Historical Services Division

US Army Heritage and Education Center 

THE UNITED STATES ARMY WAR COLLEGE 

Michael E. Lynch, PhD

Senior Historian

TELL ME HOW THIS ENDS: 

THE US ARMY IN THE PANDEMIC ERA

Jessica J. Sheets, PhD 

Research Historian 

Shane P. Reilly 

Contract Research Analyst

Conrad C . Crane, PhD 

Chief, Historical Services Division

Douglas I. Bell, PhD

Post-Doctoral Fellow

June 2020
i 

US Army Heritage and Education Center 

Historical Services Division

Prepared By: 

Conrad C. Crane, PhD Michael E. Lynch, PhD 

Chief, Historical Services Division Senior Historian 

Jessica J. Sheets, PhD Douglas I. Bell, PhD

Research Historian Postdoctoral Fellow

Shane P. Reilly 

Contract Research Analyst 

Tell Me How This Ends: The US Army in the Pandemic Era 

Michael E. Lynch, PhD*

“Everything we do before a pandemic will seem alarmist. Everything 

we do after a pandemic will seem inadequate. This is the dilemma 

we face, but it should not stop us from doing what we can to 

prepare.”

-Michael O. Leavitt, Secretary, US Department of Health and Human 

Services, 2005-2009i

 

Executive Summary 

After the 9/11 attacks, Americans yearned for a “return to normal.” The normal 

they longed for was the world as it was on September 10th, or status quo ante. That 

was impossible, however, because the events of that day irrevocably changed the 

world. The new normal, the status quo post, was the world as it was after 9/11. The 

same must be said for COVID-19. . .. We cannot return to the world before we 

understood the terms “social distance,” “herd immunity,” or “flatten the curve.” The 

Army was not prepared for the COVID-19 pandemic, but neither was the nation nor 

the world. Given the information now known about the virus and the expert 

predictions that a second wave might occur soon, the Army is better prepared to plan 

for potentially operating under pandemic conditions. Experts warn that a true second 

wave arriving in the fall or winter could be much worse than the first. If the 

 



 The author gratefully acknowledges the contributions and assistance of COL John Bonin, USAWC; 

COL David F. Boyd III, Chief, Department of Nursing, Evans Army Community Hospital , Fort Carson, 

CO; COL Robert Heath, Fort Drum, NY; COL Anthony King, Tripler Army Medical Center, HI; COL 

Randolph F. Morgan, DCO, FEMA Region IV, Atlanta GA; LTC George Barbee, Emergency Medicine 

Physician Assistant, Womack Army Medical Center , Fort Bragg, NC. 
ii

coronavirus behaves as the Spanish flu virus did in 1918-1919, then a third wave 

might be expected as well. 

With these events in mind, the Army may expect momentous changes in the 

coming years. Initially, the Army will be called upon for its vast resources, labor, and 

specific rapidly deployable capabilities, as has been demonstrated during the initial 

wave of the pandemic. The Army will also be viewed as an income generator by 

providing economic support to small contractors that will support both their local 

economies and the larger defense industry. But the pandemic's long-term effect on 

the world economy will be devastating and possibly catastrophic. The next 

administration will face the challenge of using military resources to support 

communities while reducing defense budgets. Though the defense budget is only a 

small part of the US budget, it forms a large part of the discretionary spending. The 

budget cuts, when they come, will fall, as always, disproportionately on the Army. 

Reducing the Army budget is, and always has been, quicker, easier, and less visibly 

economically damaging than cutting the budgets of the other services. This is 

because cuts to the other services’ budgets means cancelling large multiyear 

contracts that employ thousands of workers while reducing the Army budget 

inevitably means reducing manpower. This study examines the Army’s necessary 

steps over the next two years (see App. 1).
iii

Table of Contents 

Executive Summary...................................................................................................... i

The Black Swan: .......................................................................................................... 1

The Army and Pandemics: Historical View .................................................................. 2

1. Introduction:.................................................................................................. 2

Table 1- World Health Organization (WHO) Classifications ................................ 2

2. Lessons Learned: Influenza 1918 ................................................................... 2

Figure 1- 1918 Spanish Flu Mortality Rate.......................................................... 3

3. Lessons Learned: World War II....................................................................... 4

4. Lessons Learned: Ebola Outbreak (2014-2015) .............................................. 4

Looking Forward......................................................................................................... 6

1. Second Wave................................................................................................. 6

Figure 2—Possible Pandemic Wave Scenarios for COVID-19 ............................. 7

2. Third Wave .................................................................................................... 7

3. Herd immunity .............................................................................................. 7

4. Health Outlook.............................................................................................. 8

 Development:............................................................................................. 8

Doctrine & Readiness: ................................................................................................ 9

1. Short Term - 0-6 Months:.............................................................................. 9

 Mission Command: .................................................................................... 9

 Infection and Mortality Rate: .................................................................... 10

Table 2-- Table of COVID-19 Infection ............................................................. 10

 Reinfection and Recovery......................................................................... 10

2. Mid-Term - 6-12 Months:............................................................................ 11

 Natural Disasters ...................................................................................... 11

 Medical Support to Civilian Agencies (Borrowed Military Manpower): ..... 11

3. Long Term - 12-24 Months:......................................................................... 11

 Training Deployments: ............................................................................. 11

 COVID Testing for Readiness:................................................................... 11

Figure 3-- Organization Vignette ..................................................................... 12

Organization:............................................................................................................ 12

1. Short Term - 0-6 Months:............................................................................ 12

 ARNORTH as Joint Force Land Component Command (JFLCC): ............... 12

2. Mid-Term - 6-12 Months:............................................................................ 13

 Storm Season: .......................................................................................... 13

Table 3- Probabilities for At Least One Major (Category 3-4-5) Hurricane 

Landfall ............................................................................................................ 13
iv

3. Long Term - 12-24 Months:......................................................................... 13

 Possible restructuring for greater DSCA: .................................................. 13

Training & Education: ............................................................................................... 14

1. Short Term - 0-6 Months:............................................................................ 14

 Loss of Unit Cohesion:.............................................................................. 14

 Cadet Summer Training:........................................................................... 14

2. Mid-Term - 6-12 Months:............................................................................ 15

 Blended learning: ..................................................................................... 15

 Combat Training Centers (CTC): ............................................................... 15

 ACFT:........................................................................................................ 15

3. Long Term - 12-24 Months:......................................................................... 16

 Initial Entry Training:................................................................................. 16

Leadership: ............................................................................................................... 17

1. Short Term - 0-6 Months:............................................................................ 17

 Preparation .............................................................................................. 17

 Strategic communications: ....................................................................... 17

2. Mid-Term - 6-12 Months:............................................................................ 17

 Adaptation ............................................................................................... 17

 Leader Responsibility ............................................................................... 17

3. Long Term - 12-24 Months ......................................................................... 18

 Senior Leader Exposure............................................................................ 18

Figure 5- Material and Sustainment Vignette................................................... 19

Material and Sustainment......................................................................................... 19

1. Short Term - 0-6 Months:............................................................................ 19

 Masks and PPE ......................................................................................... 19

2. Mid-Term - 6-12 Months:............................................................................ 19

 Subsistence Stockpiling: ........................................................................... 19

3. Long Term - 12-24 Months:......................................................................... 20

 Just in Time Logistics:............................................................................... 20

 Destruction of food supply....................................................................... 20

 Defense mitigation actions....................................................................... 20

Personnel.................................................................................................................. 21

1. Short Term - 0-6 Months:............................................................................ 21

 Quarantine: .............................................................................................. 21

2. Mid-Term - 6-12 Months:............................................................................ 21

 Recruiting:................................................................................................ 21

 Army as Economic Engine ........................................................................ 21

3. Long Term - 12-24 Months:......................................................................... 21

 Effects on Mental Health: ......................................................................... 21
v 

Facilities.................................................................................................................... 22

1. Short Term - 0-6 Months:............................................................................ 22

 Screening and Testing.............................................................................. 22

2. Mid-Term - 6-12 Months:............................................................................ 22

 Tracking Teams ........................................................................................ 22

3. Long Term - 12-24 Months:......................................................................... 22

 PCS Moves ............................................................................................... 22

 Quarantine -- ........................................................................................... 22

Policy........................................................................................................................ 23

1. Short Term - 0-6 Months............................................................................. 23

 HPCON:.................................................................................................... 23

2. Mid-Term - 6-12 Months:............................................................................ 23

 BAS/Separate Rations:.............................................................................. 23

3. Long Term - 12-24 Months:......................................................................... 23

 Coronavirus Survivors:.............................................................................. 23

Modernization & Innovation .................................................................................... 24

1. Short Term - 0-6 Months............................................................................. 24

 Interruptions:............................................................................................ 24

 Sensors:.................................................................................................... 24

2. Mid-Term - 6-12 Months:............................................................................ 24

 Factory closures:....................................................................................... 24

 Expanded Remote Access Capacity: ......................................................... 25

3. Long Term - 12-24 Months:......................................................................... 25

 Personal Protective Equipment (PPE):....................................................... 25

 Routine and preventive medicine: ............................................................ 26

Figure 7- Increase in DoD Telework Capacity ................................................... 26

 Defense Industrial Base Resiliency: ........................................................... 27

Figure 8 - Funding Vignette ............................................................................. 28

Funding .................................................................................................................... 28

1. Short Term - 0-6 Months:............................................................................ 28

 Executing FY 20 budget............................................................................ 28

2. Mid-Term - 6-12 Months:............................................................................ 28

 Executing FY 21 budget:........................................................................... 28

 Regulatory relief: ...................................................................................... 28

3. Long Term - 12-24 Months:......................................................................... 28

 Economic changes:................................................................................... 28

 Budget bubbles and POM problems: ....................................................... 29

Defense Support to Civil Authorities (DSCA):............................................................ 30
vi 

1. Short Term - 0-6 Months:............................................................................ 30

 Continuing support to FEMA and DSCA: .................................................. 30

2. Mid-Term - 6-12 Months:............................................................................ 30

 Continuing support to FEMA and DSCA: .................................................. 30

3. Long Term - 12-24 Months:......................................................................... 31

 Continuing support to FEMA and DSCA: .................................................. 31

Medical :.......................................................................................................... 33

1. Short Term - 0-6 Months:............................................................................ 33

 Identify medical treatment rules of engagement:..................................... 33

2. Mid-Term - 6-12 Months:............................................................................ 33

 Casualties among medical personnel ....................................................... 33

 Limited resources ..................................................................................... 33

 Strategic Medical Assets:.......................................................................... 34

3. Long Term - 12-24 Months:......................................................................... 35

 Pre-positioning ........................................................................................ 35

 MTOE Assigned Personnel (MAP):............................................................ 35

 Split based, Mass Casualty (MASCAL) Operations .................................... 35

 Conversion to DHA .................................................................................. 36

 Army Medical Command MTOE (Modified Table of Organization and 

Equipment) Changes ........................................................................................ 36

 Medical Stockpiling.................................................................................. 37

 Blood products......................................................................................... 37

Conclusion................................................................................................................ 38

Appendix 1 – 2-year Pandemic Planning Cycle ......................................................... 39

Appendix 2 - Testing Requirements.......................................................................... 40

1. Diagnostic Testing Challenges: .................................................................... 40

 Specificity................................................................................................. 40

 Sensitivity ................................................................................................. 40

 Positive Predictive Value (PPV) ................................................................. 40

 Negative Predictive Value (NPV) .............................................................. 40

2. Antibody testing challenges: ....................................................................... 40

Bibliography ............................................................................................................. 41

Notes........................................................................................................................ 51
1 

The Black Swan: Nassim Nicholas Taleb, a former Wall Street trader and now risk 

manager, coined the term “Black Swan,” based on a historical event. When the first 

European explorers landed in Australia, they encountered black swans for the first 

time. Nothing in their experience had prepared them for a black swan, because all 

swans known at the time were white. Taleb defines a Black Swan as a surprise 

event that could not have been predicted and gives it three properties: 

 Low probability based on past knowledge. 

 When it does happen, it has a massive effect. 

 People do not see it coming before the fact, but after the fact, everybody saw 

it coming. It is prospectively unpredictable but retrospectively predictable.2

Some people might view the pandemic as a Black Swan event. While recent 

epidemics have given indications of a possible pandemic on the horizon, most 

people outside the medical community failed to take notice. Previous outbreaks of 

SARS and MERS did not widely affect the United States, and most Americans

believed that this sort of thing could not happen here. Severe Acute Respiratory 

syndrome (SARS) and Middle East Respiratory Syndrome (MERS) are both viral 

respiratory illnesses caused by coronaviruses. The World Health Organization 

(WHO) reported that SARS-CoV affected 8,098 people worldwide during the 2003 

outbreak, with 774 deaths. Only eight people in the United States were affected, all 

of whom had travelled abroad in SARS-affected areas. MERS-CoV first appeared in 

Saudi Arabia in 2012 and spread to several other countries including the United 

States, but few were affected here.3 

The current pandemic has certainly had a tremendous impact on the nation 

and the armed forces. The medical, scientific, and emergency management 

communities now say that it could have been predicted, and in fact, some of them 

had predicted it. Naseem Taleb himself argues that the COVID-19 pandemic is not a 

black swan event because he predicted a pandemic in 2008 in his book, The Black 

Swan: The Impact of the Highly Improbable. While that may well be true, for most 

non-specialists, the pandemic certainly was a Black Swan event. 

