1 00:00:00,140 --> 00:00:02,280 think about organizing to get after 2 00:00:02,280 --> 00:00:04,530 this problem set after I give each of 3 00:00:04,530 --> 00:00:06,530 the panelists a few minutes to talk 4 00:00:06,530 --> 00:00:08,697 about the starting position , I'll ask 5 00:00:08,697 --> 00:00:10,474 a few more questions to get the 6 00:00:10,474 --> 00:00:12,474 conversation started . My objective 7 00:00:12,474 --> 00:00:13,919 here is to really make it 8 00:00:13,919 --> 00:00:15,919 conversational . This is not just a 9 00:00:15,919 --> 00:00:18,141 straight Q and A . But hopefully we can 10 00:00:18,141 --> 00:00:20,252 have some back and forth because many 11 00:00:20,252 --> 00:00:22,419 of these folks work together regularly 12 00:00:22,419 --> 00:00:24,641 and collaborated and solving problems . 13 00:00:24,641 --> 00:00:24,620 So hearing some about that I think will 14 00:00:24,620 --> 00:00:27,010 be a great uh sort of addition to the 15 00:00:27,010 --> 00:00:30,500 conversation here . So I know that all 16 00:00:30,500 --> 00:00:32,667 the biographies of our speakers are in 17 00:00:32,667 --> 00:00:34,889 the package that you have and obviously 18 00:00:34,889 --> 00:00:37,000 these are well known senior experts , 19 00:00:37,000 --> 00:00:39,111 but I am really pleased to be able to 20 00:00:39,111 --> 00:00:41,278 have on the stage with me . Lieutenant 21 00:00:41,278 --> 00:00:43,389 General Ron place who is the director 22 00:00:43,389 --> 00:00:45,500 of the Defense Health Agency where he 23 00:00:45,500 --> 00:00:47,722 has responsibility for making sure that 24 00:00:47,722 --> 00:00:49,889 there is , you know , combat readiness 25 00:00:49,889 --> 00:00:51,889 amongst the services and across the 26 00:00:51,889 --> 00:00:54,111 force as well as directing the civilian 27 00:00:54,111 --> 00:00:56,056 component of the civilian military 28 00:00:56,056 --> 00:00:58,580 health team . I also have Bruce 29 00:00:58,580 --> 00:01:00,636 Gillingham , who is the Chief of the 30 00:01:00,636 --> 00:01:02,691 Bureau of Medicine and Surgery , the 31 00:01:02,691 --> 00:01:04,913 surgeon general of the Navy . Uh and in 32 00:01:04,913 --> 00:01:06,802 that role he is the chief medical 33 00:01:06,802 --> 00:01:08,969 advisor to the Secretary of the Navy , 34 00:01:08,969 --> 00:01:08,510 the commandant of the Marine Corps and 35 00:01:08,510 --> 00:01:10,621 the Chief of Naval operations . And I 36 00:01:10,621 --> 00:01:12,560 also have on this panel , uh Rear 37 00:01:12,560 --> 00:01:14,393 Admiral Dana thomas , who is the 38 00:01:14,393 --> 00:01:16,616 director of health Safety and work life 39 00:01:16,616 --> 00:01:18,782 at the U . S . Coast Guard , the chief 40 00:01:18,782 --> 00:01:20,671 medical officer , aka the surgeon 41 00:01:20,671 --> 00:01:20,650 general of the Coast Guard and like all 42 00:01:20,650 --> 00:01:22,761 physicians , dentists and pharmacists 43 00:01:22,761 --> 00:01:24,983 in the U . S . Coast Guard . She's also 44 00:01:24,983 --> 00:01:26,872 by definition of US public health 45 00:01:26,872 --> 00:01:28,983 service officer . So with that I look 46 00:01:28,983 --> 00:01:30,928 forward to a robust conversation . 47 00:01:30,928 --> 00:01:33,094 There are question cards on your table 48 00:01:33,094 --> 00:01:34,983 available to you . So if you have 49 00:01:34,983 --> 00:01:37,150 questions you'd like to ask any of the 50 00:01:37,150 --> 00:01:36,990 panelists or potentially all the 51 00:01:36,990 --> 00:01:39,160 panelists , please write those down . 52 00:01:39,160 --> 00:01:41,160 There are people here from the Navy 53 00:01:41,160 --> 00:01:43,160 League , he will be circulating and 54 00:01:43,160 --> 00:01:45,216 picking up those questions and bring 55 00:01:45,216 --> 00:01:47,438 them up to me on the stage . And I want 56 00:01:47,438 --> 00:01:47,400 to make sure that I leave time for for 57 00:01:47,400 --> 00:01:49,511 plenty of Q and A . From the audience 58 00:01:49,511 --> 00:01:51,344 because you're here to take full 59 00:01:51,344 --> 00:01:53,511 advantage of the team on the stage and 60 00:01:53,511 --> 00:01:55,400 I want to make sure that we leave 61 00:01:55,400 --> 00:01:57,567 enough space for that . So with that , 62 00:01:57,567 --> 00:01:59,789 let me turn it over to to general place 63 00:01:59,789 --> 00:02:01,844 for your perspective on how this all 64 00:02:01,844 --> 00:02:03,900 looked at the beginning and what the 65 00:02:03,900 --> 00:02:06,067 mission was that you were pursuing and 66 00:02:06,067 --> 00:02:08,178 how that got underway . Sure , thanks 67 00:02:08,178 --> 00:02:10,630 dr Thompson . So I think like any sort 68 00:02:10,630 --> 00:02:13,750 of a rising middle problem , you have 69 00:02:13,750 --> 00:02:16,690 to frame the problem itself shape and 70 00:02:16,690 --> 00:02:18,857 understand that , that sort of thing . 71 00:02:18,857 --> 00:02:20,801 So the things that we were talking 72 00:02:20,801 --> 00:02:23,023 about collectively so I'm going to talk 73 00:02:23,023 --> 00:02:22,760 about it but certainly conversations 74 00:02:22,760 --> 00:02:24,920 with Dr Willingham and the other 75 00:02:24,920 --> 00:02:27,142 surgeons general happened . But what is 76 00:02:27,142 --> 00:02:30,000 it Right ? How do you diagnose it ? How 77 00:02:30,000 --> 00:02:32,222 is it transmitted ? How can you protect 78 00:02:32,222 --> 00:02:34,556 yourself from it ? How can you treat it ? 79 00:02:34,556 --> 00:02:36,778 How can you understand it ? And then do 80 00:02:36,778 --> 00:02:38,889 we have the right systems in place to 81 00:02:38,889 --> 00:02:41,111 help us at an individual location or an 82 00:02:41,111 --> 00:02:43,111 individual person or collectively ? 83 00:02:43,111 --> 00:02:44,944 Across the service or across the 84 00:02:44,944 --> 00:02:44,840 Department of Defense ? How can we 85 00:02:44,840 --> 00:02:47,007 understand from a data perspective and 86 00:02:47,007 --> 00:02:49,920 as we looked around um what we thought 87 00:02:49,920 --> 00:02:51,864 we had and what we needed were not 88 00:02:51,864 --> 00:02:53,920 necessarily the right thing . So the 89 00:02:53,920 --> 00:02:56,142 initial elements of of what we tried to 90 00:02:56,142 --> 00:02:58,730 do was how can we better understand it ? 91 00:02:58,730 --> 00:03:01,008 So what are the right diagnostic tools ? 92 00:03:01,008 --> 00:03:04,220 I'll give you a data point In pick a 93 00:03:04,220 --> 00:03:07,560 date middle of February of 2020 , 94 00:03:08,020 --> 00:03:12,010 There were 11 laboratories In 95 00:03:12,010 --> 00:03:14,066 the Department of Defense that could 96 00:03:14,066 --> 00:03:17,900 diagnose COVID-11 . I love 97 00:03:17,900 --> 00:03:21,550 it . And by the summer 98 00:03:21,550 --> 00:03:24,830 of last year was 130 by the fall of 99 00:03:24,830 --> 00:03:27,052 last year , 150 I think . As of today , 100 00:03:27,052 --> 00:03:29,550 it's 177 something along those lines . 101 00:03:29,550 --> 00:03:31,717 So , I mean , the whole idea of do you 102 00:03:31,717 --> 00:03:33,940 even know what you know it was no , we 103 00:03:33,940 --> 00:03:36,320 didn't . Information just wasn't coming 104 00:03:36,320 --> 00:03:38,542 to us . And in a number of other things 105 00:03:38,542 --> 00:03:40,900 like All right , what do you do to 106 00:03:40,910 --> 00:03:43,077 protect yourselves ? Doctor Gillingham 107 00:03:43,077 --> 00:03:45,400 has some great great comments on body 108 00:03:45,400 --> 00:03:47,456 armor and what that looks like . And 109 00:03:47,456 --> 00:03:49,567 I'm guessing he's going to talk about 110 00:03:49,567 --> 00:03:51,733 so I'm not going to . But But what are 111 00:03:51,733 --> 00:03:53,900 the personal protective equipment that 112 00:03:53,900 --> 00:03:53,830 we have And how do we normally do that 113 00:03:53,830 --> 00:03:56,260 for biological agents ? And what are in 114 00:03:56,260 --> 00:03:58,427 hospital or in clinic supplies of what 115 00:03:58,427 --> 00:04:00,538 are the stockpile supplies ? What are 116 00:04:00,538 --> 00:04:02,427 the rules for getting them out of 117 00:04:02,427 --> 00:04:04,316 stockpiles ? How do we share them 118 00:04:04,316 --> 00:04:06,593 across the the entire federal response ? 119 00:04:06,593 --> 00:04:08,760 And what are the gates that we give as 120 00:04:08,760 --> 00:04:10,982 advice to the secretary defense when he 121 00:04:10,982 --> 00:04:13,149 decides what to do ? So it's all those 122 00:04:13,149 --> 00:04:15,093 sort of the skeleton of what's the 123 00:04:15,093 --> 00:04:18,080 global plan for it . And then how do 124 00:04:18,080 --> 00:04:20,840 you understand it ? And finally , you 125 00:04:20,840 --> 00:04:22,896 know , what's the treatment strategy 126 00:04:22,896 --> 00:04:25,173 people are are being diagnosed with it . 127 00:04:25,173 --> 00:04:27,340 And in general , when you don't know , 128 00:04:27,340 --> 00:04:29,451 we call it supportive care , in other 129 00:04:29,451 --> 00:04:31,618 words , to keep them alive . So I ? Ve 130 00:04:31,618 --> 00:04:34,410 therapies , breathing machines , that 131 00:04:34,410 --> 00:04:36,521 sort of thing to try to help people . 132 00:04:36,521 --> 00:04:39,020 But intuitively , lots of great 133 00:04:39,020 --> 00:04:40,909 research , some of it done in the 134 00:04:40,909 --> 00:04:43,131 Department of Defense , some of it done 135 00:04:43,131 --> 00:04:45,298 in nonfederal organizations . Academic 136 00:04:45,298 --> 00:04:47,409 locations et cetera . Were constantly 137 00:04:47,409 --> 00:04:50,040 pushing forward what's known what's not 138 00:04:50,040 --> 00:04:52,262 known what we thought to be true . What 139 00:04:52,262 --> 00:04:54,484 can we prove ? What was actually proven 140 00:04:54,484 --> 00:04:56,651 not to be true those sorts of things . 141 00:04:56,651 --> 00:04:58,950 Uh And so within about a month experts 142 00:04:58,960 --> 00:05:01,430 across the entire D . O . D . Workforce 143 00:05:01,430 --> 00:05:03,486 within the D . H . A . The service's 144 00:05:03,486 --> 00:05:05,430 uniformed services University very 145 00:05:05,430 --> 00:05:07,541 rapidly developed a clinical practice 146 00:05:07,541 --> 00:05:09,652 guidelines to try to help us sort all 147 00:05:09,652 --> 00:05:11,763 that out . It took about five days to 148 00:05:11,763 --> 00:05:13,770 write at 70 pages for everyone to 149 00:05:13,770 --> 00:05:15,992 understand . This is the knowledge that 150 00:05:15,992 --> 00:05:17,826 we have now . We're currently on 151 00:05:17,826 --> 00:05:19,603 version seven of those clinical 152 00:05:19,603 --> 00:05:21,548 practice guidelines that went from 153 00:05:21,548 --> 00:05:23,650 whatever . The first one was 60 70 154 00:05:23,650 --> 00:05:25,761 pages to now . A little bit more than 155 00:05:25,761 --> 00:05:27,428 200 pages . It's not just for 156 00:05:27,428 --> 00:05:29,206 physicians it's for respiratory 157 00:05:29,206 --> 00:05:31,428 therapists , iCU nurses , ward nurses , 158 00:05:31,428 --> 00:05:33,539 logistics , teammates , everything so 159 00:05:33,539 --> 00:05:35,483 that we can better understand . So 160 00:05:35,483 --> 00:05:37,594 really it's it's how do you go from a 161 00:05:37,594 --> 00:05:39,650 almost everything unknown to as many 162 00:05:39,650 --> 00:05:41,706 things as possible known and then at 163 00:05:41,706 --> 00:05:43,483 echelon , what you need to know 164 00:05:43,483 --> 00:05:45,594 throughout it to be able to get there 165 00:05:45,594 --> 00:05:47,706 and then we can talk more about where 166 00:05:47,706 --> 00:05:47,420 we've built from that . But that's 167 00:05:47,420 --> 00:05:49,531 where we started . Excellent . Thanks 168 00:05:49,531 --> 00:05:51,476 very much . Admiral Gillingham . I 169 00:05:51,476 --> 00:05:53,587 welcome you to begin to tell us about 170 00:05:53,587 --> 00:05:55,587 the Navy perspective on this in the 171 00:05:55,587 --> 00:05:57,809 starting position . Obviously there was 172 00:05:57,809 --> 00:06:00,031 a lot of attention to what was going on 173 00:06:00,031 --> 00:06:02,198 in the Navy in the early days . So let 174 00:06:02,198 --> 00:06:01,940 me turn it over you to set the scene 175 00:06:01,940 --> 00:06:04,162 and help us understand what that looked 176 00:06:04,162 --> 00:06:06,384 like at the early stages . Okay , thank 177 00:06:06,384 --> 00:06:08,718 you dr , Thompson . And uh first of all , 178 00:06:08,718 --> 00:06:10,884 I'd just like to thank the Navy League 179 00:06:10,884 --> 00:06:13,051 for this invitation to be here with my 180 00:06:13,051 --> 00:06:15,273 esteemed colleagues to discuss . Really 181 00:06:15,273 --> 00:06:17,329 what was extremely challenging issue 182 00:06:17,329 --> 00:06:18,940 continues to be an extremely 183 00:06:18,940 --> 00:06:20,884 challenging issue . And really the 184 00:06:20,884 --> 00:06:22,940 response to COVID-19 has just been a 185 00:06:22,940 --> 00:06:24,940 continuous , high velocity learning 186 00:06:24,940 --> 00:06:27,260 both scientifically and operationally . 187 00:06:27,840 --> 00:06:31,260 Um and at its essence , all of us 188 00:06:31,260 --> 00:06:33,093 exists to provide force , health 189 00:06:33,093 --> 00:06:35,160 protection . And so this has been 190 00:06:35,170 --> 00:06:38,380 really an extreme example of protecting 191 00:06:38,380 --> 00:06:40,380 the force so that they can do their 192 00:06:40,380 --> 00:06:42,547 critically important job to defend our 193 00:06:42,547 --> 00:06:45,250 liberties . One of our one of our real 194 00:06:45,260 --> 00:06:47,490 secret weapons in that fight our 195 00:06:47,500 --> 00:06:50,120 preventive medicine teams , public 196 00:06:50,120 --> 00:06:52,460 health experts . They often toil in the 197 00:06:52,460 --> 00:06:54,516 shadows and don't get the really the 198 00:06:54,516 --> 00:06:56,790 recognition that they deserve . So , so 199 00:06:56,790 --> 00:06:58,568 to give them some well deserved 200 00:06:58,568 --> 00:07:00,623 recognition and to help the audience 201 00:07:00,623 --> 00:07:02,568 understand the role they play on a 202 00:07:02,568 --> 00:07:04,790 daily basis . We have a short video for 203 00:07:04,790 --> 00:07:07,650 you . Mhm . 