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200428-N-VN584-1202 SAN DIEGO (April 28, 2020) A Sailor salutes the national ensign as he disembarks the guided-missile destroyer USS Kidd (DDG 100) at Naval Base San Diego, Calif., April 28, 2020 as part of the Navy’s aggressive response to the COVID-19 outbreak on board the ship. While in San Diego, the Navy provided medical care for the crew and cleaned and disinfected the ship. (U.S. Navy photo by Mass Communication Specialist 2nd Class Alex Corona/Released)

Health Workers in Uniform: Lessons Learned

By Cmdr. Michael Kaplan, DO
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.

SOUTH CHINA SEA: The Arleigh Burke-class guided-missile destroyer USS Kidd (DDG 100) conducts a replenishment-at-sea with the dry cargo and ammunition ship USNS Carl Brashear (T-AKE 7). (U.S. Navy photo by Mass Communication Specialist 2nd Class Jacob Milham/Released)

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.

200406-N-HI500-2014 PACIFIC OCEAN (April 6, 2020) Gunner’s Mate Seaman Recruit Beverly Jordan, from Los Angeles, and Ship’s Serviceman 2nd Class Naomi Dunkley, from Saint Elizabeth, Jamaica, cut paracord to create straps for cloth masks aboard the Arleigh Burke-class guided-missile destroyer USS Kidd (DDG 100). (U.S. Navy photo by Mass Communication Specialist 3rd Class Brandie Nuzzi/Released)
200325-N-HI500-1001 PACIFIC OCEAN (March 25, 2020) Hospital Corpsman 2nd Class Rhiley Bauer, from Ketchikan, Alaska examines Logistic Specialist 2nd Class Didier Dorsainville, from Orange, N.J., during a medical training drill aboard the Arleigh Burke-class guided-missile destroyer USS Kidd (DDG 100), March 25, 2020. Kidd is conducting routine operations in the eastern Pacific Ocean. (U.S. Navy photo by Mass Communication Specialist 3rd Class Brandie Nuzzi/Released)

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 preventive medicine physician; the lab technician, Hospitalman Joseph Kim; two preventive 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.

190711-N-BD308-0024 JACKSONVILLE, Fla. (July 11, 2019) Lt. j.g. Alex Orlando, from Gainesville, Fla., a pilot assigned to Patrol Squadron (VP) 30, prepares to board a P8-A Poseidon aircraft at Naval Air Station Jacksonville. (U.S. Navy photo by Mass Communication Specialist 2nd Class Levingston Lewis/Released)

Test Everyone, Even if They Don’t Show Symptoms

200529-N-SB299-1085 SAN DIEGO (May 29, 2020) A Sailor assigned to the guided-missile destroyer USS Kidd (DDG 100) has his temperature checked as he returns to the ship as part of the Navy’s aggressive response to the COVID-19 outbreak. In order to be cleared to return to the ship, Sailors must have received two separate negative test results. Kidd arrived in San Diego April 28 to receive medical care for its Sailors and clean and disinfect the ship following a COVID-19 outbreak while underway. (U.S. Navy photo by Mass Communication Specialist 2nd Class Alex Millar/Released)

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 of 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.

200511-N-VN584-1076 SAN DIEGO (May 11, 2020) Gas Turbine Systems Technician (Mechanical) 1st Class Jonathan Young, assigned to the future USS Daniel Inouye (DDG 118), left, and Navy Career Counselor 1st Class Daryl Bragg, assigned to the future USS Frank E. Petersen Jr. (DDG 121), deliver food and drinks to Sailors assigned the guided-missile destroyer USS Kidd (DDG 100). Kidd arrived in San Diego April 28 as part of the Navy’s aggressive response to the COVID-19 outbreak aboard the ship at sea. (U.S. Navy photo by Mass Communication Specialist 2nd Class Alex Corona/Released)

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.

200428-N-VN584-1071 SAN DIEGO (April 28, 2020) Chief Hospital Corpsman Michael Wade, assigned to Commander, Naval Surface Force, U.S. Pacific Fleet Medical Readiness Division, organizes medical supplies while preparing for Sailors aboard the guided-missile destroyer USS Kidd (DDG 100) as part of the Navy’s aggressive response to the COVID-19 outbreak on board the ship. (U.S. Navy photo by Mass Communication Specialist 2nd Class Alex Corona/ Released)

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.

200420-N-LR905-1564 PACIFIC OCEAN (April 20, 2020) The amphibious assault ship USS Makin Island (LHD 8) conducts routine operations in the eastern Pacific. (U.S. Navy photo by Mass Communication Specialist 3rd Class Jacob D. Bergh/Released)

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.

200518-N-VN584-1060 SAN DIEGO (May 18, 2020) Chief Cryptologic Technician (Collection) Marisol Swenney, assigned to the future USS Daniel Inouye (DDG 118), center, and Senior Chief Fire Controlman Michael Miller of the future USS Carl M. Levin (DDG 120), confirm muster sheets during crew swap, the next phase of recovery for the guided-missile destroyer USS Kidd (DDG 100). The Navy re-tested the crew for COVID-19 and transferred nearly 90 confirmed healthy Sailors from quarantine to the ship to replace the caretaker crew that went aboard after the ship arrived in San Diego April 28. (U.S. Navy photo by Mass Communication Specialist 2nd Class Alex Corona/Released)

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 planningeven though we had extraordinarily little timeand just making sure we did everything we possibly could allowed it to work out.

200603-N-VY375-1101 NAVAL BASE GUAM (June 3, 2020) The aircraft carrier USS Theodore Roosevelt (CVN 71) flies a replica of Capt. Oliver Hazard Perry’s “Don’t Give Up the Ship” flag as it arrives at Apra Harbor, June 3, 2020. Following an extended visit to Guam in the midst of the COVID-19 global pandemic, Theodore Roosevelt completed carrier qualifications June 2 and is in Guam for resupply during a deployment to the Indo-Pacific. (U.S. Navy photo by Mass Communication Specialist 2nd Class Pyoung K. Yi/Released)

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.

200428-N-SB299-1397 SAN DIEGO (April 28, 2020) The guided-missile destroyer USS Kidd (DDG 100) arrives in San Diego April 28 as part of the Navy’s aggressive response to the COVID-19 outbreak on board the ship. (U.S. Navy photo by Mass Communication Specialist 2nd Class Alex Millar/ Released)

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.

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