In 1991, Army Chief of Staff Gen. Gordon R. Sullivan coined the phrase “No 

More Task Force Smiths” to be used as a metaphor and rallying cry to improve and 

sustain Army readiness. The Army's new rallying cry could well be, “No More Black 

Swans,” a rallying cry akin to “Remember Pearl Harbor” from a previous generation. 

Now that the world is attuned to the reality of the pandemic and adapting to a new 

normal, preparation for the next event should be easier, but the next potential event 

could be right around the corner: Successive waves that cause continued illness and 

death for up to two more years; a mutation of the virus which causes another 

pandemic (COVID-19 is in fact a mutation of the SARS CoV2 virus); natural disaster; 

economic collapse; and war. 
2 

The Army and Pandemics: Historical View 

1. Introduction: 

The words “epidemic” and “pandemic” are often used interchangeably, but 

they have specific definitions and the distinctions between them are important. The 

responsibility for classifying a disease as an epidemic or pandemic belongs with the 

WHO (see Table 1). COVID-19, caused by the novel coronavirus, first appeared in 

China in November 2019 and was officially designated a pandemic by the WHO in 

March 2020. Rampant disease has been a part of military life throughout history. The 

cramped quarters of garrison encampments, overseas troop transports, and 

warships were often breeding grounds for disease, especially in the era before 

bacteria and viruses were understood. The US Army's recent experience with 

epidemics and pandemics begins with the Spanish Flu pandemic of 1918-1919 and 

includes operations as recently as the 2014-2015 Ebola epidemic in West Africa.4

 

Endemic Disease found in or restricted to a certain area or population. Endemic 

diseases are often the source of an epidemic’s “patient zero.”

Epidemic Regional or communal outbreak among a particular population.

Pandemic An epidemic that affects multiple populations. For influenza, this 

involves the appearance of a new virus subtypes that are easily 

spread (e.g. through respiratory droplets) human-human 

transmission.

Table 1- World Health Organization (WHO) Classifications5

2. Lessons Learned: Influenza 1918

The United States’ entry into World War I in 1917 saw the largest mobilization 

in US Army history to that time, raising some four million men by the end of the war. 

The American Expeditionary Forces quickly assembled in military posts, camps, 

arsenals, airfields, and supply depots all over the country. This rapid, explosive 

growth produced an Army for war on a scale previously unknown in American 

history, but it also created an environment ripe for the incubation and fast spread of 

disease, especially the constant movement of troops to different camps, ports, and 

finally overseas.6

The Army used a variety of measures in overcrowded training camps to 

prevent the spread of influenza: quarantining camps, preventing overcrowding 

through tent hospitals, providing 100 square feet of floor space for all flu cases, 

stopping large assemblies of Soldiers, keeping patients warm, providing them with 

fresh air, feeding them, and trying to prevent pneumonia. Experimental vaccines 

were used, but virus identification was in its infancy. In Europe, the flu pandemic 

struck the Army hard during the Meuse-Argonne Offensive, depleting the force by an 

estimated 20 percent to 30 percent. Besides undermining unit strength during this 

offensive, sick men in the trenches overwhelmed field hospitals attempting to 

manage battle wounds and those suffering the flu and pneumonia. Evacuations from 
3 

frontline hospitals overwhelmingly consisted of flu patients compared to the battle 

wounded. 7 

In the United States, the 1918-1919 Influenza Pandemic arrived in three 

waves over the course of one year. The second wave was much worse than the first, 

with five times the number of deaths than the first wave. The Spanish Flu also 

included a third wave that produced more than twice the number of deaths than the 

first wave. The worldwide mortality rate for the first wave was just over 5 persons per 

1,000, jumping to 25 deaths per 1,000 during the second wave, and the third wave at 

roughly 12.5 deaths per 1,000 (see Fig. 1).8

 

A study of the 1918 pandemic published in the Proceedings of the National 

Academy of Sciences concluded that the earlier pandemic was primarily stopped by 

non-pharmaceutical intervention, which in layman's terms includes social distancing, 

isolation, and quarantine: 

Non-pharmaceutical interventions (NPIs) intended to reduce infectious 

contacts between persons form an integral part of plans to mitigate the impact 

of the next influenza pandemic.... These findings support the hypothesis that 

rapid implementation of multiple NPIs can significantly reduce influenza 

transmission, but that viral spread will be renewed upon relaxation of such 

measures.9

Figure 1- 1918 Spanish Flu Mortality Rate10

The death toll in the United States reached 675,000, and the Army suffered as 

well. The War Department estimated that influenza sickened more than one million 

men, some 26 percent of the Army. The flu killed 55,322 Soldiers, nearly 30,000 of 

whom died before they even got to France. The mortality ratio of deaths from combat 

to those of disease was 1:1.1. In plain terms, for every 10 Soldiers killed in combat, 

11 died of disease. 11 
4 

3. Lessons Learned: World War II

During the interwar years, immunization and scientifically directed sanitation 

reduced the rates of many communicable diseases, but influenza, pneumonia, and 

the complications of these infections remained dangerous threats to the Army. 

Influenza remained a problem, especially in years when it spiked, five times between 

1922 and 1937, but none of these reached pandemic proportions. In 1941, the Army 

organized a commission to develop a flu vaccine as part of broader effort to find 

vaccinations for measles, mumps, meningitis, neurotropic diseases, and others. 

Much of the groundwork for vaccines developed between the wars resulted from the 

advent of powerful microscopes and other scientific developments. The Armed 

Forces Epidemiological Board isolated and grew flu virus in order to develop a 

vaccination and received approval from the FDA in 1943.12

In preparing for mobilization during WWII, the Army implemented policies to 

prevent the widespread transmission of influenza. In ports of embarkation, a 

minimum of 60 square feet per soldier was recommended to avoid overcrowding and 

illness, though an average of 12 percent of Soldiers still contracted respiratory 

disease while enroute to theater. The Medical Corps stressed the need to increase 

the floor space per man in barracks and reduce the number of troops per car train. In 

fact, troop movements during flu season where kept to a minimum. In high-priority 

units, commanders advocated medical inspection of troops and the hospitalization of 

patients with emerging diseases.13

In its post WWII study on respiratory and alimentary tracts, the Army Medical 

Department did not cite new efforts in vaccination as preventing another pandemic, 

but rather focused on biology: 

Circumstances were such that influenza comparable in severity to that of 

1918 would be insusceptible to control. No other conclusion seems possible 

but that the biology of the infectious agents was the decisive factor in avoiding 

such an event. The disease and its prevention contributed greatly to a better 

understanding of its epidemiology and were responsible in a significant 

fashion for heightened efforts to identify and control respiratory diseases of all 

types. There was, as always, a somewhat fatalistic attitude towards 

prevention or control measures, but it many situations a true effort was made 

to gain what benefit could be had by early intuition of measures to limit 

crowding, to control transport of infected men, and at times to use 

sulfonamides prophylactically in the hope of reducing complications.14

4. Lessons Learned: Ebola Outbreak (2014-2015)

 DoD had teams and agencies in place to monitor infectious diseases, 

biological and chemical weapons, but did not anticipate the size of the 

military response needed to stem the Ebola epidemic. DoD biosurveillance and modelling efforts were inadequate to rapidly identify, 

monitor and predict outbreak trends. For example, Defense Threat 

Reduction Agency (DTRA) analysts did not fully understand the complex 

dynamics of West African cultural practices such as burial rituals and 

social migration.15
5 

 The US government worked with non-governmental organizations (NGOs), 

foreign nations, and other stakeholders to clearly define roles, but DoD 

needs to advocate for a national level framework so that it can establish 

priorities and expected levels of performance. DoD should also support 

efforts to continue public health and bio-surveillance capacities and 

increase planning for specific types of disease to prepare for actual 

crisis.16

 The US Army formed a large part of large interagency response to 

manage the epidemic, but the interagency process lacked defined roles 

and hindered initial efforts.17

 The Army had little proficiency with or knowledge of Personal Protective 

Equipment (PPE) and lacked general knowledge regarding infectious 

disease response capabilities. USNORTHCOM supervised medical 

support teams (MSTs) but lacked preparation time and training and 

needed to review equipment and its uses. Although MSTs went to Africa, 

they did not have any interaction with patients which would have been 

useful in the face of future outbreaks around the world or CONUS.18 
6 

“It’s inevitable that the coronavirus will return next season. . . . When 

it does, how we handle it, will determine our fate.” 

-Dr. Anthony Fauci

April 29, 202019

Looking Forward 

1. Second Wave: Many experts, including the WHO and the Centers for Disease 

Control (CDC) predict that there will be a second wave of the coronavirus that 

will arrive around the same time as the seasonal flu virus in the fall and winter 

of 2020-21. Before that, the Army may anticipate a small wave of infections as 

travel restrictions and social distancing regulations are relaxed, and testing 

becomes more prevalent. This “wave 1.5” is already prevalent in China as 

Chinese abroad return home.20 If the second wave is as deadly as the second 

wave in 1918-1919, extrapolating the number of potential deaths based on the 

current number (62,000 as of May 1, 2020), a second wave of COVID-19 

could produce more than 300,000 deaths. Experts differ, however, on the 

potential severity of the second wave, though most agree that it will coincide 

with the arrival of seasonal flu in the fall. The Center for Infectious Disease 

Research and Policy (CIDRAP) at the University of Minnesota presents three 

possible scenarios for how the pandemic may play out over the next two 

years (See Fig. 2):

 Scenario 1 (Peaks and Valleys): The first wave is followed by a series 

of repetitive smaller waves over the next two years. Depending on the 

height of the waves, this scenario might require periodic tightening and

easing of mitigation measures for the next two years. They may also 

vary geographically. 

 Scenario 2 (Fall Peak): The first wave is followed by a larger wave in 

the fall or winter of 2020 with smaller subsequent waves in 2021. This 

resembles the same pattern as the Spanish Flu of 1918-1919 and

requires reinstitution of mitigation measures for reducing the spread of 

infection and preventing healthcare systems from being overwhelmed. 

 Scenario 3 (Slow Burn): The first wave is followed by a “slow burn” of 

ongoing transmission and case occurrence, but without a clear wave 

pattern. This pattern may vary geographically. This pattern was not 

observed in past influenza pandemics but remains a possibility for 

COVID-19. This third scenario likely would not require the reinstitution 

of mitigation measures, although cases and deaths will continue to 

occur.
7 

Figure 2—Possible Pandemic Wave Scenarios for COVID-1921

2. Third Wave: The 1918-1919 pandemic also included a third wave arriving 

some two months after the second wave. The third wave was less lethal than 

the second wave, but still killed twice as many as the first. The second wave 

is predicted to arrive in November 2020 and run through February 2021, 

which coincides with seasonal flu season. The second wave, in whatever form 

it comes, could also potentially disrupt the 2020 US general election, as the 

first wave disrupted many state primaries. If the coronavirus has a third wave 

that arrives on the same schedule as the 1918 pandemic, it will arrive in the 

spring of 2021. The first possible vaccine might be available around the same 

time. 

3. Herd immunity: Herd immunity represents the degree to which the community 

is susceptible or not to an infectious disease because of the population having 

acquired active immunity from either previous infection or immunization.

Determining herd immunity based on the observed transmissibility of SARSCoV-2, 60 percent to 70 percent of the population may need to be immune to 

COVID-19 to reach herd immunity to halt the pandemic. In lieu of a 

vaccination, which is not expected for 18 months to two years, the Army will 

likely build herd immunity through the infection of Soldiers. The danger for the 

military, however, is not in Soldiers getting the virus, it is the speed with which 

it spreads and the debilitating effect it will have on units. Isolating infected 

Soldiers is easy during garrison-based operations, but that will not be the 

case in deployed environments. While most Soldiers are probably healthy 

enough to survive such exposures, it will be much more dangerous for those 
8 

Soldiers with family members who are immuno-compromised or others who 

have undiagnosed conditions. 22

4. Health Outlook: There are certainly differences between the Army of 1918 and 

the Army of today. The soldier who joined the Army in 2018 was in much 

better shape, medically and physically, than his great-grandfather who was 

drafted in 1918. The Soldiers going to France in 1918 had been medically 

screened and some were eliminated, but those who did go were not 

necessarily in peak medical or physical condition. The Soldiers in World War I 

also experienced gas attacks and exposure to foreign climates that made 

them susceptible to lung damage. Many were physically strong due to the

manual labor that characterized most professions at the time. But today's 

recruits, even the obese ones, have the benefit of a century of better nutrition 

and nutrition education, cleaner air and water, medical interventions, 

vaccines, prophylaxis, optimized treatment regimens, and they have a 

generally healthier lifestyle. This, however, does not mean that modern 

Soldiers are out of danger. The Army’s tobacco cessation campaign of the 

1980s has been largely successful, though the Army still has smokers. In 

addition to tobacco use, there are other methods endemic to military service 

that could degrade lung function, such as vehicle and weapon exhaust fumes, 

dust, smog, allergies, and the generally lower quality of air in places where 

Soldiers are expected to work.

5. Vaccines: 

 Development: The best estimates say that a vaccine is at least a year 

away, and longer than that to make adequate stocks available. The 

development and production of those vaccines are consuming much of the 

pharmaceutical industry and has made for some unprecedented situations. 

Two of the largest drug manufacturers in the world, Sanofi and GSK, have 

formed an unusual partnership to develop vaccines for COVID-19. Each 

company contributes its own specialty: Sanofi contributes a protein-based 

antigen, which elicits a protective immune response against the pathogen. 

