Coronavirus response: what the US military can and can’t do

With civilian hospitals increasingly overwhelmed and the coronavirus outbreak in America deepening, defense and medical experts say there’s one way to help: Put the military to work.

For over a century, America’s armed forces have dealt with medical crises across the globe. Many service members today have the expertise to assist with medical care; build MASH hospitals; provide shelter; or transport food, medical equipment, and people to meet the needs of the public. That’s already happening in Georgia and Florida and New York, for example, where those states’ National Guards were called to help combat Covid-19, the disease caused by the coronavirus.

“The Department of Defense provides the ability to scale up like no other part of the US government can,” Andrew Weber, the Pentagon’s top biological defense official from 2011 to 2014, told me. “Whatever is needed to mount an appropriate response, the military can do it at scale.”

It’s important to note that America’s troops wouldn’t be leading efforts to combat Covid-19. They’d be supporting civilian leaders from the Federal Emergency Management Agency (FEMA) or the Department of Health and Human Services (HHS) with extra people, expertise, and technology.

National Guard troops distributre food to residents of New Rochelle, New York, on March 12, 2020.
Timothy A. Clary/AFP via Getty Images

That’s likely why, during the Democratic presidential debate on Sunday night, former Vice President Joe Biden called for the military to be deployed across America. “It’s a national emergency, and I would call out the military,” he said. “We’re at war with the virus.”

But the military’s involvement isn’t a panacea, and it has strict limitations on what it can do. Laws prohibit most troops from performing law enforcement functions, for example, and its actions are curtailed to helping states with things like emergency medical treatment and evacuations.

What’s more, the military only has a few small hospitals in the United States that are set up to treat military medical problems, top Pentagon officials told reporters on Monday. Those facilities aren’t particularly ready to deal with the coronavirus outbreak or provide what civilian hospitals might need. It’s also unclear how many ventilators the Pentagon would be able to add to the nearly 13,000 in America’s stockpile, which are important to help those sick with the virus breathe.

In other words, the military can help, but it can’t solve the government’s response problems. It also doesn’t help that the Army alone, for instance, is short $1 billion to respond to the outbreak. “We’re trying to be very careful about not overpromising,” Air Force Brig. Gen. Paul Friedrichs, the Joint Staff surgeon, told reporters on Monday. However, experts and some at the Pentagon believe the military can come up with the money to help if it wanted to.

As of now, there’s no indication President Donald Trump wants to use the military. Most jarring is that he doesn’t have a senior Pentagon official on his Coronavirus Task Force. (It’s possible the military doesn’t want to be involved — more on that later.)

It’s therefore not as easy a call for Trump to make as some might think, but the dozen current and former defense officials and medical experts I spoke with say he should still use his authority to put the military to work now.

“There’s just so much capacity in the Defense Department that’s completely untapped at the moment, and that’s a mistake,” Kelly Magsamen, a former top Pentagon official in the Obama administration, told me.

The legality of using the US military in the coronavirus response

Before going into what the military could do to help with the coronavirus, it’s first important to know what it’s allowed to do at the president’s request.

The US military is barred from using its capabilities directly to enforce US domestic laws unless Congress specifically authorizes it to do so. This stipulation, known as “posse comitatus,” is why US troops can only support civilian agencies like FEMA but not take direct action themselves. Per FEMA’s own website, the military is prohibited from interdicting “vehicles, conducting searches and seizures, making arrests or apprehensions, surveillance, investigation, or undercover work.”

There’s no indication that long-standing statute is going to change anytime soon. However, this rule doesn’t apply to the National Guard and the Coast Guard — which means both services could perform law enforcement functions if asked by a state’s governor. That means they could conceivably block roads or keep people from visiting family and friends, though that would be a severe response and it’s unclear any governor wants to authorize that yet.

The president, or at least his lawyers, knows all this. On Friday, Trump issued two declarations to deal with the outbreak: one reliant on the Stafford Act, and one based on the National Emergencies Act.

As my colleague Ian Millhiser wrote, “Title IV of the Stafford Act permits the president to declare that a particular crisis is a ‘major disaster,’ and such a declaration does provide the president with new powers that he may use to combat such a disaster.” Additionally, the statute says “all requests for a declaration by the President that a major disaster exists shall be made by the Governor of the affected State.”

So, as Millhiser notes, Trump “cannot simply issue a declaration and seize broad new powers.”

There’s still plenty the US government can do under this act, including coordinating relief efforts, helping state governments, and handing out food and medicine as needed. If the military can be helpful in any of those endeavors, HHS, another agency, or a state’s governor can ask the Pentagon for assistance with them.

Marine Corps Gen. Kenneth F. McKenzie, commander of US Central Command, talks to journalists at the Pentagon, on March 13, 2020.
Chip Somodevilla/Getty Images

As for the National Emergencies Act, it gives the president more sweeping authorities, Elizabeth Goiten, the co-director of the Liberty and National Security Program at the Brennan Center, wrote for the Atlantic on Monday. For Trump to use those authorities, though, he must “specify which powers he intends to invoke, and he must issue updates if he adds new powers to the list,” she explained.

