By Cmdr. Michael Kaplan, MD
Director of Medical Services
Naval Hospital Jacksonville, Florida
While USS Kidd (DDG 100) was deployed to the U.S. Fourth Fleet Area of Responsibility, a Sailor began experiencing COVID-19 symptoms April 20, a month after the ship’s last port call.
In the weeks preceding this first positive case onboard, the crew of USS Kidd was already applying the Navy’s COVID-19 lessons learned. In early April, Sailors began to make and wear cloth face masks. They conducted a quarantine and isolation drill to determine how to segregate sick and healthy crew members on a ship with limited space.
In addition, the surface Navy and operational commanders sent COVID-19 mitigation guidance to the fleet and built contingencies in the event another deployed ship experienced an outbreak.
This is the story of the seven-member medical team from Naval Hospital Jacksonville who jumped into action to provide medical care to the crew of USS Kidd.
Be Prepared to Respond Quickly to a Possible Outbreak
On the morning of April 23, my boss, Capt. Matthew Case, commanding officer of Naval Hospital Jacksonville, came over to my office. He asked if we could send a team to a ship in distress, to do testing, isolating, and quarantining of Sailors who may be sick with COVID-19, as well as provide medical support until they can get back to a safe place.
I said, “Sure, when would they need to go?”
He said three hours.
We balanced who would be most qualified and available on such short notice without leaving the hospital in a bad place, since every department had been stretched because of COVID-19.
We built a team of seven medical providers: Along with me, an allergy/immunology and internal medicine physician by trade, were Lt. Cmdr. Clifton Wilcox, MD, a preventative medicine physician; the lab technician, Hospitalman Joseph Kim; two preventative medicine technicians, Hospital Corpsman 2nd Class Derrick Hudson and Hospital Corpsman 1st Class Jason Turgeon; and finally, the two hospital corpsmen, Hospital Corpsman 3rd Class Brian Krawsczyn and Hospitalman Jason Moyer.
Within hours of the call, we were packed up with all the equipment and tests. We didn’t have much time to think about what we were getting into, which is probably a good thing. Not too many people would want to run into a burning building. When we left we knew very little about how many Sailors were currently sick.
We took a P-8 Poseidon from Jacksonville, a couple of miles down the street from our hospital. It flew us to El Salvador, and from there we took an SH-60 Sea Hawk helicopter offshore.
Test Everyone, Even if They Don’t Show Symptoms
That evening, we began testing the crew. Within 24 hours of arriving, we already had 25 percent of Kidd Sailors tested. Once we identified someone who was positive yet asymptomatic, we took the initiative to isolate them, so they couldn’t spread the infection. Our goal was to reduce further spread among potentially vulnerable Sailors who were not already infected.
Of all the Sailors who tested positive while still onboard, about 50 percent were asymptomatic.
Testing everyone took a lot time. One challenge was that our COVID-19 testing machine could only run one sample at a time. We could average about four to five tests per hour at best. Before the ship arrived in San Diego, we tested 100 percent of the crew, but this required that we run the tests 24 hours a day.
We still had days until we would arrive in San Diego and disembark the crew. Until then, we wanted to do everything we could to minimize the spread on the ship, to ensure Sailors could remain healthy and do their job.
I have to give kudos to Kidd’s independent duty corpsman, Chief Hospital Corpsman Clinton Barton, and his medical department. They did a great job identifying which Sailors were likely infected. Barton took it upon himself to isolate those not feeling well before we even got there.
Despite the limited space on a cramped destroyer, he did the right thing: isolating people he had concerns about. That allowed us to rapidly test those people first, make sure our equipment was working properly and try to mitigate the spread. As we continued to test other Sailors who did not have symptoms, we just increased the isolation ward he had created.
Minimize Exposure to Avoid Being Infected
We implemented a number of steps to try to mitigate the spread, such as administering N-95 masks to the entire crew, increasing the cleaning frequency for common areas and making sure Sailors wash their hands or use sanitizer before going into common areas such as the galley.
The location of the ship from where we started was outside the typical range of a helicopter. USS Makin Island (LHD 8) provided an additional resource, should we run into trouble and need to move Sailors off USS Kidd. Makin Island is capable of taking on types of aircraft that Kidd can’t, allowing for longer medevacs.
With an embarked fleet surgical team, Makin Island can also provide Role 2 level of care. Role 2 care includes basic resuscitation and stabilization and may include surgical capability, basic laboratory, limited x-ray, pharmacy, and temporary holding facilities.
While underway, 15 Sailors from Kidd were transported to Makin Island, where they received radiographic imaging and laboratory diagnostic services, as well as general medical services.
Test Everyone Again
Although we’d tested 100 percent of the crew already, we retested everyone in San Diego on arrival. Knowing who is positive is imperative, and the only way to know is through testing.
Learn From the Experiences of Others
We took advantage of some of the lessons from the outbreak aboard USS Theodore Roosevelt (CVN 71). I think the combination of hard work, some good planning—even though we had extraordinarily little time—and just making sure we did everything we possibly could allowed it to work out.
Having multiple courses of action is always a good idea, because you never know if something is not going to work the way you expect. Fortunately, we had enough redundancy built into the system.
Also, bring the right equipment, and think outside the box. Then you just put it together.
Clearly, this mission demonstrates having a robust and well-rounded medical force ready is integral to ensuring our Navy is capable of meeting whatever challenges arise.
NOTE: On returning to Jacksonville, Kaplan and his team retested negative, were quarantined for 14 days, and retested negative a third time before returning to work.
https://navylive.dodlive.mil/2020/06/10/health-workers-in-uniform-lessons-learned/ U.S. Navy