GSK contributes a proven adjuvant, which is an ingredient used to create 

a stronger immune response in people receiving the vaccine.23

 Testing: U.S. Army Medical Research and Development Command 

(USAMRDC) is now partnering with civilian companies to assist with 

necessary diagnostic testing. The command had previously done such 

testing on a cost reimbursable business model, but the Army is now 

moving to fund this organization so that it may continue to conduct this 

testing irrespective of clients.24

Once the vaccine is developed, full-scale production and distribution will also 

take time. 

This case study also examines how the current pandemic will fundamentally 

change the Army in the long-term, look across the planning factors of Doctrine, 

Organization, Training, Materiel, Leadership, Personnel, Facilities, and Policy that 

are familiar to Army leaders, as well as funding, Defense Support to Civil Authorities, 

modernization and innovation, and medical issues (see also App. 1). 
9 

“We have to figure out how to use [COVID-19] testing to validate the 

readiness of our forces to deploy. Testing is going to become a 

critical part of that.” 

- Gen. John Hyten, VCJS25

Doctrine & Readiness: The Army’s emerging Multi-Domain Operations (MDO) 

doctrine needs to be updated. A pandemic is not a condition or domain under which 

the Army expected to operate, but it will be for at least two years and maybe longer. 

The specific conditions of the pandemic occupy a great deal of attention now, but the 

Army needs to pay more attention to the general conditions which produced the 

current emergency. The world has endured three pandemics in the last century since 

the Spanish flu: the Asian flu (H2N2), 1957-1958; Hong Kong flu (H3N2) 1968-1970; 

and swine flu (H1N1) 2009 to 2010. These three pandemics caused 2.1 million 

deaths worldwide. In addition to these pandemics, the WHO has designated 

epidemics for SARS, MERS, HIV/AIDS, and the Zika virus. With the Army's growing 

interest in Africa and renewed interest in Asia, exposure to these diseases will 

become much more than merely a living condition. Some media outlets speculate 

that the current pandemic was either deliberately caused, or deliberately hidden, to

weaken the United States. Regardless of the validity of these claims, biological 

warfare, or the threat of it is a real possibility. The MDO concept relies primarily on 

technology, and some may argue that the pandemic is an environment rather than a 

domain, but the effect of the pandemic has achieved one of the key goals of MDO: 

dis-integration.26

1. Short Term - 0-6 Months: 

 Mission Command: In the early days of the outbreak, the Department of 

Defense and the Army appeared to give confusing guidance about how to 

protect Soldiers, resulting in reports that Army leadership was not taking 

the threat seriously. The global presence and very nature of the US 

military’s mission precluded issuing one standard guidance for all units 

worldwide, so the Secretary of Defense allowed local commanders to 

make prevention and containment decisions. While this is the essence of 

mission command, some units’ execution proved that stricter top-down 

guidance was necessary. There were several instances of commanders 

complying with the guidance and then immediately violating it with such 

things as keeping barbershops open. DoD & HQDA will need to provide 

specific guidance early, stating what commanders should and should not 

do.27
10

 Infection and Mortality Rate: Soldiers are generally younger and healthier 

than the rest of the general population. Initial reports indicated that the 

illness affected primarily the very young and the very old, but that was a 

misconception: some people conflated infection rate with mortality rate. 

Recent statistics show that 34.5 percent of those affected are in age 

groups 18 to 44, the primary age cohort of most of the Army. The age 

cohort for senior officers and NCOs, 45 to 64, also contains more than 34 

percent of the affected population. The average mortality rate of 

coronavirus is 3.2 percent, considerably higher than the 0.01 percent of 

the seasonal flu. This has caused a great deal of the reasonable concern 

in the country. However, an examination of the mortality rates for people in 

the age groups that include most of our soldier population show something 

quite different (see Table 2). 

Age Group Affected 

Percentage Age Group Mortality

18-44 34.5 percent

15-24 0.1 percent

25-44 2.6 percent

45-64 34 percent

45-54 5.1 percent

55-64 12.5 percent

65-74 10.6 percent 65-75 21.4 percent

75+ 12 percent

75-84 27.3 percent

85+ 30.7 percent

Table 2-- Table of COVID-19 Infection28

 Reinfection and Recovery: The Army may expect degraded readiness as 

the virus spreads across units throughout the force. As social distancing 

rules are relaxed, and the Army begins its normal summer PCS 

(Permanent Change of Station) cycle, we may expect to see larger 

numbers of Soldiers infected. At the beginning of the outbreak in winter 

2020, the effect on the Army was uneven. Initially, for instance, Soldiers at 

Joint Base Lewis-McChord faced greater potential infection rates because 

of the outbreak in Seattle then did Soldiers at Fort Hood, Texas. Given a 

normal PCS season during the summer, the Army may expect those rates 

to go up rapidly. There is as of yet no proven immunity to the coronavirus, 

even for those who have had it once, so the danger of reinfection is 

possible as Soldiers began to move around. Moreover, current data 

indicate that some cases require a recovery period longer than expected. 

Some patients may relapse, and others may suffer permanent lung 

damage. These will present ongoing threats to personnel readiness for the 

foreseeable future.

29
11

2. Mid-Term - 6-12 Months:

 Natural Disasters: The Army has often been called upon as a resource for 

seemingly inexhaustible labor. The current emergency, though seemingly 

unprecedented, also comes at a time where the military is not stretched 

too far. The current outbreak occurred in the spring and so far, the other 

natural disasters have been limited. The summer, however, heralds the 

arrival of wildfire season in the western states, which often requires use of 

both Regular Army and National Guard units. The arrival of fall marks the 

beginning of tornado season in the South and Midwest and may signal a 

new outbreak. Hurricane season from June through November might also 

affect operations. 

 Medical Support to Civilian Agencies (Borrowed Military Manpower): 

National Guard (ARNG) units all over the United States cleaned and 

disinfected nursing homes and assisted at food banks. Although similar to 

their Title 32 missions during natural disasters, these highlight other ways 

in which ARNG units may be overtasked in future waves. These 

operations were possible only because the National Guard units of those 

states were not deployed in overseas rotations or responding to natural 

disasters. A second or third wave arriving during the winter may stretch 

some state National Guard units beyond the limits of their capabilities.

30

 

3. Long Term - 12-24 Months:

 Training Deployments: The partial cancellation of recent exercises, such 

as DEFENDER 20 and Pacific Pathways, caused short-term logistical 

problems, such as unanticipated transportation requirements and the 

necessity of quarantining returning Soldiers. The long-term effects will be 

much greater because the cyclic and global nature of this pandemic is 

likely to prevent any large-scale exercises for at least two to three years. 

These training deployment plans will not only be potentially inhibited by the 

second and third waves of the virus, but also by the impending budget 

crunch that is sure to follow. This pandemic has also affected the United 

States’ partners and allies, and they will have even more difficulty joining 

in such exercises because of even smaller forces and smaller budgets. 

The Army will likely be unable to schedule such exercises until the 

pandemic has completely dissipated and then planning for future largescale operations such as these would require another year.31

 COVID Testing for Readiness: Widespread testing is not yet available in 

the military, but when it is, testing will become a critical component of 

readiness. Commanders must be able to identify Soldiers requiring either 

isolation or quarantine and have a means of assessing readiness based 

on the COVID infection rate. The testing procedure must include not just 

diagnostic testing to determine illness, but also antibody testing to 

determine potential immunity (see App. 2). 
12

Figure 3-- Organization Vignette32

Organization: 

The Army will need to review its force structure in the coming years to 

determine whether it is appropriate, particularly regarding medical units. The 

establishment of Urban Augmentation Medical Task Forces (UAMTF) (see figure 3) 

were a stopgap, Title 10 measure to assist local hospitals, but whether these types 

of units should be offered on a larger scale and for a longer time remains in question. 

The National Guard in several states also provided decontamination teams to clean 

nursing homes. This was another valuable service that the Army might not be able to 

duplicate on a large scale. The brigade level focus of the last 20 years has created 

brigade combat teams (BCT) of unprecedented power and complexity. Manpower 

allocations for the BCTs were created at the expense of support echelons above 

brigade (EAB) and echelons above division (EAD) units that are critical to the 

sustainment of the force. The current emphasis on large-scale combat operations 

includes a return to some of the force structures familiar during the Cold War Army, 

such as the division artillery (DIVARTY). The pandemic has shown that there is an 

enduring need for those medical and sustainment units that have been cut out of the 

force structure. 

1. Short Term - 0-6 Months: 

 ARNORTH as Joint Force Land Component Command (JFLCC): 

ARNORTH, activated as a JFLCC for the first time in its history, controls 

seven regional and functional task forces designed to support the FEMA 

regions. JFLCC COVID Response had approximately 8,200 personnel 

directly supporting COVID operations. The JFLCC had supported 128 

FEMA mission assignments, including four Disaster Mortuary Response 

Teams in New York City, as well as 3,100 medical professionals providing 

support at 23 civilian hospitals and seven Alternate Care Facilities in 11 

cities across the country. Some of these facilities, such as the Javits 

Center in New York City, are now being inactivated as the peak infection 

seems to have passed and resources are being dedicated elsewhere.33

The Army Reserve (USAR) created 85 Soldier Urban Augmentation Medical Task 

Forces (UAMTF) to provide medical assistance in regions (New York City, 

Connecticut, New Jersey, and Washington state) heavily affected by COVID-19. 

UAMTFs include medical experts, provide low acuity care, and can staff a 250-bed 

field medical station (FMS). These task forces do not include medical equipment, 

medication, or ICU capabilities.
13

2. Mid-Term - 6-12 Months: 

 Storm Season: With the approach of hurricane season and the potential 

for a second wave, the JFLCC is likely to remain active throughout the 

mid-term and into the long term. The mix of units allocated to the JFLCC is 

likely to change based on conditions, and if a considerable number of 

natural disasters (hurricanes, floods, tornadoes) occur simultaneously with 

the second wave of COVID, the JFLCC could become a significant force 

requirement. The National Oceanic and Atmospheric Administration 

(NOAA) reported that the month of April 2020 saw the deadliest outbreak 

of tornadoes in six years. NOAA recorded 140 tornadoes in the month of 

April, with more than half of them between April 12 and13. The 

Department of Atmospheric Science at Colorado State University predicts 

it will be above normal. Scientists there predict sixteen named storms, of 

which eight will reach hurricane strength, and four of which will be major 

hurricanes. The probability of those hurricanes making landfall is also high 

(see Table 2). This institution has been predicting hurricane seasons for 

the last 38 years, and for the last five years (2015-2019), its estimates 

were lower than the actual observed number of hurricanes. 34

Location Probability 

2020

Average Last 

Century

Entire continental US coastline 69 percent 52 percent

US East Coast including 

Peninsula Florida 

45 percent 31 percent

Gulf Coast from Florida to 

Texas

44 percent 30 percent

Caribbean 58 percent 42 percent

Table 3- Probabilities for At Least One Major (Category 3-4-5) Hurricane Landfall35

3. Long Term - 12-24 Months:

 Possible restructuring for greater DSCA: Global disease outbreaks continue to 

increase, and some are associated with natural or man-made disasters such 

as outbreaks of E. coli due to flooding and the spread of communicable 

diseases through overcrowding. The Army is reacting effectively to the current 

COVID-19 outbreak, but these experiences may require senior Army leaders 

to review the structure and organization of the total Army, ensuring that it 

contains the right capabilities for a variety of missions, and that sustainment 

capabilities do not become sub-optimized in the BCT-centric force.36
14

 

Figure 4- Training Vignette37

Training & Education: The way the Army trains and educates its Soldiers is 

changing and will evolve even further over the coming years. Social distancing 

requires individuals and units to use alternate communications platforms, and many 

have discovered the efficiency of these platforms. This coincides with a concurrent 

effort to explore different means of experiential education. In recent years, the 

military has been examining methods used in civilian colleges and universities. 

These technologies are acceptable for classroom-based education, but much of the 

Army's training must be done in the field or deployed environments. The biggest 

challenge to Army training will be continuing to do it properly while doing it safely to 

prevent contamination. 

1. Short Term - 0-6 Months:

 Loss of Unit Cohesion: The quarantine is affecting unit cohesion due to 

lost training time. Units should maximize electronic and whatever other 

means required to maintain morale and esprit de corps. Collective training 

activities are necessary but must be conducted safely and in a manner 

that demonstrates to Soldiers that leaders are considering their health and 

welfare. 

 Cadet Summer Training: Cadet Summer Training 2020 implemented 

training modifications, which will create second and third order effects. 