204 00:07:09,440 --> 00:07:13,400 On march 20th 2020 the Navy embarked a 205 00:07:13,400 --> 00:07:15,567 forward deployable preventive medicine 206 00:07:15,567 --> 00:07:18,540 unit F . D . P . M . You aboard ships 207 00:07:18,550 --> 00:07:21,850 of the seventh Fleet . Its mission To 208 00:07:21,850 --> 00:07:24,240 help combat the risk of and provide 209 00:07:24,240 --> 00:07:27,060 laboratory batch testing for COVID-19 . 210 00:07:27,940 --> 00:07:30,162 The role of preventive medicine units , 211 00:07:30,162 --> 00:07:33,360 PMU . S in this pandemic is nothing new . 212 00:07:34,240 --> 00:07:37,310 As far back as World War Navy 213 00:07:37,310 --> 00:07:39,280 laboratory and sanitation units , 214 00:07:39,290 --> 00:07:42,510 forerunners of the PM US were deployed 215 00:07:42,510 --> 00:07:45,160 aboard ships and to shore facilities to 216 00:07:45,160 --> 00:07:47,271 perform a series of public health and 217 00:07:47,271 --> 00:07:49,270 preventive medicine duties such as 218 00:07:49,280 --> 00:07:51,390 fighting outbreaks of meningitis and 219 00:07:51,390 --> 00:07:54,270 influenza under the administrative 220 00:07:54,270 --> 00:07:56,326 control of the Navy and Marine Corps 221 00:07:56,326 --> 00:07:58,103 Public Health Center in Norfolk 222 00:07:58,103 --> 00:08:00,400 Virginia . The Navy operates four of 223 00:08:00,400 --> 00:08:02,990 these units in Norfolk san Diego , 224 00:08:03,180 --> 00:08:05,360 Pearl harbor and rhoda spain . 225 00:08:06,840 --> 00:08:09,460 These units work hard to identify 226 00:08:09,660 --> 00:08:12,320 evaluate and monitor diseases , 227 00:08:12,600 --> 00:08:15,500 injuries and hazards in environments 228 00:08:15,500 --> 00:08:17,722 that threaten the health of deployed US 229 00:08:17,722 --> 00:08:19,850 forces And to other countries when 230 00:08:19,850 --> 00:08:21,890 deployed on humanitarian missions . 231 00:08:21,900 --> 00:08:24,810 Whether the fight against COVID-19 or 232 00:08:24,810 --> 00:08:26,921 ensuring the Navy is prepared for the 233 00:08:26,921 --> 00:08:29,970 biosphere , the US Navy will remain all 234 00:08:29,970 --> 00:08:32,390 the more resilient and stronger because 235 00:08:32,390 --> 00:08:34,168 of the vital services that Navy 236 00:08:34,168 --> 00:08:36,279 medicines , preventive medicine units 237 00:08:36,279 --> 00:08:38,960 continue to play each and every day . 238 00:08:39,340 --> 00:08:41,850 Mhm . Yeah . Mhm . 239 00:08:46,340 --> 00:08:50,300 Yeah . Who ? I hope you enjoy 240 00:08:50,300 --> 00:08:52,580 that ? And I'd like to thank our uh you 241 00:08:52,580 --> 00:08:55,300 met historian Mr Andre So Bochenski and 242 00:08:55,300 --> 00:08:57,780 our visual information team for putting 243 00:08:57,780 --> 00:08:59,836 that together to help us kind of set 244 00:08:59,836 --> 00:09:01,836 the stage for the challenge that we 245 00:09:01,836 --> 00:09:04,020 faced . And you know that challenge 246 00:09:04,020 --> 00:09:05,853 extended beyond the Force health 247 00:09:05,853 --> 00:09:08,390 Protection mission because we were also 248 00:09:08,390 --> 00:09:11,620 involved in defence support of civilian 249 00:09:11,620 --> 00:09:14,160 authorities like the other services uh 250 00:09:14,170 --> 00:09:16,392 and and learn to learn quite a bit from 251 00:09:16,392 --> 00:09:18,640 that that were actually able to now 252 00:09:18,640 --> 00:09:21,040 blend in and we can talk about , you 253 00:09:21,040 --> 00:09:23,310 know , during the question session , 254 00:09:23,320 --> 00:09:26,290 some of the , some of the future future , 255 00:09:26,300 --> 00:09:29,290 you know , aspects of that . But in 256 00:09:29,290 --> 00:09:31,180 addition to providing that public 257 00:09:31,180 --> 00:09:33,347 health and scientific support to the , 258 00:09:33,347 --> 00:09:35,710 to the fleet in the marine Corps , you 259 00:09:35,710 --> 00:09:37,950 know , we're doing also deploying teams 260 00:09:37,950 --> 00:09:40,670 actively . So certainly the marquis 261 00:09:40,670 --> 00:09:42,810 deployment was , you know , usns 262 00:09:42,810 --> 00:09:45,032 comfort pulling into the harbor and new 263 00:09:45,032 --> 00:09:48,190 york providing badly needed support 264 00:09:48,200 --> 00:09:51,320 initially intended to be a to offload 265 00:09:51,320 --> 00:09:53,431 the hospital so that they could focus 266 00:09:53,431 --> 00:09:55,542 on Covid just didn't have that luxury 267 00:09:55,542 --> 00:09:57,653 given the extent of the infections at 268 00:09:57,653 --> 00:09:59,764 that time . And so comfort , which is 269 00:09:59,764 --> 00:10:01,709 designed as a combat casualty care 270 00:10:01,709 --> 00:10:03,931 platform , transformed itself literally 271 00:10:03,931 --> 00:10:05,987 overnight into an infectious disease 272 00:10:05,987 --> 00:10:08,500 hospital and did a remarkable job , you 273 00:10:08,500 --> 00:10:10,890 know , pitching in to take care of very 274 00:10:10,890 --> 00:10:14,350 critically ill Covid patients . Um , 275 00:10:14,410 --> 00:10:17,280 may also not be aware though that in 276 00:10:17,280 --> 00:10:19,224 addition we have our expeditionary 277 00:10:19,224 --> 00:10:21,002 medical facilities which is our 278 00:10:21,002 --> 00:10:23,002 contribution to roll three casually 279 00:10:23,002 --> 00:10:25,280 care . They have medical components . 280 00:10:25,290 --> 00:10:27,980 Uh , we were able early on to recognize 281 00:10:27,980 --> 00:10:30,147 that it wasn't the equipment from that 282 00:10:30,147 --> 00:10:32,202 we needed , we needed the people and 283 00:10:32,202 --> 00:10:34,147 the expertise . And so are medical 284 00:10:34,147 --> 00:10:36,313 experts are infectious disease Doctors 285 00:10:36,313 --> 00:10:38,480 are critical care doctors , nurses are 286 00:10:38,480 --> 00:10:40,480 respiratory technicians assigned to 287 00:10:40,480 --> 00:10:42,730 those units were broken down into 288 00:10:42,730 --> 00:10:44,897 smaller units , went across the United 289 00:10:44,897 --> 00:10:46,897 States and then working with fema . 290 00:10:46,897 --> 00:10:49,350 After that initial response , we 291 00:10:49,350 --> 00:10:51,572 recognize that we had an opportunity to 292 00:10:51,572 --> 00:10:53,920 really kind of optimize those teams . 293 00:10:53,920 --> 00:10:56,031 And so that led to the development of 294 00:10:56,031 --> 00:10:59,250 44 acute care team , which is critical 295 00:10:59,250 --> 00:11:01,190 care doctor and nurse heavy with 296 00:11:01,190 --> 00:11:03,412 supporting Corman including respiratory 297 00:11:03,412 --> 00:11:05,301 technicians . And then really the 298 00:11:05,301 --> 00:11:07,134 counterpart of our four deployed 299 00:11:07,134 --> 00:11:09,830 surgical teams . The rural rapid 300 00:11:09,830 --> 00:11:12,210 response team won Critical care doctor 301 00:11:12,500 --> 00:11:14,400 five critical care nurses and 302 00:11:14,400 --> 00:11:16,330 respiratory technician . And they 303 00:11:16,330 --> 00:11:19,360 actually went out to southeast texas , 304 00:11:19,450 --> 00:11:21,660 southwest texas rather on the border 305 00:11:21,840 --> 00:11:24,530 with Mexico and set up on the fly 306 00:11:24,540 --> 00:11:27,620 critical care units ICUs in community 307 00:11:27,620 --> 00:11:29,787 hospitals that did not previously have 308 00:11:29,787 --> 00:11:32,090 that capability . Uh Their model had 309 00:11:32,090 --> 00:11:34,280 been to transfer any critically ill 310 00:11:34,280 --> 00:11:37,150 patients . Uh Covid and the saturation 311 00:11:37,150 --> 00:11:39,317 of their referral centres didn't allow 312 00:11:39,317 --> 00:11:41,390 that . And so they set up and and 313 00:11:41,390 --> 00:11:44,000 perform truly heroic work as did the 314 00:11:44,000 --> 00:11:46,260 other services in similar circumstances 315 00:11:46,940 --> 00:11:49,600 as you as you alluded to dr Thompson . 316 00:11:49,610 --> 00:11:52,130 Our wake up call was Theodore Roosevelt . 317 00:11:52,140 --> 00:11:55,090 Uh And that was that was , you know , 318 00:11:55,090 --> 00:11:58,580 the recognition that we had an outbreak 319 00:11:58,580 --> 00:12:00,660 aboard one of our capital ships or 320 00:12:00,670 --> 00:12:03,630 aircraft carrier . And it really helped 321 00:12:03,630 --> 00:12:06,560 us to understand because of one of the 322 00:12:06,560 --> 00:12:08,616 four deployed medical units that was 323 00:12:08,616 --> 00:12:11,220 deployed about aboard with research 324 00:12:11,220 --> 00:12:13,820 only S . A . At the time for Covid 19 325 00:12:13,820 --> 00:12:16,660 or SARS-COV-2 really helped us 326 00:12:16,660 --> 00:12:18,827 understand the behavior of the virus , 327 00:12:18,827 --> 00:12:21,290 which as as general place mention is 328 00:12:21,290 --> 00:12:23,401 critically important , understand the 329 00:12:23,401 --> 00:12:25,401 adversary . And so it was from that 330 00:12:25,401 --> 00:12:27,623 work and from the investigation of that 331 00:12:27,623 --> 00:12:29,679 outbreak that we learned that really 332 00:12:29,679 --> 00:12:32,340 the role of pre and asymptomatic 333 00:12:32,340 --> 00:12:35,020 transmission of Covid and how 334 00:12:35,020 --> 00:12:37,400 critically important it was to 335 00:12:37,400 --> 00:12:40,890 understand that and prevent that . Um , 336 00:12:40,900 --> 00:12:44,050 so based on that experience and then a 337 00:12:44,050 --> 00:12:47,140 subsequent experience aboard uss Kidd , 338 00:12:47,140 --> 00:12:49,196 one of our destroyers . Uh , we were 339 00:12:49,196 --> 00:12:52,370 able to learn how to diagnose how to 340 00:12:52,370 --> 00:12:54,148 quarantine how to isolate and a 341 00:12:54,148 --> 00:12:56,510 shipboard environment and then how to 342 00:12:56,520 --> 00:12:58,687 actually step back and say , how do we 343 00:12:58,687 --> 00:13:01,610 create a bubble ? To minimize the risk 344 00:13:01,610 --> 00:13:03,832 of Covid for our forward deploy hours . 345 00:13:03,940 --> 00:13:05,870 And that involved as many no 346 00:13:05,920 --> 00:13:08,142 restriction of movement for two weeks . 347 00:13:08,142 --> 00:13:10,087 Testing of those coming out of the 348 00:13:10,087 --> 00:13:12,142 restriction of movement . But at its 349 00:13:12,142 --> 00:13:14,280 heart , the success of the fleet and 350 00:13:14,280 --> 00:13:16,530 continuing to operate was really the 351 00:13:16,530 --> 00:13:19,060 resilience in the grid of our sailors 352 00:13:19,070 --> 00:13:21,590 and our marines embarked . That they 353 00:13:21,590 --> 00:13:23,750 were able to follow those very strict 354 00:13:23,760 --> 00:13:26,680 requirements and still keep their focus 355 00:13:26,680 --> 00:13:29,760 on their mission . So we can't forget 356 00:13:30,140 --> 00:13:32,830 as much as we supplied in terms of 357 00:13:32,840 --> 00:13:35,320 public health and and infectious 358 00:13:35,320 --> 00:13:38,590 disease care at its heart . The navy 359 00:13:38,590 --> 00:13:41,900 response was based on the resilience of 360 00:13:41,900 --> 00:13:45,480 our sailors um as we moved out of that 361 00:13:45,490 --> 00:13:48,380 uh and we were operating forward uh and 362 00:13:48,380 --> 00:13:51,940 developed and developed uh you know the 363 00:13:51,940 --> 00:13:54,550 vaccine we I mean as the vaccine was 364 00:13:54,550 --> 00:13:56,790 developed , it was critically important 365 00:13:56,790 --> 00:13:58,623 for coordination and hats off to 366 00:13:58,623 --> 00:14:00,512 General Place and his team at the 367 00:14:00,512 --> 00:14:02,346 Defense Health Agency for really 368 00:14:02,346 --> 00:14:04,012 providing kind of the central 369 00:14:04,012 --> 00:14:06,234 coordination , establishing and leading 370 00:14:06,234 --> 00:14:08,360 the O . P . T . The planning team to 371 00:14:08,360 --> 00:14:10,527 say how are we going to distribute the 372 00:14:10,527 --> 00:14:12,582 vaccine and then working through the 373 00:14:12,582 --> 00:14:14,693 services to execute . And that really 374 00:14:14,693 --> 00:14:16,860 is I think a very effective model that 375 00:14:16,860 --> 00:14:19,193 I think we can leverage into the future . 376 00:14:19,193 --> 00:14:21,138 So that just gives you hopefully a 377 00:14:21,138 --> 00:14:24,490 flavor of what Navy medicine did . And 378 00:14:24,490 --> 00:14:26,740 the other thing was our scientist who 379 00:14:26,750 --> 00:14:28,750 actually did a prospective study on 380 00:14:28,750 --> 00:14:31,280 marine recruits at parris Island . And 381 00:14:31,280 --> 00:14:33,500 actually to really understand 382 00:14:33,500 --> 00:14:36,260 fundamentally at an immunological level 383 00:14:36,640 --> 00:14:39,830 the response to healthy young adults in 384 00:14:39,830 --> 00:14:42,140 a tightly controlled congregate setting 385 00:14:42,260 --> 00:14:44,890 to the virus and recognize just how 386 00:14:44,900 --> 00:14:47,122 relentless it is . Because even in that 387 00:14:47,122 --> 00:14:49,178 environment about 16 of the recruits 388 00:14:49,178 --> 00:14:51,720 still became infected . So and and both 389 00:14:51,720 --> 00:14:54,330 that article and the article describing 390 00:14:54,330 --> 00:14:56,800 the comprehensive uh you know , uh 391 00:14:56,810 --> 00:15:00,140 outbreak response and investigation of 392 00:15:00,150 --> 00:15:02,317 tr we're both published in New England 393 00:15:02,317 --> 00:15:04,483 Journal . So I'm proud to say that our 394 00:15:04,483 --> 00:15:06,539 folks were able to contribute to the 395 00:15:06,539 --> 00:15:08,372 national discussion and national 396 00:15:08,372 --> 00:15:10,428 awareness of how to how to get after 397 00:15:10,428 --> 00:15:12,761 and and uh and defeat covid . Thank you . 