Quarantine in a COVID-19 Pandemic: Lessons from a Deployed Role I

The coronavirus (COVID-19) pandemic has changed the world; and the US military changed with it. Although this virus presents with a wide spectrum of disease progression (no symptoms to acute respiratory distress syndrome leading to death), its impact extends beyond health outcomes. At the time of this study, numerous research and development projects were underway to develop a COVID-19 vaccine or other treatment modalities; however, there were no Federal Drug Administration (FDA) approved vaccines or medical therapeutics that definitively provided a cure. Instead, public health officials relied on non-pharmaceutical interventions (NPI) as a main strategy to contain and mitigate the disease. The US military in partnership with host nation countries, such as the Kingdom of Saudi Arabia, exemplified unity of effort through a coordinated response: mass testing, prompt contact tracing, quarantine, and isolation. One main non-pharmaceutical intervention (NPI) strategy includes social distancing which has been shown to significantly impact pandemic influenza transmission translating to COVID-19 mitigation measures. In the military, strict adherence to quarantine, restriction of movement, and isolation orders can be a challenge since appropriate facilities and resources are limited in deployed and training environments. Further, asymptomatic carriage and transmission of COVID-19 disease (mean incubation time 6.2 days and range of 2-14 days) can complicate quarantine and testing methodologies. Moreover, deployment of the NPI mitigation strategies such as quarantine and isolation in an effective and timely manner is essential to prevent further spread. In essence, quarantine is the prevention, and isolation is the cure. This paper aims to describe how a deployed US Army Role I can effectively utilize NPI and containment strategies during a global pandemic in an austere environment.