Arrangements have been made to conduct some instruction for some 

cadets during the fall and spring, but with the coming second wave, this

may not be possible. Assuming that such training can be conducted, it will 

affect the training and readiness of the units on the installations that are 

tasked to support it. When ROTC Advanced Camp was conducted at Fort 

Lewis, Fort Riley, and Fort Bragg, garrison units were disrupted for a four 

to six-week period in the summer. Under the proposed arrangement, 

cadets from designated college and university programs would move to 

military installations for four-day weekends of training. This will pose 

logistical problems not only for the host units, but also for the ROTC 

Soldiers from D Troop, 6th Squadron, 9th Cavalry, third ABCT based at Fort 

Hood are using the War Thunder massive, multiplayer online (MMO) game to 

practice both armor doctrine and teamwork. The troop uses the MMO 

technology during the quarantine to fill a temporary capability gap as the unit 

transitions between tanks. The unit turned in its older series M-1 Abrams main 

battle tanks and is awaiting delivery of newer M1A2s. In War Thunder each 

Soldier from a tank crew operates his own tank and each crew and forms a 

platoon. Since every soldier is a tank commander in the game, the younger 

Soldiers get new insights on what their leaders do, as well as gain additional 

training they will need as they grow inexperience. 
15

battalions and the students themselves. Cadet Basic Training and Cadet 

Field Training at the US Military Academy (USMA) will also likely be 

affected, because of the substantial number of troops are assigned to 

support it. Although upperclassmen conduct most of the training, Soldiers 

are required for specialized training. If the US experiences a very severe 

second wave or a third wave, these difficulties with summer training will be 

repeated in 2021.38

 

2. Mid-Term - 6-12 Months:

 Blended learning: The quarantine has forced units to use alternate 

methods of training, and units are becoming more proficient at using virtual 

capabilities to practice communications and other warfighting skills. As 

units become more comfortable with these training techniques, they will 

likely remain in place even after all restrictions are lifted. Though nothing 

replaces the individual attention of the sergeant to the Soldier, some units 

have discovered that some training can be taught using distributed 

techniques and modern platforms with no loss of effectiveness. For 

example, a unit at Fort Hood completed a rotation to Korea and then 

turned in their M1s and are awaiting new equipment issue of M1A2s. The 

unit has since gone into quarantine and is using the massive multi role 

online (MMO) game War Thunder as a training tool (see Fig. 4). This sort 

of commercial application can build on previous success of such devices 

as the Close Combat Tactical Trainer (CCTT), and Integrated Visual 

Augmentation System (IVAS).39

 

 Combat Training Centers (CTC): Cancelling rotations to the CTCs is one 

of the immediate and most visible effects on training. The 81st Stryker 

Brigade’s (SBCT) rotation to the National Training Center at Fort Irwin was 

cancelled because the SBCT was recalled to Washington state on the 

governor’s orders. In the near term, units will likely not be able to resume 

Combat Training Center (CTC) rotations immediately, due to lost training 

time resulting from coronavirus mitigation protocols. Assuming units begin 

a recovery process in early June, the Army may expect a 90-day recovery 

period to ensure that a unit is capable of completing a CTC rotation. The 

CTC rotation schedule might need to be adjusted based on which 

previously scheduled units are affected, although how severely is yet to be 

determined.40 

 ACFT: The postponement of the Army Combat Fitness Test (ACFT) for 

this training year requires an additional training period so that Soldiers will

be ready for next year. The closure of gyms and other activities prevented 

Soldiers from training for specific activities for the ACFT, resulting in an 

expected loss of fitness. Training for the ACFT is more complex and 

extensive than the previous Army Physical Fitness Test (APFT). Logistics 

requirements for conducting training and testing are also more significant, 

so the full implementation of the ACFT might need to be delayed for as 

much as two years. The Army's decision on that is due in June 2020.41
16

3. Long Term - 12-24 Months:

 Initial Entry Training: The Army recently instituted a two-week pause on 

sending recruits to basic training to work out details for curriculum 

modification and conducting health screenings. After resuming training 

with new procedures in place, the Army will likely need to continue these 

processes in the near future. The Army developed new closed movement 

procedures, using both buses and military air, to safely move Soldiers from 

basic training to Advanced Individual Training (AIT), and then from AIT to 

first duty stations. These procedures are also likely to be necessary for the 

foreseeable future.42 
17

“We can’t telework to combat.” 

-Gen. James McConville43

Leadership: The sudden, worldwide spread of COVID-19 challenged all instruments 

of national power. It has also made things easier, in a sense, for Army leaders. The 

far-reaching quarantine requirements have already sketched a worst-case scenario 

in terms of the scope and scale of individual and unit isolation measures. The 

pandemic could potentially grow worse in terms of infected numbers and lethality, 

which could have a devastating effect on units, including widespread illness and 

death. Army leadership, in the coming months, must be prepared to make timely and 

accurate decisions. The virus cannot be killed by adding an appropriate level of 

“HOOAH,” so leaders must demonstrate the flexibility required to adapt to a 

continually changing environment. 

1. Short Term - 0-6 Months:

 Preparation: Leaders should assume the worst by planning and preparing 

for additional quarantine periods during the second wave. If a unit is 

scheduled for a major training exercise, CTC rotation, or deployment, it 

should incorporate all the prophylactic measures currently being used to 

combat COVID-19. 

 Strategic communications:In addition to communicating the mission, senior 

leaders must communicate both the risks to the mission and the risk to the 

force presented by such threat as another viral outbreak. Readiness 

assessments, though classified, should be realistic in terms of current 

status and potential recovery. Strategic messaging must portray a position 

of strength to potential enemies, while not understating the seriousness of 

the situation. 

2. Mid-Term - 6-12 Months:

 Adaptation: With the assumption of a second wave arriving in 

approximately six months, there is time for leaders to advocate to adapt 

both training and operational systems to the environment, using innovative 

techniques that have either been developed or discovered during the 

current emergency. 

 Leader Responsibility: Commanders should be aware of what local civilian 

leaders are doing about quarantine, but they remain responsible for the 

health and well-being of their Soldiers. Based on the experiences of the 

first wave, DoD is not likely to issue blanket guidance in subsequent 

waves for all commands around the world. Because of the geographical 

variances in the first wave, military commanders will need to follow the 

guidance of local civilian authorities. A leader should not order a less 

restrictive Health Protection Condition than the local civilian authorities; 

however, he or she may order a more restrictive one. DoD has recognized 

“the essential need to protect installations, facilities, and personnel in the 

event of a public health emergency due to biological warfare, or terrorism 

or other public health emergency communicable disease epidemic.”44 
18

3. Long Term - 12-24 Months

 Senior Leader Exposure Recent exposures of White House staff and the 

Chief of Naval Operations demonstrate that leaders at all levels must 

prepare for their own potential quarantine or isolation. While units have

experience with “man down” drills after years of combat, leaders must plan 

for distinct kinds of casualties, including senior civilian and uniformed 

personnel. Leaders must prepare for key staff, commanders, or 

themselves being quarantined.45
19

Figure 5- Material and Sustainment Vignette46

Material and Sustainment

1. Short Term - 0-6 Months:

 Masks and PPE Within 48 hours of the Secretary of the Defense’s order to 

begin wearing masks, Pine Bluff Arsenal began producing masks for all its

Soldiers and employees. PBA already produces Chemical Patient 

Protective Wrap Integrated Footwear System and neck dams, so shifting 

to face masks was easy. Most people were able to create or buy their own 

masks, but that was only a temporary measure. Medical personnel all over 

the country ran short of material and PPE became the most important and 

visible requirement for everyone. PPE is now a pacing item for the 

pandemic, and the Army must procure sufficient stocks for all its Soldiers, 

civilians, family members, and especially medical personnel to include 

replacement stocks. 47

 

2. Mid-Term - 6-12 Months:

 Dining Facilities: Many restaurants remained open but were restricted to 

carry out. The restaurant industry suffered as much as a 90 percent 

reduction in its business. The Army will need to develop a long-term 

solution for treating Soldiers in garrison. Soldiers in the barracks do not 

have the same options that married Soldiers do and require a dining 

facility. 

 Subsistence Stockpiling: The first wave caused acute supply problems 

across the United States and around the world, and the Army needs to 

adapt its subsistence procurement system to accommodate the shortages. 

Stockpiling critical foodstuffs guarantees a supply for the DoD and assists 

in maintaining a subsistence reserve. Here are two examples of food 

supply challenges that occurred during the pandemic: 

o The dramatic reduction in restaurant usage resulted in greatly 

decreased supply requirements, especially for fresh items such as milk. 

That lack of demand has required dairy farmers to dump milk did they 

could not sell. The reduced production from the farmers in turn affected 

the specialized milk trucking industry, which very suddenly did not have 

enough business to sustain it. 

o In another example, meat processing plants across the country have 

been forced to shut down because of the sickness of their workers. The 

meat shortages resulting from that shut down started to ripple across 

the country in early May 2020. Tyson Foods CEO John Tyson 

The immediate need for masks at the beginning of the outbreak required some ingenuity, 

and many people and units stepped in to help. The XVIII Airborne Corps launched 

Operation Dragon Mask, using parachute riggers from the 647th QM Co. to create and 

sew masks, while units from the 18th Field Artillery Brigade worked with donated material 

face shields. Even civilians and families get involved, as two people were noted for 

making 300 each. 
20

purchased a full-page ad in newspapers in late April declaring, “the, 

“The food supply chain is breaking.” Ten percent of the nation’s beef 

production capacity, and 25 percent of its pork production capacity had 

closed by the third week of April 2020. The situation became so bad 

that some companies began euthanizing flocks and herds that could 

not safely be slaughtered and processed. Larger grocery stores 

including Kroger, Costco, and military commissaries began rationing 

meat purchases to ensure availability.48

 

3. Long Term - 12-24 Months:

 Just in Time Logistics: One of the things the pandemic has demonstrated 

is that the “just-in-time” logistics concept requires an intact sustainment 

chain. Now that the worldwide logistics chain is breaking in multiple areas, 

the necessity for stockpiling is evident. The closure of non-life sustaining 

businesses and the radical reduction in the amount of food used by them 

had, by May 2020, begun to cause cascade failure of the entire logistics 

system with the world's economy teetering on the brink of collapse. Even 

industries that deemed life sustaining were affected.

 Destruction of food supply: The plant closures and drastically reduced 

requirements and caused many farmers to begin destroying crops in the 

field and even euthanizing animals that could not be sold or safely 

processed. This may eventually cause an even greater food shortage 

later. The shortages are already affecting military commissaries and will 

doubtless begin affecting dining facilities across the force.49

 Defense mitigation actions: The DOD should immediately abandon the 

“just in time” logistics model and return to stockpiling of all critical 

materials, especially food supplies. This will provide the following: 

o Ensure adequate stocks for dining facilities, commissaries, and ships at 

sea. 

o Provide a reliable source of supply for overseas garrisons. 

o Help sustain the nation's food supply by providing a reliable market. 
21

“We are committed to maintaining the Army’s fighting strength by reducing the 

spread of the virus while simultaneously maintaining dynamic force employment 

capabilities.” 

- GEN James C. McConville, CSA50

Personnel 

1. Short Term - 0-6 Months:

 Quarantine: Allowing Soldiers to carry over leave into next fiscal year 

due to the inability to take leave because of quarantine was the right 

move. Commanders may be faced, however, with large numbers of 

Soldiers who want to take leave as soon as the quarantine is lifted, in 

some instances, to visit affected family members. Depending on 

conditions, this might require another quarantine. Successive 

quarantines could affect the readiness and morale of the unit. 

2. Mid-Term - 6-12 Months:

 Recruiting: While the quarantine has limited the ability of recruiters to meet 

directly with prospective Soldiers, Army Recruiting Command (USAREC) 

continues to use e-mail, text, video conferencing, and other technologies 

with a prospect population that is familiar with these communication 

means. The quarantine forced the Army to adjust basic training ship dates 

for recruits, but the recruiting mission continues. The latest indications are, 

however, that USAREC has experienced difficulty recruiting electronically 

and will need to return to face to face recruiting as soon as possible.51

 Army as Economic Engine: Because of the worsening economy, the Army 

may expect an increase in the number of recruits, especially in the 

younger, low, or no skilled demographics. This might assist in making the 

recruiting mission, but the Army needs to be prepared to handle an influx 

of recruits while maintaining standards. The weakening economy and loss 

of jobs might push political authorities to encourage greater enlistment to 

provide economic relief. The Army has already begun paying contracted 

recruits who were delayed from attending basic training. 52

3. Long Term - 12-24 Months:

 Effects on Mental Health: The initial fear of the unknown that accompanied 

the first outbreak has largely dissipated. Other factors, however, can 

increase the strain on Soldiers’ mental health: high casualty rates, 

including widespread fatalities; lengthy quarantines in barracks; mass 

casualty situations, such as the USS Theodore Roosevelt incident; illness 

or death of extended family members or friends; the near-certain arrival of 

a second or third wave; and the potential for the virus to mutate into 

something worse are all factors that weigh on the minds of Soldiers. 

Commanders should be alert to these and use some of the same 

resiliency tools used after combat or deployment. Leaders will also need to 

carefully craft strategic messaging to counteract misinterpreted data or 

“fake news” medical reports. 
22

“Once COVID-19 gets inside the gate, inside the door, it spreads, 

and spreads very significantly.” 

-Gov. Mike DeWine (Ohio)53

Facilities

1. Short Term - 0-6 Months:

 Screening and Testing: While most installations developed screening 

procedures, testing is not yet universal. The development of widespread 

testing procedures will reveal even more positive cases and potentially 

signal the start of a second wave. 

 Permanent Change of Station (PCS) Moves: The nation is beginning to 

reopen slowly as the military moves into the normal summer PCS season. 

While stop move and other actions designed to halt virus spread, not all 

moves can be stopped. Many Soldiers can be extended in place, but that 

will be detrimental for many and impossible for others. Commanders and 

other key leaders should move on schedule, as Soldiers do with schooling 

requirements. This is imperative for senior leaders attending such yearlong 

programs as Senior Service Colleges (SSC). Fort Jackson developed the 

capability to test 700 Soldiers per day for basic training, but this capacity 

should be required for the rest of the force.54

2. Mid-Term - 6-12 Months:

 Tracking Teams: -- Several installations created COVID-19 tracking and 

tracing teams to monitor the movement of infected personnel, help 

quarantine them, and clean any potentially infected areas. These units are 

based on models created in Italy and Europe to limit the spread of the 

disease. The Army should publish standard operating procedures (SOP) 

for the creation and standardization of all installation tracking teams.55

3. Long Term - 12-24 Months:

 PCS Moves: The difficulties caused in 2020 with universal PCS moves are 

likely to cause ripple effects throughout the next two to three years. 

