Special report
An on-board quarantine was implemented six days after the first case of Covid-19 was declared on the USS Theodore Roosevelt.
4,500– 4,800
The approximate number of crew personnel aboard the USS Theodore Roosevelt during its mission in the west Pacific in March 2020.
1,156 USS Theodore Roosevelt 14
radiological and nuclear. Protocols were built around the idea that danger comes from the outside. Everything is closed and you create a high-pressure environment, and then you and your staff are safe from toxins trying to work their way in. “The very hard lesson that militaries learned during the first wave of the pandemic is that biological risk doesn’t always work that way,” says Dr Benjamin Queyriaux, medical director at the Health Intelligence Protection Surveillance Agency (HIPS), which works with public and private organisations to identify, prevent and mitigate health and biological risks. “Once the agent – the virus – is inside, it’s too late, and it’s people that are bringing it inside. All the protections built against the CBRN threats were totally useless and even counterproductive.” From April 2020, Queyriaux was contracted as a pandemic advisor to Nato, where he played a key role in advising high command and helping them plan for the second wave of Covid-19. “It was very interesting because they had never coped with an issue like this,” he recalls. While the response to the first wave was simply to remain resilient and hope to resume business as usual by summer 2020, their mindset completely changed in autumn.
“They understood that they were running a marathon, not a sprint, and realised the biological risk of a virus was something completely different,” says Queyriaux. “At that point they began saying that they were ready to tackle this problem, and take it into account in their planning and operational processes.”
Design changes and the end of the handshake
The number of positive Covid-19 cases on board the ship by 5 May 2020.
It may sound like an insignificant change, but Queyriaux hopes that the pandemic will lead to the end of the handshake in the military. “That would be an absolute revolution, and we really hope that they will keep it in the future,” he says. “We’ve been trying to promote [ending the handshake] for years without any success, but suppressing handshakes between military
personnel [during the pandemic] has really improved the situation. It seems simple but it’s a critical point.” Dr Nelson Michael is the director of the Walter Reed Army Institute of Research’s Center for Infectious Diseases Research. He says that once a decision like this is made at high command, it is likely to stick. “When you come into any military worldwide, you gain benefits but you lose some of your rights as a citizen to autonomy – that’s the deal,” he explains. “When my commander says you will physically distance and wear a face mask, there aren’t any personal decisions that come in. It gets done. We follow the rules. We are unique in our ability to execute those rules.” In addition to the obvious measures that have been brought in during the pandemic – reduced handshaking, physical distancing and face masks – Queyriaux advises further training of crews and commanders in biological risk, not only in the Cold War sense of the term, but also taking transmissible diseases into account. These risks, he says, must be integrated into business continuity plans, which should include protocols on how to reorganise the crew in the event of an epidemic to avoid cross contamination. In the longer term, design changes will also be necessary. In fact, one of the toughest lessons learned from the USS Theodore Roosevelt and Charles de Gaulle outbreaks, according to Queyriaux, is that it’s practically impossible to stop the spread of a virus and isolate contagious patients in buildings that have not been designed with a situation like this in mind, an issue his predecessors grappled with in 1918. “We know perfectly well that we can control pneumonia absolutely if we could avoid crowding the men, but it is not practicable in military life to avoid this crowding,” Army Surgeon General Gorgas had said during the First World War, recommending that army housing provide 60ft2
per soldier to prevent such an issue, but was all too often ignored.
Fast forward to the present and there is still a lot of work to do, according to Queyriaux. “Medium term, we’ll be looking at modification of the architecture, and
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