3.3: Command in the Time of COVID
There’s no way to write about COVID and not hurt someone’s feelings. This post is likely going to hurt everyone’s feelings since the issue was made unnecessarily polarizing. You’ve been warned.
I arrived to the battalion in the first summer of COVID, which meant going straight into two weeks of quarantine. To combat the spread of the disease, the Japanese government had shut down international flights into and out of Okinawa. Nearly everyone who entered the country on a commercial flight into Tokyo was required to complete two weeks RoM in Tokyo before continuing to their destination.1 I was fortunate enough to catch a military flight in, which meant I was able to fly all the way into Okinawa after a few stops at US air force bases along the way. I did my RoM in the on-base house I would ultimately live in for two years. A lot of people had it worse.
We didn't know a ton about COVID that summer. A lot of arguments I hear today about how we handled COVID discount the uncertainty we had back then. Across the army everyone seemed to fall into one of two polar extremes. On one end, there were those who believed COVID was made up, a political conspiracy that would magically disappear in November. On the other end were those who saw the disease as a new Black Plague. They wanted to take zero risks. Stuck squarely between these two camps were my battalion surgeon and me.
We both knew COVID was real and a significant challenge. But we also needed to still do our jobs. We needed to train, and we still needed to deploy our soldiers. My battalion was not in Japan to stay in Okinawa but was assigned forward to travel around the Indo-Pacific and work alongside our international partners and allies. While the missions scaled back under COVID, they never stopped.
RoM was a significant challenge, in particular because the US military did not have the space up in mainland Japan to house all the soldiers, marines, and airmen — and their families — for two weeks before PCSing them into Okinawa. Adding in the soldiers in our battalion who were flowing in and out repeatedly, we were punching above our weight in the demand for rooms.
The manner they executed RoM up in the mainland was also taking a toll on the mental health of the soldiers. The costs of isolation are well documented, and those in RoM up in Tokyo were prohibited from even opening the windows to their rooms that summer. Ostensibly to combat the spread of the disease, each single soldier was also placed in their own room. This had a knock-on effect of exacerbating the effects of the phycological isolation which comes with a PCS to a foreign country.
For our battalion, we weren’t just calculating the health risks of COVID. We were also calculating the safety and readiness of soldiers to do their job. As one of my first SF NCO mentors was fond of repeating, ‘We don’t bake cookies for a living.’ That meant jumping out of airplanes onto a drop zone surrounding by coral reefs and crashing surf. It meant live-fire shooting, and demolitions training, and rock climbing, and three-kilometer open ocean swims. Not doing training increased the risk of something going wrong when soldiers of the battalion were forward with partners.
We were also balancing the mental health of soldiers and their families in a time of significant stress. COVID restrictions prohibited eating indoors at restaurants and even flying home to see loved ones, ways families typically beat the isolating effects of moving overseas. There was also the need to balance the risks to our Japanese hosts, who were trying to protect their own population, with a significant elderly population down in Okinawa.
It was hard to quantify some risks, but not impossible. In fact, Thomas Bayes’ theorem is designed to be continuously updated with new information, working from a position of uncertainty to one of ever improving probability. I’d thought that basic statistics and an understanding of Bayes’ theorem were part of the medical school training every doctor went through. But apparently it was not part of the curriculum for the head medical officer up in mainland Japan.
We tried (successfully) to argue the value of rooming soldiers together, and (unsuccessfully) for relying on a more aggressive testing regimen. The medical officer kept coming back to uncertainty around false negatives in testing. So, I laid out our math. If we assumed a false negative rate of .5 — 50% or a coin flip, which was higher than the actual false negative rate — and gave a soldier three tests, then the cumulative false negative risk was down to 12.5%.
Our unit also came up with a plan to put soldiers in three-bedroom homes together down on the bases in Oki.2 Still sequestered, the homes had a kitchen and kept people together, which helped combat the impacts of isolation.3 Instead of testing a single person, this approach meant we were testing a biome of three people who ate and worked together. We proposed a regimen of three tests each after ten days. The odds of all nine COVID tests coming back with a false negative were down to .0019 (<0.2%). But the doctor was not moved.