 Quarantine -- The necessity to quarantine Soldiers will continue for at least 

two years. Installations will need to provide facilities and support for these 

quarantine activities. Some of the quarantine may involve civilians or other 

nonmilitary personnel, as demonstrated by the need to quarantine cruise 

ship passengers during the initial outbreak. 
23

“We’re [DoD] going to have to be able to operate in a COVID-19 

environment . . . . there will need to be changes.” 

-Deputy SECDEF David Norquist56 

Policy

1. Short Term - 0-6 Months

 HPCON: DoD ordered all installations to Health Protection condition 

(HPCON) Charlie on March 25, 2020, but bases may not be able to reduce 

HPCON at the same rate. Local commanders may need to raise or lower 

the HPCON based on local conditions. Because of the way infection 

moves, commanders should coordinate with state and local health 

authorities for assignment of HPCON.

57

 

2. Mid-Term - 6-12 Months:

 BAS/Separate Rations: The difficulties with supply and requirements for 

social distancing might require new arrangements for dining facilities. But if 

successive waves require dining facilities to be closed, extending separate 

rations to individual Soldiers in the barracks might be necessary for 

periods of time. 

3. Long Term - 12-24 Months:

 Coronavirus Survivors: DoD's recent announcement that COVID-19 

survivors would be permanently disqualified from enlistment, followed just 

days later by an announcement from the Chairman, Joint Chiefs of Staff 

that no such final decisions had been made point to the confusion in the 

Pentagon about how to handle the coronavirus. Such a decision would 

have second and third order effects, such as what would happen to 

currently-serving Soldiers who survived the virus and whether they would 

be barred to re-enlistment or perhaps administratively discharged.58

 
24

 Figure 6 - Modernization and Innovation Vignette59

Modernization & Innovation: The difficulty with innovation has never been finding 

innovative thinkers or resourcing. The challenge is convincing leaders with 

established mindsets. They outnumber the innovators in the Army by a large margin. 

The quarantine, however, is giving a boost innovation. In February 2020, most 

people in the Army, and certainly the older and more experienced people, had never 

heard of Zoom, Slack, MS Teams, or similar platforms. By March they were holding 

daily meetings on these platforms with little degradation or effectiveness.

1. Short Term - 0-6 Months

 Interruptions: Overseas subsidiaries of American defense contractors are 

also impacted by the COVID-19 pandemic. The US aerospace industry, 

which relies on sub-contractors in Mexico, is one example. There were 

more than 346,700 jobs eliminated between March and April due to virusrelated concerns. These layoffs have affected large DoD contracting firms 

including Honeywell, General Electric, and Lockheed Martin.60

 Sensors: The Army has deployed some sensors as stopgap measures in 

key locations such as the Pentagon, using infrared sensors to check for 

elevated temperatures. The new Integrated Visual Augmentation System 

(IVAS) system has also been modified to check body temperatures. 

These, however, are temporary measures and not fully deployed across 

the force. The efficacy of temperature screening is still in debate among 

medical professionals due instrument variations and usage, but the Army 

Futures Command should continue to develop quick solutions to be 

deployed across the force.61 

2. Mid-Term - 6-12 Months:

 Factory closures: Even with ambitious plans in place, the Army will find its 

progress toward modernization slowed. Boeing recently closed the 

manufacturing facility in the Philadelphia area that builds the CH-47 for the 

Army, the V-22 Osprey for the Marine Corps, and the new MH-139 for the 

Air Force. The closure only lasted two weeks, but it doubtless caused a 

ripple effect throughout its supply chain as well as a delay in fielding 

finished helicopters. It will not be the last such closure. The big 

manufacturers such as Boeing, Lockheed-Martin, General Electric, 

Honeywell, and Eurocopter are dependent upon smaller companies to 

supply parts, and some of those companies have also shut down due to 

the virus. Due to lack of stockpiling, some of these manufacturers may be 

Combat Capabilities Development Command (CCDC), a subordinate, command of 

Army Futures Command (AFC), assisted COVID-19 relief efforts through the 

development and distribution of advanced personal protective equipment (PPE), 

including ventilators and issuing updated software systems to aid National Guard 

units providing direct support to infected populations. The CCDC facilitated 

equipment modernization by connecting experts from the academic, scientific, and 

military communities.
25

forced to shut down because of lack of parts. Some of them are located 

outside the United States, which complicates the process even further.62 

 Expanded Remote Access Capacity: The requirements for social 

distancing forced the DOD to rapidly expand its telework capabilities (see 

Fig. 7). The Army has the largest number or teleworkers, numbering 

800,000. The USN currently has 250,000 personnel online and the Air 

Force has 100,000 users and expects to double that number shortly. The 

US Marine Corps plans to increase from its current number of 70,000 to 

105,000. The Army has moved many functions to virtual platforms, 

including meetings and conferences, spiritual activities, and the routine 

medical activities that were foreshadowed by telemedicine years ago. As 

the crisis continues, the Army continues to discover a greater variety of 

activities that can be conducted virtually, and those activities become more 

routine through repetition. The initial rush to get enough equipment for 

everyone to use has passed, but other potential requirements loom. A 

second or third wave might require even greater capacity and possibly 

even classified capabilities. The Army's greatest need now is to examine 

architecture that supports teleworking. The explosion of teleworking has 

strained the networks an increased the service’s vulnerability to cyber 

attack. That vulnerability has become even greater, as many government 

workers discover that their government issued computers are not capable 

of operating the necessary software or are slowed unnecessarily by use of 

Army networks. This pushes them to use civilian laptops, which are 

generally faster, more powerful, more capable, and more vulnerable than 

government issued machines.63

3. Long Term - 12-24 Months:

 Personal Protective Equipment (PPE): The coronavirus pandemic is likely 

not the last such event the nation will face in the coming years. As the 

Army looks too modernize and innovate, it is rightly focused on combat 

systems that are now decades old. But the current emergency 

demonstrates the need to look at other equipment which in normal times 

would be considered too mundane to receive focused attention. The Army 

should look to modernize its entire range of PPE, not just the N95 PPE 

that is necessary for medical personnel, but the full range of uniforms and 

equipment necessary for hazardous materials handling and for operating 

in a contaminated environment. The current suit used for operations in the 

chemical, biological, radioactive, and nuclear (CBRN) environment, the 

Joint Services Lightweight Integrated Suit Technology (JSLIST), has been 

in use for 20 years but differs little in weight and function from its 

predecessor dating back to the 1960s. Even the most physically fit soldier 

operating in Mission Oriented Protective Posture (MOPP) condition 4 is 

seriously degraded, and any unit operating for extended periods of time 

under conditions of high temperature can be rendered combat ineffective 

very quickly. The Army Futures Command should survey the available 

civilian market to determine what innovative technologies are available or 

emerging to improve the current PPE. 
26

 Routine and preventive medicine: In the clear medical emergency 

presented by the pandemic, most routine or preventive health care was 

postponed to prevent overwhelming health care facilities both military and 

civilian. Many states expressly forbade conducting any sort of medical 

activities beyond emergency care, and therefore health care providers 

lost the ability to manage their patients’ chronic conditions, and patients 

lost the ability to seek preventive care. Even where non-emergent 

treatments were not prohibited, patients elected not to come in to avoid 

overloading the system. Limiting access to some non-urgent health care 

was required in some hospitals, but patients and providers will begin to 

see the consequences of delayed treatment or lack of prevention in the 

coming months. A second wave coming potentially at the same time as a 

seasonal flu outbreak will greatly exacerbate the problems created by this 

lack of routine care. Military members are perhaps more disciplined than 

civilians about preventive medicine because personnel readiness is 

baked in, but if those Soldiers do not have access to preventive, 

readiness will suffer, even if those Soldiers do not get the coronavirus. 

Secretary of Defense Chuck Hagel ordered a review of the military health 

system to see if the access to care standards established by Federal 

regulation (Title 32 CFR 199.17) were being met. That report concluded 

that DoD, as a whole, met the access to care standards but the 

performance varied across the system. A DoD report in 2017 concluded 

that DoD did not consistently meet standards for acute and routine 

appointments at the several MTFs, even though the MHS used virtual 

health tools and, at the time, employed a sufficient number of providers. 

AI and other tools will help, but the loss of 17,000 uniformed medical 

personnel billets will further degrade access to care.64

Figure 7- Increase in DoD Telework Capacity65
27

 Defense Industrial Base Resiliency: Contracting officers worked to identify 

supply chain impacts to determine feasibility of telework arrangements for 

contractors, which required contract modification in some cases. This is 

an opportunity for Army Futures Command to develop new and expand 

existing linkages to leverage corporate research labs, university research 

labs, government research labs, and private research labs. Much of the 

defense industrial base consists of smaller subcontractors that provide

components and parts to the larger manufacturers such as Boeing, BAE 

Systems, and Sikorsky. Many of those businesses have sustained much 

greater economic damage from the pandemic than the larger 

corporations, and in some cases might not survive without assistance.

The DoD should consider a similar process to the Air Force’s Special 

Acquisition Task Force which was created to help manage industrial base 

support both during and after the current COVID-19 pandemic. That task 

force is operating on 4 lines of effort: 

 “Relief.” Planning for potential external assistance requests and 

how best to apply contracting to move out “billions of dollars if 

needed.” 

 “Resilience.” Focusing on defense industrial base health issues 

such as small businesses with severely strained cash flow and how 

to apply contracting to move out “billions of dollars if needed 

 “Recovery.” Post-crisis planning to figure out what funding 

programs might need to get back on track after a schedule slip. 

 “Being rapid for small businesses.” Rapidly completing contracts 

for small businesses.

66

 
28

Figure 8 - Funding Vignette67

Funding 

1. Short Term - 0-6 Months:

 Executing FY 20 budget: Many units and organizations are likely to have 

difficulty executing the FY20 budget due to the quarantine. The 

Department of Defense was recently allocated $1 billion as part of the 

Coronavirus Aid, Relief, and Economic Security Act, $750 million of which 

is reserved for medical supplies. Because the government prioritizes small 

and disadvantaged businesses, many of which were put at extraordinary 

risk by the pandemic, the remaining $250 million is earmarked to keep 

specific suppliers in business. This is a boon to the DOD, and the Army 

should reap the benefits; however, it also exacerbates the problem of 

unspent funds at the end of the fiscal year. The Army should direct units to 

purchase personal protective equipment for (PPE) for stockpiling 

throughout the force, especially medical units, and for specific medical 

equipment requirements. The opportunity for fraud waste and abuse is 

obvious.68

2. Mid-Term - 6-12 Months: 

 Executing FY 21 budget: The second wave is expected to hit and 

potentially occupy the first six months of FY21 creating the same 

challenges for next year. Some of this problem may be ameliorated by 

unplanned expenditures on DSCA, but additional spending will be 

necessary to completely exhaust fiscal years funds. Recommend that the 

Army allocate funds for purchasing stockpiles of PPE and related medical 

equipment that can be stored with unit equipment in pre-positioning 

stocks. 

 Regulatory relief: The Army should also seek regulatory relief from DoD to 

turn in unexpended funds at the end of the fiscal year. The DOD should 

also use the opportunity to pursue legislative relief from the requirement to 

expand all funds in the fiscal year in which they were appropriated. 

3. Long Term - 12-24 Months:

 Economic changes: The economic changes due to the quarantine are 

going to affect the Army in other ways besides recruiting. Some 

businesses will not recover from long shutdowns. Others will reopen, but 

they will have taken the opportunity to automate as many functions as 

possible and therefore will not need many of the workers they furloughed. 

Even before the Coronavirus crisis, the retail shopping industry had fully 

embraced automation, reducing the number of attended cash registers 

and replacing them with self-checkout kiosks. Those jobs and others 

The COVID-19 financial relief package, Coronavirus Aid, Relief, and Economic Security 

(CARES) provided $2 trillion to compensate both unemployed personnel and 

businesses forced to close to help contain the spread of COVID-19. This included $17 

billion for defense and loans totaling $80 billion for aerospace defense contractors
29

replaced by automation will not come back when the quarantine is over. At 

the other end of the technological spectrum, many highly skilled workers 

could also see themselves permanently out of work due to changes in their 

industry. For instance, the airline industry as of May 2020 was shrinking 

rapidly, with several airlines eliminating entire aircraft types from their 

inventory. Other smaller, regional carriers are going out of business 

entirely. This will put many highly skilled workers and white-collar 

employees with formerly well-paying jobs out of work. Losing these wellpaying jobs will hurt the economy even more, and the government will be 

simultaneously called upon to provide relief for those unemployed and to 

cut government spending. The budget will therefore be shrinking more 

dramatically then had already been predicted.69

 

 Budget bubbles and POM problems: The Pentagon is likely to encounter a 

boom and bust cycle with budgets in the next few years. Initial budget 

predictions will remain unchanged, and the services might even benefit 

from small end strength increases granted by Congress to offset 

catastrophically high civilian unemployment. The DOD will in some ways 

be viewed as an income generator for small businesses that do defenserelated work and economic stimulant for local economies. As the federal 

deficit continues to grow, however, accelerated by stimulus payments to 

taxpayers, bailouts to companies to keep them in operation, and greatly 

reduced tax revenues due to record unemployment, the Defense 

Department will be viewed as a drain on the nation's economy and steeper 

budget cuts will follow. The Army might anticipate even steeper budget 

cuts in the out years than had been expected previously. The budget cuts 

will fall disproportionately on the Army because Navy, Air Force, and 

Space Force budgets support large-scale weapons programs that also 

provide large-scale civilian employment. 
30

"Sir, I got a lot of building to do.” 

