VA Secretary Robert Wilkie confirmed the first case in a veteran in a congressional hearing on March 4. The veteran arrived at the VAMC in Palo Alto, CA, on March 2 in a transfer from another facility at the patient’s request, said VA Acting Under Secretary of Health Richard Stone, who was also testifying at the hearing.

The first servicemember tested positive in South Korea on February 25, a day after the widow of a retired soldier living in Daegu was confirmed with the virus. The 23-year-old American soldier, stationed at Camp Carroll, had been in Camp Walker and Camp Carroll in the days before his diagnosis. Four days later, his wife was diagnosed with COVID-19. A Korean employee of U.S. Forces Korea has also tested positive. Contact tracing and screening continues on bases in South Korea.

In response to the outbreak in South Korea, the department postponed planned joint military exercises at the request of the Korean chairman of the Joint Chiefs of Staff, according to U.S. Joint Chiefs of Staff General Mark Milley. More than 25 South Korean soldiers have contracted coronavirus and 10,000 were under quarantine.

As of March 2, joint exercises planned in Thailand and Europe were continuing as scheduled, despite a rapidly rising number of coronavirus cases in both locations.

The DoD “has standing plans to respond to the infectious disease outbreaks and we’re executing those plans at our bases and operating locations around the world,” Milley said in a press briefing.

The plans had three primary goals. “My number one priority remains to protect our forces and their families,” Secretary of Defense Mark Esper said. “Second is to safeguard our mission capabilities, and third to support the interagency, whole-of-government approach. We will continue to take all necessary precautions to ensure our people are safe and able to continue their very important mission.”

Restrictions, Quarantines

The DoD has taken aggressive action to protect the health and lives of servicemembers.

“Access to bases being restricted in certain locations, such as Northern Italy and in South Korea as an example; secondly is travel restrictions,” Milley noted. “So the soldiers that are on these bases or airmen that are on these bases are being restricted in terms of their travel inside the [area of responsibility].”

Areas with restricted travel, in many cases prohibiting “all leave and liberty” travel, include the U.S. European Command, Central Command, and Indo-Pacific Command.

U.S. Forces Korea raised its risk level to “High” or “Health Protection Condition Charlie (HPCON C)” after the first U.S. service-related diagnosis on the peninsula. As a result, service members in Korea are prohibited from attending non-essential off-installation activities, including social events, shopping other than for groceries, and dining out.

Non-mission essential meetings and gatherings as well as temporary duty travel are banned, and non-essential civilian employees and contractors have been told not to come onto bases. Servicemembers were told to expect delays accessing installations in light of implemented screening procedures.

More broadly, Acting Defense Undersecretary for Personnel and Readiness Matthew Donovan encouraged installation commanders to “maximize the proportion of the workforce that can perform their duties via telework” prior to an outbreak in their community in a memo issued February 25. If coronavirus cases occur, he advised stepping up restrictions as seen in other locations to include travel limitations, modified exercises, providing protective gear, and implementing quarantines, depending on the severity of the event.

Additional screening has been implemented for servicemembers returning home from Korea as well. For the 800 troops expected to return to Fort Hood in early March, “medical teams in South Korea and at Fort Hood are screening and following established protocols in the pre-departure and post-departure phase of the returning flights,” said Steven Lamp, Third Corps deputy public affairs officer.

Elsewhere in the U.S., the commander at Joint Base Lewis-McChord in Washington State “has shut down some large, widely attended gatherings,” Milley said. The base is “taking appropriate mitigation measures,” as it is located near the largest and deadliest outbreak in the U.S. so far. No cases have been reported at the base.

Up to 1,000 Army, National Guard, and Reserve recruits arriving for basic training each week started answering coronavirus screening questions regarding travel, exposure, and symptoms in early March. They also had their temperatures taken. Anyone with fever or positive answers to the questions would be sent for medical evaluation, according to Gen. Paul Funk, head of the Army’s Training and Doctrine Command.

Sailors are also coming under increased restrictions. U.S. Pacific Fleet commander John Aquilino ordered ships in the 7^th Fleet area of operations to “remain at sea for at least 14 days before pulling into another port in order to monitor sailors for any symptoms.” The 6^th Fleet has implemented the same guidance for self-quarantine for all ships making port in Europe.

Also in Europe, the Army closed all schools, religious centers, childcare facilities, and gyms in Vicenza, Italy. The actions affected more than 6,000 troops and their families in Veneto, one of the hardest hit regions in Italy. Travel to the Lombardy region was prohibited and non-official travel discouraged.

As of March 4, the Army had “zero confirmed cases of COVID-19 for any U.S. servicemembers, civilians, or family members in the U.S. Army Garrison Italy footprint,” according to Daniel J. Vogel, USAG Italy garrison commander. However, he noted that soldiers and families returning to the U.S. from the garrison “should anticipate being placed in quarantine for 14 days.”

Veterans At Risk

Last month, soldiers stationed on U.S. Army Garrison Casey conduct pre-screening processes for coronavirus (COVID-19) on individuals awaiting entry to the base, USAG-Casey, Dongducheon, Republic of Korea. That was because of an outbreak in the community near the base. Now, both the DoD and VA have reported their first cases. Army photo by Sgt. Amber I. Smith

While the DoD has moved quickly to limit spread of coronavirus within its ranks, its personnel tend to be young and fit and, therefore, have lower risk of dying from the infection. Not so for many veterans. The China CDC found that the overall mortality rate for COVID-19 was 2.3%, but among those over age 80, the fatality rate rose to nearly 15% compared to 0.4% in individuals in their forties and 0.2% in those younger than 40.¹

“One thing that is clear is that nursing homes and hospitals are potentially at greater risk, and we are really going to have to think hard about what can be done to protect them,” said Tom Frieden, a former director of the U.S. Centers for Disease Control and Prevention.

The high death rate among patients at the nursing home at the center of the outbreak in Washington State underscored the risk.

The VA has begun screening patients with respiratory issues for COVID-19 before they enter emergency departments. Facilities have also started restricting visitors to hospitals and nursing homes to control the spread of both coronavirus and influenza.

“Our special concern is that we operate 135 nursing homes with over 8,000 vulnerable veterans in them,” Stone noted. “They are on our campuses, and we must protect them. And therefore, at the risk of some inconvenience, we are screening everybody coming into the institutions.” Screening started in the state of Washington and has spread out from there.

The VA has about 1,000 negative air flow rooms available for isolation of patients, Stone added.

The VA has also activated its emergency management coordination cell to coordinate its response across the country, though it has not requested any additional funding to date.

That could change, Stone said. “If this develops into a pandemic, in which parts of the American health system break down, we’re going to have a different conversation.”

1. Zhang Y, The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Disease (COVID-19)-China, 2020. http://weekly.chinacdc.cn/en/article/id/e53946e2-c6c4-41e9-9a9b-fea8db1a8f51