We made other data-informed decisions. Our battalion had its own human performance facility, which is dedicated to holistic health and fitness. While the rest of the military was shutting down their gyms, we switched ours to 24-hour access. This actually reduced our risks of COVID, as we freed up more time for people to use the facility and thus maintain social distancing.4 Our demographic of young and healthy soldiers was not high risk. Adding in the high barriers to the disease enforced by the Japanese meant that down on our island the risk of infection was lower, so we prioritized the readiness of our teams and soldiers. In the two years I was in command, we never had a single case of COVID trace back to our THOR facility, to include when the strength coach caught the virus.
We also sustained our ‘wet silk' training. In airborne units, if you're going to do a water jump, soldiers have to complete pool training to demonstrate they can safely get out of their harness, swim away from a parachute, and tread water well enough to survive until they are picked up by a boat. When we were doing our wet silk training in the on-base pool, an air force officer interrupted to complain about a lack of social distancing. Again, I turned to the data. The risks of airborne operations are well documented, and in Oki every jump is a potential water jump, since our drop zone is on an even smaller island, Ie Shima. All I had to do was lay out the risks of a drowning versus the risks of a death of COVID. This time I found a fellow commander more willing to accept the math.
We adapted our posture throughout the time I was in command, tightening up some when COVID finally started to spread aggressively on the island. We took measured risks, and understood the risk moves; it was not a fixed constant, which meant updating our assessment of it regularly. When we did get positive cases, we identified close contacts and their secondary contacts, inputting everything into a single tracking database. This database was a significant part of how we managed to prevent any spread to that secondary ring over those two years.
When the vaccines came to Oki in January of 2021, we were able to again leverage data to help.5 The battalion had a high uptake of the vaccines before they instituted a mandate. Partly this was because the countries across Asia were requiring vaccines, so any soldier who wanted to go on those missions had to opt in. But it was also because the battalion surgeon had been deliberate throughout the outbreak to communicate the risks and to update the battalion on what the latest data told us.
As it became clear a mandate was coming, I took a look at the data across the battalion. The largest portion of those hesitant to get the vaccine were in our support companies, where the age demographic was the youngest and where we had a higher percentage of minorities. This was in line with the research being published. Until I sorted it by MOS.
The SF soldiers in the line companies were the ones most directly impacted by the mandates other countries had imposed, so we only saw a handful of each MOS that were refusing the vaccine. But among the support MOS’s, I had one MOS where 100% of the soldiers weren’t getting the jab. That caught my eye and prompted my CSM and I too look into why. It turned out the NCOIC was in the ‘Bill Gates microchips’ anti-vax camp, and so he was preventing his soldiers from getting the vaccine.
My CSM and I talked to his leadership, who in turn sat down with him. We let him know that there was currently no requirement he get the vaccine, but holding up his soldiers was denying his soldiers the chance to deploy with the teams and support them. He stepped aside, and later, when he was the only soldier in his section who hadn’t gotten his jabs, he changed his mind.
In the end, our battalion weathered COVID as well as we could. We had minor flare ups, but never a full outbreak, tamping down the infections by tracking close contacts. Our med team kept up with every COVID case and made sure the more severe cases got the care they needed, to include the members of our families who got sick. We got the entire battalion to accept the vaccine, all without resorting to legal threats or kicking anyone out. We did this because we were patient. Patient with people, but also with not knowing and having to make risk informed decisions, based on data, not on partisanship.
Restriction of movement. RoM and quarantine meant a lot of different things depending on where you were. In Japan we were required to isolate in a hotel room for two weeks and receive a negative covid test before we could set foot outside the room.
There was a batch of homes that were scheduled for a full remodel and were vacant. When COVID shut down construction, we coordinated with the base to use the empty houses for RoM.
Our soldier’s demographic (under 50, fit) meant their risks of a severe COVID infection were low. Thus, while soldiers in RoM were still monitored for any adverse reactions, our battalion opted to focus on combatting the spread of COVID as our primary concern.
When I arrived in Oki there were signs declaring 'COVID rules' in the gym. They included things like ‘rerack your weights’ and ‘wipe down the equipment when you were done’. I took a marker and crossed off the 'COVID' from the sign, reminding everyone those are the rules for the gym regardless. Barbells aren’t the only thing that gets cleaned in the gym.
I’ll be surprised if this post doesn’t draw some anti-vax comments. I’m not going to engage with any that show up, but will leave this post by Nate Silver as a general stance of where I see the data. Fine, I'll run a regression analysis. But it won't make you happy. (natesilver.net).