The nation is at war with the COVID-19 pandemic, and New York has become one of the biggest battlefields. This isn’t just reflected in hospitals but in the city itself, from the arrival of the USS Comfort hospital ship in New York harbor to field hospitals popping up in Central Park.
Though it’s true that, as Dr. Anthony Fauci quipped recently, “You don’t make the timeline, the virus makes the timeline,” astute Army officers know it’s useful to shape the battle space. With the country on a war footing, all of us have been drafted, whether that means shifting our production lines to make masks, providing spaces for makeshift hospitals or even just by obeying “shelter-in-place” orders. So consider this the first step in your basic training: learning the Army’s tried and tested lessons in battle preparation and how you can apply them to this war.
Lesson One: Define the battlefield environment
It helps to start by knowing where you need to fight. In the United States, the COVID-19 battlefield environment is everywhere. Even areas that haven’t seen any cases yet need to act now. As we have seen in major metropolitan areas like New York, New Orleans and Atlanta, the cost of waiting for the first case to be confirmed is very high. The absence of known infected persons does not mean the absence of actual infected persons.
Lesson Two: Gather intelligence
In a battle, it is important to identify the enemy’s location so you know where to train your rifles and target your artillery. That’s why having the high ground on the battlefield has distinct advantages.
The same goes for a communicable infection like COVID-19. Clearly, this virus spreads very efficiently in enclosed spaces. We saw it on the Diamond Princess cruise ship in Japan, and we are seeing it now in nursing homes and hospitals.
We are flying blind in this outbreak: we still don’t know the extent of who is and who is not infected. A recent study by the CDC in a skilled nursing facility found that 30% of tested residents were infected. Over half of those had no symptoms during early testing, but there was no significant difference in their concentrations of virus compared to those that did show them. This was shocking.
We need more studies like this to understand the extent of the spread by asymptomatic people. We don’t currently have the ability to test everyone and, in many cases, people still need a doctor’s order to take a test. We desperately need national policy and resources allowing testing across large swaths of the country regardless of symptoms. Only then will we have the appropriate “observation and fields of fire” to shape the battle to our advantage and trace who really should be isolated from contact with others. This could allow us to cut the virus with the precision of a scalpel rather than whack it with an inexact instrument (mass quarantine). This has worked very effectively in Singapore and South Korea to keep the spread to a low level. We should strive to achieve something similar.
Lesson Three: Conceal and cover
On a battlefield, the enemy always seeks cover by concealing himself behind small mounds, trees and bushes. Without the ability to see them, we are susceptible to sniper attack. A skilled battlefield commander knows the sites of concealment. Similarly, we need to know where the virus hides in order to stop it.
New research released by my colleagues at the University of Nebraska Medical Center (UNMC) gives us ‘night vision goggles’ to see where the virus is hiding. Basically, we live in a cesspool of microbes. We already knew that, but the UNMC study revealed that in rooms housing infected patients inside their specialized quarantine and isolation units, SARS-CoV2 (the virus that causes COVID-19) was hiding on commonly used items: cell phones, remotes, personal items, etc. This is not overly surprising, but it is surprising they found it in places like the floor under the bed, window ledges and bedside tables. Even more surprising: they found it in the air – both in the patient’s room within and beyond six feet of the patient as well as in the hallway outside the room. They were testing for genetic material, so all identified samples may not have been live, infectious virus, but it sure unveiled where this microbe could be hiding. Knowing this can help us target the optimal spaces in our households and hospitals to clean and disinfect.
Lesson Four: Develop your battle plan
Once armed with battlefield intelligence you can take the fight to the enemy with appropriate courses of action. One of those is the unity of effort and concentration of force. Every state and jurisdiction across the country has been fighting the COVID-19 war differently and making its own policies. This uncoordinated approach guarantees failure on the battlefield. Too often, our actions have been reactive, rather than proactive. It is time for a national strategy.
Lesson Five: Do Your Part
Like any good soldier, it’s important to apply the knowledge of the enemy to improve your position. I won’t repeat the usual hand hygiene recommendations, but here are some other things to consider:
- Keep yourself healthy. Despite the constraints, try to remain active, eat well and get an adequate amount of sleep.
- Assume others are infected. Maintain your distance, even if there are no known cases in your community.
- If someone in your household is ill, assume your commonly used items (cell phones, door handles, rails, toilets) are contaminated. Disinfect these items regularly.
- Stay educated, but avoid resources that sensationalize and fearmonger. Don’t forget that the vast majority of people who get infected will recover.
- Take care of each other. Check in on your neighbors (by phone or video call) and ask how they are doing, especially those from vulnerable populations. A friendly comment can help to alleviate stress in this challenging time. In this fight, we are all ‘battle buddies’ together.