It’s therefore possible that under this statute, Trump could order the military to do more than a state’s governor wants, but he’d have to notify everyone of those intentions.

What’s most likely to happen, though, is that the military will abide by its long-standing process and doctrine of “Defense Support for Civilian Authorities,” or DSCA.

For emergencies in the homeland like the coronavirus outbreak, the military sees its role as providing “support to prepare, prevent, protect, respond, and recover from domestic incidents.” Such support is “provided in response to requests from civil authorities and upon approval from appropriate authorities.”

US troops, then, won’t start deploying to parts of the country without HHS or other government agencies asking them to, and even then the military will act strictly in support of what that agency wants.

In essence, Trump couldn’t use the military as his own personal coronavirus response force and law enforcement agency. It’ll be subordinate to the government agencies that request its assistance. How a National Guard unit acts, though, is highly dependent on a state’s governor.

HHS has already asked the Pentagon for help with quarantining Americans coming back from Wuhan, China — where the outbreak started — as well as infected passengers aboard the Diamond Princess cruise liner. Military officials are also at the 11 feeder airports that passengers from abroad must go through for medical screenings before entering the US.

But so far, that’s it. “We’ve not received any other [requests] at this time,” Jonathan Hoffman, a top Pentagon spokesperson, told reporters on Monday.

Yet experts tell me that, if states and agencies would just request it, the Pentagon could be even more helpful.

How the military can help the US coronavirus response

There are four main ways the US military could assist in the country’s pandemic response: 1) provide care; 2) assist with logistics; 3) develop a vaccine or other treatment; and 4) control crowds and provide other calming effects.

1) Provide care

Even as Americans aim to “flatten the curve” to keep coronavirus cases in the country low, hospitals find that they’re struggling to keep up with the number of patients that need medical care. A dearth of hospital beds, ventilators, and rested physicians means a spike in people requiring hospitalization could greatly overwhelm the civilian health system.

Should those resources run low, the Defense Department “could use authorities under the Defense Production Act to rapidly acquire a range of equipment such as N-95 respirators, gloves for medical personnel, and ventilators,” James Miller, the top Pentagon policy official from 2012 to 2014, told me.

The military also has thousands of physicians who could help treat patients. Dr. Angela Rasmussen, an infectious disease expert at Columbia University, told me the military could create new hospitals if needed — as New York Gov. Andrew Cuomo called on the Army Corps of Engineers to do — or repurpose current ones, for example by converting parts of hospitals into intensive care units.

But it should be noted that the military isn’t completely stocked up to help on all of this. As mentioned before, the Pentagon has fewer than 40 military hospitals, each of them small and geared toward healing troops in specific communities. “Our fixed facilities are designed to the force that we have there — not 1,000-bed medical centers all over the United States,” Friedrichs, the Joint Staff surgeon, told reporters on Monday.

By contrast, there are around 6,000 civilian hospitals in the country up and running today.

And while the military also has 424 medical clinics, including a massive hospital ship named USNS Comfort, they’re not built to quarantine patients that have the disease. Still, if there are many patients who require care at one time, the military would surely look to house them on their military bases as a kind of overflow facility.

The Department of Veterans Affairs (VA) could also lend its doctors and facilities for the response if the VA secretary authorizes their use. “The VA system was explicitly designed with the idea of not only treating veterans but providing redundancy for the civilian system,” said Sasha Baker, a top aide to former Defense Secretary Ash Carter.

And the VA says it’s ready to help if called upon. “VA stands ready to surge capabilities into civilian health care systems in the event those systems encounter capacity issues, but at this time they are not encountering such issues,” Christina Mandreucci, the VA’s press secretary, told me. “Requests for such support would flow through the HHS, which is leading the federal government’s Covid-19 response efforts.”

But should the National Disaster Medical System (NDMS) — a government program consisting of about 5,000 medical professionals — be called into action by a state or the federal government, the VA would play a huge role in making it work. “The VA is the backbone for the NDMS,” said Anthony Principi, the VA secretary from 2001 to 2005.

2) Assist with logistics

When I asked a current Marine officer how the military could best help if called upon, the officer’s response was short and to the point: “We are good at logistics.”

“We’ve got trucks, warehouses, and people,” the officer continued, “plus a few cargo planes and helicopters.” In other words, the military is full of highly trained professionals with top-of-the-line equipment that could be incredibly useful for transporting civilian officials and materials around the country.

That last part is key as doctors may need additional medical tools quickly to treat patients, or those in affected areas might require food and water to survive. Indeed, if so many people are sick that even grocery stores close down, they’ll need all the sustenance they can get. Only the military, really, has the trucks, helicopters, and planes necessary to deliver everything in an efficient manner. They’d also prove useful should someone require a medical evacuation.

Armed forces could coordinate all this in command and control centers, Barry McCaffrey, a retired Army general, told me. That would help streamline all these efforts so the response isn’t so haphazard.