398 00:15:13,040 --> 00:15:15,096 Thanks very much . I appreciate that 399 00:15:15,096 --> 00:15:17,151 perspective . I'm Alina thomas . Can 400 00:15:17,151 --> 00:15:19,500 you uh can you provide some insights on 401 00:15:19,510 --> 00:15:21,566 a um you know , what was the mission 402 00:15:21,566 --> 00:15:23,677 that the Coast Guard had and who were 403 00:15:23,677 --> 00:15:26,010 your primary sort of targets of concern ? 404 00:15:26,010 --> 00:15:28,121 And how how how did you approach this 405 00:15:28,121 --> 00:15:30,177 problem ? And how would you describe 406 00:15:30,177 --> 00:15:32,121 your mission as this unfolded last 407 00:15:32,121 --> 00:15:34,066 spring ? Thank you Dr Thompson and 408 00:15:34,066 --> 00:15:35,899 thank you to the Navy League for 409 00:15:35,899 --> 00:15:37,843 inviting me to join you today . So 410 00:15:37,843 --> 00:15:40,010 initially again , the Coast Guards are 411 00:15:40,010 --> 00:15:41,732 very external , outward facing 412 00:15:41,732 --> 00:15:45,010 organization . And I found myself in 413 00:15:45,010 --> 00:15:48,540 january um beginning to 414 00:15:48,540 --> 00:15:51,920 address cruise ship passengers that 415 00:15:51,920 --> 00:15:53,753 were ill and how are we going to 416 00:15:53,753 --> 00:15:55,809 collaborate with the captains of the 417 00:15:55,809 --> 00:15:58,600 port and the division of global 418 00:15:58,600 --> 00:16:00,940 migration and quarantine from C . D . C . 419 00:16:00,950 --> 00:16:03,850 To help assess and remove patients . 420 00:16:04,340 --> 00:16:06,396 But you could see what was happening 421 00:16:06,396 --> 00:16:08,396 with the spread on these ships that 422 00:16:08,396 --> 00:16:10,740 this was like you know kind of Somebody 423 00:16:10,740 --> 00:16:12,907 else's problem for a short time before 424 00:16:12,907 --> 00:16:15,018 you knew it was gonna be your problem 425 00:16:15,018 --> 00:16:17,184 because with the Coast Guard we have a 426 00:16:17,184 --> 00:16:18,962 lot of boats two and you know , 427 00:16:18,962 --> 00:16:20,962 learning what we did . I think just 428 00:16:20,962 --> 00:16:23,129 that was really uh you know long drawn 429 00:16:23,129 --> 00:16:25,184 out Maley many of you might remember 430 00:16:25,184 --> 00:16:27,073 there were a lot of like floating 431 00:16:27,073 --> 00:16:29,129 islands of disease out there that no 432 00:16:29,129 --> 00:16:31,129 one would remove the crew from even 433 00:16:31,129 --> 00:16:33,240 after we got all the passengers off . 434 00:16:33,240 --> 00:16:35,518 So just there was some diplomatic push . 435 00:16:35,518 --> 00:16:37,684 There was just trying to really do the 436 00:16:37,684 --> 00:16:39,684 right thing for people . But that's 437 00:16:39,684 --> 00:16:41,940 sort of where you realize as the rest 438 00:16:41,940 --> 00:16:44,273 of the country was talking about , well , 439 00:16:44,273 --> 00:16:46,384 we need to protect the airports . The 440 00:16:46,384 --> 00:16:48,384 Coast Guard had to come back to the 441 00:16:48,384 --> 00:16:50,551 government and say , you need to think 442 00:16:50,551 --> 00:16:52,718 about the ships coming over because of 443 00:16:52,718 --> 00:16:55,180 this longer um Period of Kyrenia 444 00:16:55,190 --> 00:16:57,134 between someone being infected and 445 00:16:57,134 --> 00:16:59,190 someone being contagious . There are 446 00:16:59,190 --> 00:17:01,357 people that will land here coming from 447 00:17:01,357 --> 00:17:03,523 the far east within 14 days and may be 448 00:17:03,523 --> 00:17:05,730 asymptomatic . So really trying to put 449 00:17:05,730 --> 00:17:08,350 out enough notification for the , the 450 00:17:08,350 --> 00:17:10,550 maritime community , the marine 451 00:17:11,240 --> 00:17:13,980 information bulletins that just to keep 452 00:17:13,980 --> 00:17:16,147 people apprised of this is what you're 453 00:17:16,147 --> 00:17:17,980 looking for . This , what you're 454 00:17:17,980 --> 00:17:17,970 looking for if you're ill . This is how 455 00:17:17,970 --> 00:17:20,137 this has to be reported . I think that 456 00:17:20,137 --> 00:17:23,590 that was your entree in the next steps 457 00:17:23,590 --> 00:17:27,530 were quick pivot to saying , how are we 458 00:17:27,530 --> 00:17:29,697 going to take care of our own people ? 459 00:17:29,697 --> 00:17:31,808 Because it's really easy to say , You 460 00:17:31,808 --> 00:17:33,808 know , well , when you pick up that 461 00:17:33,808 --> 00:17:36,141 person in the water or the migrant that , 462 00:17:36,141 --> 00:17:38,141 that that's how you're going to get 463 00:17:38,141 --> 00:17:40,308 infected . But I will tell you 100% of 464 00:17:40,308 --> 00:17:42,252 the cases of infections within the 465 00:17:42,252 --> 00:17:44,419 Coast Guard on a ship who did not come 466 00:17:44,419 --> 00:17:46,641 from the migrants , They came from blue 467 00:17:46,641 --> 00:17:48,808 suitors wearing blue suit , other blue 468 00:17:48,808 --> 00:17:51,030 suit friends because we never practiced 469 00:17:51,030 --> 00:17:53,420 that type of must stay away . You must 470 00:17:53,420 --> 00:17:55,198 keep this kind of space amongst 471 00:17:55,198 --> 00:17:57,309 ourselves . You just , we just didn't 472 00:17:57,309 --> 00:17:59,309 have that . You know , in the early 473 00:17:59,309 --> 00:18:01,570 months , how aggressive asymptomatic 474 00:18:01,570 --> 00:18:03,737 spread was going to be with a nonstick 475 00:18:03,737 --> 00:18:05,848 person . So when we would have ever , 476 00:18:05,848 --> 00:18:07,959 you know , some ships would come into 477 00:18:07,959 --> 00:18:09,880 Baltimore and it would be like 13 478 00:18:09,880 --> 00:18:12,390 people on the crew , 13 people positive 479 00:18:12,400 --> 00:18:14,830 go to Vegas , you're gonna win . You 480 00:18:14,830 --> 00:18:17,052 know , they managed to get every single 481 00:18:17,052 --> 00:18:19,052 person sick . Um what you had to do 482 00:18:19,052 --> 00:18:20,886 that , it was really protect the 483 00:18:20,886 --> 00:18:22,997 workers at the Baltimore yard who are 484 00:18:22,997 --> 00:18:25,274 not , you know 20 and 30 year old kids , 485 00:18:25,274 --> 00:18:27,386 but 50 and 60 year old adults working 486 00:18:27,386 --> 00:18:30,230 on their ships . So just the testing 487 00:18:30,230 --> 00:18:32,341 and the contact facing then began . I 488 00:18:32,341 --> 00:18:34,508 think that we were much like the other 489 00:18:34,508 --> 00:18:38,100 services in understanding basic 490 00:18:38,110 --> 00:18:40,332 preventive medicine concepts , but like 491 00:18:40,332 --> 00:18:42,670 we had never as a service organized 492 00:18:43,040 --> 00:18:45,320 contact tracing teams and medical is so 493 00:18:45,320 --> 00:18:47,431 small , we said we're not going to be 494 00:18:47,431 --> 00:18:49,487 everywhere four years . So we had to 495 00:18:49,487 --> 00:18:51,598 train the line how to establish their 496 00:18:51,598 --> 00:18:53,764 own contact tracing teams with medical 497 00:18:53,764 --> 00:18:56,300 guidance . Um I think that that PPE as 498 00:18:56,300 --> 00:18:58,356 you might remember , was really also 499 00:18:58,356 --> 00:19:00,578 challenged in the beginning , um from a 500 00:19:00,578 --> 00:19:02,633 different department , Department of 501 00:19:02,633 --> 00:19:04,689 Homeland Security . And we have been 502 00:19:04,689 --> 00:19:06,411 told for years maybe you heard 503 00:19:06,411 --> 00:19:08,689 something similar ? Don't buy anything , 504 00:19:08,689 --> 00:19:10,744 don't store anything . Everything is 505 00:19:10,744 --> 00:19:12,800 just in time . We're going to get it 506 00:19:12,800 --> 00:19:12,540 for you when you need it . Well , how 507 00:19:12,540 --> 00:19:15,080 does that work ? Not so well , I mean 508 00:19:15,080 --> 00:19:17,910 thank goodness Defense Logistics Agency 509 00:19:17,910 --> 00:19:20,021 was able to look at us as part of the 510 00:19:20,021 --> 00:19:22,077 service and help us with some of the 511 00:19:22,077 --> 00:19:24,610 PPE we needed from masks , two gloves . 512 00:19:24,610 --> 00:19:26,666 So just to be able to do our regular 513 00:19:26,666 --> 00:19:29,020 medical job because I don't know where 514 00:19:29,020 --> 00:19:31,076 we would have fallen on the DHS list 515 00:19:31,076 --> 00:19:33,242 but not high enough to get anything by 516 00:19:33,242 --> 00:19:35,930 now . I'd imagine so . I mean I think 517 00:19:35,930 --> 00:19:37,986 it really was looking at what do you 518 00:19:37,986 --> 00:19:40,208 have to protect yourself ? What can you 519 00:19:40,208 --> 00:19:42,380 do ? What is our plan since we have no 520 00:19:42,380 --> 00:19:44,380 tertiary care centers ? What is our 521 00:19:44,380 --> 00:19:47,140 plan for mitigating sick people are of 522 00:19:47,140 --> 00:19:49,473 our own how where we're gonna send them ? 523 00:19:49,520 --> 00:19:51,576 and laboratory was another challenge 524 00:19:51,576 --> 00:19:53,810 for us because we do not have 11 labs 525 00:19:53,810 --> 00:19:56,570 that would do this . We had with a few 526 00:19:56,570 --> 00:19:58,792 labs that have a clear wave test , like 527 00:19:58,792 --> 00:20:01,440 a gene expert in them now and 528 00:20:01,450 --> 00:20:03,561 everything else we do by laboratory , 529 00:20:03,561 --> 00:20:05,617 whether we're using Quest or Labcorp 530 00:20:05,617 --> 00:20:09,390 was all sent out Fast forward to 531 00:20:09,390 --> 00:20:12,740 today . We have established three um 532 00:20:12,750 --> 00:20:15,220 surveillance testing programs in large 533 00:20:15,230 --> 00:20:17,341 congregate settings . So our training 534 00:20:17,341 --> 00:20:19,341 center , Cape May Training Center , 535 00:20:19,341 --> 00:20:21,286 Petaluma and the academy . Because 536 00:20:21,286 --> 00:20:23,452 surveillance testing , it doesn't have 537 00:20:23,452 --> 00:20:25,619 to have the same clear regulations and 538 00:20:25,619 --> 00:20:27,508 you can just test people that are 539 00:20:27,508 --> 00:20:29,397 unvaccinated , whomever your your 540 00:20:29,397 --> 00:20:31,508 parties are that you're interested in 541 00:20:31,508 --> 00:20:33,452 on a regular basis as long as it's 542 00:20:33,452 --> 00:20:35,563 anonymous testing . So I mean I think 543 00:20:35,563 --> 00:20:37,841 that we have had a lot of growth to do . 544 00:20:37,841 --> 00:20:40,119 Thanks . Excellent thank you very much . 545 00:20:40,119 --> 00:20:42,119 Um let me just get the conversation 546 00:20:42,119 --> 00:20:44,286 going a little and I'll start with you 547 00:20:44,286 --> 00:20:46,174 general place . Can you from your 548 00:20:46,174 --> 00:20:48,230 perspective at D . H . A . Give us a 549 00:20:48,230 --> 00:20:50,174 sort of an overview from your your 550 00:20:50,174 --> 00:20:52,341 experience in the seat that you had in 551 00:20:52,341 --> 00:20:54,508 this . How ready were we for this kind 552 00:20:54,508 --> 00:20:56,674 of pandemic ? You know , what had been 553 00:20:56,674 --> 00:20:58,786 the planning assumptions and training 554 00:20:58,786 --> 00:21:01,119 assumptions ? How appropriate were they ? 555 00:21:01,119 --> 00:21:03,341 And and one of the big things that have 556 00:21:03,341 --> 00:21:05,508 been learned about future readiness to 557 00:21:05,508 --> 00:21:05,370 respond . Sure , that's a good question . 558 00:21:05,380 --> 00:21:08,390 So if I was going to give us a grade 559 00:21:08,400 --> 00:21:10,567 for the readiness to be able to handle 560 00:21:10,567 --> 00:21:12,622 this particular pandemic , I'd say I 561 00:21:12,622 --> 00:21:15,160 don't know . Be depending on the 562 00:21:15,170 --> 00:21:17,650 subsets of the criteria . Be some 563 00:21:17,650 --> 00:21:19,872 routine B plus B minus . I don't know . 564 00:21:19,872 --> 00:21:22,206 But a good solid B . I guess where I go . 565 00:21:22,206 --> 00:21:24,206 A lot of that is because of the way 566 00:21:24,206 --> 00:21:26,317 that we already handle are integrated 567 00:21:26,317 --> 00:21:28,920 system , are evacuations are casualty 568 00:21:28,920 --> 00:21:31,430 responses as Admiral William . Already 569 00:21:31,430 --> 00:21:33,597 mentioned with Roll Three facilities . 570 00:21:33,597 --> 00:21:35,880 So we even define a role one being , 571 00:21:35,890 --> 00:21:37,946 that health care that's with you and 572 00:21:37,946 --> 00:21:39,946 its role to a sort of resuscitative 573 00:21:39,946 --> 00:21:42,057 surgical care . Roll three is a three 574 00:21:42,057 --> 00:21:44,279 theater hospital . And Roll for is what 575 00:21:44,279 --> 00:21:47,120 we have , um , perhaps in in Germany or 576 00:21:47,120 --> 00:21:50,270 Japan or other Coolants locations or 577 00:21:50,270 --> 00:21:52,159 here in the United States . So we 578 00:21:52,159 --> 00:21:54,159 already have a system in place that 579 00:21:54,159 --> 00:21:53,920 knows how to do it . We have a system , 580 00:21:53,920 --> 00:21:55,976 knows how to talk to each other . We 581 00:21:55,976 --> 00:21:58,309 have a system that has a centralized um , 582 00:21:58,309 --> 00:22:00,476 logistics arm , a centralized pharmacy 583 00:22:00,476 --> 00:22:02,890 arm we have on the shelf pandemic plans 584 00:22:02,890 --> 00:22:04,946 that were okay . I mean they weren't 585 00:22:04,946 --> 00:22:06,834 terrible . That's for sure . They 586 00:22:06,834 --> 00:22:09,001 weren't perfect , but they were good . 