“We’re the first line of defense,” is the motto that the West Point Department of Public Health lives by to protect West Point and six other installations in the Northeast it serves in public, environmental, industrial hygiene and occupational health. The job they do in general over the years may have gone under the radar, but when the COVID-19 pandemic hit the frontal lobe of everyone’s minds, it powered public health to the spotlight.
“Before COVID-19, nobody knew who we were,” Lt. Col. Michael Greifenstein, former chief of the West Point Department of Public Health and currently an assistant public health emergency officer to the U.S. Military Academy, said. “We were working behind the scenes. It’s a glory-less job for all intents and purposes. COVID-19 has thrusted us to the forefront … nothing that we ever wanted but we’re happy we are here to do what we did protecting the community.”
Greifenstein has a saying from a Benjamin Franklin axiom, “an ounce of prevention is worth a pound of cure,” which is about stopping something from happening in the first place rather than trying to repair the damage after it has happened. This axiom is the world that public health is always functioning in to be one step ahead of a possible health disaster.
“We are the ounce of prevention to make sure the commanders don’t have to pull out a pound of cure, specifically my hospital commander (Col. Brett H. Venable),” Greifenstein said of the former Keller Army Community Hospital commander. “My job is to keep people out of the sick bay, sick call, keep the population healthy and allow them to thrive and do what they need to do.
“If my folks fail at that mission, we put people at risk,” he added. “Not just people at the installation to include service members, DOD civilians, contractors and families, but also visitors as we have a duty to protect our visitors who come to this installation.”
Public Health, once known as Preventive Medicine, is essentially the right-hand man to the KACH commander, USMA Superintendent Lt. Gen. Darryl A. Williams, West Point Garrison commander Col. Harry C. Marson and the other six garrison commanders that it services in the Northeast to include Fort Hamilton, Picatinny Arsenal, Tobyhanna Army Depot, Stewart Air Base, Fort Devens and Natick Soldier Systems Center. Outside of giving sound advice in complex situations that includes the current COVID-19 pandemic, the West Point Department of Public Health mirrors what happens outside the gates with public health departments throughout the country.
“Our normal job encompasses environmental health inspections for restaurants on post, all our bathing facilities whether it be the lakes on the military reservation or the pools in Arvin gymnasium, doing vector surveillance and collection of mosquitos and ticks to see if they are carrying communicable disease … sexually transmitted infection prevention and classes, and overseeing all the CDCs and CYSs with medical assessments and inspections that occur there to protect the children in those age groups,” Greifenstein said.
Two other missions include occupational health, which Greifenstein said is taking care of government civilians and their medical care for return to duty, hiring or anything that may occur on the job. Lastly, industrial hygiene, he said, is taking care of workspaces for workplace hazards and putting in mitigations to lessen risks through inspections and recommending people for medical-screening programs.
“These last two years have been the hardest years of my military career”
The four missions that the Department of Public Health tackles on a normal basis have been complicated by two grueling crises within the last two years — environmental issues in privatized housing on West Point and the COVID-19 pandemic.
“Our mission is very diverse and complex, but then only further complexed by crisis,” Greifenstein said. “We have had two under my watch as the chief of the public health department with the environmental issues that were identified in privatized housing being the first.
“We had some issues, preventive maintenance was waning and some other things slid, so some moisture issues came to the forefront, some concerns about deteriorating lead-based paint, issues with brown or murky water, so we played a role working with (West Point) Garrison to understand the problem set and advising them from the public health side,” Greifenstein added.
If he thought that was going to be the biggest cross to bear in his career, a respiratory viral infection starting in China late in 2019 and working its way worldwide eventually to the United States made everything else pale in comparison.
“In March of this year came the COVID-19 pandemic, which none of us necessarily thought we’d see in our public health careers,” Greifenstein said. “We definitely played an integral role in helping advise commanders on how to go about navigating the public health emergency at hand and what we could do to set the conditions and the posture of this community to protect it against widespread infection.”
Greifenstein said everything was a very deliberate and measured process that took a lot of planning and quick action, including the Corps of Cadets not returning from spring break in mid-March and a good portion of the workforce working remotely. Also, one of among the many items public health is involved in, which became a buzzword within the community, was upping the health protection conditions (HPCON) of West Point.
“(HPCON) quickly elevated during the timeframe of mid-March through the end of April as the threat of widespread community-based infection for COVID-19 was very high in this area that was shown by the number of cases and fatalities across the region,” Greifenstein said. “Because of the actions we took on the installation, whether it be gate screenings to changing hours at locations, putting screening mechanisms at different locations, reducing the populations who could use the commissary and PX, face coverings, nonpharmaceutical interventions all across the installation helped stifle the infection and send it into decay here.”
At the start of COVID-19, it was recognized that if it hit West Point at the magnitude it was hitting off post or what was originally expected, the installation and KACH couldn’t handle the health threat. However, capacities, in the meantime, were being built to test, treat and monitor patients on the installation, Greifenstein said.
“We had to build the capacity here in house to take care of an advanced respiratory patient, so we built the capacity to monitor, which is Team COVID,” Greifenstein said. “That consists of restriction of movement, building up facilities that we could house people to isolate or quarantine them if we needed to remove them from the population to stifle infection.”
