An Outbreak of Covid-19 on an Aircraft Carrier

BACKGROUND

An outbreak of coronavirus disease 2019 (Covid-19) occurred on the U.S.S. Theodore Roosevelt, a nuclear-powered aircraft carrier with a crew of 4779 personnel.

METHODS

We obtained clinical and demographic data for all crew members, including results of testing by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). All crew members were followed up for a minimum of 10 weeks, regardless of test results or the absence of symptoms.

RESULTS

The crew was predominantly young (mean age, 27 years) and was in general good health, meeting U.S. Navy standards for sea duty. Over the course of the outbreak, 1271 crew members (26.6% of the crew) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by rRT-PCR testing, and more than 1000 infections were identified within 5 weeks after the first laboratory-confirmed infection. An additional 60 crew members had suspected Covid-19 (i.e., illness that met Council of State and Territorial Epidemiologists clinical criteria for Covid-19 without a positive test result). Among the crew members with laboratory-confirmed infection, 76.9% (978 of 1271) had no symptoms at the time that they tested positive and 55.0% had symptoms develop at any time during the clinical course. Among the 1331 crew members with suspected or confirmed Covid-19, 23 (1.7%) were hospitalized, 4 (0.3%) received intensive care, and 1 died. Crew members who worked in confined spaces appeared more likely to become infected.

CONCLUSIONS

SARS-CoV-2 spread quickly among the crew of the U.S.S. Theodore Roosevelt. Transmission was facilitated by close-quarters conditions and by asymptomatic and presymptomatic infected crew members. Nearly half of those who tested positive for the virus never had symptoms.

Contributions of the Global Emerging Infections Surveillance and Response System Network to global health security in 2011

In its 15th year, the Global Emerging Infections Surveillance and Response System (GEIS) continued to make significant contributions to global public health and emerging infectious disease surveillance worldwide. As a division of the US Department of Defense's Armed Forces Health Surveillance Center since 2008, GEIS coordinated a network of surveillance and response activities through collaborations with 33 partners in 76 countries. The GEIS was involved in 73 outbreak responses in fiscal year 2011. Significant laboratory capacity-building initiatives were undertaken with 53 foreign health, agriculture and/or defense ministries, as well as with other US government entities and international institutions, including support for numerous national influenza centers. Equally important, a variety of epidemiologic training endeavors reached over 4,500 individuals in 96 countries. Collectively, these activities enhanced the ability of partner countries and the US military to make decisions about biological threats and design programs to protect global public health as well as global health security.

Military medical informatics: accessing information in the deployed environment

Physicians use multiple sources of information to search for answers to clinical questions. These sources include textbooks, journals, colleagues, and electronic resources, including the Internet.

METHODS

To explore what sources are most commonly used by staff military physicians, we distributed a survey asking them to describe sources of medical information they used most frequently while in garrison and while on deployment.

RESULTS

Most military physicians use the Internet to access medical information every day while in garrison. The frequency and pattern of use of medical resources differs while on deployment. The most common sources of electronic medical information are general Internet search engines (Google). Open-domain sites (PubMed and MEDLINE) are more commonly used by military surgeons, while filtered secondary information sources (UptoDate, MD Consult) appear to be more commonly used by military primary care physicians. Younger physicians use electronic resources more commonly than do older physicians.

CONCLUSIONS

Knowing what sources of medical information military physicians use to search for answers to their clinical questions can help guide allocation of medical informatics resources, particularly to deployed military physicians providing in-theater care.