Department of Defense Travel Restrictions Memo

March 11, 2020 (copied pdf text)

https://media.defense.gov/2020/Mar/11/2002263242/-1/-1/1/TRAVEL-RESTRICTIONS-FOR-DOD-COMPONENTS-IN-RESPONSE-TO-CORONAVIRUS-DISEASE-2019.PDF

SUBJECT: Travel Restrictions for DoD Components in Response to Coronavirus Disease 2019

This memorandum applies to all DoD uniformed and civilian personnel and their

sponsored family members not under the responsibility of a U.S. Chief of Mission.

Effective March 13, 2020, all DoD uniformed personnel, civilian personnel and family

members traveling to, from, or through Centers for Disease Control and Prevention (CDC)

Travel Health Notices Level 3 (COVID-19) designated locations, will stop movement for the

next 60 days. This includes all forms of official travel, including Permanent Change of Station,

Temporary Duty, and government-funded leave. For DoD uniformed personnel, this also

includes personal leave and other non-official travel. DoD travelers should carefully plan travel

to ensure their scheduled flights do not transit through or originate in Level 3 designated

locations. Authorized Departures are delayed until appropriate transportation and reception

procedures are in place for their intended route of travel as prescribed in this memorandum.

Effective March 13, 2020, and for the 60 days thereafter, concurrent official travel for

family members of DoD uniformed personnel and civilian personnel is denied to CDC Travel

Health Notices Level 2 (COVID-19) designated locations. Additionally, until the travel

restrictions prescribed above are lifted, DoD civilian personnel hiring actions for positions in

Level 2 and Level 3 designated locations are postponed for non-essential civilian personnel who

have not yet begun travel.

Also effective March 13, 2020, DoD Components must determine whether official travel

by DoD personnel to locations other than CDC Travel Health Notices Level 3 designated

locations is mission essential and must defer non-mission essential travel. Mission-essential

travel refers to work that must be performed to ensure the continued operations of missionessential functions, as determined by the DoD Component.

Exceptions may be granted in writing to the guidance contained herein for compelling

cases where the travel is: (1) determined to be mission essential; (2) necessary for humanitarian

reasons; (3) warranted due to extreme hardship. Approval authority for these exceptions belongs

to the Combatant Commander if the individual is assigned to a combatant command. The

Secretary of the Military Department concerned and the Chief Management Officer in the case of

Defense Field Activities and Field Agencies retain the authority for all other individuals. This

authority may be delegated in writing no lower than the first general or flag officer or member of

the Senior Executive Service in the traveler's chain of command or supervision. These

exceptions are to be done on a case by case basis, shall be limited in number, and shall be

coordinated between the gaining and losing organizations. Individuals pending retirement or

separation within the next 60 days are exempt. Individuals traveling under an exception or

exemption, including those traveling as part of a Department of State-issued Authorized

Departure, are subject to travel screening protocols as provided in reference (a).

These actions give preeminence to the safety and security of our personnel and their

families. During the next 60 days, the Department will take several measures to enhance traveler

safety. Each of your organizations, as applicable, shall take immediate action to:

• Establish pre- and post- travel screening and reception procedures for all

travelers as provided in reference (a), to include providing members or civilian

employees information regarding prescribed actions for them and their family

members given their particular circumstances;

• Establish a means of communication with all personnel throughout the reception

process until they are allowed to resume their normal duties;

• Transition to military or DoD contracted aircraft for DoD sponsored travelers

coming from or going to CDC Level 3 or Level 2 designated areas, to the

greatest extent practical; and

• Inform all travelers of their responsibility to contact their gaining organization

in advance of travel and to keep the organization updated on their travel

itinerary.

Refer to the latest Force Health Protection Supplement for all areas not

specifically addressed by this guidance

(https://www.defense.gov/Explore/Spotlight/Coronavirus/).

Our understanding of COVID-19 is rapidly evolving, and this guidance will be

continuously evaluated as conditions warrant. Component heads should ensure this

guidance is clearly communicated to those affected by these changes to travel policy.

VA locks down nursing homes to prevent COVID-19 infections; department tracking six cases

(Patricia Kime Mar 10 2020)

https://www.militarytimes.com/news/your-military/2020/03/10/va-locks-down-nursing-homes-to-prevent-covid-19-infections-department-tracking-six-cases/

The Department of Veterans Affairs has taken the drastic step of banning visitors from its spinal cord injury wards and 134 nursing homes, except for close family members of dying veterans.

