“COVID is coming,” said Col. Tom Pugsley, commander, U.S. Army Garrison- Kwajalein Atoll, at a recent town hall meeting. “I would not be doing you any justice if I sugar-coated (the information). Knowledge is power and knowing is important so I’m not going to tell you everything is going to be okay.”
While it was understood that COVID-19 would eventually come to the atoll, Pugsley said, the Kwajalein community can now do a lot of planning and preparation to mitigate the impact of COVID once it enters this community.
“Once we do get community spread, which we think will be soon after implementation of the five-day Restriction of Movement on the RMI side, at some point after that we expect it to leech into the community,” Pugsley said. “There’s going to be a building period of about a couple weeks where one case will spread to two, four or six until we get a spike period of 21-35 days. We will see a vast spike of cases within the community and then it will level off over a couple weeks, and then burn off after about a month.”
Pugsley said that these are the same types of spikes we’ve seen many times back in the States. The difference here is that we have a community which, for the most part, has never been exposed.
“The good news is we’ve not been exposed to the really bad variants,” Pugsley said. “As you know, viruses try to infect as many people as possible, and tries not to kill them because that would not make for a very smart virus. This is why you see the impacts in hospitalizations and deaths across the U.S. drastically decrease with the various variants as time goes on.”
COVID’s Impact in the RMI
The RMI is a different population than what we have. The RMI is extremely densely packed so we will see fast community spread, for the most part more pre-existing conditions and medically vulnerable population than here on Kwaj. With that we have a new variant across the U.S. You are seeing spikes much more contagious.
With Omicron, for every person who got sick, they affected three to four people; with the new variant it’s 18.
The medical team estimates we are looking at infection rates of 15 - 30 percent with most numbers spread out over the entire peak. Based on our population, we are looking at anywhere from 225 - 450 cases. If you look at the average numbers across the U.S. that’s 11-20 hospitalizations and a lesser number of ventilators. We have some advantages compared to a lot of the analysis. “The vaccination rate in the U.S. is 34 percent while ours is 85 percent. The RMI’s rate is even higher, so we have that going in our favor,” said Pugsley.
Also, medications have recently come out that will drastically decrease the impact of symptomatic patients by about 90 percent. With a combination of high vaccination rates, a later variant of COVID, and medication, we can reduce the impact of the spikes when it hits.
Flattening the curve – hopefully we will do it in three to four weeks, and not two years like we saw back in the States. We have very limited medical capabilities to the point we will probably close down the clinic once we have two patients on ventilators. We need to do our best to mitigate the extreme cases and spread that out over the curve when it eventually hits here.
What can we do?
Follow CDC guidelines, https://www.cdc.gov of good personal hygiene, washing hands often, using hand sanitizer and wearing masks. Try to minimize exposure. We’re not cancelling school; we’re not going to overreact like we saw back in the States.
At some point we’ll have to consider when we wear masks; at some point we will have to consider our telework policy. That’s difficult. Early on, most Army organizations closed shop. We don’t have that flexibility. We have a mission that must be completed. How do we work around these levels of restrictions for COVID to try to maintain safety in the community but still continue to deliver the services that our mission depends on?
A lot of that is on the contractor—how we keep serving food and trash picked up, providing power to the installation. Some organizations have more flexibility. A good chunk of my team can do their mission from home. It’s not optimal but I can do it for a little bit of time.
We will start engaging with all the stakeholders across the installation to determine what that looks like for everyone and communicate it so everyone knows what to expect, what their roles and responsibilities are going to be to avoid any last minute panic.
The best-case scenario is that we have three to four months to prepare for this. Worst-case scenario is a mistake is made and someone who has a border case gets out and we’re dealing with this sooner than later. Hopefully that doesn’t happen. We’ve been successful with our quarantine process for the past two years so the odds are low but they are not insignificant.
We’ve had about 50 border cases between the RMI and U.S. in quarantine with no hospitalizations.
Here are some things to think about going forward.
What can you do now? First and foremost, the most important thing you can do to mitigate risk is to get vaccinated. Believe it or not, there are 200+ contractors on this installation not vaccinated. Hopefully, this announcement that COVID is coming, it’s now only a matter of time that spurs some action out of some people. Contact firstname.lastname@example.org to get vaccinated.
Impacting the medical facility. What I don’t want is everyone who gets the sniffles, a headache or a sore throat to run to the clinic. You can order free at-home antigen tests at https://www.covid.gov/tests.
Wash your hands. Stock up on some masks and hand sanitizer. Please don’t hoard. Think about your neighbor. Preparing is smart but don’t over-prepare.
Have a conversation with your family on what they can expect. It’s important to be aware about what is likely to happen and deal with it now rather than reacting later. Be proactive. What’s the plan if one of your children gets sick? What if a family member gets sick? Who is staying home? Have you deconflicted with your work? What do you do at work if a colleague gets sick and has to stay home? Who is picking up that slack? It’s all about planning.
Do you have someone who can help you out if someone in your family tests positive? Someone who can pick up stuff for you and have it delivered?
Families should have a mutual agreement to help each other out.