587 00:22:09,001 --> 00:22:11,223 And so if you look at all the different 588 00:22:11,223 --> 00:22:13,168 elements that were there , we were 589 00:22:13,168 --> 00:22:15,334 pretty ready . But , but every , every 590 00:22:15,334 --> 00:22:19,190 pandemic , every biological disease is 591 00:22:19,190 --> 00:22:21,134 a little bit different . And so uh 592 00:22:21,134 --> 00:22:24,530 certainly updates had to be made . But 593 00:22:24,530 --> 00:22:27,270 I would be stunned to hear that 594 00:22:27,840 --> 00:22:30,680 that someone suffered . Someone that we 595 00:22:30,680 --> 00:22:32,930 are responsible suffered because we 596 00:22:32,930 --> 00:22:36,120 weren't ready . We were ready and ready 597 00:22:36,120 --> 00:22:37,842 to learn along the way as more 598 00:22:37,842 --> 00:22:40,270 information came in . And would you , 599 00:22:40,280 --> 00:22:42,280 would you characterize the learning 600 00:22:42,280 --> 00:22:44,391 piece of this as being something that 601 00:22:44,391 --> 00:22:46,447 we need to bring forward in terms of 602 00:22:46,447 --> 00:22:48,780 being prepared to as you just described , 603 00:22:48,780 --> 00:22:51,002 everything is a little different . Each 604 00:22:51,002 --> 00:22:53,169 biological event is different . Are we 605 00:22:53,169 --> 00:22:55,002 doing enough to prepare critical 606 00:22:55,002 --> 00:22:56,447 thinking and and have the 607 00:22:56,447 --> 00:22:58,336 infrastructure to quickly do that 608 00:22:58,336 --> 00:23:00,558 experimentation learning track . So for 609 00:23:00,558 --> 00:23:02,780 all of you , one of the things that you 610 00:23:02,780 --> 00:23:04,836 should feel comfortable with is your 611 00:23:04,836 --> 00:23:07,002 the Department of Defense Medical Team 612 00:23:07,002 --> 00:23:09,830 has insatiable curiosity . So there's 613 00:23:09,830 --> 00:23:13,290 no um there's no deficit of man . How 614 00:23:13,290 --> 00:23:15,512 could how could we do this better ? Are 615 00:23:15,512 --> 00:23:17,401 there better ways to diagnose the 616 00:23:17,401 --> 00:23:17,390 better ways to treat ? Are there better 617 00:23:17,390 --> 00:23:19,557 ways to be organized ? Is there better 618 00:23:19,557 --> 00:23:21,501 ways to do the logistics as animal 619 00:23:21,501 --> 00:23:23,834 thomas was just talking about ? So yeah , 620 00:23:23,834 --> 00:23:25,446 it's a continuous process of 621 00:23:25,446 --> 00:23:27,668 improvement within our organizations to 622 00:23:27,668 --> 00:23:29,946 be able to get better . Excellent . Um , 623 00:23:29,946 --> 00:23:29,880 and reflecting actually wanted , I'm 624 00:23:29,880 --> 00:23:32,213 getting a whole bunch of questions here . 625 00:23:32,213 --> 00:23:34,324 There are one or two things I want to 626 00:23:34,324 --> 00:23:36,380 make sure we cover before we go on . 627 00:23:36,380 --> 00:23:35,760 But this reflects one of the questions 628 00:23:35,760 --> 00:23:37,871 and I'll ask you Admiral Gillingham , 629 00:23:37,871 --> 00:23:40,093 both D . A . J . And Coast Guard have a 630 00:23:40,093 --> 00:23:42,204 clearly interconnected civilian peace 631 00:23:42,204 --> 00:23:44,149 to this right with Tricare and the 632 00:23:44,149 --> 00:23:46,482 families and veterans for for for D . H . 633 00:23:46,482 --> 00:23:48,649 A . And obviously the migrants and the 634 00:23:48,649 --> 00:23:50,427 commercial communities that you 635 00:23:50,427 --> 00:23:52,593 interact with . But for the navy right 636 00:23:52,593 --> 00:23:54,760 as a military service you were pressed 637 00:23:54,760 --> 00:23:56,927 into this civilian support interacting 638 00:23:56,927 --> 00:23:59,149 with civilian officials . Um , what did 639 00:23:59,149 --> 00:24:01,149 that look and feel like ? Um , what 640 00:24:01,149 --> 00:24:03,260 have you learned and how how prepared 641 00:24:03,260 --> 00:24:05,482 was the navy to be in direct support of 642 00:24:05,482 --> 00:24:07,450 really a wide array of civilian 643 00:24:07,450 --> 00:24:09,760 agencies and organizations that we're 644 00:24:09,760 --> 00:24:11,760 confronting this challenge ? Yeah , 645 00:24:11,760 --> 00:24:13,760 thank you know , I would say that I 646 00:24:13,760 --> 00:24:15,704 would say that certainly there was 647 00:24:15,704 --> 00:24:17,927 quite a bit of learning there , but but 648 00:24:17,927 --> 00:24:19,871 the interagency work , I cited the 649 00:24:19,871 --> 00:24:22,093 relationship with fema uh , and and and 650 00:24:22,093 --> 00:24:24,038 working through a health and human 651 00:24:24,038 --> 00:24:26,340 services . Uh , I think uh , to general 652 00:24:26,340 --> 00:24:28,740 places point framework was there ? So 653 00:24:28,740 --> 00:24:30,573 the actual practice , the actual 654 00:24:30,573 --> 00:24:32,573 tactical execution was where we did 655 00:24:32,573 --> 00:24:34,684 some very early learning . I will say 656 00:24:34,684 --> 00:24:36,851 though , that the way that we were set 657 00:24:36,851 --> 00:24:39,350 up within the military health system 658 00:24:39,440 --> 00:24:41,440 lended itself that , you know , the 659 00:24:41,440 --> 00:24:43,384 Assistant Secretary of Defense for 660 00:24:43,384 --> 00:24:45,384 health affairs really was that node 661 00:24:45,384 --> 00:24:47,680 working with civilian agency and then 662 00:24:47,690 --> 00:24:49,746 and then we were we were kind of the 663 00:24:49,746 --> 00:24:51,857 next echelon down and working through 664 00:24:51,857 --> 00:24:54,023 Defense Health Agency . So early on we 665 00:24:54,023 --> 00:24:55,968 had really established a very good 666 00:24:55,968 --> 00:24:58,060 battle rhythm of an interagency 667 00:24:58,060 --> 00:25:00,770 coordination . So I think I think it it 668 00:25:00,770 --> 00:25:02,937 worked well . I think the , you know , 669 00:25:02,937 --> 00:25:05,103 the lesson for us was uh you know , to 670 00:25:05,103 --> 00:25:08,420 to um you know , admiral thomas point . 671 00:25:08,430 --> 00:25:11,350 We uh we have older people who work in 672 00:25:11,350 --> 00:25:13,720 our shipyards and that was a population 673 00:25:13,720 --> 00:25:15,887 that was a great risk . And so working 674 00:25:15,887 --> 00:25:17,887 very closely again , our scientific 675 00:25:17,887 --> 00:25:20,109 experts , public health experts working 676 00:25:20,109 --> 00:25:23,310 very closely with with nancy was able 677 00:25:23,310 --> 00:25:25,532 to establish protocols and things to be 678 00:25:25,532 --> 00:25:28,090 able to keep keep them safe yet 679 00:25:28,090 --> 00:25:30,420 continued the very necessary work of 680 00:25:30,420 --> 00:25:32,860 shipbuilding , ship repair and that 681 00:25:32,860 --> 00:25:34,804 sort of thing . So , and the other 682 00:25:34,804 --> 00:25:37,520 piece just kind of related is I think 683 00:25:37,530 --> 00:25:39,586 one of the greatest surprises for me 684 00:25:39,586 --> 00:25:41,641 was just how important the accession 685 00:25:41,641 --> 00:25:43,586 pipeline is , particularly for the 686 00:25:43,586 --> 00:25:46,950 Marine Corps . And uh and our Chief of 687 00:25:46,950 --> 00:25:49,172 new personnel and the Marine Corps made 688 00:25:49,172 --> 00:25:51,394 it very clear that we had to keep those 689 00:25:51,394 --> 00:25:53,561 recruit pipelines going . And so we've 690 00:25:53,561 --> 00:25:55,617 invested a lot of work to figure out 691 00:25:55,617 --> 00:25:57,283 how we could do that safely , 692 00:25:57,283 --> 00:25:59,506 recognizing that we had recruits coming 693 00:25:59,506 --> 00:26:01,617 from all parts of the United States . 694 00:26:01,617 --> 00:26:03,672 How do we , how do we ensure that we 695 00:26:03,672 --> 00:26:05,839 don't have a major outbreak ? That the 696 00:26:05,839 --> 00:26:08,600 charm study that I that I mentioned in 697 00:26:08,600 --> 00:26:10,790 the introduction was significant , 698 00:26:10,800 --> 00:26:13,030 significant help in that , but it was 699 00:26:13,030 --> 00:26:15,086 really sitting down and figuring out 700 00:26:15,086 --> 00:26:16,752 how do we maintain continuous 701 00:26:16,752 --> 00:26:18,919 operations of accession so that we can 702 00:26:18,919 --> 00:26:20,808 keep that pipeline going . That's 703 00:26:20,808 --> 00:26:23,030 essential uh for us to the Navy and the 704 00:26:23,030 --> 00:26:25,480 Marine Corps . Thank you Admiral thomas . 705 00:26:25,480 --> 00:26:27,647 If I can ask you a perspective as a as 706 00:26:27,647 --> 00:26:30,290 a senior leader in a military 707 00:26:30,290 --> 00:26:32,620 organization , I can imagine there are 708 00:26:32,620 --> 00:26:34,731 several levels at which you needed to 709 00:26:34,731 --> 00:26:36,842 be operating yourself . There was the 710 00:26:36,842 --> 00:26:38,787 overseeing an integrating tactical 711 00:26:38,787 --> 00:26:40,787 execution . There was being able to 712 00:26:40,787 --> 00:26:42,620 step back and say , what are the 713 00:26:42,620 --> 00:26:42,590 broader trends ? What are the policies , 714 00:26:42,590 --> 00:26:44,646 where does that coordination ? And I 715 00:26:44,646 --> 00:26:46,701 suspect , um there was an insatiable 716 00:26:46,701 --> 00:26:48,868 demand for information for from people 717 00:26:48,868 --> 00:26:51,034 senior to you or people that the Coast 718 00:26:51,034 --> 00:26:52,979 Guard was supporting . How did you 719 00:26:52,979 --> 00:26:55,201 manage and balance those different sort 720 00:26:55,201 --> 00:26:57,368 of competing responsibilities for your 721 00:26:57,368 --> 00:26:59,368 time ? Energy and bandwidth as this 722 00:26:59,368 --> 00:27:02,190 unfolded , I doubled my days 48 hours . 723 00:27:02,200 --> 00:27:04,660 24 . Just was not going to be enough . 724 00:27:05,040 --> 00:27:06,990 But I know I think that you're 725 00:27:06,990 --> 00:27:09,620 absolutely the amount of explanation 726 00:27:09,630 --> 00:27:12,390 because our line leadership is very 727 00:27:12,390 --> 00:27:15,600 smart , but they're not physicians , 728 00:27:15,610 --> 00:27:17,750 they're not medical epidemiologist , 729 00:27:17,870 --> 00:27:20,340 they're not laboratory ins and just 730 00:27:20,350 --> 00:27:23,560 trying to explain to them what the 731 00:27:25,040 --> 00:27:27,670 accuracy of some large testing 732 00:27:27,680 --> 00:27:29,736 iterations might be or how you would 733 00:27:29,736 --> 00:27:31,736 have these false positives or false 734 00:27:31,736 --> 00:27:34,100 negatives and that really getting them 735 00:27:34,100 --> 00:27:36,156 beyond . Like as soon as the day you 736 00:27:36,156 --> 00:27:38,580 had testing , once we had some testing 737 00:27:38,580 --> 00:27:40,590 available to us , it was like more 738 00:27:40,600 --> 00:27:43,790 cowbells please , you know like now I 739 00:27:43,790 --> 00:27:46,012 need more and I said well you need more 740 00:27:46,012 --> 00:27:48,150 but you need to be doing it took the 741 00:27:48,150 --> 00:27:50,094 Coast Guard and I'm not sure about 742 00:27:50,094 --> 00:27:52,261 other services . Um the better part of 743 00:27:52,261 --> 00:27:54,800 that first year into 20 to understand 744 00:27:54,800 --> 00:27:57,320 that restriction of movement Rahm it 745 00:27:57,320 --> 00:27:59,550 really means your family members from 746 00:27:59,550 --> 00:28:01,550 out of town can't come to visit you 747 00:28:01,550 --> 00:28:04,070 while you're in Rome . I mean they just , 748 00:28:04,080 --> 00:28:06,750 they did not want to be so harsh with 749 00:28:06,750 --> 00:28:09,820 people , but you can't rahm people when 750 00:28:09,820 --> 00:28:12,030 they get to a school . And then every 751 00:28:12,030 --> 00:28:13,974 evening let people go out and have 752 00:28:13,974 --> 00:28:15,974 beers together in town because like 753 00:28:15,974 --> 00:28:18,030 you're not gonna surely talk to some 754 00:28:18,030 --> 00:28:20,308 new people you don't know . I think so . 755 00:28:20,308 --> 00:28:22,480 It was just it's they understood it by 756 00:28:22,480 --> 00:28:24,647 the end , they understood . By the end 757 00:28:24,647 --> 00:28:26,591 of the first year we turned around 758 00:28:26,591 --> 00:28:28,758 national security cutters enough times 759 00:28:28,758 --> 00:28:30,813 with missing a positive person . And 760 00:28:30,813 --> 00:28:32,980 then if you remember how christmas was 761 00:28:32,980 --> 00:28:35,147 male was so incredibly slow because of 762 00:28:35,147 --> 00:28:37,258 our laboratory capacity or or lack of 763 00:28:37,258 --> 00:28:39,424 laboratory capacity . We used a saliva 764 00:28:39,424 --> 00:28:41,647 based test that and the fact that there 765 00:28:41,647 --> 00:28:43,647 was a lot of restrictions are short 766 00:28:43,647 --> 00:28:45,869 supply of swabs and things . So imagine 767 00:28:45,869 --> 00:28:47,647 a saliva based test that you're 768 00:28:47,647 --> 00:28:50,430 spitting into a cup Like 23 and me it 769 00:28:50,430 --> 00:28:53,050 worked very well . They would do the 770 00:28:53,050 --> 00:28:56,160 test in 24-48 hours , but wherever I 771 00:28:56,160 --> 00:28:58,620 was I had to mail it to New Jersey . If 772 00:28:58,620 --> 00:29:01,620 anyone male was like at christmas , Not 773 00:29:01,620 --> 00:29:03,842 for love or money because you've gotten 774 00:29:03,842 --> 00:29:05,898 something across the country in less 775 00:29:05,898 --> 00:29:08,009 than eight or 12 days , which is part 776 00:29:08,009 --> 00:29:10,120 of why we said we're going to have to 777 00:29:10,120 --> 00:29:12,231 stand up some surveillance testing on 778 00:29:12,231 --> 00:29:14,231 each coast for ourselves because it 779 00:29:14,231 --> 00:29:14,170 really begins the turnaround time . 780 00:29:14,540 --> 00:29:16,373 You're holding a ship from going 781 00:29:16,373 --> 00:29:18,373 anywhere . So you see how many more 782 00:29:18,373 --> 00:29:20,596 people could be positive . I think that 783 00:29:20,596 --> 00:29:22,651 always keeping leadership informed , 784 00:29:22,651 --> 00:29:26,400 making sure that the C . D . C . Writes 785 00:29:26,400 --> 00:29:28,622 guidance . I spent seven years with C . 786 00:29:28,622 --> 00:29:30,789 D . C . So I will never say a bad word 787 00:29:30,789 --> 00:29:32,956 about them . C . D C . Writes guidance 788 00:29:33,540 --> 00:29:36,990 for the general population . We have 789 00:29:37,000 --> 00:29:39,056 operational missions that we have to 790 00:29:39,056 --> 00:29:41,450 meet that may not allow us every day to 791 00:29:41,450 --> 00:29:43,840 do everything that CDC would want for 792 00:29:43,840 --> 00:29:45,840 the general population to be done . 