Regaining Lost Ground: Defense Support in the Coronavirus Pandemic

As the United States grapples with the coronavirus pandemic, discussion of the military’s potential contributions to a more robust federal response have taken center stage. In the absence of effective federal action, hopes of containing the virus have given way to an increased focus on slowing its transmission through measures like social distancing and belatedly filling critical health care gaps. Given its size and capabilities, it is both appropriate and unsurprising that many have called upon the Department of Defense (DoD) to assist these efforts. Indeed, in recent days, we have seen such calls from New York Governor Andrew Cuomo and Massachusetts Senator Elizabeth Warren.

Although there is no modern analog to the current coronavirus pandemic, there are many examples throughout U.S. history of military assistance during disasters both man-made and natural. In the past 15 years, three stand out for their scale. When Hurricane Katrina struck the Gulf Coast in August 2005, DoD mounted a massive response, involving an estimated 70,000 troops. However, that response was, broadly, uncoordinated, delayed, and insufficient. Learning important lessons from this experience, the Defense Department stepped up its response measures for Hurricane Sandy. While not perfect, when Sandy made landfall in October 2012, the Department was prepared and the response was far more proactive and unified.

On the global health front, from 2014 to 2015, the West African Ebola crisis claimed 11,325 lives and had a fatality rate of nearly 60 percent. President Ellen Sirleaf of Liberia requested that the United States send assistance before the disease took hold of urban areas. The United States responded, sending 2,800 service members, who built treatment facilities, provided logistical assistance, and set up mobile testing labs. The successful mission was the first overseas deployment of U.S. military personnel to combat an infectious disease outbreak.

To date, the federal response to the coronavirus is much closer to that in Hurricane Katrina than Hurricane Sandy or West Africa’s Ebola outbreak. It has been late, disjointed, and has lacked unity of effort. FEMA has just now moved to level 1, and the Secretary of Defense began speaking in depth to the crisis for the first time this week. There are many lessons to be learned in how slow and poorly managed the response has been to date. Those lessons will hold for another day. Now that the federal government has awakened, and the Defense Department has committed to integrating into a “whole of nation” response, it’s important to keep the military’s eye on two priorities—military force protection and readiness and defense support to civil authorities.

Force Protection and Readiness. The Department must care for the health of military service members and their families. It also has responsibilities toward civilian employees and others who live and work on its facilities and are critical to its missions. Both abroad and at home, there are cases of U.S. military personnel having been infected with the coronavirus. The first such case abroad occurred in late February in South Korea at Camp Carroll. Since then, there have been other confirmed cases abroad, including a sailor in Italy as well as a sailor assigned to U.S. Army headquarters in Germany. In the United States, as of March 18, more than 40 U.S. military personnel have tested positive for the coronavirus. Military personnel aside, last week, a doctor at the Veterans Affairs Medical Center in Brooklyn, New York tested positive for the virus.

Compared to the rest of the federal government, Secretary of Defense Mark Esper moved quickly to impose travel and other restrictions to “flatten the curve” in military infections. These were crucial early decisions that will bear fruit. During this pandemic, it is essential that DoD ensures that U.S. forces remain protected from the coronavirus. It cannot conduct its warfighting and support to homeland missions if it is sick and stood down from essential defense activities. However, it cannot remain so self-quarantined that it fails to remain capable of performing its mission. It will take careful management to ensure military health policies boost long-term readiness.

Support to Civilian Authorities. The Department of Defense also has a responsibility to support national needs. Now that the Defense Department is leaning in to this reality, military provision of medical supplies, personnel and assets (medical and otherwise), and vaccine development and therapeutic supply are especially valuable.

  • Medical supplies: The U.S. military’s mobilization potential is significant. It not only has standing inventories of some medical equipment; it has unique national defense contracting authorities that can be tapped now and as the coronavirus pandemic continues. It will need to husband some equipment for its own needs, especially that used by mission-critical service members and civilian employees, but Secretary Esper has already committed to providing the Secretary of Health and Human Services with 5 million N95 respirator masks and 2,000 ventilators.

With President Trump’s decision to invoke his emergency authorities under the Defense Production Act (DPA), there are opportunities to significantly ramp up government contracting for medically essential goods and materials. This includes masks, ventilators, hospital beds, and hygiene items. The Act requires companies to prioritize U.S. government orders to fill emergency needs over the orders of existing customers, even where doing so is less profitable. It also provides liability protection to these manufacturers, as they divert resources from existing contractual obligations. DPA authority may even be useful for prioritizing manufacturing of coronavirus test kits. Although he has invoked the authority for DPA, President Trump appears reluctant to allow the federal government to begin placing orders. This is foolish—the Trump administration should move aggressively now. There are known essential goods in short supply, and the government should begin contracting for these immediately. The United States can also use DPA authority to start getting ahead of challenges in the next stages of the coronavirus response. For instance, the Act’s Title III authorities, which are "designed to create, maintain, protect, expand, or restore domestic industrial base capabilities,” would allow the United States to invest now in long-lead capital equipment for testing and other relevant capabilities.