At some point I may have to restrict dining at the Zamperini or spread out tables, extend the hours to rotate people through. Additionally, I may have to limit the number of people. I’m hoping this doesn’t have to happen but I have to plan for it all the same. Prepare. Plan. Pay attention.
Questions and Answers
What’s the expectation here if someone has COVID?
I hope the majority of people who get COVID aren’t even aware of it. But, we have to consider the worst case scenario. 1.1 million people have died from COVID-related illness in the U.S. With the new variant, there is an uptick in hospitalizations and deaths as well, nowhere near the spikes that we saw last January. But my expectation is somewhere in the middle.
Do I think that we’re going to get through this with no one extremely sick? Odds would say no.
It is possible we are going to get some extreme cases. It’s very likely we will have to medically evacuate people and it’s possible people will die.
There is a significant emotional event coming to this community. It’s something that the rest of the U.S. and world have already dealt with and have been dealing with for two years and in a lot of ways, are now desensitized to it. I do think with good planning, preparation and communication, time is what we have right now. We can set ourselves to get through it the best way possible and come out the other end hopefully a little less worse for wear.
When a PCR shows positive, how will we handle it?
Antigen tests are very rarely inaccurate. You have to be contagious, shedding the virus actively, to trigger the antigen test. The PCR is notorious for having false positives. You can test positive on a PCR up to 90 days after and it has a cyclical process where you can take it and test negative and take it a week later and test positive.
When we get a PCR positive, especially if we know they’ve had COVID in the last 30 to 60 days, we follow it up immediately with an antigen test.
If that is negative, 24 hours later we do another. With two negative antigen tests following a positive PCR, you are considered a historical case and you’re released (from quarantine). If you are positive on an antigen test, then you are truly positive. That’s where you earn your extra time in quarantine.
Is it true that it will be mandatory to be vaccinated to enter the RMI in October?
The RMI has made it mandatory for their citizens to be vaccinated to enter the country over the past year. The RMI understands they cannot enforce a rule that I legally cannot uphold. I cannot legally mandate people to be vaccinated, other than the military.
Meanwhile, most tenant units and contractors are requiring vaccinations for their employees.
Fully vaccinated. What does that mean?
Two shots are fully vaccinated. I cannot enforce the booster shots but I can encourage it.
Do we still need to show proof of vaccinations at the airport?
That is something I can enforce. It’s a requirement to have all the other vaccinations to come to Kwaj. COVID is so new and there is so much contention and friction over it, it’s holed up in court.
Are there enough COVID medications here?
We did a test order a few weeks ago for a base level amount and made a larger order last week. I’m really confident in the next few weeks we will have what we need.
If I test positive on a home test kit, what do I do?
The medical staff is coming up with procedures to self-triage. It will be clear on when to go to the hospital.
What will be the status of United flights once the borders open?
As of now, we currently limit flights to one United per week. We do not plan to open up any other flights than the one per week. The reason is for logistics. The process I have goes like clockwork but having it increased will drastically increase the odds of us making a mistake. For the interim, we will only offer one tranche per week due to a limit on housing.
I can only bring in a certain amount of people per week. The quarantine process and tranche process remain in effect for the foreseeable future even if United opens to three flights a week.
Will the number of people on United be increased after October 1?
Yes. The limiting factor will be United and housing. Housing allows 50 people per week into quarantine but I doubt that we will fill a United flight. We are going to align ourselves with the rest of the world and live with COVID.
Regarding transportation from the Hale Koa to Hickam AFB, can we get a bus instead of individual cabs to minimize exposure to the virus?
The risk of exposure in a cab is small. The cab company we contract is a COVID-safe company. We have left that up to the contractor to figure out the best mechanism to get passengers to Hickam. The risk is not at the terminal or on the cab ride. The risk is before you enter quarantine (in Hawaii) and at the airport.
Starting August 1, all contractors must fly on United to come here. The ATI will go back to being for military and their dependents, and retirees only.
Are we prepared to keep the schools open on Kwajalein?
Vectrus is working with the schools to come up with their plan. We are not going to overreact.
The plan is that school will open as designed. Once we start closing schools, it impacts the community. Who will stay home with the kids?
What’s the impact to their education? Our goal is to continue to provide while mitigating risk. We are looking hard at this and will have a plan in the next few weeks.
We have a lot of Marshallese workforce employees at Nan, Inc. Has any thought been given to in the case of COVID spread, transportation from Ebeye to Kwaj over the ferry system and how it will be affected?
A much more complicated problem is with the critical workforce that is the Marshallese workers. We have 1,108 Marshallese who work for the garrison.
This place will not operate without them. We are working through what happens once COVID hits Ebeye and how will that impact operations. We are also working on how the tenants will continue to operate when a good chunk of their workforce is probably going to be at risk?
Ten percent of Ebeye works on this installation and another 30 to 40 percent are dependent on this installation.
Are you informing the RMI about this Town Hall?
We will work with KALGOV to inform the Marshallese workforce. In a lot of ways, they are better prepared. Their hospital is much more robust, they have more beds and ventilators.
I’m a retiree and a contractor. After August 1, how hard will it be for me to fly on the ATI for Space A?
Leaving is easy. You just have to be on a tranche to return. Work with your human resources department to get onto a tranche.