793 00:29:45,840 --> 00:29:48,007 There's going to be some risk that you 794 00:29:48,007 --> 00:29:50,007 take . The idea of like that 14 day 795 00:29:50,007 --> 00:29:52,173 quarantine . Then coming down to maybe 796 00:29:52,173 --> 00:29:54,380 we'll attend or seven day if you could 797 00:29:54,380 --> 00:29:57,680 test out was very helpful . And that's 798 00:29:57,680 --> 00:29:59,180 just how you have two more 799 00:29:59,180 --> 00:30:01,347 pragmatically think about the missions 800 00:30:01,347 --> 00:30:03,458 that have to do the taxpayers money . 801 00:30:03,458 --> 00:30:06,700 We have to patrol shores and fly planes 802 00:30:06,700 --> 00:30:09,650 and everything else . So I think that 803 00:30:09,650 --> 00:30:12,030 the two things I did I'm most proud of 804 00:30:12,080 --> 00:30:15,770 in terms of field communications and I 805 00:30:15,770 --> 00:30:17,881 don't want to miss stop talking about 806 00:30:17,881 --> 00:30:20,048 this one . So the first one I will say 807 00:30:20,048 --> 00:30:22,490 I established very early on wellness 808 00:30:22,490 --> 00:30:26,390 Wednesday , which is an hour panel when 809 00:30:26,390 --> 00:30:29,560 we talk about um how are you doing with 810 00:30:29,560 --> 00:30:31,727 various types of stress or anxiety you 811 00:30:31,727 --> 00:30:33,671 might be feeling in your life , It 812 00:30:33,671 --> 00:30:36,310 could be a chaplain and um e a p . It 813 00:30:36,310 --> 00:30:38,640 could be a doctor and you know , a 814 00:30:38,640 --> 00:30:40,610 member that's had a tough time but 815 00:30:40,610 --> 00:30:43,160 basically humanizing and letting 816 00:30:43,170 --> 00:30:46,450 everyone know these are apparent 817 00:30:46,460 --> 00:30:48,590 conditions . And if you did not feel 818 00:30:48,590 --> 00:30:50,840 some level of stress anxiety out of 819 00:30:50,840 --> 00:30:53,010 your comfort zone , depression , for 820 00:30:53,010 --> 00:30:55,121 some of the things that you're losing 821 00:30:55,121 --> 00:30:57,232 or finding yourself losing , it would 822 00:30:57,232 --> 00:30:59,454 be I'd be more concerned about you . So 823 00:30:59,454 --> 00:31:02,250 bringing that conversation into the the 824 00:31:02,250 --> 00:31:05,600 wardroom or the workplace for if I said , 825 00:31:05,600 --> 00:31:07,711 hey , how are you doing ? I'm doing ? 826 00:31:07,711 --> 00:31:09,767 And he says fine . I can say how are 827 00:31:09,767 --> 00:31:11,822 you really doing and have that ? How 828 00:31:11,822 --> 00:31:13,711 are you really doing conversation 829 00:31:13,711 --> 00:31:15,544 whether I'm the boss or the pier 830 00:31:15,940 --> 00:31:18,610 because people weren't fine last year 831 00:31:18,620 --> 00:31:20,890 and they're just barely not even fine 832 00:31:20,890 --> 00:31:23,050 now . But I think that giving that 833 00:31:23,050 --> 00:31:24,994 space , so every every week it's a 834 00:31:24,994 --> 00:31:26,939 different topic . And I mean these 835 00:31:26,939 --> 00:31:29,330 range from now from you know via 836 00:31:29,330 --> 00:31:32,170 transition issues and long covid to 837 00:31:32,180 --> 00:31:34,830 they're not all covid related but to pt 838 00:31:34,830 --> 00:31:37,050 things physical therapy things as well 839 00:31:37,050 --> 00:31:39,740 as again a lot of the psycho social 840 00:31:39,740 --> 00:31:42,110 dynamics , that was one thing that we 841 00:31:42,110 --> 00:31:44,540 will continue as a best practice . The 842 00:31:44,540 --> 00:31:46,860 other thing we did was we took every um 843 00:31:48,540 --> 00:31:50,707 well as we printed all this guidance , 844 00:31:50,707 --> 00:31:52,818 this community of practice guidance , 845 00:31:52,818 --> 00:31:54,873 all this dynamically changing safety 846 00:31:54,873 --> 00:31:57,480 guidance , we decided to have town 847 00:31:57,480 --> 00:32:00,120 halls on Tuesdays and Thursdays and we 848 00:32:00,120 --> 00:32:02,231 would do them in like two week blocks 849 00:32:02,231 --> 00:32:04,430 cycles because you would want the 850 00:32:04,430 --> 00:32:06,640 people that were interested in area 851 00:32:06,640 --> 00:32:08,780 level or district level , thinking 852 00:32:08,790 --> 00:32:10,957 about the platforms and what was going 853 00:32:10,957 --> 00:32:12,957 to have to have our one level , the 854 00:32:12,957 --> 00:32:14,623 next people might be all your 855 00:32:14,623 --> 00:32:16,623 countrymen , they're on a different 856 00:32:16,623 --> 00:32:18,679 call , your small boat stations on a 857 00:32:18,679 --> 00:32:20,568 different call , your aviators on 858 00:32:20,568 --> 00:32:22,457 another call . But like basically 859 00:32:22,457 --> 00:32:24,346 having the conversations with the 860 00:32:24,346 --> 00:32:26,346 communities who we're going to go , 861 00:32:26,346 --> 00:32:25,940 we're going to go over what we've said 862 00:32:25,940 --> 00:32:28,580 this policy means . And now we want to 863 00:32:28,580 --> 00:32:30,636 hear your questions as to how you're 864 00:32:30,636 --> 00:32:32,858 going to struggle with or it's going to 865 00:32:32,858 --> 00:32:35,024 be super easy to implement , but let's 866 00:32:35,024 --> 00:32:34,510 make sure we're talking about the same 867 00:32:34,510 --> 00:32:37,020 policy . So I think that was really 868 00:32:37,020 --> 00:32:40,000 helpful . Thank you very much . Uh 869 00:32:40,010 --> 00:32:42,177 general place . I have a question from 870 00:32:42,177 --> 00:32:44,121 the audience here that gets to the 871 00:32:44,121 --> 00:32:46,830 broader context in which you all are 872 00:32:46,830 --> 00:32:48,830 trying to do your jobs and and meet 873 00:32:48,830 --> 00:32:51,340 these challenges . And and obviously 874 00:32:51,340 --> 00:32:53,451 during this period of time the social 875 00:32:53,451 --> 00:32:55,562 media environment , the news coverage 876 00:32:55,562 --> 00:32:57,460 environment , the sort of broader 877 00:32:57,460 --> 00:32:59,516 political environment in the country 878 00:32:59,516 --> 00:33:01,420 meant that information and the 879 00:33:01,420 --> 00:33:04,850 information space um was was not simple 880 00:33:04,860 --> 00:33:07,750 or unified and there wasn't one story 881 00:33:07,750 --> 00:33:09,861 that was getting out there . What was 882 00:33:09,861 --> 00:33:12,139 it like to operate in that environment ? 883 00:33:12,139 --> 00:33:14,194 You know , what , what did you learn 884 00:33:14,194 --> 00:33:16,250 from it ? And how do you think about 885 00:33:16,250 --> 00:33:18,083 the the information component of 886 00:33:18,083 --> 00:33:20,194 pandemic response going forward based 887 00:33:20,194 --> 00:33:22,139 on the experience you had ? Yeah . 888 00:33:22,139 --> 00:33:24,250 Thanks for the question . And I think 889 00:33:24,250 --> 00:33:26,361 it's a uniquely important thing to at 890 00:33:26,361 --> 00:33:28,670 least consider . There's , You know , 891 00:33:28,670 --> 00:33:30,837 hundreds of millions of Americans . We 892 00:33:30,837 --> 00:33:32,892 each have our own individual story . 893 00:33:32,892 --> 00:33:34,892 We've many of us at least have been 894 00:33:34,892 --> 00:33:36,726 impacted either personally or or 895 00:33:36,726 --> 00:33:38,740 someone close to us in some form or 896 00:33:38,740 --> 00:33:40,962 fashion over the last 18 months or so . 897 00:33:41,140 --> 00:33:45,100 And that information is true for 898 00:33:45,100 --> 00:33:46,810 me or for you or whose ever 899 00:33:46,810 --> 00:33:48,810 experiencing it , but it may not be 900 00:33:48,810 --> 00:33:51,240 statistically true . And so balancing 901 00:33:51,240 --> 00:33:53,820 the the life and the experiences that 902 00:33:53,820 --> 00:33:55,920 people have or the desires that they 903 00:33:55,920 --> 00:33:58,530 have for a particular outcome that they 904 00:33:58,530 --> 00:34:00,474 want to have happen . And is there 905 00:34:00,474 --> 00:34:02,586 information that supports whatever it 906 00:34:02,586 --> 00:34:04,697 is that they want to have happen that 907 00:34:04,697 --> 00:34:06,641 then gets into uh the social media 908 00:34:06,641 --> 00:34:09,490 environment ? On the other hand , I 909 00:34:09,500 --> 00:34:11,611 have my own personal desires for many 910 00:34:11,611 --> 00:34:13,500 things as well , But but I'm most 911 00:34:13,500 --> 00:34:15,920 interested in putting information out 912 00:34:15,930 --> 00:34:19,300 in the space that's 913 00:34:19,310 --> 00:34:21,421 scientifically accurate . At least as 914 00:34:21,421 --> 00:34:23,760 much as that we know . Uh and in fact , 915 00:34:23,770 --> 00:34:25,659 it's even better if it's balanced 916 00:34:25,659 --> 00:34:27,770 scientific information , Right ? It's 917 00:34:27,770 --> 00:34:29,548 not all sunshine and unicorns . 918 00:34:29,548 --> 00:34:31,826 Everything that we want is not perfect . 919 00:34:31,826 --> 00:34:33,937 It's what's the balance of what do we 920 00:34:33,937 --> 00:34:36,159 know ? What do we not know ? What do we 921 00:34:36,159 --> 00:34:38,326 think ? Why do we think it so it's all 922 00:34:38,326 --> 00:34:38,140 those things put together . And , and 923 00:34:38,150 --> 00:34:40,150 quite frankly , I think that's it's 924 00:34:40,150 --> 00:34:42,206 terribly important for all of us and 925 00:34:42,206 --> 00:34:44,372 irrespective of whether you wanna talk 926 00:34:44,372 --> 00:34:46,428 about Covid or or any other thing in 927 00:34:46,428 --> 00:34:48,539 life . Social media is an interesting 928 00:34:48,539 --> 00:34:50,650 concept and it has huge value to it , 929 00:34:50,650 --> 00:34:52,817 but it also has huge risk to it and we 930 00:34:52,817 --> 00:34:55,039 have to be able to all of us . I mean , 931 00:34:55,039 --> 00:34:56,928 this is my advice to everybody to 932 00:34:56,928 --> 00:34:59,020 include my kids . Uh , make sure you 933 00:34:59,020 --> 00:35:01,190 balance whatever it is that you're 934 00:35:01,190 --> 00:35:03,810 reading on social media post and make 935 00:35:03,810 --> 00:35:06,032 sure that if it's a story that you want 936 00:35:06,032 --> 00:35:08,032 to read , that's fine . There's all 937 00:35:08,032 --> 00:35:10,254 kinds of books or articles or all kinds 938 00:35:10,254 --> 00:35:12,366 of things that we can do to bring joy 939 00:35:12,366 --> 00:35:12,190 or entertainment or whatever into our 940 00:35:12,190 --> 00:35:14,390 lives that doesn't necessarily make 941 00:35:14,390 --> 00:35:16,790 them scientifically true . Um , and so 942 00:35:16,790 --> 00:35:18,790 try to balance those things out and 943 00:35:18,790 --> 00:35:21,012 then balance the emotion of what we may 944 00:35:21,012 --> 00:35:23,123 feel about what's happening somewhere 945 00:35:23,123 --> 00:35:25,410 against what we know to be as true as 946 00:35:25,420 --> 00:35:28,470 possible based on real data and real 947 00:35:28,470 --> 00:35:30,760 information . So how to balance those 948 00:35:30,760 --> 00:35:33,460 things . And then from our perspective 949 00:35:33,460 --> 00:35:35,682 within the DHS , at least for the diode 950 00:35:35,682 --> 00:35:37,627 beneficiaries , how do you provide 951 00:35:37,627 --> 00:35:39,738 useful information in general ? We as 952 00:35:39,738 --> 00:35:41,627 physicians , we tend to talk in a 953 00:35:41,627 --> 00:35:43,849 different language , just like aviators 954 00:35:43,849 --> 00:35:46,071 talking a different language or tankers 955 00:35:46,071 --> 00:35:48,182 talking a different language . And we 956 00:35:48,182 --> 00:35:48,110 often think that what we're saying is 957 00:35:48,120 --> 00:35:50,800 absolutely accurate and it is and it 958 00:35:50,800 --> 00:35:53,022 makes absolutely no sense to those that 959 00:35:53,022 --> 00:35:54,856 were saying it too . And so just 960 00:35:54,856 --> 00:35:56,911 because we've said , it doesn't mean 961 00:35:56,911 --> 00:35:59,022 that it's received in the way that we 962 00:35:59,022 --> 00:36:01,244 intended it for it to be received . The 963 00:36:01,244 --> 00:36:01,130 last part of it is we've had to adjust 964 00:36:01,140 --> 00:36:03,362 in some ways . Just like admiral thomas 965 00:36:03,362 --> 00:36:05,440 was talking about , uh , when she 966 00:36:05,440 --> 00:36:07,607 mentioned that our line leaders aren't 967 00:36:07,607 --> 00:36:08,996 physicians , they're not 968 00:36:08,996 --> 00:36:11,218 epidemiologists . And yet in many cases 969 00:36:11,218 --> 00:36:13,107 I think we're speaking a language 970 00:36:13,107 --> 00:36:15,329 different than them and what we thought 971 00:36:15,329 --> 00:36:17,496 was very easy to understand because we 972 00:36:17,496 --> 00:36:19,607 were speaking in our code wasn't very 973 00:36:19,607 --> 00:36:21,718 easy for other people to understand . 974 00:36:21,718 --> 00:36:23,496 So changing it to be able to be 975 00:36:23,496 --> 00:36:25,662 understood by the intended recipient . 976 00:36:25,662 --> 00:36:28,160 All those things are my best advice . 977 00:36:28,550 --> 00:36:30,760 Yeah . If I could just build on the , 978 00:36:30,770 --> 00:36:32,992 you know , the two previous questions , 979 00:36:32,992 --> 00:36:35,850 um , absolutely . The information , you 980 00:36:35,850 --> 00:36:37,961 know , requirement , the requests for 981 00:36:37,961 --> 00:36:39,628 information flooding into our 982 00:36:39,628 --> 00:36:42,300 headquarters was astounding . I could 983 00:36:42,310 --> 00:36:44,254 guarantee that if there had been a 984 00:36:44,254 --> 00:36:46,088 story about some advance or some 985 00:36:46,088 --> 00:36:48,610 finding on CNN that I would , my email 986 00:36:48,690 --> 00:36:51,470 would be explode would explode . So 987 00:36:51,480 --> 00:36:53,536 almost as self preservation . But it 988 00:36:53,536 --> 00:36:55,702 turned out to be extremely helpful and 989 00:36:55,702 --> 00:36:57,869 effective . Was uh , I said , listen , 990 00:36:57,869 --> 00:37:00,091 I need a I need to pull our experts . I 991 00:37:00,091 --> 00:37:02,091 need to defer to expertise here . I 992 00:37:02,091 --> 00:37:04,430 need to leverage these remarkable 993 00:37:04,440 --> 00:37:06,496 scientists and public health experts 994 00:37:06,496 --> 00:37:09,240 and virologists that we have in uniform 995 00:37:09,690 --> 00:37:11,912 and in our laboratories , are civilians 996 00:37:11,912 --> 00:37:14,023 who are in our laboratories as well . 