  • Personnel and Assets: The U.S. military can also provide forces and assets to support the Department of Health and Human Services, state governors, and other local officials. Significant attention is already focused on DoD’s medical capabilities. These are unfortunately neither scaled nor optimized for large-scale infectious disease response. Defense medical professionals largely reside in the Reserve Component, meaning that many already work day-to-day in the civilian health care system. Activating them for military service would most likely disrupt their roles at the frontline of our current response. However, there are smart ways to tap into DoD’s medical personnel. First, the military services can seek volunteers from its Reserve Component, such as those who may believe they can make more direct contributions to the pandemic crisis through military activation. Second, the military can identify active duty medical personnel, especially medics, who can deploy now to help with triage and other duties to free up civilian health care workers to focus on battling the coronavirus directly.

There are also medical platforms and related assets that the military should deploy in this crisis. The Navy’s two hospital ships, the USNS Comfort and USNS Mercy, are often called upon to ready in emergencies, as Secretary Esper has recently done. These vessels are designed for treating trauma cases associated with combat, with each providing roughly 1,000 beds and 80 intensive care units. They will not prove useful for treating the coronavirus directly, as they are poorly designed for containing infectious diseases. These ships can instead assist in relieving the burden on civilian medical facilities, thereby focusing hospitals on the epidemic itself. They may also provide extra bed space for other types of patients, especially those recovering from surgery or even sleeping quarters for medical personnel. At a more strategic level, they serve as a highly visible sign of the military’s commitment to supporting the health of civilians during this crisis. However, they will take time to ready and move—it has been reported that Comfort “could take weeks to prepare” and Mercy “will need several days to deploy.” Moreover, they are limited to offshore operations in two locations, Seattle and New York. There are fly-away medical teams in the Air Force and Army field hospitals that can and should deploy sooner, and DoD appears to be moving in this direction.

Even as the Defense Department’s medical professionals and assets are bought to bear in this pandemic, a greater share of uniformed personnel will be valuable for their ability to aid in basic security, logistics, and other areas support. Members of the military can help in duties like crowd control, emergency construction of field hospitals for initial screening of symptomatic persons—away from the general population—and assisting in the movement of medical professionals. For historical and statutory reasons, these missions are typically performed by National Guard units operating under the direction of their state governor, sometimes with federal funds. This is the right approach in this coronavirus pandemic as well. Nevertheless, there are many precedents for also tapping into capabilities in the Active Component, which should be done in parallel. In addition to the Active Component medical support described above, the military can help in design and construction projects already in high demand. The Navy’s Seabees and engineer units with an expeditionary construction mission are suited to such roles. There have already been high-profile calls for the Army Corps of Engineers—which designs but contracts out all of its construction—to engage with states on temporary hospital expansion, which it is doing. Given the toll this pandemic is taking on businesses, the use of military personnel should never displace commercial vendors where it is safe and sufficiently expedient to use them.

  • Vaccines and Therapeutics: Finally, the U.S. military can assist in the pursuit, acquisition, and distribution of a future coronavirus vaccine and, short of that, proven therapeutic treatments. The Defense Department has a direct interest in ensuring a coronavirus vaccine is available as soon as possible. Vaccinating military personnel and other essential workers protects readiness; vaccinating military dependents is a core duty that directly supports readiness. The U.S. Army Medical Research and Development Command at Ft. Detrick, Maryland recently arranged for an investigational coronavirus drug to be made available to U.S. service members. Agreements such as this help spur vaccine study and testing and may lay the early contracting foundation for production and even stockpiling of such a vaccine if it proves out. Investigation of therapeutics to reduce mortality in coronavirus-infected patients is now underway. If FDA-approved therapeutics emerge for which the Defense Department has inventory to share, especially should public supply for therapeutics dwindle or be prohibitively expensive, the Secretary of Defense should authorize the release of these drugs.

The U.S. government and the Department of Defense lost precious time in the last two months by failing to prepare for the national emergency now upon us. The delay has no logical basis—the virus’ impact could be seen across the world weeks before it came to America’s shores—and the inaction belied every lesson of prior domestic disasters, health or otherwise. Now, as the national response is finally turning from derision to decision, civilian leaders must set a strategy and move quickly to mitigate the virus’ impact. The Defense Department can play a meaningful role in supporting these civilian authorities. Secretary Esper’s actions this week suggest he grasps the importance of this mission. There is still time left on the clock for DoD to save lives and advance the “whole of nation” approach we desperately need.

Kathleen H. Hicks is senior vice president, Henry A. Kissinger Chair, and director of the International Security Program at the Center for Strategic and International Studies (CSIS) in Washington, D.C. Joseph Federici is an associate director and associate fellow with the CSIS International Security Program.

Commentary is produced by the Center for Strategic and International Studies (CSIS), a private, tax-exempt institution focusing on international public policy issues. Its research is nonpartisan and nonproprietary. CSIS does not take specific policy positions. Accordingly, all views, positions, and conclusions expressed in this publication should be understood to be solely those of the author(s).

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Kathleen H. Hicks

Joseph Federici