The subsequent chapters are deliberately detailed and intended for the reader seeking to develop and implement the described measures and strategies. A more concise summary is provided through this Executive Summary and the bulleted lessons learned at the beginning of each chapter.

The chapters are broken into four sections. The lessons learned from each chapter are included here in the Executive Summary. Further details can be found in the respective chapters. The first two chapters discuss the background and setting of COVID in the forward deployed setting. Chapters 3-7 focus on the fundamental principles of COVID-19 risk mitigation. The next two chapters, chapters 8-9, highlight events and lessons learned from our experiences building and maintaining isolation and quarantine facilities.

The final two chapters discuss austere medical and nursing COVID-19 care, as well as MEDEVAC considerations. Finally, the appendices are for supplemental usage and include the lessons learned report by unit surgeon from the initial, single-camp COVID-19 outbreak.

FUNDAMENTAL PRINCIPLES OF COVID-19 RISK MITIGATION

Bluntly stated, our location was not adequately prepared for the COVID-19 outbreaks that began in June and escalated into late August and early September. While the initial, single-camp outbreak provided early observations and lessons learned, it may have contributed to a false sense of security that COVID-19 could be easily contained and controlled. The base-wide outbreak occurring in August quickly dispelled this belief. During the 25-day outbreak, our leadership discovered that it required a deliberate, multi-faceted strategy to prevent widespread infection. Specifically, we developed a COVID-19 risk mitigation plan built upon the following principles:

- Aggressive Contact Tracing and Testing
- Deliberate Messaging
- COVID-19 Source Control
- Data-Driven Algorithms and Decisions
- Team-Based Solutions

A comparison between the base-wide outbreak and the subsequent multi-cluster outbreak suggests the validity of our methods. The local national base-wide outbreak began with a single exposure point and spread across the base. Over 25 days, there were 210 positive cases from 23 different units. In contrast, the operational exposure outbreak had five independent exposure sources, yet only lasted 18 days and had 85 positive cases. Despite four additional “patient zeros,” the outbreak lasted seven days less with 60% fewer cases. Additionally, base amenity closures were significantly reduced during the multi-cluster outbreak. Lastly, two units with a minimalist COVID-19 mitigation posture proved responsible for 51 of the 85 positive cases. With stricter internal mitigation practices in these two units, it is estimated that 60% of the cases could have been avoided.