997 00:37:14,023 --> 00:37:16,246 And so we put together scientific panel 998 00:37:16,246 --> 00:37:18,710 and we would meet weekly . They would , 999 00:37:18,720 --> 00:37:20,831 they would come to me with really the 1000 00:37:20,831 --> 00:37:23,040 latest greatest , you know , latest , 1001 00:37:23,040 --> 00:37:25,096 most definite information they could 1002 00:37:25,096 --> 00:37:27,340 with an interpretation to get past that 1003 00:37:27,340 --> 00:37:30,340 barrier of language . And we put that 1004 00:37:30,340 --> 00:37:32,830 together as essentially a newsletter 1005 00:37:32,830 --> 00:37:35,980 that went out weakly , uh you know , to 1006 00:37:35,980 --> 00:37:38,500 senior leadership , but also all of our 1007 00:37:38,500 --> 00:37:40,940 Fleet Marine Corps surgeons . And so 1008 00:37:40,940 --> 00:37:43,370 there was there was the take home 1009 00:37:43,370 --> 00:37:46,680 message implications for operations . 1010 00:37:46,710 --> 00:37:49,500 And then for those more scientifically 1011 00:37:49,500 --> 00:37:51,722 inclined , there was the actual article 1012 00:37:51,722 --> 00:37:54,870 or uh , so that team really continues 1013 00:37:54,870 --> 00:37:56,926 to this day . Now we're at every two 1014 00:37:56,926 --> 00:37:59,148 weeks continues to put that information 1015 00:37:59,148 --> 00:38:01,900 out and we have found that to be very 1016 00:38:01,900 --> 00:38:03,900 valuable . And that same scientific 1017 00:38:03,900 --> 00:38:07,220 panel meets weekly verbally virtually 1018 00:38:07,220 --> 00:38:09,920 with all of our senior caregivers 1019 00:38:09,930 --> 00:38:12,910 surgeons and both Fleet Marine Corps . 1020 00:38:13,070 --> 00:38:15,380 And that has turned out to be 1021 00:38:15,380 --> 00:38:17,740 enormously valuable to stay ahead of 1022 00:38:18,120 --> 00:38:20,570 that information . That you know , that 1023 00:38:20,580 --> 00:38:22,580 relentless demand for information . 1024 00:38:22,920 --> 00:38:24,920 Excellent . Thank you very much . I 1025 00:38:24,920 --> 00:38:27,031 have several questions that relate to 1026 00:38:27,031 --> 00:38:29,087 industry and the partnership between 1027 00:38:29,087 --> 00:38:31,253 the military and industry . And so let 1028 00:38:31,253 --> 00:38:33,309 me let me try to bring three of them 1029 00:38:33,309 --> 00:38:35,309 together at at once . And then I'll 1030 00:38:35,309 --> 00:38:37,309 open up to any of the panelists who 1031 00:38:37,309 --> 00:38:39,531 would like to speak to that one is sort 1032 00:38:39,531 --> 00:38:41,698 of the what question ? You know , what 1033 00:38:41,698 --> 00:38:43,809 kinds of things should industry be be 1034 00:38:43,809 --> 00:38:46,090 providing , investing in thinking about 1035 00:38:46,090 --> 00:38:47,812 their capacity going forward , 1036 00:38:47,812 --> 00:38:49,979 partnerships for future development to 1037 00:38:49,979 --> 00:38:51,940 be prepared for the next one . The 1038 00:38:51,950 --> 00:38:54,117 second question is sort of for what is 1039 00:38:54,117 --> 00:38:56,283 you think about the future operational 1040 00:38:56,283 --> 00:38:58,506 force and what it requires and how it's 1041 00:38:58,506 --> 00:39:00,561 going to operate . For example , the 1042 00:39:00,561 --> 00:39:02,970 Navy and dynamic maneuver or thinking 1043 00:39:02,970 --> 00:39:05,340 about high end combat coming back into 1044 00:39:05,340 --> 00:39:07,451 the field or other things like that . 1045 00:39:07,451 --> 00:39:09,562 You know , how do we think about that 1046 00:39:09,562 --> 00:39:11,618 operating environment and what do we 1047 00:39:11,618 --> 00:39:13,784 need ? And then the third area is so , 1048 00:39:13,784 --> 00:39:16,140 so how how does industry partner better 1049 00:39:16,140 --> 00:39:18,380 more effectively , particularly small 1050 00:39:18,380 --> 00:39:20,436 businesses ? Are those that have not 1051 00:39:20,436 --> 00:39:22,658 been in the field of medical response , 1052 00:39:22,658 --> 00:39:24,769 medical support preparedness begin to 1053 00:39:24,769 --> 00:39:26,760 develop that partnership with the 1054 00:39:26,760 --> 00:39:28,704 uniformed services and the defense 1055 00:39:28,704 --> 00:39:30,871 Health agency . So I just open that up 1056 00:39:30,871 --> 00:39:34,210 too to any of our panelists . Yeah . 1057 00:39:34,220 --> 00:39:37,040 Thanks . I'll take a stab . I think , 1058 00:39:37,050 --> 00:39:39,720 you know , the , the information and uh , 1059 00:39:39,730 --> 00:39:43,260 you know , providing ideas to us was 1060 00:39:43,260 --> 00:39:45,427 very valuable . So what , what I did , 1061 00:39:45,427 --> 00:39:47,649 I would get , I would get a number of , 1062 00:39:47,649 --> 00:39:51,000 hey , we have this to help you diagnose 1063 00:39:51,000 --> 00:39:53,660 covid , for example , or we have this , 1064 00:39:53,670 --> 00:39:57,000 uh , to help you sterilize , you know , 1065 00:39:57,000 --> 00:40:00,430 workspace . And so what we did is that 1066 00:40:00,430 --> 00:40:02,208 was the other real value of the 1067 00:40:02,208 --> 00:40:04,374 scientific panels . I was able to have 1068 00:40:04,374 --> 00:40:06,597 our scientific panel evaluate that . So 1069 00:40:06,597 --> 00:40:09,400 I think we need a , a faster way to 1070 00:40:09,400 --> 00:40:11,456 take those cutting edge things being 1071 00:40:11,456 --> 00:40:13,678 developed in industry and be able to be 1072 00:40:13,678 --> 00:40:15,733 able to analyze them and see if they 1073 00:40:15,733 --> 00:40:17,950 fit our environment . But it's beyond 1074 00:40:17,950 --> 00:40:20,570 covid . Uh , the challenge that we face , 1075 00:40:20,580 --> 00:40:22,870 uh , as we look at distributed maritime 1076 00:40:22,870 --> 00:40:24,981 operations , expeditionary , advanced 1077 00:40:24,981 --> 00:40:27,148 basing operations for the Marine Corps 1078 00:40:27,148 --> 00:40:30,100 is uh , you know , the , when I was in 1079 00:40:30,110 --> 00:40:32,332 Fallujah in 2000 and four , many of the 1080 00:40:32,332 --> 00:40:34,770 casualties I treated I got within 10 1081 00:40:34,770 --> 00:40:36,826 minutes , certainly rarely more than 1082 00:40:36,826 --> 00:40:39,720 the golden hour of 60 minutes . And we 1083 00:40:39,720 --> 00:40:41,664 certainly saw the value of that in 1084 00:40:41,664 --> 00:40:44,790 Afghanistan as well . In this demo 1085 00:40:44,790 --> 00:40:46,901 environment , we talk about the brass 1086 00:40:46,901 --> 00:40:50,140 96 we talk about the vast distances , 1087 00:40:50,510 --> 00:40:52,910 you know , and how we , how are we 1088 00:40:52,910 --> 00:40:55,021 going to provide medical care in that 1089 00:40:55,021 --> 00:40:58,480 environment ? And so while while damage 1090 00:40:58,480 --> 00:41:00,147 control surgery and immediate 1091 00:41:00,147 --> 00:41:02,830 resuscitation has definitely proved its 1092 00:41:02,830 --> 00:41:05,930 value . How do we replicate that and 1093 00:41:05,930 --> 00:41:08,130 recognize that many of those patients 1094 00:41:08,130 --> 00:41:11,060 probably will not come to surgical care ? 1095 00:41:11,060 --> 00:41:13,700 Resuscitative care within that , you 1096 00:41:13,700 --> 00:41:15,922 know , then that vaunted golden hours . 1097 00:41:15,922 --> 00:41:19,170 So I think prolonged resuscitative care , 1098 00:41:19,170 --> 00:41:22,350 prolonged combat casualty care prior to 1099 00:41:22,350 --> 00:41:25,950 roll to as as a general place to find . 1100 00:41:25,950 --> 00:41:28,230 It is an area where we need tremendous 1101 00:41:28,230 --> 00:41:30,341 assistance . And we have to recognize 1102 00:41:30,341 --> 00:41:32,720 too . When you look at , when you look 1103 00:41:32,720 --> 00:41:35,060 at the survival curves in any conflict , 1104 00:41:35,070 --> 00:41:37,900 there's a ramp up and we're working on 1105 00:41:37,900 --> 00:41:40,067 that in terms of making sure our folks 1106 00:41:40,067 --> 00:41:42,289 are absolutely at the top of their game 1107 00:41:42,289 --> 00:41:44,511 before they deploy . But the other side 1108 00:41:44,511 --> 00:41:46,622 of that is just understanding the new 1109 00:41:46,622 --> 00:41:48,710 complex of injuries . And so in the 1110 00:41:48,710 --> 00:41:50,877 maritime environment , the things that 1111 00:41:50,877 --> 00:41:53,099 keep me up at night are what happens if 1112 00:41:53,099 --> 00:41:55,154 a missile hits the ship and I've got 1113 00:41:55,154 --> 00:41:57,377 close base inhalation injury , I've got 1114 00:41:57,377 --> 00:41:59,543 burned , uh , and something we haven't 1115 00:41:59,543 --> 00:42:01,599 treated in large numbers since World 1116 00:42:01,599 --> 00:42:03,766 War two immersion injury . If I've got 1117 00:42:03,766 --> 00:42:05,932 sailors that are in the water for long 1118 00:42:05,932 --> 00:42:08,154 periods of time . And so that's an area 1119 00:42:08,154 --> 00:42:10,060 as we look to the future where 1120 00:42:10,060 --> 00:42:12,050 tremendous help is required from 1121 00:42:12,050 --> 00:42:14,930 industry as to what do we know , what 1122 00:42:14,930 --> 00:42:16,819 are some of the tools that we can 1123 00:42:16,819 --> 00:42:19,097 develop to get after that problem said , 1124 00:42:20,700 --> 00:42:22,700 if I could add to what animal going 1125 00:42:22,700 --> 00:42:24,867 home just mentioned . I mean , the way 1126 00:42:24,867 --> 00:42:26,978 that I think about it is uh , the 1st 1127 00:42:26,978 --> 00:42:28,756 1st order of business is always 1128 00:42:28,756 --> 00:42:30,867 prevention and that prevention can be 1129 00:42:30,867 --> 00:42:30,810 something done to the human body or 1130 00:42:30,810 --> 00:42:32,977 something done around the human body . 1131 00:42:32,977 --> 00:42:35,550 And so for us , we're most worried , 1132 00:42:35,560 --> 00:42:37,504 we're interested in taking care of 1133 00:42:37,504 --> 00:42:39,560 everybody . Service members , family 1134 00:42:39,560 --> 00:42:39,390 members , retirees , retiring family 1135 00:42:39,390 --> 00:42:41,279 members . But the military health 1136 00:42:41,279 --> 00:42:44,580 system exists for the military , that's 1137 00:42:44,580 --> 00:42:46,580 our purpose . And so we think about 1138 00:42:46,580 --> 00:42:49,090 service members . What can we do to 1139 00:42:49,100 --> 00:42:51,700 keep them healthy ? What can we help 1140 00:42:51,700 --> 00:42:53,756 them inside their own body or what , 1141 00:42:53,756 --> 00:42:56,033 what piece of kit ? What piece of gear ? 1142 00:42:56,033 --> 00:42:58,033 What piece of anything can we do to 1143 00:42:58,033 --> 00:43:00,200 prevent anything bad from happening to 1144 00:43:00,200 --> 00:43:02,367 them ? It can be an infectious thing . 1145 00:43:02,367 --> 00:43:04,533 It can be a cold . I am a Gillingham's 1146 00:43:04,533 --> 00:43:06,644 talking about immersion injuries . It 1147 00:43:06,644 --> 00:43:10,490 can be directed energy is if you think 1148 00:43:10,490 --> 00:43:12,890 about it , I mean right now we're both 1149 00:43:12,890 --> 00:43:15,001 surgeons , Admiral Willingham and I , 1150 00:43:15,001 --> 00:43:16,890 most of the issues that we saw in 1151 00:43:16,890 --> 00:43:20,100 Afghanistan or Iraq or Syria where 1152 00:43:20,100 --> 00:43:22,750 projectile injuries of some sort and 1153 00:43:22,760 --> 00:43:24,649 the challenge with the projectile 1154 00:43:24,649 --> 00:43:26,760 injuries , what it does to tissue and 1155 00:43:26,760 --> 00:43:28,871 how it lets the most important liquid 1156 00:43:28,871 --> 00:43:31,093 inside of you leak out . Right ? That's 1157 00:43:31,093 --> 00:43:30,780 the issue that we dealt with . How do 1158 00:43:30,780 --> 00:43:32,891 you stop the bleeding and then how do 1159 00:43:32,891 --> 00:43:34,891 you prepare for the greatest degree 1160 00:43:34,891 --> 00:43:37,058 possible ? The tissues the way they're 1161 00:43:37,058 --> 00:43:39,058 supposed to be so that the body can 1162 00:43:39,058 --> 00:43:41,169 heal itself . That's what we do . But 1163 00:43:41,169 --> 00:43:42,947 but those are relatively recent 1164 00:43:42,947 --> 00:43:45,169 challenges . I mean , in the history of 1165 00:43:45,169 --> 00:43:47,280 mankind with high velocity injuries . 1166 00:43:47,280 --> 00:43:49,336 So what's the next , what's the next 1167 00:43:49,336 --> 00:43:51,391 injury type ? And how are we getting 1168 00:43:51,391 --> 00:43:51,260 ahead of that ? Were preventing it or 1169 00:43:51,260 --> 00:43:53,538 how we're preparing to take care of it ? 1170 00:43:53,900 --> 00:43:56,011 But if the first part is prevention , 1171 00:43:56,011 --> 00:43:58,178 then the second part is diagnosis . If 1172 00:43:58,178 --> 00:44:00,289 you look at diagnostic capabilities , 1173 00:44:00,289 --> 00:44:00,250 in particular diagnostic capabilities 1174 00:44:00,250 --> 00:44:02,417 on the battlefield , it's difficult to 1175 00:44:02,417 --> 00:44:05,510 hell around an MRI scanner in a platoon , 1176 00:44:06,390 --> 00:44:09,090 right ? It's just you can't do it . And 1177 00:44:09,090 --> 00:44:11,312 so if you look at diagnostic imaging 50 1178 00:44:11,312 --> 00:44:13,312 years ago is X rays . That's all we 1179 00:44:13,312 --> 00:44:15,257 have now . We got CT scans and pet 1180 00:44:15,257 --> 00:44:18,620 scans and mris and ultrasounds and and 1181 00:44:18,630 --> 00:44:20,408 nuclear medicine . All kinds of 1182 00:44:20,408 --> 00:44:22,519 different ways . So what's the what's 1183 00:44:22,519 --> 00:44:24,630 the best diagnostic capability that's 1184 00:44:24,630 --> 00:44:26,686 actually effective in an operational 1185 00:44:26,686 --> 00:44:28,686 environment ? And how can we get it 1186 00:44:28,686 --> 00:44:30,852 there ? So that's about waiting cube ? 