Editor's note: This is the third installment in a 6-part series that highlights the efforts of the Military Health System laboratories and the technicians who worked to identify COVID-19 variants using special sequencing technology.

Tripler Army Medical Center, a Military Health System hospital serving military communities in Hawaii, established a fully functional whole genome sequencing surveillance program for SARS-CoV-2 during the pandemic. The Honolulu-based hospital consistently reported samples with some of the fastest turn-around-times in the network.

"This is credited to their ongoing dedication to the mission and close collaboration with the on-site clinic and other military hospitals and clinics," said Kathleen Creppage, who holds a doctorate in epidemiology and is a senior epidemiologist and science advisor for Department of Defense's Global Respiratory Pathogen Surveillance.

TAMC also has access to unique samples from Pacific Navy vessels, residents in Hawaii, and other locations within the U.S. Indo-Pacific Command area of responsibility. As the only military hospital with sequencing capability in the INDOPACOM area, TAMC continues to strengthen its capability and plans to assist other similar military-owned laboratories to implement sequencing.

"TAMC had been partnering with GEIS (Global Emerging Infections Surveillance network) efforts for evaluating new technologies for respiratory disease in the Pacific region for several years before the COVID-19 pandemic," said Catherine Uyehara, who holds a doctorate and is the director of research for the Defense Medical Readiness Research Directorate of the Regional Health Command-Pacific.

The Armed Forces Health Surveillance Division GEIS Next Generation Sequencing and Bioinformatics Consortium established a critical data-sharing network and connection with scientists at TAMC with the shared passion to focus on expanding the knowledge needed to combat this unprecedented pandemic. The scientific collaboration of former GEIS director U.S. Navy Capt. Guillermo Pimental, TAMC, and experts at United States Army Medical Research Institute of Infectious Diseases, resulted in the sharing of valuable ideas and data, as well as developing solutions.

"We were also very fortunate to have Dr. Jonathan D'Ambrozio, who had just arrived at TAMC and happened to have the necessary expertise in bioinformatics needed to spearhead the establishment of a dedicated TAMC genome sequencing lab," said Uyehara. "The initial funding that GEIS provided helped TAMC procure the molecular genome sequencing supplies and extra technical help needed to hone in on examining the evolution of SARS-CoV-2 and detection of variants in our patient population in Hawaii."

This work is important to military and local civilian populations.

"Being in the middle of the Pacific, with the constant crossing of travelers through our island state from all over the world, makes our military and local civilian population at risk of respiratory disease spread," said Uyehara. "It is usually not a matter of if, but when we get exposed to the latest evolving disease."

For this reason, GEIS began establishing a respiratory disease surveillance program at TAMC over 20 years ago.

"The near-real time consistent generation of data from our genomic surveillance program provides public health officials, clinicians, and military commanders with actionable information that best informs decision-making," said Uyehara. "The scientific talent at the military medical facilities is a hidden asset for developing real-time translational practical solutions in advancing military health care capabilities."

She continued, "The ability of AFHSD GEIS to provide resources and networks needed to establish and support surveillance efforts in key strategic locations throughout the world, such as in the INDOPACOM, helps provide timely, crucial information that allows informed strategic decision making. This approach is essential during a pandemic with a rapidly evolving virus like SARS-CoV-2 and helps to ensure quick insight into the most current circulating viral variants."