All VA medical facilities began screening visitors this month for the novel coronavirus, COVID-19, and many have started limiting the number of visitors or barring children under age 18, and in some cases, 16, from medical campuses.

But on Tuesday, the department announced that its nursing homes, also called community living centers, and 24 spinal cord injury and disorder centers will have a “no visitor” rule starting immediately and lasting “until further notice.”

The facilities house or care for more than 65,000 veterans.

“While the COVID-19 risk to average Americans remains low, these commonsense measures will help protect some of our most vulnerable patients,” VA Secretary Robert Wilkie said in a release. “VA will make every effort to minimize the impact of these policies on veterans while putting patient safety first.”

ccording to VA, many of its nursing home residents and all its spinal cord injury patients have complex medical conditions that make them susceptible to infection. The COVID-19 outbreak in the U.S. has killed 25 people, 13 of whom were housed at the Life Care Center nursing home in Kirkland, Washington.

A study of more than 72,000 COVID-19 cases in China published online last month by the Journal of the American Medical Association found the virus affects patients with severe underlying medical conditions as well as the elderly more severely than younger, healthier patients.

According to the study, the case fatality rate among those already critically ill from another existing medical condition was 49 percent. For patients over the age of 80, it was 14.8 percent, and for those ages 70 to 79, 8 percent.

For the vast majority, however, the illness was mild, meaning it did not cause pneumonia or resulted in only a mild case of pneumonia. According to the research, compiled by the Chinese Center for Disease Control and Prevention, 81 percent of the 72,000 cases were mild and resulted in no deaths.

Across the country, VA is caring for or monitoring six COVID-19 cases among veterans, mostly in the western U.S.

A VA spokeswoman said Tuesday that in addition to one patient at the VA Palo Alto Medical Center in California with a confirmed case, the VA Southern Nevada Healthcare System in Las Vegas and Southeast Louisiana Veterans Health Care System in New Orleans each have one patient awaiting confirmation from the Centers of Disease Control and Prevention on their positive screenings.

Three other veterans — patients of the VA Puget Sound Health Care System, the Rocky Mountain Regional VA Medical Center and the VA Portland Healthcare System — are under quarantine at home with presumed positive cases that must be certified by the CDC, VA Press Secretary Christina Mandreucci said.

According to VA, veterans who have flu-like symptoms should call their providers first or send a secure message through MyHealtheVet before venturing to a hospital or clinic. If they have a medical appointment, they should arrive at least 30 minutes before the scheduled time to get through the medical screening process now being held outside VA medical facilities.

In addition to temperature checks, they will be asked whether they have a fever, cough or flu-like symptoms, if they have traveled to China, Japan, Italy, Iran or South Korea in the past 14 days or had close contact with someone confirmed to have COVID-19.

In addition to the “no visitor” rule at VA nursing homes and spinal cord injury centers, VA also will not be taking any new veteran residents and will limit inpatient admissions to its spinal cord injury centers to patients needing acute care. Respite care will be suspended until further notice.

The exceptions to the “no visitor” rule include veterans who are in the final stages of their life in hospice, according to VA.

“In those cases, visitors will be limited to a specific veteran’s room only,” according to VA.

Congress – Corona virus timeline:

May 15 2019

House introduces the H&HS appropriations bill HR 2740

https://www.congress.gov/bill/116th-congress/house-bill/2740/text

June 19 2019

House vote (226-203) on H&HS appropriations and passed to the Senate

Sept 18 2019

Senate vote 51-44

Sept 19 2019

President Trump signs EO 13887 that allowed CDC to redirect available funds toward flu season research and vaccination.

https://www.federalregister.gov/documents/2019/09/24/2019-20804/modernizing-influenza-vaccines-in-the-united-states-to-promote-national-security-and-public-health

Oct 1 2019

Start of the fiscal year and no appropriations bill passed by Congress for H&HS and the CDC

Oct 28-Nov 1 2019

House and Senate combine overdue appropriations bills into HR 1865

note: HR 1865 was not an appropriations bill, it was originally titled

"National Law Enforcement Museum Commemorative Coin Act"

https://www.congress.gov/bill/116th-congress/house-bill/1865/summary/55

Dec 17-19 2019

House and Senate finally agree to amends and pass HR 1865, retitled by amendment

"Further Consolidated Appropriations Act, 2020"