Members of the National Guard prepare food for residents near a one-mile radius containment area set up to halt the spread of coronavirus in New York on March 13, 2020.
Pacific Press/LightRocket via Ge

Experts also noted that the armed forces have communications equipment allowing better coordination among several parts of the government. For example, if there needs to be a teleconference meeting, the military has the technology to set up such a meeting for personnel stationed in remote places.

And troops can offer generators to provide electricity around the clock if needed. Generators are especially useful for field hospitals or if electrical workers in a particularly badly affected area have to stay home.

But, here again, there’s still a problem. The military is failing to come up with money for its own coronavirus response. Part of that comes from Trump administration efforts to cut the amount of military medical personnel the US can have by 18,000, or 20 percent of the force.

3) Help develop a vaccine or effective treatment for the virus

The Army leads the US military’s medical research, primarily at Fort Detrick in Maryland. Gen. James McConville, the Army’s chief, told Breaking Defense earlier this month that there are already researchers working on finding a vaccine for the novel coronavirus. “They’ve been dealing with Ebola, they’ve been dealing with Zika, they’ve been dealing with MERS, and now they’re dealing with coronavirus,” McConville said.

Weber, now at the Council on Strategic Risks, told me that the only viable vaccine candidates and experimental drugs created during the 2014 Ebola crisis came from the Pentagon (in partnership with the Canadian Ministry of Defense). Once it looked like that vaccine could work, the National Institutes of Health took it “the last 10 yards,” said Weber.

But that’s not all. Columbia’s Rasmussen told me that other Pentagon agencies, such as the Defense Threats Reduction Agency and the Defense Advanced Research Projects Agency (DARPA), are working on tools that could potentially help fight the virus.

In DARPA’s case, it has a program called the Pandemic Prevention Platform that will “temporarily protect someone from contracting the virus before a vaccine is ready,” Amy Jenkins, the program’s director, told NPR in February.

Basically, it’s a treatment that protects someone from the virus for about six months. It serves as a temporary fix while waiting for a vaccine that can take several weeks to kick in, and it consists of antibodies from people who’ve had Covid-19 and recovered. “This technology could be used in this current coronavirus,” she said, “but this is still a very early technology.”

At the time of the interview, Jenkins noted that the technology might be available within 90 days.

4) Crowd control and calming effects

The military’s manpower could be helpful in managing large crowds, experts say. They could direct traffic at drive-through testing centers, for example, or control the flow of entries at medical facilities.

This would mostly be a job for the National Guard, the Marine officer told me, as people tend to freak out if they see other services trying to keep people calm within the US.

And, as mentioned above, there are legal reasons why the National Guard would have to be the service doing the crowd control work and not the federal military.

So far there are about 670 National Guard members activated in 15 states.

The public’s trust in the military might help calm nerves that the US government has the situation under control. “It would give the American public confidence,” Weber told me.

Experts told me it’s therefore surprising that Esper and Army Gen. Mark Milley, the Joint Chiefs chair, haven’t been more visible so far in reassuring the nation that all will be well.

The risks of having the military involved in the coronavirus response

While everyone I spoke with said the military had some role to play, many noted that deploying the armed forces also comes with very real risks.

One Air Force officer I talked to worried about exposing troops to sick people, which could increase the number of cases in the ranks. Having a large number of mostly young service members around crowds could also cause the virus to spread, since younger people may be infected without showing any symptoms. “That hurts our ability to respond without endangering the very people we intend to protect,” the officer said.

Plus, the military is already reluctant to help with pandemic response.

During the 2014 Ebola crisis, former defense officials told me, top military officials didn’t want 4,000 US troops going to West Africa to help. The feeling among some US uniformed leaders was that America’s service members should be focused on fighting wars, not curing diseases. Under immense White House pressure, though, the military did deploy and by most accounts proved instrumental in quelling the crisis.

President Trump holds a press briefing at the White House, on March 16, 2020.
Brendan Smialowski/AFP via Getty Images

Today’s military brass seems to hold similar views, as the Defense Department is still mainly focused on the health of the force. From March 16 to May 11, for example, troops aren’t allowed to travel domestically. It’s unclear that Pentagon leadership has turned its attention to a national response yet, experts tell me.

The Air Force officer has one theory as to why that may be: Surging military physicians to treat civilians means there’s a “risk of no treatment for your defense force in an era where soldiers are still getting rocket attacked downrange and North Korea is firing missiles into the East Sea,” the officer said. “There’s still an argument for readiness” — meaning the military’s ability to respond to any contingency — “and our physicians and medical professionals help us maintain that posture.”

Other experts also noted that the Trump administration wants the armed forces focused on “great power competition” — preparing for fighting major wars in the future with the likes of China and Russia. If troops start spending months on the coronavirus crisis, they might be less prepared to engage in those conflicts.

Despite those concerns, though, most I spoke with believe Trump will turn to the military sooner rather than later — though they wish he’d done so earlier.

“He downplayed the virus, and appeared not to understand what was happening, let alone what was coming,” Miller told me. “The price will be paid in American lives.”


Source: https://www.vox.com/2020/3/17/21181115/coronavirus-military-response-national-guard

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