These events led to Buildings 785, 662 and 624 all being improved to help isolate or quarantine individuals depending on the needs. Team COVID expanded and branched to Team Trace and Team Clean to hit all aspects of trying to eliminate COVID-19.
“Team Trace has the ability to find primary contacts of known affected folks,” Greifenstein said. “If somebody is infected with COVID-19 and we’ve diagnosed them with it and tested positive, then Team Trace is deployed to find out who that infected person may have come in prolonged contact with … which allows us to find primary contacts who we would put in quarantine and the person who tested positive would go into isolation.”
The last component of the capacity to monitor is Team Clean, which is the competence of cleaning behind a known COVID-19 positive patient.
“Team Clean will respond within 24 hours and do a comprehensive cleaning behind that to break the secondary route of transmission of COVID-19, which is contact transmission when you touch a dirty surface, then touch your eyes, nose or mouth and then self-inoculate yourself with the virus,” Greifenstein said. “(In the end), we’re asking all individuals on post as part of the nonpharmaceutical interventions to be a first-line cleaner. Everybody is responsible for their own battlespace and they should be cleaning it consistently.”
Throughout this whole period, especially at the start of COVID-19, it has been a long, intense process for Greifenstein and the 40 members of his Public Health team on the seven installations they service, including the 19 members at West Point.
“It’s been an absolute sprint. It’s been long days and nights and easily been days as long as 12-to-14 hours of work especially at the beginning when we were trying to figure out what to do and how we were going to set the conditions and build those capacities to protect the installation,” Greifenstein said. “I can tell you out of my 24 years of service, these last two years have been the hardest years of my military career — from handling the housing issues alongside Col. Marson and handling COVID-19. It kept me as busy as I’ve ever been.”
The return of the cadets and training to maintain force health protection
As COVID-19 started slowly subsiding in the local region, in late May the USMA Class of 2020 returned to graduate. Greifenstein had a chance to speak to the graduating class during the commandant’s (Brig. Gen. Curtis Buzzard) leadership series, then continued for the classes participating in Cadet Basic Training and Cadet Field Training. He spoke to them about how to balance the risk to force and risk to mission in a post-COVID-19 environment with the use of nonpharmaceutical interventions to maintain force health protection.
“I wanted to not just focus on COVID-19, but also something called force health protection,” Greifenstein said. “It is understanding the medical threats that are at hand and mitigate the risk of those types of threats, whether it is malaria, cholera, dysentery or COVID-19. As leaders, they are responsible for the health of their force and they have to understand that if they don’t keep an eye on the ball when it comes to the health of their force, that disease non-battle injury (DNBI) can quickly diminish the force’s ability to get after the mission and reduce their effectiveness as a fighting force.”
Greifenstein spoke to the classes about the responsibilities concerning sanitation and hygiene of all Soldiers when taking lead of a platoon.
“It’s making sure (their Soldiers) are doing all the right things, whether you are at garrison or forward deployed in Asia or Africa, and you have to be cognizant of that,” Greifenstein said. “Sometimes, I don’t think it’s a lesson they learn until it’s too late and I wanted to make sure they got it before they went out (into the force), and COVID-19 was a perfect conduit to present them that.
“I was honored that Brig. Gen. Buzzard allowed me to speak to the (classes),” he added. “Hopefully, they took some good lessons learned and use them both now and in the future as Army leaders.”
The road ahead and a tip of the cap to the Public Health team
The road ahead will not include Greifenstein being knees deep into the public health venture as he is transitioning to become an instructor in the Department of Geography & Environmental Engineering. In the interim, Maj. Paul Ziegler, Greifenstein’s deputy chief, will become the chief until his replacement, Maj. Andrew Bigelow, arrives in late August.
While Greifenstein is moving on from day-to-day operations to work in GENE, he will still be involved as an APHEO and give guidance to commanders when needed during a public health emergency. During the last four-plus months, Greifenstein has had high praise for his team and the community for the resiliency they showed through the work, long hours and being disciplined through dramatic change.
“It showed the resiliency and ability for my team to adapt to very different day-to-day activities,” Greifenstein said. “We kind of put the other stuff aside to focus on COVID-19 because it was such a formidable medical threat. Also, what it really showed me about this community was from the military and civilian sides of the house was the ability for everybody to rally around the mission at hand, which was to protect the community and then transition into reopening and get back to mission.”
Greifenstein praised as he called it, “the sheer magnitude of officers and DOD civilians who came together to work COVID-19. It was incredible.”
“It didn’t matter what you did on this installation, the fight became COVID-19,” he said. “It goes to show West Point can do anything. We’ve been a leader in this fight. What we did here to set the conditions … we were the hardest hit area in the world, yet the infection rate on this installation was dramatically low even compared to outside the gates. That was all because of the work that everybody did.”
But what does that mean in the months ahead? Greifenstein didn’t want to be a buzzkill or kill joy as he said, but he foresees continuing nonpharmaceutical interventions, which primarily includes wearing face masks, social distancing, washing hands constantly and continuously cleaning workspaces because they have proven to work.
“What I’m hoping comes from all this is we become a healthier population in the way we go about our health and hygiene,” Greifenstein said. “People may live a little cleaner, become more cognizant about their hands and touching contact surfaces and keeping those contact surfaces clean.
“They may have a different mindset after all this regardless of COVID-19 or not,” he concluded. “But we will get beyond this and we will be better for it.”
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