1187 00:44:30,852 --> 00:44:32,810 Or if it's got it's got radiation 1188 00:44:32,810 --> 00:44:34,810 associated with protection from all 1189 00:44:34,810 --> 00:44:36,977 involved with the radiation capability 1190 00:44:36,977 --> 00:44:39,143 that it has And then treatment sort of 1191 00:44:39,143 --> 00:44:41,254 thing . So if you look at what we had 1192 00:44:41,254 --> 00:44:43,199 from a pharmaceutical intervention 1193 00:44:43,199 --> 00:44:45,254 capability 50 years ago or 100 years 1194 00:44:45,254 --> 00:44:47,088 ago compared to now it's been an 1195 00:44:47,088 --> 00:44:49,410 explosion of that . And so what are the 1196 00:44:49,420 --> 00:44:51,531 types of things that we're really not 1197 00:44:51,531 --> 00:44:53,420 even considering now for the most 1198 00:44:53,420 --> 00:44:55,420 common reasons that service members 1199 00:44:55,420 --> 00:44:57,476 can't be at work ? And over the last 1200 00:44:57,476 --> 00:44:59,698 year the number one reason that service 1201 00:44:59,698 --> 00:45:01,864 members weren't at work was because of 1202 00:45:01,864 --> 00:45:03,864 covid . Number one . Now , a lot of 1203 00:45:03,864 --> 00:45:06,087 that's because this Admiral thomas said 1204 00:45:06,087 --> 00:45:08,198 the restriction of movement , right ? 1205 00:45:08,198 --> 00:45:07,150 You can't come to work because you got 1206 00:45:07,150 --> 00:45:09,039 to be somewhere else , just doing 1207 00:45:09,039 --> 00:45:11,460 nothing , not infecting yourself or 1208 00:45:11,460 --> 00:45:14,010 other people . But the most common 1209 00:45:14,010 --> 00:45:16,121 reasons for not being at work and the 1210 00:45:16,121 --> 00:45:18,232 most common reason for not being work 1211 00:45:18,232 --> 00:45:20,800 is Natural pregnancy . I think we're 1212 00:45:20,800 --> 00:45:23,400 okay with that one or musculoskeletal 1213 00:45:23,400 --> 00:45:25,567 injuries . And so what are we doing on 1214 00:45:25,567 --> 00:45:27,067 the prevention side of the 1215 00:45:27,067 --> 00:45:29,233 musculoskeletal injuries ? What are we 1216 00:45:29,233 --> 00:45:31,400 doing on the intense rehabilitation of 1217 00:45:31,400 --> 00:45:30,310 them or what are we doing on the 1218 00:45:30,310 --> 00:45:32,560 pharmaceutical part of musculoskeletal 1219 00:45:32,560 --> 00:45:34,782 injuries . So when we think about where 1220 00:45:34,782 --> 00:45:37,004 we're going , those are the things that 1221 00:45:37,004 --> 00:45:39,227 we need help with . How do we prevent ? 1222 00:45:39,227 --> 00:45:41,393 How do we diagnose in particular ? How 1223 00:45:41,393 --> 00:45:43,560 do we diagnosed at McGill in Hampstead 1224 00:45:43,560 --> 00:45:43,400 and distributed maritime operations ? 1225 00:45:43,410 --> 00:45:45,132 How about distributed military 1226 00:45:45,132 --> 00:45:47,354 operations ? Because we don't want to I 1227 00:45:47,354 --> 00:45:49,577 don't want to fight at home . These are 1228 00:45:49,577 --> 00:45:51,688 away games that we're talking about . 1229 00:45:51,688 --> 00:45:53,799 So how do we take it with us and then 1230 00:45:53,799 --> 00:45:56,021 should something bad happen , how do we 1231 00:45:56,021 --> 00:45:58,188 very rapidly bring people back to full 1232 00:45:58,188 --> 00:46:00,660 capability wherever industry happens to 1233 00:46:00,660 --> 00:46:03,150 have your niche that may interject into 1234 00:46:03,150 --> 00:46:05,372 one of those areas ? That's where we're 1235 00:46:05,372 --> 00:46:07,428 interested . Excellent . Thank you . 1236 00:46:07,428 --> 00:46:10,180 Please . Right . I really appreciated 1237 00:46:10,180 --> 00:46:12,790 that discussion . The I am a I started 1238 00:46:12,790 --> 00:46:14,790 off as a general surgeon . I did my 1239 00:46:14,790 --> 00:46:17,012 first year , my internship here in that 1240 00:46:17,012 --> 00:46:19,234 and I am a prevention ist now . And one 1241 00:46:19,234 --> 00:46:21,457 of the reasons why people spent so much 1242 00:46:21,457 --> 00:46:23,679 time at home because of Covid this year 1243 00:46:23,679 --> 00:46:25,512 is because as soon as you were a 1244 00:46:25,512 --> 00:46:27,679 contact and I might have had Covid I'm 1245 00:46:27,679 --> 00:46:29,790 waiting for my test . But you have my 1246 00:46:29,790 --> 00:46:32,012 contact , You're in , you're in the box 1247 00:46:32,012 --> 00:46:34,123 for 14 days and there's no way to get 1248 00:46:34,123 --> 00:46:36,290 people out of that . Well , one of the 1249 00:46:36,290 --> 00:46:38,457 things that that Detroit had worked on 1250 00:46:38,457 --> 00:46:41,330 previously with two other companies was 1251 00:46:41,330 --> 00:46:44,790 a way to alert the member 1252 00:46:45,180 --> 00:46:47,236 to how their physiological state may 1253 00:46:47,236 --> 00:46:50,610 have changed And it's a score and it's 1254 00:46:50,610 --> 00:46:52,832 a score using two pieces of equipment . 1255 00:46:53,180 --> 00:46:56,210 one is this watch and one is this ring 1256 00:46:56,680 --> 00:46:58,736 because people can't understand that 1257 00:46:58,736 --> 00:47:01,010 concept . I think very easily . What do 1258 00:47:01,010 --> 00:47:03,177 you mean ? I have to say six ft away . 1259 00:47:03,177 --> 00:47:05,232 I've got a mask all the time but you 1260 00:47:05,232 --> 00:47:07,232 probably can't understand . Look at 1261 00:47:07,232 --> 00:47:09,690 your phone , you have an app , Check 1262 00:47:09,690 --> 00:47:13,020 your rate score every day . My score is 1263 00:47:13,020 --> 00:47:15,490 normally one , sometimes it's five , 1264 00:47:15,880 --> 00:47:19,210 But if it's up to 100 , my score was 25 1265 00:47:19,780 --> 00:47:22,200 tomorrow . Guess what I would not do 1266 00:47:23,180 --> 00:47:26,480 would not go to work because the risk 1267 00:47:26,480 --> 00:47:29,320 and the epidemic , a pandemic of me 1268 00:47:29,330 --> 00:47:32,160 having Covid and then all the tail 1269 00:47:32,160 --> 00:47:34,327 chasing that has to occur with all the 1270 00:47:34,327 --> 00:47:36,493 different people . I've got to go find 1271 00:47:36,493 --> 00:47:38,716 and swab and put them in in , in in the 1272 00:47:38,716 --> 00:47:40,827 whole while we wait for those tests . 1273 00:47:40,827 --> 00:47:43,049 The amount of wasted testing and time I 1274 00:47:43,049 --> 00:47:45,049 spent on that would have been worth 1275 00:47:45,049 --> 00:47:47,020 alone a watch and a ring for every 1276 00:47:47,020 --> 00:47:49,370 person because it gives them the 1277 00:47:49,370 --> 00:47:51,720 personal feedback on their sleep data 1278 00:47:51,730 --> 00:47:53,786 on their heart rate , variability on 1279 00:47:53,786 --> 00:47:55,619 their respiratory rates . It was 1280 00:47:55,619 --> 00:47:57,730 actually tested , was actually tested 1281 00:47:57,730 --> 00:48:00,270 on several other illnesses prior to 1282 00:48:00,270 --> 00:48:02,326 Covid coming out and they said , but 1283 00:48:02,326 --> 00:48:04,381 doesn't work for Covid . And it does 1284 00:48:04,381 --> 00:48:06,492 your lead times usually 48 hours from 1285 00:48:06,492 --> 00:48:08,437 the time . You will feel a symptom 1286 00:48:09,070 --> 00:48:11,950 while I'm still able to spread . But I 1287 00:48:11,950 --> 00:48:14,117 would be completely unaware that I was 1288 00:48:14,117 --> 00:48:16,283 infected . So to me , I mean , I would 1289 00:48:16,283 --> 00:48:18,506 really also move us further upstream in 1290 00:48:18,506 --> 00:48:20,839 everything we do with prevention . Well , 1291 00:48:21,370 --> 00:48:24,200 I can't I can't let us uh , get off the 1292 00:48:24,200 --> 00:48:26,256 stage here without talking about the 1293 00:48:26,256 --> 00:48:28,422 vaccine and the vaccine rollout . Um , 1294 00:48:28,422 --> 00:48:30,422 and there are many , many questions 1295 00:48:30,422 --> 00:48:30,210 about it . And obviously there are lots 1296 00:48:30,210 --> 00:48:32,266 of I have several questions from the 1297 00:48:32,266 --> 00:48:34,488 panel about when and where and how much 1298 00:48:34,488 --> 00:48:36,543 and and mandatory and authorized and 1299 00:48:36,543 --> 00:48:38,766 all sorts of things like that . But let 1300 00:48:38,766 --> 00:48:41,043 me make it an open ended question . Um , 1301 00:48:41,043 --> 00:48:43,400 What was the what was the what was the 1302 00:48:43,410 --> 00:48:46,100 impact of the vaccine rollout on the 1303 00:48:46,100 --> 00:48:47,989 force ? And what is the potential 1304 00:48:47,989 --> 00:48:50,670 impact going forward of the suite of 1305 00:48:50,670 --> 00:48:52,726 vaccines that we have for COVID-19 ? 1306 00:48:52,726 --> 00:48:54,614 And I see you nodding your head , 1307 00:48:54,614 --> 00:48:56,503 killing him . So I'll ask you the 1308 00:48:56,503 --> 00:48:58,559 question . Yeah . I think I think if 1309 00:48:58,559 --> 00:49:00,614 you're aboard ship , um , you saw an 1310 00:49:00,614 --> 00:49:02,503 immediate impact in that our Navy 1311 00:49:02,503 --> 00:49:04,614 Marine Corps Public Health Center was 1312 00:49:04,614 --> 00:49:07,450 able to model levels of vaccination and 1313 00:49:07,450 --> 00:49:10,490 likelihood of outbreaks , uh , and and 1314 00:49:10,490 --> 00:49:13,220 they hit on a number uh , in that 1315 00:49:13,220 --> 00:49:16,250 environment . I , you know , want to 1316 00:49:16,250 --> 00:49:18,194 make very sure that that's in that 1317 00:49:18,194 --> 00:49:21,040 environment . About 85% vaccination 1318 00:49:21,050 --> 00:49:23,580 gave skippers the opportunity to relax 1319 00:49:23,580 --> 00:49:27,300 restrictions . So if that crew got 1320 00:49:27,300 --> 00:49:29,360 aboard and were 85% affected pretty 1321 00:49:29,360 --> 00:49:31,900 quickly , we were safe . We said with 1322 00:49:31,900 --> 00:49:33,733 it , you know , continue the non 1323 00:49:33,733 --> 00:49:35,789 pharmaceutical interventions for two 1324 00:49:35,789 --> 00:49:38,011 weeks . But at that point , if no one's 1325 00:49:38,011 --> 00:49:40,067 no one's developed , Covid , you can 1326 00:49:40,067 --> 00:49:42,120 relax restrictions . So that really 1327 00:49:42,130 --> 00:49:44,400 reduced some of the burden aboard ship 1328 00:49:44,400 --> 00:49:47,190 board . So , so a very tangible 1329 00:49:47,200 --> 00:49:51,130 operational value , I think also just , 1330 00:49:51,140 --> 00:49:53,770 you know , sunday intangibles . The 1331 00:49:53,780 --> 00:49:56,002 idea that folks could go to the gym and 1332 00:49:56,002 --> 00:49:58,440 blow off steam and not not be 1333 00:49:58,440 --> 00:50:01,800 restricted are very important to get to 1334 00:50:01,800 --> 00:50:04,450 some of the the stress issues . That 1335 00:50:04,460 --> 00:50:06,890 this is one more thing . One more 1336 00:50:06,890 --> 00:50:08,946 outlet that I'm restricting you from 1337 00:50:08,946 --> 00:50:11,112 doing and the social interaction which 1338 00:50:11,112 --> 00:50:13,040 we know is critical . So so game 1339 00:50:13,040 --> 00:50:15,830 changer , you know , and and we 1340 00:50:15,830 --> 00:50:18,240 continue to push for our force to get 1341 00:50:18,240 --> 00:50:20,296 vaccinated . It is a readiness issue 1342 00:50:20,760 --> 00:50:23,290 first and foremost for us . And if 1343 00:50:23,290 --> 00:50:25,610 you're vaccinated , you're much less 1344 00:50:25,610 --> 00:50:29,100 likely to , you know , to get very ill 1345 00:50:29,330 --> 00:50:31,274 or be hospitalized . And so you're 1346 00:50:31,274 --> 00:50:33,386 going to keep , you're going to be in 1347 00:50:33,386 --> 00:50:35,497 the game general place hinted at it . 1348 00:50:35,497 --> 00:50:38,380 But I look at it very simply , we would 1349 00:50:38,380 --> 00:50:41,030 not send our folks into combat without 1350 00:50:41,030 --> 00:50:43,380 flak and Kevlar . The enemy this time 1351 00:50:43,380 --> 00:50:45,770 is a virus and we have a biologic body 1352 00:50:45,770 --> 00:50:48,200 armor for them to take and use to 1353 00:50:48,200 --> 00:50:50,240 protect them . And so that's how I 1354 00:50:50,250 --> 00:50:52,620 that's how I really a phrase that this 1355 00:50:52,620 --> 00:50:55,430 is biologic body armor , put it on , be 1356 00:50:55,430 --> 00:50:59,210 protected . Cool . And before we finish 1357 00:50:59,210 --> 00:51:01,266 up this panel light , I do note that 1358 00:51:01,266 --> 00:51:03,099 the title of this panel is Covid 1359 00:51:03,099 --> 00:51:05,099 response and post pandemic National 1360 00:51:05,099 --> 00:51:07,154 Security . And I got a question from 1361 00:51:07,154 --> 00:51:09,321 the audience about how do we how do we 1362 00:51:09,321 --> 00:51:11,377 how do we place what we have learned 1363 00:51:11,377 --> 00:51:13,630 and what we need to do in the context 1364 00:51:13,630 --> 00:51:15,940 of broader strategic competition ? 1365 00:51:15,940 --> 00:51:18,162 Right . The military has to play a role 1366 00:51:18,162 --> 00:51:20,273 across the spectrum of conflict . And 1367 00:51:20,273 --> 00:51:22,384 we are adversaries are are looking at 1368 00:51:22,384 --> 00:51:24,496 us and and learning and they're going 1369 00:51:24,496 --> 00:51:26,718 through their own pandemic experience . 1370 00:51:26,718 --> 00:51:28,884 Um , I'll ask you general place , um , 1371 00:51:28,884 --> 00:51:31,620 how should we think about covid 1372 00:51:31,620 --> 00:51:34,140 response ? Pandemic response , disease 1373 00:51:34,140 --> 00:51:36,700 control and management in the context 1374 00:51:36,700 --> 00:51:39,870 of great power competition . And how 1375 00:51:39,870 --> 00:51:42,092 would you rate us ? How are we doing in 1376 00:51:42,092 --> 00:51:44,314 that regard of getting ready for that ? 1377 00:51:44,314 --> 00:51:47,060 Well , if you look at it um , from a 1378 00:51:47,060 --> 00:51:49,940 scientific perspective , uh military 1379 00:51:49,940 --> 00:51:52,780 scientific perspective with the B and C . 1380 00:51:52,780 --> 00:51:55,140 Burn being biologic , I mean , this is 1381 00:51:55,140 --> 00:51:58,740 a biological event , right ? And I'm 1382 00:51:58,740 --> 00:52:00,962 not going to get any sort of conspiracy 1383 00:52:00,962 --> 00:52:03,020 theories about purposeful or not 1384 00:52:03,020 --> 00:52:05,353 purposeful . Is this a wild type or not ? 