-LTG Todd Semonite, Chief of Engineers70

April 20, 2020 

Defense Support to Civil Authorities (DSCA): The pandemic has driven a degree 

of civil-military cooperation unseen in recent history. Army support to FEMA begins 

with the activation of defense support to FEMA regions, and all ten FEMA regions 

have been activated for the first time in history. Since the beginning of the 

emergency the US Army Corps of Engineers (USACE) has completed 32 of 37 

projects (as of May 15 2020) which included developing four distinctive designs to 

convert existing college dorms, hotels, sports arenas, and convention centers to 

hospitals. In various alternative care facilities, such as the Javits Center in New York, 

USACE has completed 15,066 beds, using a total of 37 contracts, to convert arenas, 

hotels, and dorms to alternate care facilities.71

The Army may expect continued challenges for the next 18 to 24 months as 

COVID-19 potentially comes back in waves. Defense Support to Civil Authorities 

(DSCA), especially the support the support the Army has provided, may continue 

well after the immediate danger has passed. The work of the Army Corps of 

Engineers in converting hotels, dormitories, and large event centers into makeshift 

hospitals has been tremendous, but it underlines the need for a hospital in a box that 

can be quickly and easily deployed again in the future if necessary. Most of the Army 

Corps of Engineers is civilian and relies on contractors for the construction, but 

future emergencies might require the deployment of Army units for this construction.

1. Short Term - 0-6 Months:

 Continuing support to FEMA and DSCA: In the short term, US Army Corps 

of Engineers should continue completing facilities where necessary and

closing out those facilities that are no longer necessary. It should also 

establish quick contracting arrangements in all major population areas to 

quickly build alternate care facilities again if the need arises. None of the 

assessments were done on military installations, so USACE should 

conduct some assessments of potential alternate care facilities on military 

installations before the second wave arrives. This is especially true for 

overseas installations, and the Army should stockpile necessary materials 

in advance. 

2. Mid-Term - 6-12 Months:

 Continuing support to FEMA and DSCA: USACE should be prepared to 

continue to do assessments and supervise construction of alternate care 

facilities. The field Army should be prepared to provide Soldiers to assist in 

construction efforts where necessary. 

 Civilian Infrastructure Support:The devastation after Hurricane Katrina was 

so severe as to cause the breakdown of the social order in many areas 

surrounding New Orleans, and local more enforcement and first 

responders were themselves incapacitated by either damage, injury, or the 
31

chaos of a mass evacuation. The combination of catastrophic wind 

damage, unprecedented flood levels, and a poorly handled evacuation 

resulted in the deaths of over 1800 people and the injury or serious illness 

of countless others. The potential for natural disaster occurring during the 

second wave is high, and the combination of considerable damage and 

the high rate of illness will require the Army to augment civilian disaster 

response operations. This is a traditional National Guard mission, but the 

expanding requirements may entail augmentation from some Regular 

Army and the US Army Reserve units. There is a precedent for Regular 

Army support to non-posse comitatus activities, such as the wildfires that 

habitually plague the Western US every season. The Regular Army also 

deployed under extraordinary circumstances to quell riots in Detroit in 

1967 and Los Angeles in 1992. 

 Possible Additional Missions: 

o Augment public health and medical services 

o Provide logistic support and distribution of commodities to quarantined 

and/or isolated persons 

o Provide labor and security support to points of distribution and ports of 

entry 

o Provide subject matter experts, manpower, and technical assistance to 

augment mortuary affairs operations 

o Provide transportation support 

o Provide continuity of government 

o Augment communications for local, state, tribal and federal 

communications resources for interoperability 

o Provide base and installation support to other local, state, and federal 

agencies 

o Ensure protection of defense industrial base, critical infrastructure, and 

mission assurance 

o Provide military assistance to civil disturbance for restoration of civil 

order as it relates to quarantine and isolation enforcement72 

3. Long Term - 12-24 Months:

 Continuing support to FEMA and DSCA: The pandemic emergency 

created problems in other industries that may require Army assistance. 

Recent discussions of difficulties with the US Postal Service (USPS) recall 

the Postal Strike of 1970, and the potential for the Army to be used for 

other DSCA missions. While the circumstances with the postal strike were 

very different, the situation demonstrated the Army's flexibility and 

potential for nontraditional missions. While the Army does have a great 

deal of adaptability, including the capability to surge quickly and react to 

contingencies with substantial number of troops, units deployed must 

always have an exit strategy. Units supporting civilian authorities in the 

absence of civilian capability must be prepared to redeploy as soon as the 
32

required capability is established. The quarantine displaced workers and, 

in some cases, entire industries, dramatically affecting the economy. The 

timely and proper removal of Army unit from a civilian support mission, will 

allow the local civilian economy to recover faster. 73 
33

“This is our war. Never in the history of the United States military has 

medical been the warfighter, but we are the warfighter. We are the 

tip of the spear.” 

–MG Joe Robinson. CG, 3rd MEDCOM74 

Medical : Medical support is the most visible development of temporary alternative 

medical facilities. This includes the deployment of three Army field hospitals and the 

Navy's hospital ships’ deployment to cities overburdened by the medical workload.

All three hospitals were alerted for deployment on 23 March 2020. The 627th 

Hospital Center deployed to Seattle, set up a 250-bed hospital using the unit’s 

MTOE (Modified Table of Organizational Equipment) and began treating patients on 

30 March 2020. The 9th and 531st Hospital Centers deployed to New York and 

established a 750-bed hospital in the Jacob Javits Center by 2 April 2020.75

1. Short Term - 0-6 Months:

 Identify medical treatment rules of engagement: Despite this rapid 

deployment capability and large bed capacity, the effort was somewhat 

wasted. Failure to properly utilize these DoD provided medical assets 

tainted the military’s image in the public eye. Not using these facilities to 

capacity appeared to the public that the military was either not involved or 

did not support the public. After deploying two of the military’s greatest 

strategic medical assets in a great show of support, the military suddenly 

seemed unsupportive. This situation requires a well-executed strategic 

communications plan to explain to the public how and why these assets 

are being used. Future planning efforts must incorporate better prior 

planning to fully maximize the hospitals. The 627th Hospital Center began 

to re-deploy only one week after it was deployed, because it arrived after 

the peak infection in Seattle, and local hospitals were able to handle the 

surge. The Javits Center was never fully used to its capacity, and the 

hospital ship USNS Comfort redeployed after only two weeks on station, 

never having come close to using its capacity. The initial planning for the 

military hospitals was to treat only non-COVID-19 patients, but the process 

of screening patients at civilian hospitals before they could be transferred 

to military facilities became too cumbersome. By the time military facilities 

were authorized to accept COVID-19 patients, the surge had passed, and 

they were not needed as much.76

2. Mid-Term - 6-12 Months:

 Casualties among medical personnel: The continued treatment of 

coronavirus patients will eventually take its toll on military medical 

personnel, as it had on civilian medical personnel. The Army must be 

prepared for potentially debilitating casualties for a low-density unit. 

 Limited resources: During the current emergency, three active duty field 

hospitals deployed to various cities to assist with patient treatment. These 

were short term deployments, but when the medical personnel deployed 
34

with them, it reduced the medical coverage at the bases where they were 

assigned. If there is a second wave of the coronavirus, more deployments 

of medical personnel may be expected. With less than 1/3 of the Army’s 

medical infrastructure assigned to Compo 1, the potential to stretch the 

available resources beyond the breaking point is obvious. Moreover, the 

total Army contains only 36 Preventive Medicine detachments, only 12 of 

which are assigned to the active component. Any large deployments for or 

during a second corona virus outbreak could potentially exceed the 

capabilities of the Defense Health Agency (DHA) and Army Medical 

Command (MEDCOM) units.

77

 Strategic Medical Assets: The USNS Comfort and USNS Mercy were 

some of the most visible symbols of the pandemic. Not just because of 

their size and appearance, but also because of the symbol they 

represented: the military providing large scale support to the civilian world. 

But in a future conflict, the value of those assets could easily be negated 

by chemical or biological weapons used on them, or by the same weapons 

used on a port they intended to use. These assets need not be destroyed 

to be rendered ineffective: their crews can be affected by virus, and they 

can be denied entry to ports in the same way that cruise ships have been 

denied in the current crisis. 

 Artificial Intelligence: AI allows machines to perform normal human tasks 

such as recognizing patterns, learning from experience, drawing 

conclusions, making predictions, or taking action. AI depends on large data 

volumes, advanced algorithms, and computing power and storage.AI is 

also already being used in the fight against COVID-19, but it does not yet 

have the large body of data that has been collected over years from other 

diseases. The proteins that make up viruses are arranged in a sequence 

of amino acids that give the protein its shape. Understanding a protein’s 

structure helps scientists develop drugs that work with the protein’s unique 

shape. AI can assist that research by examining possible other shapes: 78

In January [2020], Google DeepMind introduced AlphaFold, a cuttingedge system that predicts the 3D structure of a protein based on its 

genetic sequence. In early March, the system was put to the test 

on COVID-19. DeepMind released protein structure predictions of 

several under-studied proteins associated with SARS-CoV-2, the 

virus that causes COVID-19, to help the research community better 

understand the virus.79

Researchers are using the relatively recent information from COVID-19 to identify 

other viruses with similar elements and then determine which drugs could be used 

against the virus.80
35

3. Long Term - 12-24 Months:

 Pre-positioning: Future planning for this kind of operation should include 

prepositioning of hospital equipment, much in the same way that tactical 

equipment is prepositioned overseas. This would speed the deployment of 

hospital units to crisis areas. Pre-positioned equipment sets overseas 

should also include hospital equipment sets to ensure that they are ready 

for large scale operations.

 MTOE Assigned Personnel (MAP): MEDCOM has recently changed how it 

assigns doctors and other medical professionals to hospitals in units. 

Previously, doctors and other medical professionals were assigned to 

hospitals and Military Treatment Facilities (MTF) and then attached to 

units for deployment or training under the professional filler system 

(PROFIS). Under MAP, or reverse PROFIS, medical professionals will be 

assigned to tactical units and then attached to hospitals to maintain their 

medical proficiency. The recent deployment of hospital center personnel 

along with their assigned field hospitals identified a potential problem. If 

the hospital center, its component field hospital, and augmentation units 

deploy, either in CONUS to support another pandemic or overseas for 

combat or training, the MTF might then be overwhelmed by a second or 

third wave of the coronavirus, or a new, undiscovered pathogen. 

 Split based, Mass Casualty (MASCAL) Operations: The initial wave of the 

Coronavirus affected the military with some 10,000 Soldiers affected by 

the first week of June 2020. These casualties did not overwhelm the 

military medical system, but the second wave might hit the military harder 

than before. The Army Medical Command should be prepared to deploy in 

support of mass casualty operations in civilian population centers, and 

also deal with internal MASCAL operations. This will place a severe strain 

on an already overtaxed and short-handed medical system. The DHA 

should use the opportunity to establish or solidify local relationships 

between military medical treatment facilities and civilian hospitals. Mass 

casualty operations in either place would require cooperation and 

coordinated planning between the two. DHA should also examine specific 

areas where Military capacity specifically exceeds civilian capacity, such 

as Fort Leonard Wood, Missouri. Protocols and operating procedures 

need to be in place to allow the treatment of civilians in military facilities.81

 Re-examine Medical Force Structure Changes: DoD should reconsider the 

current efforts to restructure medical forces. The 2018 National Defense 

strategy eliminated 17,000 uniform medical billets across all services, 

resulting in a 13% reduction of the uniform medical strength. The 

pandemic has shown the great need for medical personnel, and the 

decision to cut 17,000 spaces from the military health system MHS in 

order to build combat capabilities further weakens a medical force 

structure that will be critical for MDO operations. The theater medical 

structure in place for Operation Desert Storm included more than 18,500 

hospital beds, 13,000 of which belonged to the Army. Current planning for 

large-scale combat operations recalls the large operations plans during the 

Cold War, but the recent force structure changes relied too heavily on 

civilian sector health care facilities and recalling reserve units. The loss of 
36

such a large number, even when apportioned across the services, is 

particularly devastating in a field in which most, if not all, military 

occupational specialties (MOS) are low density.82

 Conversion to DHA: A study in 2015 determined that more than 20,000 

Soldiers were medically non-deployable due to health-related issues. 

