War, H1N1, and Personnel Readiness

This blog is about DoD's health communications, and the potential utility of a "whole of government response" to assist DoD with H1N1.

As H1N1 makes its way around the globe via public travel, and --troop deployments-- we also are apparently busy in Southern Command delivering protection kits to health care workers in Latin America (Click on the title of this blog for the story from Southcom). I have thought about this particular post for several days now because I am currently in training at a military base. Training at a military base involves heavy 'social' interaction. We eat together, do physical fitness training together, sit in a classroom, huddle around maps for harried planning discussions, congregate over a computer to produce briefing slides for the group, eat together some more, and live in a dorm-like setting. Social distancing is nearly impossible. A trip from my class room to the ladies' bathroom room requires that I touch 3 door handles/doors one way, or a total of six 'fomites' (things that carry germs by being touched repeatedly--like a door knob) for a round trip. While it might seem paranoid that I know this, apparently on this particular base there are verified cases of H1N1. We were told 22 cases when we first arrived. Yesterday, a class mate told me that someone in my class of about 125 students (but not in my particular section of 13 students) had fallen ill and was 'quarantined' to the back of the class. "WHAT?" I asked him. "Yah, the guy had to sit in the back of the class away from everyone-that's what I heard" said my colleague. We were warned, on the first day, that were we to fall ill, we would be quarantined and therefore miss more than the acceptable amount of course work with the end result of being expelled from the the course. Obviously the use of the word quarantine has strayed from its actual meaning.

There are real and potentially unpleasant results should we come down with H1N1. Most of us have been toiling for about a year now, and this is our last phase--to drop out now would be distressing. It might even mean that we would have to start all over because there are limited amounts of upcoming classes, and a limited amount of time to complete the entire course. (Therefore, my heightened sense of concern about the door handles is at least explainable, and perhaps entirely warranted. ) The dire warnings of quarantine therefore produce an incentive to not seek treatment for flu symptoms.

But getting back to the protection kits. While I completely understand the goodwill gesture of distributing protection kits, I am somewhat baffled by the institutional response of DoD. Rumors are starting to circulate about H1N1, with odd descriptions of quarantine and treatment (e.g. treatment with Tamiflu--one of the more dubious rumors) with a predictable amount of resulting confusion. This is how the military works, unfortunately.

So I went surfing through the publicly available DoD information on H1N1 is illuminating--it tells us to wash our hands, cover our nose and mouth when sneezing and stay at home if we get ill. The efficacy of face masks is unproven, therefore not among the recommended actions. Here's the DoD watchboard for H1N1: http://fhp.osd.mil/aiWatchboard/. Although we did receive a 'briefing' about H1N1 that told us that the symptoms of H1N1 are remarkably long lasting, and to cover our nose and mouths when we sneeze, we were not told about where to get more information, and the briefing concluded with the warning about quarantine.

Health communication seems to be the weak point in the DoD's response. While we are generous with our neighbors, I have to wonder if we are appropriately generous with ourselves? Is one website really an appropriate instutional response? Or, a briefing given to an officer with no public health background to present to a packed auditorium of students freshly arrived from disparate parts of the globe? Is this really the best we can do for ourselves? And, is this the appropriate level and style of communication considering the importance of troop readiness? After all, we are in the middle of two wars and troops cannot fight if they are sick. The military health system is stretched thin. Could the Public Health Service be useful here? Where is our "whole of government" response when we are trying to cope with a threat to our own national security right here at home?

While it could be argued that I'm thinking like Chicken Little and fretting over a falling sky, I suspect that our response to this relatively benign flu does not indicate a measured response should a more virulent flu appear this fall.