1385 00:52:05,353 --> 00:52:07,464 I'm not going to get to that in large 1386 00:52:07,464 --> 00:52:09,520 part because I don't know . Um , but 1387 00:52:09,520 --> 00:52:11,742 make no mistake about it . It has had a 1388 00:52:11,742 --> 00:52:11,720 biological effect . That's why you 1389 00:52:11,720 --> 00:52:13,942 heard Admiral Willingham just mentioned 1390 00:52:13,942 --> 00:52:16,164 this is biological , body armor . It is 1391 00:52:16,164 --> 00:52:18,220 what it is . And so where are we ? I 1392 00:52:18,220 --> 00:52:20,220 think we're in a , we're in an okay 1393 00:52:20,220 --> 00:52:22,387 place . We're not in a great place for 1394 00:52:22,387 --> 00:52:24,664 an okay place . But I think one of the , 1395 00:52:24,664 --> 00:52:26,887 the things that many of us believe is a 1396 00:52:26,887 --> 00:52:29,053 fallacy and that is , it's going to go 1397 00:52:29,053 --> 00:52:31,220 away . It's not going away , just like 1398 00:52:31,220 --> 00:52:33,331 influenza is not going away . It is . 1399 00:52:34,150 --> 00:52:36,600 And the thing about many viruses is 1400 00:52:36,600 --> 00:52:39,930 they tend to mutate and they tend to do 1401 00:52:39,930 --> 00:52:42,600 things that keep them alive . And I 1402 00:52:42,600 --> 00:52:44,711 think for all of us , you know , when 1403 00:52:44,711 --> 00:52:46,989 it comes to influenza , we just , okay , 1404 00:52:46,989 --> 00:52:49,267 either we get the flu shot or we don't , 1405 00:52:49,267 --> 00:52:51,378 we know that the flu affects people . 1406 00:52:51,378 --> 00:52:53,600 The reason that influenza tends to stay 1407 00:52:53,600 --> 00:52:56,160 outside of most of our , um , our ways 1408 00:52:56,160 --> 00:52:58,320 of thinking about except for , Yeah , 1409 00:52:58,330 --> 00:53:00,386 okay . I got it this year and I've , 1410 00:53:00,386 --> 00:53:02,441 you know , I feel terrible and maybe 1411 00:53:02,441 --> 00:53:04,608 have to stay home for a few days . But 1412 00:53:04,608 --> 00:53:06,663 in general , those of us who are who 1413 00:53:06,663 --> 00:53:06,470 are adults and healthy , yeah , maybe 1414 00:53:06,470 --> 00:53:08,414 we get a little sick but otherwise 1415 00:53:08,414 --> 00:53:10,303 don't really worry about it . But 1416 00:53:10,303 --> 00:53:09,830 ladies and gentlemen , tens of 1417 00:53:09,830 --> 00:53:11,941 thousands of americans die every year 1418 00:53:11,941 --> 00:53:15,480 from influenza every year every year . 1419 00:53:17,250 --> 00:53:19,417 And what most of you likely don't know 1420 00:53:19,417 --> 00:53:21,870 is we have a tri valent vaccine every 1421 00:53:21,870 --> 00:53:24,890 year because influenza subtypes a 1422 00:53:24,890 --> 00:53:27,440 sometimes be always mutate and mutates 1423 00:53:27,440 --> 00:53:29,607 in the northern hemisphere and it goes 1424 00:53:29,607 --> 00:53:31,662 to the southern hemisphere , mutates 1425 00:53:31,662 --> 00:53:31,590 more . It goes back to the northern 1426 00:53:31,600 --> 00:53:33,620 hemisphere seasonally . It does all 1427 00:53:33,620 --> 00:53:35,880 those sorts of things and we manage it 1428 00:53:36,650 --> 00:53:38,594 with the public health things that 1429 00:53:38,594 --> 00:53:40,761 Admiral thomas was talking about . And 1430 00:53:40,761 --> 00:53:42,970 while most of us in the uniformed 1431 00:53:42,980 --> 00:53:44,702 services get vaccinated , most 1432 00:53:44,702 --> 00:53:48,380 americans actually don't . That's a 1433 00:53:48,380 --> 00:53:51,640 problem for us . So I don't see covid 1434 00:53:51,640 --> 00:53:53,751 is a thing that's going to go away or 1435 00:53:53,751 --> 00:53:55,900 coronavirus is I I actually see it 1436 00:53:55,910 --> 00:53:57,799 sticking around and continuing to 1437 00:53:57,799 --> 00:54:00,370 mutate and and and we're going to have 1438 00:54:00,370 --> 00:54:02,810 to deal with it . And and the great 1439 00:54:02,810 --> 00:54:04,880 thing about ingenuity and I'll talk 1440 00:54:04,880 --> 00:54:06,713 about the ingenuity of the human 1441 00:54:06,713 --> 00:54:08,824 species , but specifically within the 1442 00:54:08,824 --> 00:54:11,158 environment . That is the United States . 1443 00:54:11,158 --> 00:54:13,102 The reasons that we have such good 1444 00:54:13,102 --> 00:54:15,158 vaccines , A suite of vaccines right 1445 00:54:15,158 --> 00:54:17,380 now Isn't because the magical thinking 1446 00:54:17,380 --> 00:54:19,930 happened by some manufacturers in the 1447 00:54:19,930 --> 00:54:22,850 spring of 2020 . This is based on years 1448 00:54:22,850 --> 00:54:24,961 in some cases , more than a decade of 1449 00:54:24,961 --> 00:54:28,390 research and how to take the the 1450 00:54:28,390 --> 00:54:31,170 vaccination methodology to a new level . 1451 00:54:31,540 --> 00:54:33,596 And so whether it's M . R N . A . Or 1452 00:54:33,596 --> 00:54:35,800 nanoparticle or whatever it is , there 1453 00:54:35,800 --> 00:54:37,856 is huge improvements in the way that 1454 00:54:37,856 --> 00:54:39,911 we're looking at how vaccines work . 1455 00:54:39,911 --> 00:54:43,280 And and I believe that that we will get 1456 00:54:43,280 --> 00:54:45,224 to a place where we're not talking 1457 00:54:45,224 --> 00:54:47,280 about covid all the time . And we're 1458 00:54:47,280 --> 00:54:49,420 not worried about how is Covid 1459 00:54:49,430 --> 00:54:51,374 affecting this , that or the other 1460 00:54:51,374 --> 00:54:53,810 thing that likely that will be in the 1461 00:54:53,810 --> 00:54:56,650 relatively near future , but not this 1462 00:54:56,650 --> 00:54:58,650 week , not this month and maybe not 1463 00:54:58,650 --> 00:55:00,761 even this year , but we will get to a 1464 00:55:00,761 --> 00:55:02,817 place where it's going to be another 1465 00:55:02,817 --> 00:55:05,094 infectious disease that we worry about . 1466 00:55:05,094 --> 00:55:07,261 And we think about much like influenza 1467 00:55:07,261 --> 00:55:11,240 or measles or tetanus or another thing 1468 00:55:11,240 --> 00:55:13,462 that Yeah , Okay . All right . I'll get 1469 00:55:13,462 --> 00:55:15,629 my vaccination . It's going to be part 1470 00:55:15,629 --> 00:55:17,462 of our reality for a long time . 1471 00:55:17,462 --> 00:55:19,462 Excellent . Great . Thank you Apple 1472 00:55:19,462 --> 00:55:21,407 Times . Um from your perspective , 1473 00:55:21,407 --> 00:55:23,407 working across the inter agency and 1474 00:55:23,407 --> 00:55:25,720 coordination , um , in terms of the 1475 00:55:25,730 --> 00:55:27,730 lessons we've learned and how we've 1476 00:55:27,730 --> 00:55:30,570 evolved , um , how how how can we do 1477 00:55:30,570 --> 00:55:33,360 you think we can best prepare for 1478 00:55:33,370 --> 00:55:35,200 collaborative responses between 1479 00:55:35,200 --> 00:55:37,200 civilian and military going forward 1480 00:55:37,200 --> 00:55:39,400 between the Coast Guard and industry , 1481 00:55:39,400 --> 00:55:41,260 between us and our international 1482 00:55:41,260 --> 00:55:43,490 partners ? What would be the sort of 1483 00:55:43,490 --> 00:55:45,657 foundational things that we would need 1484 00:55:45,657 --> 00:55:47,768 to think about to make sure that that 1485 00:55:47,768 --> 00:55:49,712 collaboration and coordination and 1486 00:55:49,712 --> 00:55:51,768 shared learning and preparedness can 1487 00:55:51,768 --> 00:55:53,823 happen , not just within the uniform 1488 00:55:53,823 --> 00:55:56,046 services where there's a lot of ability 1489 00:55:56,046 --> 00:55:57,768 to control and direct , but in 1490 00:55:57,768 --> 00:56:00,260 partnership with others . Thank you dr 1491 00:56:00,260 --> 00:56:02,482 Thompson . So it's interesting . I mean 1492 00:56:02,482 --> 00:56:04,730 the CDC really does have a pretty good 1493 00:56:04,730 --> 00:56:07,810 playbook for highly transmissible 1494 00:56:07,820 --> 00:56:10,560 respiratory viruses . We didn't kind of 1495 00:56:10,560 --> 00:56:12,782 pull it down right away and start using 1496 00:56:12,782 --> 00:56:14,671 it . But other countries that did 1497 00:56:14,671 --> 00:56:16,671 really well in the beginning , they 1498 00:56:16,671 --> 00:56:18,727 didn't have a lot of testing or they 1499 00:56:18,727 --> 00:56:20,893 didn't have a lot of anything but what 1500 00:56:20,893 --> 00:56:20,730 they had , they put into contact 1501 00:56:20,730 --> 00:56:22,897 tracing , they put into quarantine and 1502 00:56:22,897 --> 00:56:25,119 isolation and when they had testing and 1503 00:56:25,119 --> 00:56:27,341 they stood that up and they really kept 1504 00:56:27,341 --> 00:56:29,452 their numbers . So I think you having 1505 00:56:29,452 --> 00:56:32,730 that national will regardless , 1506 00:56:32,740 --> 00:56:35,100 regardless of politics , to sort of do 1507 00:56:35,100 --> 00:56:37,211 the right thing in public health will 1508 00:56:37,211 --> 00:56:41,200 save lives . The idea that because I 1509 00:56:41,200 --> 00:56:43,311 don't think anyone tries to look at , 1510 00:56:43,530 --> 00:56:46,340 how do we not partner with because all 1511 00:56:46,340 --> 00:56:48,284 of us have civilian members of our 1512 00:56:48,284 --> 00:56:50,340 family , Right ? So we want the same 1513 00:56:50,340 --> 00:56:52,507 good health for ourselves as we do for 1514 00:56:52,507 --> 00:56:54,900 our family members . Um and I think 1515 00:56:54,900 --> 00:56:56,900 there's just , I think there's been 1516 00:56:56,900 --> 00:57:00,750 great progress on a real 1517 00:57:00,760 --> 00:57:02,610 openness . This to me , what was 1518 00:57:02,610 --> 00:57:05,900 amazing was seeing something um MRNA 1519 00:57:05,900 --> 00:57:07,789 vaccines in particular brought to 1520 00:57:07,789 --> 00:57:10,460 fruition in such a short time because 1521 00:57:10,460 --> 00:57:14,380 the the globe was a tremendous 1522 00:57:14,380 --> 00:57:16,500 threat . Every population was a 1523 00:57:16,500 --> 00:57:18,556 tremendous threat if we did not have 1524 00:57:18,556 --> 00:57:22,000 vaccine . And it's been great . I mean , 1525 00:57:22,010 --> 00:57:24,590 we're over 70% of our active duty and 1526 00:57:24,800 --> 00:57:27,330 reserve forces are vaccinated right now . 1527 00:57:27,360 --> 00:57:30,550 But that's not enough . And almost like 1528 00:57:30,550 --> 00:57:32,717 where we are right now is since you're 1529 00:57:32,717 --> 00:57:34,661 seeing all the breakthrough , um , 1530 00:57:34,830 --> 00:57:38,180 cases Do I go back to Rome and testing 1531 00:57:38,180 --> 00:57:40,347 people before they're getting underway 1532 00:57:40,347 --> 00:57:42,569 for 90 days and my back exactly where I 1533 00:57:42,569 --> 00:57:44,513 was rather than rather than at the 1534 00:57:44,513 --> 00:57:46,624 wonderful modeling that was done . If 1535 00:57:46,624 --> 00:57:48,680 you have this level of vaccination , 1536 00:57:48,680 --> 00:57:50,902 don't worry about the other 15% because 1537 00:57:50,902 --> 00:57:52,958 I am a little bit more worried about 1538 00:57:52,958 --> 00:57:54,902 them now and I'm worried about the 1539 00:57:54,902 --> 00:57:57,013 spread to other people even if it's a 1540 00:57:57,013 --> 00:57:59,013 milder disease . So I think the the 1541 00:57:59,013 --> 00:58:01,236 game changes which keeps it interesting 1542 00:58:01,236 --> 00:58:03,402 for us . But like , um , general place 1543 00:58:03,402 --> 00:58:05,624 that I I have no expectation that Covid 1544 00:58:05,624 --> 00:58:08,070 will go away . There won't be another 1545 00:58:08,070 --> 00:58:10,590 coronavirus or a similar viruses . This 1546 00:58:10,590 --> 00:58:12,590 will mutate , I think . But I think 1547 00:58:12,590 --> 00:58:14,812 we're smart enough to figure out how to 1548 00:58:14,812 --> 00:58:17,120 protect ourselves . Excellent . Well , 1549 00:58:17,130 --> 00:58:19,241 unfortunately , we've , we've quickly 1550 00:58:19,241 --> 00:58:21,463 reached the end of the time . We have a 1551 00:58:21,463 --> 00:58:23,574 lot and for this , I have a couple of 1552 00:58:23,574 --> 00:58:23,100 thank you . So I'd like to say before 1553 00:58:23,100 --> 00:58:25,390 we finish up this panel . And first and 1554 00:58:25,390 --> 00:58:27,612 foremost I'd like to thank the audience 1555 00:58:27,612 --> 00:58:29,779 for being interested participating . I 1556 00:58:29,779 --> 00:58:31,779 had a huge stack of questions . I'm 1557 00:58:31,779 --> 00:58:33,890 sorry . I didn't get to all of them , 1558 00:58:33,890 --> 00:58:36,112 but I think we had a really substantive 1559 00:58:36,112 --> 00:58:38,168 conversation . Um , and and that was 1560 00:58:38,168 --> 00:58:40,001 driven by the questions from the 1561 00:58:40,001 --> 00:58:42,112 audience . I'd like to thank the Navy 1562 00:58:42,112 --> 00:58:44,223 League for inviting the panelists and 1563 00:58:44,223 --> 00:58:43,550 drawing them together and creating this 1564 00:58:43,550 --> 00:58:45,772 venue for this important conversation . 1565 00:58:45,890 --> 00:58:48,510 And it also very much like to thank the 1566 00:58:48,510 --> 00:58:50,720 services , the Defense Department and 1567 00:58:50,720 --> 00:58:52,831 these individuals here that represent 1568 00:58:52,831 --> 00:58:54,887 that for taking your time and energy 1569 00:58:54,887 --> 00:58:57,109 for thinking about these issues for the 1570 00:58:57,109 --> 00:58:59,109 contributions and learning that you 1571 00:58:59,109 --> 00:59:01,164 made over the last year and a half , 1572 00:59:01,164 --> 00:59:00,320 and your willingness to come and share 1573 00:59:00,320 --> 00:59:02,376 that today . So so Admiral thomas at 1574 00:59:02,376 --> 00:59:04,320 will killing him a general place . 1575 00:59:04,320 --> 00:59:04,180 Thank you very much for your 1576 00:59:04,180 --> 00:59:06,402 participation in this panel . It's been 1577 00:59:06,402 --> 00:59:08,458 a real pleasure , uh , and thank you 1578 00:59:08,458 --> 00:59:08,750 all for being here today .