With healthcare costs exceeding ten percent of the DoD budget, 

Congress ordered the consolidation of medical assets into a joint 

command to reduce expenses. The National Defense Authorization Act 

(NDAA) of 2017 directed the transfer of all fixed medical treatment 

facilities from the services to the newly formed Defense Health Agency 

which was established to manage costs and ensure integration between 

the services, and also to coordinate with the Veteran’s Administration 

(VA). The process for that is not yet complete and, in fact, has been 

temporarily halted due to the COVID-19 response. This initiative’s 

success is currently undetermined. The overweening focus on managing 

budgets at fixed facilities, however, comes at a cost: it obscures the 

Army's critical tactical mission.83 

 Army Medical Command MTOE (Modified Table of Organization and 

Equipment) Changes:All Combat Support Hospitals (CSH) are converting 

to Hospital Centers (to be completed by FY22).The conversion of combat 

support hospitals to field hospitals has made the system more responsive, 

modular, scalable, and easily deployable, but it has also drastically 

reduced available bed space. The deployment of the 9th, 531st, and 627th 

Hospital Centers to New York and Seattle validated the new Hospital 

Center structure that is replacing the Combat Support Hospital. While this 

is designed for future multi-domain operations, its capability to augment 

civilian medical facilities in a crisis is evident. The Army should accelerate 

the conversion of the remaining CSHs where possible to add flexibility to 

the system but consider whether the resulting structures will have 

sufficient bed space for large-scale operations. 84

 
37

 Medical Stockpiling Vaccines: The best estimates for a coronavirus 

vaccine place it at one year away, but more realistic assessments show 

that at least two years will be required to develop, test, approve, and 

widely administer a vaccine. The current crisis has shown the necessity 

for having adequate stocks of critical medical supplies on hand. The 

shortage of PPE demonstrated that medical supply of some commodities 

can be a zero-sum game: stocks going to the civilian sector will not be 

available for the military sector, and vice versa. This is not the first 

instance in which critical medical supplies were in short supply. The 

great fear of the anthrax threat after 9/11 caused a shortage of 

ciprofloxcillin during Operation Iraqi Freedom. In addition to the other 

crises previously mentioned, natural disasters also require large amounts 

of normal saline and other supplies. Both civilian and military health care 

systems are also subject to the dangers of a potentially small number of 

suppliers. Sanofi Pasteur, the manufacturer of the only yellow fever 

vaccine (YF-Vax) licensed in the United States, has announced a total 

depletion of YF-Vax as they transition to a new production facility. Sanofi 

Pasteur is reassessing the timing of YF-Vax return to supply and expect 

to provide an update by the second quarter of 2020.85

 Blood products: The supply of blood and blood products isis always a 

critical issue, and blood and its associated components are pacing items. 

The military generally regards its blood supply as a closed system, since 

donations can come from within. However, the current pandemic raises 

questions about who will be eligible to donate and when. Research is 

currently underway to determine whether or not previously infected 

soldiers can donate blood to healthy soldiers, and, if so, if the antibodies 

carried in the blood will be effective in the recipient. Blood transfusion is 

not a typical means of transferring antibodies. 
38

Conclusion 

Writing a historical study about an event that is still in progress is a flawed 

approach and potentially dangerous, especially when the events under examination 

lack precedent. The true value of a historical case study is the perspective that 

comes from the passage of time. The present case, however, allows an exception. 

The Spanish Flu of 1918 - 1919 provides a clear precedent, and the lessons from 

that experience and more recent experiences have already proved invaluable. The 

value of historically minded study of contemporaneous events lies in the insights and 

reasoned projections based on identifiable patterns and relevant experiences.

The pandemic has affected the Army across all the DOTLMPF-P, and some 

of the impacts are not yet fully known. As the country starts a return in early June 

2020 toward a somewhat more normal schedule, other political and societal events 

began to divide the Army’s attention. Nationwide riots and simmering racial problems 

captured the public's attention, and Regular Army and National Guard units were 

deployed in support of local police forces. It is just this sort of divided mission the 

Army must consider as part of its nearly certain future. The civil disorder spreading 

across the country, with large crowds gathering in major cities will likely cause flareups of the coronavirus again. Army leaders should consider the potential multiple 

challenges conducting training and operational missions, complicated by civil unrest 

at home, potential natural disasters, and successive waves of the virus.

The speed with which the nation and the Army moved from fully open to 

quarantine and then began to develop adaptations, bodes well for the future. The 

Army and various other agencies have conducted exercises in the past to prepare

for a pandemic event, but many of the projected actions doubtless seemed 

unrealistic even to the most invested participants. The Cold War planning from the 

1980s often centered on the phrase, “when the balloon goes up.” It was a dreaded 

yet somewhat mythical time that would indicate that the nation was at war with the 

Soviet Union, and what would doubtless become World War III. Before COVID-19, 

most people outside the epidemiology community considered a pandemic a “when 

the balloon goes up” type event possible, but unlikely. Before COVID-19, just as after 

the 9/11 attacks, the unthinkable has already happened. It is now possible to think 

much more realistically about potential safety measures that would have been 

difficult to comprehend before the pandemic. “Tell me where this ends” is difficult to 

do as the nation recovers from the first wave, and exact predictions are impossible. 

Nevertheless, however, insights from the past and evidence from the present allow 

for reasonable forecasts for the future 
39

Appendix 1 – 2-year Pandemic Planning Cycle 
40

Appendix 2 - Testing Requirements 

1. Diagnostic Testing Challenges:

Despite the nationwide testing now underway, the procedure remains inexact. In 

addition to the five to fourteen-day incubation period after exposure, the diagnostic 

testing procedure remains inexact. 

Diagnostic testing is based on two principles: specificity (SPIN) and sensitivity 

(SNOUT). 

 Specificity: Based on the concept of a Specific test that is Positive to Rule In 

(SPIN), or how often a test is negative when a patient is well. Specificity tells 

how good a test is at identifying the well. If a test is 80 percent specific, 80 

percent of healthy people will test negative. 

 Sensitivity: Based on the concept of a Sensitive test that is Negative to Rule 

Out (SNOUT), or how often a test is positive when a patient has disease. 

Sensitivity tells how good a test is at identifying the sick. If a test is 80 percent 

sensitive, 80 percent of sick people will test positive. 

The quality of the test is based on two factors: 

 Positive Predictive Value (PPV): Tells how often a patient who tests positive 

for disease is sick. A PPV of 80 percent means 80 percent of people who test 

positive will be sick. 

 Negative Predictive Value (NPV): Tells how often a patient who tests negative 

for disease is well. An NPV of 80 percent means 80 percent of people who 

test negative will be healthy.86 

In layman's terms, these tests seek to differentiate the following: 

o True positive: The patient has the disease and the test is positive. 

o False positive: The patient does not have the disease, but the test is 

positive. 

o True negative: The patient does not have the disease and the test is 

negative 

o False negative: The patient has the disease, but the test is negative.87

2. Antibody testing challenges: An antibody is a defensive protein created by 

the body's immune system in recognition of the specific antigens present in a 

virus. When the immune system detects these antigens, it deploys these 

antibodies to fight off the virus. The problem with the novel coronavirus is that 

it is so new, that the data are unclear as to whether the presence of 

antibodies represents full immunity.
41

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Notes 
52

i

 Jeffrey R. Ryan, ed., Pandemic Influenza: Emergency Planning and 

Community Preparedness (Boca Raton, FL: Taylor & Francis, 2009).. 

2

 Allen Webb and Naseeem Nicholas Taleb. “Taking improbable events 

seriously: An interview with the author of the Black Swan.” Other. The McKinsey 

Quarterly, December 2008. www.mckinsey.com/quarterly. 

3

 “Severe Acute Respiratory Syndrome (SARS),” Centers for Disease Control 

and Prevention (Centers for Disease Control and Prevention, December 6, 2017), 

https://www.cdc.gov/sars/index.html; “Middle East Respiratory Syndrome (MERS) | 

CDC,” Centers for Disease Control and Prevention (Centers for Disease Control and 

Prevention, August 2, 2019), https://www.cdc.gov/coronavirus/mers/index.html. 

4

 Jeanna Bryner, “1st Known Case of Coronavirus Traced Back to November 

in China,” LiveScience (Purch, March 14, 2020), https://www.livescience.com/firstcase-coronavirus-found.html. 

5

 Pietro Tornabee, The Military Response to Pandemic: The New Global 

Threat. Student Research Project (Carlisle, PA: US Army War College, 2009), 4-5; 

Peter Doshi, “The Elusive Definition of Pandemic Influenza,” Bulletin of the World 

Health Organization 89, no. 7 (January 2011): pp. 532-538, 

https://doi.org/10.2471/blt.11.086173. 

6

 Conrad C. Crane et al., “Battling the Bug: The Army’s Response to 

Epidemics and Pandemics” (Carlisle, PA: US Army Heritage and Education Center, 

2014), 15-19.

7 Carol R. Byerly, Fever of War: the Influenza Epidemic in the U.S. Army 

during World War I (New York: New York University Press, 2005) 82-87, 108-117. 

8

 “1918 Pandemic Influenza: Three Waves,” Influenza (Flu) (Centers for 

Disease Control and Prevention), https://www.cdc.gov/.

9 Richard J. Hatchett, Carter E. Mecher, and Marc Lipsitch, “Public Health 

Interventions and Epidemic Intensity during the 1918 Influenza Pandemic,” 

Proceedings of the National Academy of Sciences 104, no. 18 (June 2007): pp. 

7582-7587, https://doi.org/10.1073/pnas.0610941104..

10 “1918 Pandemic Influenza: Three Waves.”

11 Kathleen M Fargey, “The Deadliest Enemy The U.S. Army and Influenza, 

1918–1919,” Army History, April 1, 2019, 25; Vincent J. Cirillo, “Two Faces of Death: 

Fatalities from Disease and Combat in America's Principal Wars, 1775 to Present,” 

Perspectives in Biology and Medicine 51, no. 1 (2007): 

https://doi.org/10.1353/pbm.2008.0005, 127; Carol R. Byerly, “The U.S. Military and 

the Influenza Pandemic of 1918–1919,” Public Health Reports 125, no. 3_suppl 

(2010): 81-91, https://doi.org/10.1177/00333549101250s311.

 
53

 

12 Ebbe Curtis Hoff, Phebe M. Hoff, and John Boyd Coates, Communicable 

Diseases Transmitted Chiefly through Respiratory and Alimentary Tracts, vol. IV 

(Washington, DC: Office of the Surgeon General, Dept. of the Army, 1958); Andrew 

W. Artenstein et al., “History of U.S. Military Contributions to the Study of Vaccines 

against Infectious Diseases,” Military Medicine 170, no. 4S (April 1, 2005): pp. 3-11, 

https://doi.org/10.7205/milmed.170.4s.3. , 88-90; Kendall Hoyt, “How World War II 

Spurred Vaccine Innovation,” The Conversation, May 8, 2015, 

https://theconversation.com/. 

13 Ebbe Curtis Hoff, Phebe M. Hoff, and John Boyd Coates, Communicable 

Diseases Transmitted Chiefly through Respiratory and Alimentary Tracts, vol. IV 

(Washington, DC: Office of the Surgeon General, Dept. of the Army, 1958), 103-104. 

14 Ebbe Curtis Hoff, Phebe M. Hoff, and John Boyd Coates, Communicable 

Diseases Transmitted Chiefly through Respiratory and Alimentary Tracts, vol. IV 

(Washington, DC: Office of the Surgeon General, Dept. of the Army, 1958), 110. 

15 Operation UNITED ASSISTANCE: The DOD Response to Ebola in West 

Africa (Suffolk, VA: Joint and Coalition Operational Analysis (JCOA), Joint Staff J7, 

2016), 13, 25.. 

16 Glendon Diehl, Nicole Bradstreet, and Felicia Monahan, “The Department of 

Defense at the Forefront of a Global Health Emergency Response: Lessons Learned 

from the Ebola Outbreak,” Health Security 14, no. 5 (2016): 366-374, 

https://doi.org/10.1089/hs.2016.0022. 

17 Operation UNITED ASSISTANCE: The DOD Response to Ebola in West 

Africa (Suffolk, VA: Joint and Coalition Operational Analysis (JCOA), Joint Staff J7, 

2016), 13-14.

18 Operation UNITED ASSISTANCE: The DOD Response to Ebola in West 

Africa (Suffolk, VA: Joint and Coalition Operational Analysis (JCOA), Joint Staff J7, 

2016), , 19-20. 

19 J. Edward Moreno, “Fauci Says Second Wave of Coronavirus Is 'Inevitable ...,” The 

Hill, April 29, 2020, https://thehill.com/changing-america/resilience/naturaldisasters/495211-fauci-says-second-wave-of-coronavirus-is.

20 Yew Lun Tian and Huizhong Wu, “COVID-19 China: Nation Fights Second 

Wave of Resurgent Virus as Cases Grow,” National Post, April 13, 2020. 

21 Kristine A. Moore et al., “COVID-19 - CIDRAP,” CIDRAP Viewpoint (Center 

for Infectious Disease Research and Policy, University of Minnesota, April 30, 2020), 

https://www.cidrap.umn.edu/, 6. 

22 David Greenwood et al., Medical Microbiology a Guide to Microbial 

Infections: Pathogenesis, Immunity, Laboratory Diagnosis and Control (Edinburgh: 

Churchill Livingstone Elsevier, 2012), 727.; Moore et al., “COVID-19 - CIDRAP,” 

CIDRAP Viewpoint. 
54

 

23 “Sanofi and GSK to Join Forces in Unprecedented Vaccine Collaboration to 

Fight COVID-19,” Sanofi US, April 13, 2020, https://www.sanofi.com/. 

24 Ryan J. McCarthy, “Secretary of the Army Address to USAWC Class of 

2020.” Senior Leader Engagement Series. Speech, May 21, 2020; “US Army 

Medical Research and Development Command Resources,” US Army Medical 

Research and Development Command, March 16, 2020, 

https://mrdc.amedd.Army.mil/. 

25 Meghann Myers, “The Military Diagnosed about 1,000 Troops with 

Coronavirus for the Third Week in a Row,” Military Times, April 24, 2020, 

https://www.militarytimes.com. 

26 “Past Pandemics,” Influenza (Flu) (Centers for Disease Control and 

Prevention, August 10, 2018), https://www.cdc.gov/. 

27Paul Szoldra, “Troops say the US military is not taking COVID-19 seriously,” 

Task and Purpose (blog), March 24, 2020, https://taskandpurpose.com/. 

28 “Provisional Death Counts for Coronavirus Disease (COVID-19),” Centers 

for Disease Control and Prevention, May 1, 2020, https://www.cdc.gov/ ; “Previous U.S. 

