to further ensure they deploy COVID-free, testing of more than 7,000-plus Sailors is presently underway. Similar plans are being conducted for future deploying ships and subs; including SSBNs. The coordination performed by Navy Medicine assets in both fleet and medical treatment facilities to make this happen reflects the continued value and importance of operating as a ONE NAVY MEDICINE team.
Finally, as DoD shifts into a “stabilization” phase in the COVID-19 fight, we will soon welcome back the COMFORT to Norfolk. The hospital ship served as a powerful symbol of hope and resilience during this crisis. The men and women of the COMFORT did a commendable job bravely going into harm’s way to serve at the epicenter of the virus, treating severely ill New Yorkers. They shall return to “Ready 5” status and remain ready for future tasking.
Thank you for your continued collaboration, coordination, communication and most importantly, the care you bring to your work and to the well-being of your families, co-workers and yourself. We are in the early stages of this marathon. A steady, sustained pace, recharging ourselves physically and mentally along the way, will continue to be a key factor in our ability to project the full force of our Navy Medical Power.
It has been said that an individual can make a difference, but that only a team can make a miracle. Whether you are contributing by holding the fort at your MTF; teleworking from your kitchen table while grading your child’s homework or caring for your family members; deploying to one of our nation’s community hospitals to link arms with and relieve exhausted civilian medical staff or underway on the vanguard of freedom YOU are a critically important part of the Navy Medicine team. We are a team that is remaining steadfast in its resolve to protect and defend our shipmates and our fellow citizens. Of such sustained dedication and commitment miracles are made.
With my continued respect and admiration,
SG
Bruce L. Gillingham, MD, CPE, FAOA
RADM, MC, USN
Surgeon General, U.S. Navy
Chief, Bureau of Medicine and Surgery
Updated Summary of COVID Related ALNAVs and NAVADMINs
There’s been a number of COVID-19-related ALNAV and NAVADMIN messages released since the last summary. This document summarizes all of these messages (the newest ones are highlighted) and hyperlinks are provided for the messages:
COVID19 Message Summary (24Apr20)
Thanks to CAPT Kemper at BUMED who sends me these summaries.
Two COVID Info Sheets for Those With Travel or PCS Issues
Here are two PDFs that might help people in certain situations.
This PDF is for anyone “ordered by their command to self-monitor somewhere other than their home if they are not on official travel orders”:
HARDSHIP-DUTY-PAY-RESTRICTION-OF-MOVEMENT
This one is for anyone who has “entered into a rental or purchase agreement at their prospective duty station, but are unable to execute PCS orders due to travel restrictions”:
IMPACT-OF-TRAVEL-RESTRICTIONS-ON-BASIC-ALLOWANCE-FOR-HOUSING-ENTITLEMENTS
Message from the SG – When Can Navy Medicine Get There?
Esteemed Navy Medicine Shipmates,
As you know, our One Navy Medicine Team is on the front lines of this fight combating COVID-19 on multiple platforms and working across many disciplines. Last week I shared with you several examples of how our clinicians are stepping out of their traditional roles to provide “boots on the ground” health care support in this national emergency. Our clinicians remain a vital part of this effort, and they are not alone in the fight.
This past Monday, Navy and Marine Corps Public Health Center professionals partnered with the Centers for Disease Control and Prevention to conduct an outbreak investigation in Guam with volunteers from the USS Theodore Roosevelt. The purpose of this investigation is to gather data which will help inform future testing strategies, operational planning, and COVID-19 mitigation measures to ensure the readiness of Navy ships and our Force.
Since the coronavirus outbreak was first recognized, our scientists from Navy Medicine’s Research & Development enterprise immediately began to harness the power of our global network of laboratories to help develop vaccines and therapeutics against SARSCoV-2, the virus that causes COVID-19. Our research experts are looking at operational needs and working to develop countermeasure products that will make their way down to the deckplate. Our Navy Medicine Researchers are focusing on four priorities:
- Producing purified human anti-SARSCoV-2 polyclonal antibodies. Naval Medical Research Center has partnered with Sanford Applied Biosciences to produce human neutralizing antibodies from humanized cows (Tc Bovines) that can potentially be used to treat COVID-19 infected patients. When administered to at-risk individuals exposed to COVID-19 infected patients, these Tc Bovine-derived human antibodies may prevent infection or significantly reduce illness associated with a secondary COVID-19 infection.
- Psoralen-inactivated SARSCoV-2 vaccine. Developing an inactivated whole virus COVID-19 vaccine using a flexible vaccine development platform that is based on the use of a psoralen compound, which interrupts virus replication by inactivating viral genes, while leaving the outer virus proteins largely intact. These intact outer virus proteins in psoralen-inactivated vaccines promote a better immune response compared to standard formalin-inactivated vaccines where the outer virus proteins may be distorted or destroyed by the formalin inactivation method leading to a less robust immune response.
- Phage-based COVID-19 vaccine. Designing a multi-subunit phage-based vaccine that will be ready for testing within weeks. They have secured funding for purification, manufacturing, and large-scale throughput to prepare numerous Current Good Manufacturing Practice vaccines, identifying optimal polyvalent vaccines prepared for phase I clinical trials.
- Spearheading a robust and field-deployable rapid diagnostic test suited to meet shipboard demands. Navy researchers are working with Defense Advanced Research Projects Agency on gene editors that could operate as rapid detectors of pathogenic threats. The development initiative is called “Detect it with Gene Editing Technologies” to enable biosurveillance detection of any threat, anytime, anywhere.
We are eager to see these projects contribute to our fight against COVID-19 and Navy Medicine continues to make meaningful progress by leveraging high-velocity learning to be resourceful and innovative. I would like to note, that the contributions from our doctors and scientists are not always conducted bedside or from a lab bench. In Lima, Peru, team members from Naval Medical Research Unit Six were recently recognized by the State department for stepping up to support the repatriation efforts of over 7,000 U.S. citizens stranded in Peru and transport them back to America. When there is a challenge before us and people are in need, the men and women of our One Navy Medicine Team are there to provide help and support.
Whatever your role, I want each of you to know that your contributions continue to make a difference. It is a well known fact that our Navy is the 911 force for our Nation and often the first words uttered by our leadership in the time of crisis is “When can the Carriers get there?” Because of the Power that you bring to this fight and the immediate game-changing impact you are having, the first thing I’m hearing is “When can Navy Medicine get there?” Thank you for your responsiveness, dedication, and professionalism to our Sailors, Marines, families, and our fellow citizens. You are the game changers in this fight!
With my continued respect and admiration,
SG Sends
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