An Outbreak of Covid-19 on an Aircraft Carrier | NEJM

As winter approaches we are told it will be a 'dark' season due to the third wave of COVID19 pandemic Some of us may have forgotten the Outbreak of Covid-19 on the Aircraft Carrier, U.S.S Theodore Roosevelt, CVN 71

Unknowingly and without much warning CVN 71 would become a laboratory to study the epidemiology of a novel Coronavirus,  COVID 19. The naval vessel, with a shipboard complement of approximately 6000 sailors who were mostly young and between the ages of 18 and 35 had been docked in Southeast Asia and set out to sea at the first indication of the Covid19 outbreak in Asia.. Immediately upon leaving port. the crew was tested for coronavirus and found to be negative.  Several days later at sea personnel became ill and were tested again.

BACKGROUND

An outbreak of coronavirus disease 2019 (Covid-19) occurred in the U.S.S. Theodore Roosevelt, a nuclear-powered aircraft carrier with a crew of 4779 personnel.

METHODS

We obtained clinical and demographic data for all crew members, including results of testing by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). All crew members were followed up for a minimum of 10 weeks, regardless of test results or the absence of symptoms.

RESULTS

The crew was predominantly young (mean age, 27 years) and was in general good health, meeting U.S. Navy standards for sea duty. Over the course of the outbreak, 1271 crew members (26.6% of the crew) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by rRT-PCR testing, and more than 1000 infections were identified within 5 weeks after the first laboratory-confirmed infection. An additional 60 crew members had suspected Covid-19 (i.e., the illness that met the Council of State and Territorial Epidemiologists clinical criteria for Covid-19 without a positive test result). Among the crew members with the laboratory-confirmed infection, 76.9% (978 of 1271) had no symptoms at the time that they tested positive and 55.0% had symptoms develop at any time during the clinical course. Among the 1331 crew members with suspected or confirmed Covid-19, 23 (1.7%) were hospitalized, 4 (0.3%) received intensive care, and 1 died. Crew members who worked in confined spaces appeared more likely to become infected.

CONCLUSIONS

SARS-CoV-2 spread quickly among the crew of the U.S.S. Theodore Roosevelt. The transmission was facilitated by close-quarters conditions and by asymptomatic and presymptomatic infected crew members. Nearly half of those who tested positive for the virus never had symptoms.

It is interesting in lieu of the present explosion of reported positive Covid 19 tests of over 100,000 cases/day if these statistics are carried forward today, only 50,000 are symptomatic from COVID 19. The reliability of the nasal swab test method has been called into question. Testing procedures have evolved in the past 9 months to included PCR identification, a rapid test, and also purported to be more accurate.  

                                                         @elonmusk

Currently, Elon Musk stated he had four tests in one day and reported two were positive and two were negative. He did not state if the tests were done at the same facility or whether he was symptomatic.

Authenticity of RT-PCR

Musk's statement calling the tests "bogus" has once again raised concerns about the authenticity of the PCR tests that are key to isolating the COVID-19 positive cases in order to curb the transmission of the disease. However, as per a report by Healthline, experts say the current diagnostic tests for the new coronavirus are highly accurate, but the antibody tests are not as trustworthy. The typical swab tests are 100 percent effective, and while the PCR offers the capacity to detect RNA in minute quantities, whether that RNA represents infectious virus may not be clear, according to scientists. Testing makes the enemy visible, Dr. Emily Volk, an assistant professor of pathology at the University of Texas-Health in San Antonio and president-elect of the College of American Pathologists (CAP) reportedly said. She added that the RT-PCR nasopharyngeal tests should be conducted 8 days after suspected exposure for more accuracy. 

For additional drama the incident created a wave of dismissals and resignations in the U.S. Navy.  The report of the outbreak was transmitted via insecure channels rather than through the routine chain of command. The ship's commander, CAPT, Brett Crozier, pleaded for help from the Navy, sending an e-mail to ten Pacific Fleet admirals and captains, including his superior, the commander of Carrier Strike Group-9, and the commander of the Pacific Fleet, requesting that his ship be evacuated.[50][51][52] Crozier was relieved of command for not reporting through the chain of command.  Amidst this Crozier was then reinstated due to congressional action, and finally relieved of his command but allowed to remain in the Navy. The events rapidly became politicized.

On April 2, 2020, while serving as Acting Secretary of the Navy, Thomas Modly dismissed Captain Crozier from command of the Theodore Roosevelt. Modly said he had lost confidence in Crozier's judgment because he claimed the letter went against the advice of Admiral Michael M. Gilday, Chief of Naval Operations, who argued that usual Navy procedures would require an investigation before such an action.[20]. 

The politicization of the Covid 19 pandemic has caused real harm through real or imagined threats to health and national security

Without question, this has created confusion and a lack of trust toward federal representatives.  Most citizens trust on the recommendations of public health officials.

 NEJM