Dec 20 2019

President Trump signs the overdue appropriations bill into law

note: HR 1865 appropriation Reduced funding from FY 2019 and the introduced bill for

immunization and respiratory diseases $44,750,000

public health preparedness and response $615,000,000

Mar 4-6 2020

Congress introduces, passes and the President signs H.R.6074 - Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 ($8.3 billion emergency appropriations in 2 days)

https://www.congress.gov/bill/116th-congress/house-bill/6074/text

note: delays by Congress to fulfill their responsibility to appropriate funds, meant that CDC was restricted on what work it could perform and relied on the Executive Order to redirect available funding for almost 3 months.

Status of state public school Corona closures - eastern half US

(used gov’t sauce if readily available evening March 13, details may change)

Snowflake Paranoia States (especially Louisiana)

Delaware https://news.delaware.gov/2020/03/13/governor-carney-directs-two-week-closure-of-delaware-public-schools/

Illinois https://www2.illinois.gov/Pages/news-item.aspx?ReleaseID=21247

Louisiana (1 month / primary postponed) https://gov.louisiana.gov/index.cfm/newsroom/detail/2403

Maryland http://www.wboc.com/story/41888547/maryland-governor-closes-public-schools-port-from-coronavirus

Michigan (3 week) https://www.michigan.gov/coronavirus/0,9753,7-406-98163-521561–,00.html

Ohio https://governor.ohio.gov/wps/portal/gov/governor/media/news-and-media/announces-school-closures

Oregon https://www.myoregon.gov/2020/03/12/governor-kate-brown-announces-statewide-school-closure-for-students-in-oregon-from-monday-march-16-through-tuesday-march-31/

Pennsylvania https://www.governor.pa.gov/newsroom/gov-wolf-sec-of-health-pa-chamber-outline-covid-19-mitigation-guidance-for-pennsylvania-schools-businesses-and-additional-closures-in-delaware-county/

Rhode Island https://www.997wpro.com/2020/03/13/governor-closes-rhode-island-schools-next-week-9-new-cases-of-covid-19-announced-in-ri/

South Dakota https://siouxcityjournal.com/news/local/state-and-regional/noem-orders-south-dakota-k–schools-to-close-next/article_14ddb2a4-3a5d-5a1c-b467-eb3327f2392e.html

Virginia https://www.governor.virginia.gov/newsroom/all-releases/2020/march/headline-854442-en.html

West Virginia https://governor.wv.gov/News/press-releases/2020/Pages/COVID19-UPDATE-Gov.-Justice-announces-closure-of-West-Virginia-schools.aspx

Wisconsin https://kstp.com/politics/wisconsin-governor-directs-dhs-to-mandate-closure-of-all-k-12-schools-in-state/5673794/

Peer Pressure to Sensible States

Arkansas if advised by state health https://www.ozarksfirst.com/local-news/regional-news/governor-asa-hutchinson-secretary-of-adh-announces-five-new-presumptive-coronavirus-cases-school-closures-in-four-counties-for-two-weeks/

Connecticut waive 180 days per district evaluation https://www.nbcconnecticut.com/news/local/governor-waives-180-day-requirement-for-schools/2237445/

Florida state of emergency https://www.ajc.com/news/education/governor-schools-should-consider-closing-for-two-weeks/m6ccgfuAQkJBVtrXNiM8YI/

Georgia not mandated, per district evaluation https://www.ajc.com/news/education/governor-schools-should-consider-closing-for-two-weeks/m6ccgfuAQkJBVtrXNiM8YI/

Indiana per district evaluation https://www.michigansthumb.com/news/education/article/Indiana-governor-letting-school-districts-decide-15129658.php

Iowa disaster proclamation https://idph.iowa.gov/News/ArtMID/646/ArticleID/158298/Gov-Reynolds-signs-Disaster-Proclamation-Following-Additional-COVID-19-Cases-in-Iowa-3920

Kentucky recommends closure but not mandated https://wsiltv.com/2020/03/12/kentucky-governor-urges-schools-to-close-at-least-2-weeks/

Massachusetts state of emergency, per district evaluation https://www.mass.gov/service-details/state-of-emergency-information

Nebraska emergency declaration, per district evaluation https://governor.nebraska.gov/press/gov-ricketts-issues-guidance-school-closures-leaders-provide-covid-19-response-update

