Serving on the Navy’s Hospital Ships During the Response to COVID-19: Perspective from Two Deployed Missouri Physicians

In the spring of 2020 as the COVID-19 global pandemic swept across the United States and around the world, the Department of Defense mobilized the armed forces in an historic response to assist the civilian medical infrastructure to protect American lives. In a matter of days to weeks, active duty and reserve personnel from the United States Army, Navy, Air Force, and Marine Corps were rapidly deployed to cities facing near existential crises as hospital systems operated at or beyond their breaking points due to the numbers of infected patients.

As part of this response, the United States Navy stood up the USNS Mercy (T-AH-19) and USNS Comfort (T-AH-20) hospital platforms under Task Force 130.1. As United States Navy Reserve Medical Corps Officers—one a neurosurgeon (G.P.D.) and the other an anesthesiologist (B.A.B.)—based in St. Louis, Missouri, we will review and reflect on our experiences on both ships and provide some “lessons learned” in a dynamic global environment.

As COVID-19 was gripping Seattle and increasing in New York City in mid-March, there was tremendous concern that our country’s hospital system would not be able to support a suddenly large number of critically ill COVID-19 patients as well as the rest of the civilian population with serious medical conditions. Facing a world-class medical system suddenly in extremis, the Department of Defense directed the Navy’s hospital ship assets to the epicenters of escalating infection. To this end, the USNS Mercy was activated to support Los Angeles and the surrounding counties followed shortly thereafter by the USNS Comfort to New York City. Both ships, under the aegis of Military Sealift Command, are staffed by civilian mariners, but have the same command triad as shore-based military treatment facilities (MTFs). Both hospitals were also supported by a Commodore and his line staff. Because both ships had 1,000 patient beds, 12 operating rooms, and state of the art imaging technology, their mission was to acutely expand the local civilian capacity to provide patient care by becoming another large hospital in the region to offload local centers that were beyond capacity.

The speed with which the mission developed was stunning. Both ships, in “maintenance availability” status at the time of activation, were ready to get underway within five days and required nearly herculean efforts by the crew. Active duty and reserve providers were notified to report to their respective ships within several days. One of the authors was mobilized over a weekend and slept in a bunk in a stateroom of the USNS Mercy in San Diego by Sunday evening. This rapid deployment was only possible because of a highly effective logistics on the active-duty side, the superb readiness of the Navy Medicine Reserve community—both force-wide and at the level of our St. Louis Navy Operational Support Command—and the deep level of support shown by our civilian employers and colleagues. Moreover, there was outstanding support from the active duty subspecialty communities. To a member, the reserve community was highly enthusiastic and humbled to serve the country in this way; although many had deployed in other theaters previously, this mission was the first deployment for a large proportion including the authors. Once each ship was fully staffed, the reserve and active duty groups integrated seamlessly to execute the mission. Everyone’s journey to Navy medicine is unique and, together, forms the incredibly rich tapestry of this community. The working relationships between active and reserve sailors was a success story of this deployment.

Once underway, both ships became highfunctioning hospitals by the time they reached their destinations and began to treat patients shortly thereafter. The mantras from the USNS Mercy and USNS Comfort were “Ready on Arrival” and “United We Sail/Comfort of the Sick on the Sea”—both were true. We were incredibly impressed by the high-quality care delivered by providers from all backgrounds including MTFs, the VA, civilian academic institutions, and civilian private practice settings. These diverse backgrounds stimulated a strong desire to learn from each other, and as a result, both ships formed “Grand Rounds” talks during which speakers delivered presentations on areas of expertise. We also noted the advanced COVID-19 testing capacity that was quickly established on board. On the USNS Mercy, several cutting edge COVID-19 testing platforms were developed and validated in a period of days, which undoubtedly played a crucial role in mission success. Naturally, “Semper Gumby” (Always Flexible) was a constant refrain due to the quickly changing parameters of each mission. In the case of the USNS Comfort, the ship transitioned from a non-COVID to COVID facility, necessitating berthing of most personnel off the ship to maximize safety while taking care of COVID patients onboard. Similarly, personnel of the USNS Comfort also ultimately transitioned to berthing onshore to maximize individual safety.

Brad Bernstein, MD, on the deck of the USNS Comfort docked at Pier 90 in NYC.

As the missions for both platforms concluded, it was clear that we and others had learned a great deal from the efforts of Navy Medicine to provide support to the civilian community. As distressed as New York City was during the zenith of its COVID-19 infections, the USNS Comfort treated only a modest number of patients. Although several articles in the press pointed to a complex set of regulations that made it challenging to transfer patients, other factors were likely in play. Specifically, it will be important to understand the role that health care economics played in the willingness of local hospitals to transfer patients not only to the USNS Comfort, but also to field hospitals in locations nationwide. Effectively, a brand-new hospital opened in each city virtually overnight, and at a time when every hospital was hemorrhaging financially, it may have been difficult to untangle “assistance” from “competition” in some settings. It remains a tragic paradox during this entire pandemic—the very hospitals tasked with caring for the sick are simultaneously under staggering financial constraints. In the case of the USNS Mercy, limited patient volume had more to do with the success that California experienced in early and aggressive social mitigation tactics which decreased the slope of COVID-19 infections. Overall, it is important to understand all of the critical vectors when trying to support civil authorities in instances where there is overlap between civilian and military functions. We also recognize that patients admitted to each hospital ship often experienced difficulty communicating with their families ashore, which will be important to resolve in the future.

The sailors of the USNS Comfort and USNS Mercy, as well as those who served in other efforts across the country, should be proud of their service to the country in spring 2020. Indeed, COVID-19 has touched every corner of the globe, and the members of Task Force 130.1 did their part to answer an early call from a nation in distress, reeling from a new and uncertain specter, and trying to find its way through the darkness. These platforms are highly valuable assets that will surely be deployed to other turbulent areas in the years ahead. However, the value of our Navy’s hospital ships, albeit substantial, was perhaps not the central lesson from these mobilizations. The most impressive asset that we saw as mobilized members of the United States Navy was its people—ready to serve in missions at home and abroad.

Gavin Dunn, MD, PhD, (left) in the operating room on the USNS Mercy.