COVID-19 Case Data | CDC,” Centers for Disease Control and Prevention, May 1, 

2020, https://www.cdc.gov/. Data updated daily. 

29 William Feuer, “Coronavirus Patients Discharged from Hospitals Report ...,” 

CNBC.com, May 11, 2020, https://www.cnbc.com/.

30 William Carraway, “Georgia Guard Disinfecting Nursing Homes across the 

State ...,” Army.mil, April 3, 2020, www.Army.mil/; Bonnie Blakely, “Mass. Guard 

Conducts COVID-19 Testing at Nursing Homes ...,” www.nationalguard.mil/News// 

31 Kyle Rempfer, “Soldiers Return Early from Southeast Asian Exercises over 

COVID-19 Concerns, with More Adjustments Expected,” Army Times, April 15, 

2020..

32 Courtesy Story, “Army Deploys Medical Task Forces to Help Hard-Hit 

Communities,” Defense.gov, April 5, 2020, https://www.defense.gov/.

33 US Army North “U.S. Army North’s ongoing response to COVID-19,” media 

release # 20-04-005, Apr. 30, 2020; “U.S. Army North’s ongoing response to 

COVID-19,” media release # 20-05-001, May 11, 2020, 

https://www.arnorth.Army.mil/media/pages/media-releases.aspx 

34 “‘Near-Average’ April Was Marked by Deadliest Tornado ...,” NOAA website 

(National Oceanic and Atmospheric Administration, May 6, 2020), 

https://www.noaa.gov/news/.

35

 Philip J. Klotzbach, Michael M. Bell, and Jhordanne Jones, “Extended Range Forecast of 

Atlantic Seasonal Hurricane Activity and Landfall Strike Probability for 2020” (Tropical Meteorology 

Project, April 2, 2020), https://tropical.colostate.edu.
55

 

36 John T. Watson, Michelle Gayer, and Maire A. Connolly, “Epidemics after 

Natural Disasters,” Emerging Infectious Diseases 13, no. 1 (2007): pp. 1-5, 

https://doi.org/10.3201/eid1301.060779. 

37 Kyle Mizokami, “The U.S. Army Is Using an MMO for Training During the 

Pandemic,” Popular Mechanics, May 5, 2020, https://www.popularmechanics.com/. .

38 George Wright, “Army Cancels ROTC Cadet Summer Camp over 

Coronavirus Concerns,” Army Times, May 12, 2020, https://www.armytimes.com/.

39 Vonnie Wright, “Soldiers Conduct Virtual Training, Practice Social 

Distancing,” Army.mil, April 17, 2020, https://www.Army.mil/. 

40 “U.S. Army to Adjust Rotations to Combat Training Centers ...,” Army.mil, 

March 18, 2020, www.Army.mil/. 

41 Ryan J. McCarthy, “Secretary of the Army Address to USAWC Class of 

2020.” Senior Leader Engagement Series. Speech, May 21, 2020. 

42 Alexandra Shea, “Soldiers Ship to Fort Lee as Part of Pilot Program ...,” 

Army.mil, April 10, 2020, https://www.Army.mil/; Tish Williamson, “Army Combat 

Medics Depart Training for Follow-On Duty Stations,” April 10, 2020, 

https://www.Army.mil/.

43 Ryan J McCarthy and James McConville, “Hon. Ryan McCarthy and Gen. James 

McConville, Press Conference, Apr. 30, 2020” (Washington, DC, n.d.). 

44 Robert I. Miller, “The Impact of Quarantine on Military Operations,” The 

Counterproliferation Papers, Future Warfare Series No. 31 , no. 31 (August 1, 2005), 

https://doi.org/10.21236/ada446165, 23. See also: “DOD Directive 6200.3, Emergency 

Health Powers on Military Installations, 12 May 2003,” DOD Directive 6200.3, 

Emergency Health Powers on Military Installations, 12 May 2003 § (n.d.).

45 Diana Stancy Correll, “Navy’s Top Officer to Quarantine after Exposure to 

Coronavirus,” Military Times, May 11, 2020, https://www.militarytimes.com/.

46 Hubert Delany, “Operation Dragon Mask: XVIII Airborne Corps Creates and 

...,” Army.mil, April 16, 2020, https://www.Army.mil; Amy Tolson, “Sewing to Save Lives,” 

Army.mil, April 9, 2020, https://www.Army.mil/article/234388; Beth Holliker, “Time at 

Home Means Time to Help Make Masks,” Army.mil, April 8, 2020, 

https://www.Army.mil/article/234351.

47 Lori McFate, “Pine Bluff Arsenal Designs and Produces Face Masks to ...,” 

Army.mil, April 9, 2020, https://www.Army.mil/article/234418/. 

48 Kevin Keegan, “COVID-19: Operations and Supply Chain Disruption - 

PwC,” PwC.com,.; Amelia Lucas, “Tyson Foods Chairman Warns 'Food Supply 

Chain Is Breaking ...,” CNBC.com, April 27, 2020, 

https://www.cnbc.com/2020/04/27/.
56

 

49 Adam Jeffrey and Emma Newburger, “Wasted Milk, Euthanized Livestock: Photos Show 

How ... - CNBC,” CNBC.com, May 2, 2020, https://www.cnbc.com/2020/05/02/. 

50

 Kyle Rempfer, “Army Goes to HPCON Charlie across All Bases, Delta for 

...,” Army Times, March 25, 2020, https://www.armytimes.com/news/yourArmy/2020/03/25/ 

51 “USAREC Begins Deliberate, Methodical Return to in-Person ...,” Army.mil, 

April 27, 2020, https://recruiting.Army.mil/News/Article-Display/Article/2165599/ 

52 “USAREC Shifts to Virtual Recruiting to Reduce COVID-19 ...,” Army.mil, 

March 20, 2020, https://www.Army.mil/; “Future Soldiers with Coronavirus-Related 

Hardships May Be ...,” Army.mil, April 2, 2020, https://www.Army.mil/article/234215/ 

53 Rick Rojas and Michael Cooper, “Georgia, Tennessee and South Carolina 

Say Businesses Can Reopen Soon,” New York Times, April 20, 2020, 

https://www.nytimes.com. 

54 Sean Kimmons, “COVID-19 Testing Being Ramped up Army-Wide,” 

Army.mil, April 16, 2020, https://www.Army.mil/article/234676/. 

55 Joseph Lacdan, “Army Using Special Tracking Teams to Control the Spread 

of ...,” Army.mil, April 16, 2020, https://www.Army.mil/article/234655/. 

56 Paul McLeary, “COVID-19 Spreads to USS Nimitz; DoD Must ‘Operate in a 

COVID Environment,” Breaking Defense, April 9, 2020, https://breakingdefense.com. 

57 Kyle Rempfer, “Army Goes to HPCON Charlie across All Bases, Delta for 

...,” Army Times, March 25, 2020, https://www.armytimes.com/. 

59 Suzan Holl, “AFC’s Combat Capabilities Development Command Supports 

National COVID-19 Response,” Army.mil, April 16, 2020, https://www.Army.mil/. 

60 Joe Gould, “COVID Closed Mexican Factories that Supply US Defense 

Industry. The Pentagon Wants Them Opened,” Defense News, April 21, 2020, 

www.defensenews.comwww.defensenews.comwww.defensenews.com

61 Ryan Pickrell, “US Army Uses Futuristic IVAS Heads-up Display to Fight ...,” Defense 

News, April 28, 2020, https://www.businessinsider.com/ Sydney J. Freedberg, “Army IR Cameras 

Check Temperatures At Pentagon,” Breaking Defense, May 1, 2020, https://breakingdefense.com/.

62 Valerie Insinna, “Boeing Set to Reopen Major Military Helicopter Production 

...,” Defense News, April 17, 2020, https://www.defensenews.com/; Joe Gould, 

“COVID Closed Mexican Factories That Supply US Defense ...,” Defense News, 

April 21, 2020, https://www.defensenews.com.

63 C. Todd Lopez, “Growth in DOD Telework Capability May Outlive 

Coronavirus,” Defense.gov, April 14, 2020, https://www.defense.gov/; “USAREC 

Shifts to Virtual Recruiting to Reduce COVID-19 ...,” Army.mil, March 20, 2020, 

https://www.Army.mil/; Sydney J. Freedberg, “COVID-19: DoD Remote Access 

Capacity Soars Tenfold,” Breaking Defense, April 13, 2020, 
57

 

https://breakingdefense.com/; Thomas Brading, “Army Boosts Virtual Health, 

Communication Capabilities,” Army.mil, April 16, 2020, https://www.Army.mil/. 

64 Department of Defense, “Access to Care at Selected Military Treatment 

Facilities,’ Report No. DODIG-2018-111,” May 1, 2018, https://media.defense.gov.

65 Freedberg, “COVID-19: DoD Remote Access Capacity.” 

66 Diane Pollard, “Army Promotes Defense Industry Base Resiliency during 

...,” Army.mil, March 31, 2020, https://www.Army.; Theresa Hitchens, “COVID-19: 

Roper Stands Up Task Force To Assist Industrial Base,” Breaking Defense, March 

31, 2020, https://breakingdefense.com/. 

67 John A. Tirpak, “The Defense Industry After COVID-19,” Air Force 

Magazine, May 1, 2020, www.airforcemag.com/.

68 Aaron Mehta, “Pentagon Bracing for Three-Month Slowdown on Major 

Defense ...,” Defense News, April 20, 2020, https://www.defensenews.com/. 

69 Victor Tan Chen, “The Second Phase of Unemployment Will Be Harsher,” 

The Atlantic, April 20, 2020, www.theatlantic.com.

70 Donald J. Trump and Todd Semonite, “Press Conference,” (April 20, 2020). 

71 “US Army Corps of Engineers COVID-19 Response Efforts,” Headquarters 

U.S. Army Corps of Engineers, May 5, 2020, https://www.usace.Army.mil/. 

72 Frank William Sherod II, “Avian Influenza Pandemic May Expand the 

Military Role in Disaster Relief.” Thesis, US Army War College, 2006., 10-11.

73 Jim Harvey, “National Mail Call: Army Keeps the Mail Moving | Article ...,” 

Army.mil, April 13, 2020, https://www.Army.mil/article/234376/. 

74 Lilo H. Stainton, “Military’s Medical Response to COVID-19 in NJ May Lead 

to ...,” NJ Spotlight, April 23, 2020, https://www.njspotlight.com. 

75 Devon Suits, “Army Focuses on Support to FEMA, Plans Eventual Opening 

of ...” Army News Service, April 1, 2020. https://www.Army.mil/; Gary Sheftick, “Army 

Hospitals Ready in New York and Seattle,” Army News Service, April 1, 2020, 

https://www.Army.mil. 

76 Suits, “Army Focuses on Support to FEMA.”

77 “U.S. Army Provides Medical Facilities to Support COVID-19 ...,” Army.mil 

(Army News Service, March 24, 2020), https://www.Army.mil “Force Managers 

‘Leader's Book,’” Force Managers "Leader's Book" § (n.d.).. 

78 Anthony M. King, “Artificial Intelligence in Medicine: Augmenting Health 

Systems as a Predictive Intervention Tool.” Thesis, US Army War College, 2019, 5;

“Summary of the 2018 Department of Defense Artificial Intelligence Strategy,” 
58

 

Department of Defense, February 12, 2019, https://media.defense.gov/; David D. 

Luxton, “Artificial Intelligence in Behavioral and Mental Health Care,” in Artificial 

Intelligence in Behavioral and Mental Health Care, ed. David D. Luxton (Amsterdam: 

Elsevier/Academic Press, 2016), 2. 

79 Oren Etzion and Nicole DeCario, “AI Can Help Scientists Find a COVID-19 

Vaccine,” Wired, March 28, 2020, www.wired.com. 

80 Jo Best, “AI and the Coronavirus Fight: How Artificial Intelligence ...,” ZDNet, April 9, 2020, 

https://www.zdnet.com.

81 Hope Hodge Seck, “The Military's Coronavirus Cases: The Latest Rundown,” Military.com, 

March 16, 2020, https://www.military.com/

82 Tom Philpott, “More than 17,000 Uniformed Medical Jobs Eyed for 

Elimination,” Stripes.com, January 10, 2019, https://www.stripes.com/. 

83 Robert J. Heath, “Readiness: The Relevance of Army Medicine.” Thesis, US 

Army War College, 2015; Barbara Holcomb, “Presentation to Army Pre-Command 

Course, April 23, 2015.” Fort Leavenworth, KS; ; Douglas Robb, “The Defense 

Health Agency,” Congressional Record (Committee on Armed Services: 

Subcommittee on Military Personnel., February 26, 2014), 

https://www.congress.gov/congressional-record/2014/02/26/house-section. 

84 Michael F. LaBrecque and Michael A. Honsberger, “Army Field Hospitals 

and Expeditionary Hospitalization,” Army Sustainment, September 2018, 50. 

85 “Yellow Fever Vaccine Information - Sanofi U.S.,” Sanofi U.S., December 1, 2019, 

https://www.sanofi.us/.

86 Kevin Chung. Interpretation of SARS-CoV-2 Tests: What We Know To Date. USU COVID19 Clinical Case Conference #7, 14 May 2020.

87 Abdul Ghaaliq Lalkhen and Anthony McCluskey, “Clinical Tests: Sensitivity 

And Specificity,” Continuing Education in Anaesthesia Critical Care & Pain 8, no. 6 

(December 2006): 221-223. 
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