James Ruvalcaba was the lead operational planner and Joe Plenzler was the public affairs officer for III Marine Expeditionary Force in Okinawa, Japan. They were responsible for authoring the III MEF CONPLAN 5003 to protect all U.S. forces, their families, and Defense Department personnel in Japan. They are both retired Marine lieutenant colonels.
As former lead operational planners for the Biohazard Defense Contingency Plan for all military service members, their families and Defense Department employees in Japan, we noticed the strong possibility of a COVID-19 pandemic in early February of this year.
There are lessons to be learned from an earlier viral outbreak.
In response to the H5N1 or "bird flu" outbreak in 2005, President George W. Bush issued a National Strategy for Pandemic Influenza (PI) that November.
Thirteen days later, Chairman of the Joint Chiefs Gen. Peter Pace issued a planning order (PLANORD) directing all combatant commanders to conduct execution-level planning for a DoD response to pandemic influenza.
The guidance was clear and broad: Develop a contingency plan that specifically addressed the three major missions of force health protection, defense support for civil authorities, and humanitarian assistance and disaster relief.
As leaders of the planning efforts, we recruited medical experts and researched preventive health materials from the World Health Organization, Centers for Disease Control, National Institute of Health, and disease exposure control studies from the Center for Strategic and International Studies.
This 18-month planning effort included tabletop exercises with State Department officials and local government officials and resulted in a 650-page biohazard response plan for all Marine Corps forces in Japan.
The plan also involved the additional major mission of continuity of operations to ensure that local governments and military installations continued to provide essential and emergency services during a pandemic.
The plan required all units and critical support agencies and businesses to classify their employees or service members as nonessential, essential or emergency-essential personnel.
The lessons we learned in this comprehensive 2005 planning effort are extensive, but they have not been fully implemented in response to COVID-19.
So what can policymakers, emergency medical responders and today's planners learn from our plan?
Expect a "new normal" until a proven vaccine is developed. Social distancing measures and restrictions on mass gatherings must continue until the population has been vaccinated and the current COVID-19 virus is no longer a threat.
Just like we adapted to the post-9/11 terrorist attacks by instituting new security measures, we must also adapt to the pandemic by continuing social distancing measures until a proven vaccine has been developed, tested and administered to the entire global community. We must do this to avoid subsequent pandemic waves.
Our plan operated under the advice from health experts that a vaccine may take about a year to develop and that it will take months more for it to be readily available to the entire population. We recommend that the vaccine be prioritized and allocated first to medical responders and other personnel designated as emergency-essential responders. Local public health experts should draft immunization plans, to include the prioritization of immunizations to emergency-essential personnel.
The public should expect to experience additional shortages of medical equipment. We've seen the shortages of N95 masks, ventilators and ICU beds in hospitals; however, when restrictive measures are eased or lifted, our planning revealed that there will be a huge demand for infrared thermal detection systems (IR thermometers) in order to conduct public health febrile surveillance -- especially prior to boarding flights or mass transportation. The post-pandemic environment will most likely involve febrile screenings to ensure viral threats are contained.
Ongoing surveillance and contact tracing are extremely critical after the first pandemic wave is contained to a manageable level, in order to prevent a second wave or spreading it to another region. We should leverage technology in our smartphones to self-report if we have been in contact with infected people. China successfully implemented these protocols in Wuhan province through a phone app.
The demand for mortuary services may exceed available capacity. Additionally, new protocols must be established for conducting funerals.
Public Service Announcements are critical to shape public action to comply with evolving restrictive measures implemented by public health officials. Additionally, PSAs alleviate fear and anxiety by providing reassurance and critical educational material to assist the public in helping to contain and reduce the pandemic. Simply stated, PSAs help to reset the expectations of the evolving crisis and the associated escalatory or de-escalatory restrictive measures.
A pandemic may produce a second wave after the first outbreak, and sometimes even a second cycle outbreak after a few seasons. This is due to previously undetected pockets of viral outbreaks, a lapse in compliance to restrictive measures, the reintroduction of the virus from an external source, or the possibility of the virus mutating gradually by antigenic drift, or abruptly by antigenic shift. It is important for medical responders, public officials and the public to understand that we must not let our guard down when we start seeing a reduction in the transmissibility of the COVID virus or a reduction in the number of people infected.
We cannot lean on unfounded messages of hope; rather, we should look to science and condition-based assessments to decide when to ease or lift restrictive measures. The message to policymakers and high-ranking preventive health officials is clear: Demand science-based justifications for lifting restrictive measures.
For all that have closely tracked the evolution of this COVID-19 virus from its initial outbreak to a pandemic, the writing on the wall is obvious: National leaders made grave mistakes by not taking the threat seriously.
The lack of early mitigation has now cost us more than 427,000 sick Americans, more than 14,000 deaths and more than $2.3 trillion.
Our nation is paying a terrible cost for not taking this pandemic seriously enough, early enough. We must act in earnest to implement these lessons to help contain the viral spread so we can safely ease the restrictive measures while preventing a second pandemic wave or subsequent pandemic cycle.
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