New Jersey state of emergency, anticipate school closings https://nj.gov/governor/news/news/562020/approved/20200309b.shtml

New York waive 180day, per district evaluation https://www.amny.com/coronavirus/governor-cuomo-waves-180-instruction-requirement-for-new-york-schools/

North Carolina state of emergency https://files.nc.gov/governor/documents/files/EO116-SOE-COVID-19.pdf

North Dakota state of emergency , per district evaluation https://www.governor.nd.gov/news/updated-burgum-declares-state-emergency-response-coronavirus-k-12-guidance-issued

South Carolina state of emergency, some closures https://governor.sc.gov/news/2020-03/gov-henry-mcmaster-declare-state-emergency-order-lancaster-kershaw-county-schools

Common Sense States (may have emergency declaration but no school details)

Alabama Kansas Maine Minnesota Mississippi New Hampshire Oklahoma Tennessee Vermont

Medical Ventilator Manufacturers ALREADY Increased Production

Manufacturers were already ramping up production of ventilators and medical supplies. No government DPA order was/is needed. If there was any delay to increase production, it was because states and hospitals did not place orders earlier. A rush to add new manufacturers increases the risk of some products not meeting medical grade standards, even 3M had get an exception for liability protection.

Hospital administrators and state DOH should be capable of answering the questions:

When did you agency begin planning and reviewing for the Wuhan Flu epidemic?

When were medical supplies inventoried and additional stock ordered?

Were other agencies or hospitals contracted to compare inventories of essential items and if so when?

What additional healthcare training was recommended and provided?

How many influenza patients are placed on ventilators during a typical week and flu season?

Does your hospital/agency have a natural disaster pandemic emergency plan, how often is it reviewed, and training?

(partial list of more relevant questions)

GE Healthcare says it is increasing production of ventilators and other equipment

(Milwaukee Journal Sentinel March 19 2020)

https://www.jsonline.com/story/money/business/health-care/2020/03/19/ge-healthcare-increase-production-ventilators-response-coronavirus-crisis/2875423001/

GE Healthcare said it has increased its manufacturing capacity of ventilators, which it makes in Madison, and other equipment in response to the coronavirus crisis.

A potential shortage of ventilators for patients with COVID-19, the respiratory disease caused by the virus, is one of the most serious vulnerabilities in the U.S. health care system.

An estimated 5% of COVID-19 patients become seriously ill and about half of them require ventilators.

“As the global pandemic evolves, there is unprecedented demand for medical equipment, including ventilators," Kieran Murphy, president and CEO of GE Healthcare, said in a statement. "We continue to explore all options to support this increased need."

The business, a division of GE Co., said it is adding manufacturing lines to its ventilator production and increasing the number of shifts to produce around the clock. It also said is it hiring additional manufacturing employees and shifting current employees to help meet the increased demand.

GE Healthcare did not respond to questions on how many ventilators it makes a week, how much it can increase production and whether getting components is a potential problem.

'We’ll take them all': Demand for ventilators spikes as coronavirus looms

https://abcnews.go.com/Health/demand-ventilators-spikes-coronavirus-looms/story?id=69597233

excerpt

Firms that make the machines said they are ramping up for coming needs. An official from General Electric told ABC News the company is “taking steps to maximize our manufacturing capability and output while ensuring our plants can continue safe operations.”

Officials at another manufacturer, Drägerwerk AG & Co., told ABC News they just received an order for 10,000 ventilators from the German government. “The delivery of the order will stretch across the entire year and requires a substantial increase of the production capacity,” a spokesperson said.

Additional articles:

Coronavirus: Ventilator Manufacturers Not Ramping Up Production — Yet

https://www.breitbart.com/health/2020/03/13/coronavirus-ventilator-manufacturers-not-ramping-up-production-yet/

Ireland:

Medtronic Increasing Ventilator Production to Address COVID-19 Pandemic

https://www.globenewswire.com/news-release/2020/03/19/2003071/0/en/Medtronic-Increasing-Ventilator-Production-to-Address-COVID-19-Pandemic.html

Sweden:

Ventilator Maker Increases Production

https://www.manufacturing.net/safety/video/21122831/ventilator-maker-increases-production

>>8531131

Automotive parts manufacturers to make medical ventilators

The U.S. Needs More Ventilators. GM and Ford Might Help Make Them.

https://www.barrons.com/articles/ventilators-gm-ford-medical-device-makers-covid-19-51584623085

As public health authorities ring warning bells about a shortage of ventilators needed to treat the most seriously ill Covid-19 patients, two major car manufacturers said they were looking into helping manufacture the devices.

