In the fight against coronavirus, what the military can — and can't — do to help
President Trump and Vice President Pence in a press conference Tuesday discussed the possibility of deploying active-duty service members in the fight against the coronavirus, just a day after Pentagon officials had tried to temper public expectations of a role for the military.
As governors in 18 states have mobilized the National Guard to aid in the fight against COVID-19, the question of using the U.S. military in the emergency has taken on more urgency. The president’s tone has also become markedly more somber, from boasting on Sunday that his administration had “tremendous control” of the outbreak to acknowledging Monday that the pandemic was “not under control” anywhere in the world, and that “it’s bad.”
In a Pentagon press conference on Tuesday, Defense Secretary Mark Esper said the department would make available to the Department of Health and Human Services up to 5 million of the coveted N95 respirator masks — 1 million of them immediately — and up to 2,000 deployable ventilators, which help critically ill patients breathe. In addition, he said, the Defense Department was making its 14 (soon to be 16) certified coronavirus testing labs available to civilians.
Esper acknowledged that adding 2,000 ventilators — which he said was the maximum the Pentagon could provide — “doesn’t put much of a dent” in the number that some studies project that the United States will need. The New York Times last week estimated that if the pandemic follows the pattern of the 1918 Spanish flu outbreak, the country would require 740,000 ventilators. It’s not known how many there are in civilian hospitals, but the best estimate is around 160,000.
The Pentagon was also considering “activating National Guard and Reserve units to assist states with planning, logistics and medical support as needed,” Esper said, adding that “there hasn’t been a need yet for active duty” troops. National Guard units can be mobilized by state governors without federal authorization, but under certain circumstances the Defense Department can activate them under federal authority. The National Guard troops mobilized by governors so far have been used mostly for nonmedical tasks, such as delivering food to quarantined residents in New Rochelle, N.Y.
Trump and Pence identified two specific military capabilities they thought could help expand medical capacity: tented field hospitals that could be deployed to provide emergency intensive-care beds, and the Army Corps of Engineers, which Pence said could “renovate existing buildings,” presumably to turn them into medical facilities.
But in a Pentagon press conference Monday, Brig. Gen. Paul Friedrichs cautioned that military medical capabilities are limited, are set up to provide emergency care to young servicemembers rather than fight a pandemic disease and come with a lot of trade-offs.
“We do have tent hospitals,” Friedrichs said. “The challenge is they are designed to take care of trauma patients and combat casualties,” rather than patients suffering from a highly contagious disease. The tent hospitals range in size from 25 beds to “much larger than that,” Friedrichs said. But the issue is the kind of care the military is geared to provide. “If we build a 200-bed or a 25-bed trauma hospital to take care of people with coronavirus, that’s not really a great solution to the coronavirus challenge,” he said. “We don’t have any 500-bed hospitals designed for infectious disease outbreaks. That does not exist in the inventory.”
The Navy also has two hospital ships, the Comfort, based in Norfolk, Va., and the Mercy, based in San Diego. “We’ve already given orders to the Navy a few days ago to lean forward to get them ready to deploy,” Esper said. But he said the ships, like other military facilities, are “focused on trauma” and lack “the segregated spaces to deal with infectious diseases.”
One way the military could help in the crisis is to treat civilian trauma victims and other noncontagious cases, freeing hospital beds for COVID-19 patients, Esper said.
But he and other Pentagon officials acknowledged that they will have to make trade-offs when deploying active duty military medical personnel or mobilizing National Guard and Reserve medical personnel to staff such hospitals. Those personnel are already either treating active-duty servicemembers and their dependents, or, if they are in the Guard and Reserves, almost certainly have civilian medical jobs anyway. The Pentagon needs to ensure when it calls up these units “that we aren’t robbing Peter to pay Paul,” Esper said.
As for the Army Corps of Engineers, it is “ready, willing and able,” Trump said. But retired Army Lieut. Gen. Guy Swan said it was important to remind people of that organization’s limitations. “The Corps of Engineers really doesn’t construct anything,” Swan said. Rather, it is “a contracting agency” that oversees private construction firms working on government projects, said Swan, who served as director of operations for U.S. Northern Command and as commander of U.S. Army North, two organizations that would be at the heart of any military response to a pandemic in the United States. “The corps has good capability to orchestrate all that, but it will still require private companies to execute the construction,” Swan said.
The corps can provide “expeditionary” support by overseeing the construction of holding areas, such as they have done for Customs and Border Protection on the U.S. border with Mexico, “but not on a large scale,” Swan said. “I don’t think the corps can build a hospital in 10 days like the Chinese can.”
But building hospitals might not be the wisest move, according to Swan. “Do you really want to build a hospital that, four months from now, is going to be excess capacity?” he said, adding that it would make more sense to lease a hotel and convert it into a hospital, or create a more “expeditionary” capability in a gym. In the latter case, he said, “then you could see 22-year-old soldiers helping put that together.”
The military also has 36 brick-and-mortar hospitals in the United States, according to Friedrichs, who described them as “relatively small in size” and configured to support the needs of the local military communities. “They’re not thousand-bed hospitals,” he said.
Those hospitals are responsible for treating 3.8 million servicemembers, dependents and beneficiaries who live within 40 miles of those 36 facilities, Esper said. “We have to treat our own populations.”
“We have a surge capacity,” said Pentagon spokesman Jonathan Hoffman. But when it comes to hospital beds, that capacity is limited. Hoffman estimated that Defense Department owns “2 or 3 percent … of the hospital beds in the country.”
A decade and a half ago, the Defense Department undertook “a thorough and comprehensive review” of all the missions that the department might have to conduct in support of civil authorities in the event of a pandemic, said Paul McHale, who was assistant secretary of defense for homeland defense from 2003 to 2009. That analysis produced a list of “almost two dozen” types of missions, most of which were logistical rather than medical and would have been required as part of a military response to any natural disaster, he said.
However, what the review found was that surging medical care in a timely manner to communities where it is needed “is probably the single most difficult and important function that the Department of Defense might have to achieve,” McHale said. “That kind of logistical movement, in order to be effective, needs to be very carefully and very rapidly planned.”
Advance planning — meaning before the pandemic has taken hold — is essential, according to McHale. His office identified which airfields around the country would serve as the best hubs for flights carrying medical personnel and equipment, he said.
“Identifying the necessary resources is something that you absolutely cannot do effectively on the fly,” McHale said. “You have to identify the location of such resources and have preliminary plans in place for the movement of those resources and associated personnel in order to ensure that the help you are providing gets there in time.”
Esper seemed to personify the Trump administration’s newfound sense of urgency in reacting to the coronavirus pandemic. “At this point, the key is speed,” he said. But time, like crucial supplies and equipment, is running out. “Everything is late in a crisis,” Swan said.
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