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McCaffery offers HA perspective to COVID-19

Man in mask presents military coin to female soldier Kudos from the top... the Honorable Thomas McCaffery, Assistant Secretary of Defense for Health Affairs presents a personal coin to Hospitalman Katherine Evans, assigned to Naval Hospital Bremerton's OB/GYN clinic for her sustained efforts in supporting patients during the ongoing pandemic outbreak. McCaffery and U.S. Army Lt. Gen. Ronald J. Place, Defense Health Agency (DHA) director visited NHB July 16, 2020 to observe first-hand the commitment by Navy Medicine in helping stop the spread of COVID-19, as well as discuss the ongoing evolution of the military health system in ensuring the commitment to mission readiness (Official Navy photo by Mass Communication Specialist 3rd Class Meagan Christoph, NHB/NMRTC Bremerton public affairs).

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As it became increasingly clear that the highly contagious respiratory infection COVID-19 would span the globe, leadership within the Department of Defense quickly tapped its own experts for potential solutions.

“We were immediately looking to our research folks and saying, well, what are we doing in this area that can be leveraged?” said Thomas McCaffery, DoD's assistant secretary of Defense for Health Affairs. “We then brought that to our senior leaders with ideas about how we could accelerate and redirect research dollars in other areas to vaccine and therapeutics development.”

Since coming aboard, McCaffery said he has witnessed the strength of the DoD during a national crisis due to the pandemic. “Our uniformed leaders and our civilians are exceptionally good at adapting to change; it’s part of the culture, part of their DNA,” he said. From the onset, the DoD showcased its ability to pivot with the deployment of forces to support local governments, including moving hospital ships on both U.S. coasts and quickly setting up field hospitals in cities to account for a potential influx of patients. “The enemy, so to speak, changed our direction and we needed to be able to adapt accordingly,” he said. “It was like clockwork.”

McCaffery admitted that nearly all his time and energy have focused on the Military Health System’s response to the pandemic as hospitals and health care workers across the country became overwhelmed with critical cases requiring additional support. Typically, military medical forces deploy to care for trauma-related injuries. “This was vastly different, a very different enemy,” he said. “As we saw in New York City, we had several hundred of our uniformed medical providers actually helping staff civilian hospitals.”

Military medical forces played a core role in the domestic response to COVID-19 in supporting medical infrastructure to help the nation, he added. The DoD also leveraged current research and vaccine development efforts into highly contagious and deadly viruses. For example, military scientists applied ongoing research into Remdesivir to treat Ebola-like viruses and tested it against COVID-19. The Food and Drug Administration recently approved the drug for use in COVID-19. Citing research in medical counter measures to keep troops safe as one example, McCaffery said, “We were very quick to pivot and leverage that kind of research that has already been going on for our military purposes to focusing on vaccine research and development for COVID-19 therapeutics for treatment.” As part of the normal course of business for the DoD, researchers will continue to accelerate appropriate vaccine candidates and different therapeutic candidates, he added.

While the DoD research scope is largely for military operational purposes, the science has far-reaching implications to the civilian health care sector, especially when combating an unknown disease like COVID-19, explained McCaffery, who has more than 20 years in the health care sector.

A recently published report by the Navy and the Centers for Disease Control and Prevention studying the COVID-19 outbreak on the aircraft carrier USS Theodore Roosevelt found that among sailors exposed to the virus, almost 20% were asymptomatic.

Continued testing across the services could yield insight into the impact of the disease on a subset of the population, specifically a fit fighting force. “We don’t have all the data right now to say we know exactly what that infection rate is across the board and how many are asymptomatic, but that’s what we’re continuing to do with the data we are collecting,” he said.

The framework exists across the MHS to track trends and results from observational studies for force health protection. “I think we’re good for the long term and we’re pushing really for the quickest and safest way to get a vaccine out there and therapeutics out there,” he said. “While we are hunkered down and focused on as early as possible getting vaccines and therapeutics available for our active duty, we also know that we don’t know where that’s going to go.”

While McCaffery couldn’t have predicted just a few years ago that he would be among those leading a response to a global pandemic, he is confident the department will continue to be a central part of the whole government response to COVID-19 while also continuing to meet the needs of the MHS.

“It is kind of a COVID all day every day, and what we want to do is be able to figure out how we continue that support while moving some of the other significant changes in the health care system forward,” he said.

Over the years, core investments into research and development made it possible to leverage existing research to COVID-19. Those same investments will give the DoD the ability to respond to future threats, be they natural or man-made, McCaffery said. “Our folks are always looking at what’s the next thing on the horizon,” he added. “That is normal operating procedure for the department.”

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DoD COVID-19 Practice Management Guide Version 5

Technical Document
7/30/2020

This Practice Management Guide does not supersede DoD Policy. It is based upon the best information available at the time of publication. It is designed to provide information and assist decision making. It is not intended to define a standard of care and should not be construed as one. Neither should it be interpreted as prescribing an exclusive course of management. It was developed by experts in this field. Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of this guideline is responsible for evaluating the appropriateness of applying it in the setting of any particular clinical situation. The Practice Management Guide is not intended to represent TRICARE policy. Further, inclusion of recommendations for specific testing and/or therapeutic interventions within this guide does not guarantee coverage of civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil or by contacting your regional TRICARE Managed Care Support Contractor.

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