A General Motors (ticker: GM) spokesman confirmed to Barron’s that the company is evaluating the possibility of making ventilators, and looking into how it can be useful. Ford (F) didn’t immediately respond to a request for comment, but a spokeswoman told Automotive News that the company is in preliminary talks with government officials in the U.S. and Britain about making ventilators, and was investigating whether it was feasible.

Both of the auto makers, along with Fiat Chrysler (FCAU), announced this week that they were temporarily shutting down their automobile factories because of the Covid-19 epidemic.

Health officials have said that the need for ventilators to treat Covid-19 patients will vastly outstrip the supply. Ventilators are complex devices that assist breathing in patients unable to breathe for themselves.

As auto makers consider stepping in, major ventilator makers said Wednesday night and Thursday morning they were vastly increasing production. Early Thursday, General Electric (GE) subsidiary GE Healthcare said the company was committing additional manufacturing lines to the production of ventilators, and adding shifts so that the lines will be active 24 hours a day.

“As the global pandemic evolves, there is unprecedented demand for medical equipment, including ventilators,” GE Healthcare President and CEO Kieran Murphy said. “We continue to explore all options to support this increased need.”

GE Healthcare also said it was hiring employees, reallocating current staff and taking other measures to increase production.

Medtronic (MDT), another major ventilator maker, said Wednesday night it had already increased ventilator production by 40% and planned to more than double its ventilator manufacturing capacity. The company said it has more than 250 employees working on ventilator manufacturing in its Ireland factory, and would transfer staff from other Medtronic facilities to help double that number. Production at the plant is shifting to a 24/7 schedule.

“Medtronic recognizes the demand for ventilators in this environment has far outstripped supply,” Bob White, president of Medtronic’s Minimally Invasive Therapies Group, said. “No single company will be able to fill the current demands of global health-care systems. However, with all manufacturers increasing their production and through partnerships with governments, hospitals and global health organizations, Medtronic is committed to getting more ventilators into the market and to the right locations in the world to help doctors and patients dealing with Covid-19.”

The process isn’t likely to be fast. A spokesman for Vyaire Medical, a private medical-device manufacturer that was spun out of Becton Dickinson (BDX) and is a major manufacturer of ventilators, said an individual ventilator takes up to 40 days to manufacture.

>>8531131

Concerns about unqualified/verified manufacturers of medical ventilators and supplies

Coronavirus: Plan to ramp up ventilator production 'unrealistic'

https://www.bbc.com/news/business-51914490

Craig Thompson, head of products at Oxfordshire company Penlon, said the idea that other firms could switch production was unrealistic.

Prime Minister Boris Johnson has urged engineering firms, including carmakers, to explore if they could make the life-saving equipment.

Ventilators are critical in the care of some people suffering coronavirus.

But there is concern the National Health Service will face a shortage of equipment as the virus infects more people.

The manufacturers association, Make UK, says that it would be possible for some specialist engineers to scale up production under licence.

Ford, Honda, car parts firm Unipart, digger maker JCB, and aero-engine maker Rolls Royce are among companies looking into the feasibility of switching some production.

Medical ventilators are used to provide oxygen to patients with breathing difficulties, but there are not nearly enough of them to deal with the coronavirus outbreak.

The Department of Health has revealed that in a worst case scenario the NHS will need an additional 20,000 of the machines. The NHS currently has about 5,000 adult ventilators and 900 for children in critical care facilities.

The Health Secretary, Matt Hancock, has tweeted asking for help from "all manufacturers who can support our National Effort for coronavirus ventilator production".

But Penlon, which makes anaesthesia machines that include a ventilator, is cautious about hopes that other companies can start making the equipment.

"The idea that an engineering company can quickly manufacturer medical devices, and comply with the rules, is unrealistic because of the heavy burden of standards and regulations that need to be complied with," said Penlon's Mr Thompson.

He said "the focus should be on existing medical device companies increasing supply of ventilators".

His firm makes 750 machines a year and could double production, given time. In the short term he could provide the NHS with up to 200 more machines.

"The manufacture of medical devices, such as ventilators, is highly regulated," Mr Thompson adds. "Typically a new medical device takes two or three years to develop and launch."