Side boys salute former Secretary of the Navy John Lehman as he is piped aboard the aircraft carrier USS Theodore Roosevelt (CVN 71). The ship is off the coast of Southern California conducting routine training operations. (U.S. Navy photo by Mass Communication Specialist 3rd Class Victoria Galbraith/Released)

Free Pratique: Managing Illness and Quarantine At Sea

Captain Brett Crozier, the Commanding Officer of the USS Theodore Roosevelt, sent a letter to his commanders in the Pacific Fleet this week. His warning was dire. As COVID-19 was starting to spread through the Sailors embarked on his ship, he believed that vast numbers were in danger of losing their life, and his ship – which has a small hospital on board – was ill prepared for such an outbreak. The last time the Navy released public numbers of infected on the Roosevelt, the number was over 40, and with the confined spaces Sailors exist in, that number is only expected to grow exponentially. In this piece, U.S. Navy Surface Warfare Officer Anthony Clay examines the practice of “Free Pratique” and disease management aboard a warship.

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While the world is learning to practice social distancing, and it now paying special attention to disease transmission, this has been something that mariners have dealt with for centuries. Moving from continent to continent, sailors were often the ones responsible for bringing illnesses, infestations, invasive species, whatever bad thing you can think of, alongside the positive things they brought with them. Typically, ships are expected to manage their own illnesses and declare “Free Pratique” before they pull into a port. Essentially his means they are declaring themselves free of illness and should not require inspections of their crew, and any cargo that will not be going through customs. For warships this is typically a formality, as they also have authorities under UNCLOS that allow them to refuse inspections.

The current crisis has raised questions around what happens when they can’t declare pratique? About a year ago, I was directly involved in the case of the USS Fort McHenry; an American Dock Landing Ship deployed to the Middle East with several hundred Marines from the 22nd Marine Expeditionary Unit on board. Shortly after they transited the Suez Canal and entered our area of responsibility, it was discovered they had a mumps-like illness dubbed Parotitis. While it was a strain that wasn’t covered in the MMR vaccination all military members have had, it was rarely fatal in adults who had been vaccinated. It was nothing more than an annoying flu for those that ended up contracting it, but it could have been potentially fatal for children or unvaccinated adults.

To protect possibly at-risk populations, our command ended up keeping Fort McHenry at sea for approximately four months straight, cancelling exercises, port visits, and the ship’s involvement in real world operations. This level of caution is beyond unusual in a peacetime environment, and we kept her in theatre ready to support any contingency she was needed for, assuming the infection risk would be accepted by a commander if needed.

The difference here is that COVID-19 is much more fatal, and has much higher rates of transmission. On Fort McHenry, the infections were mostly confined to a single berthing of Marines, who aren’t usually very involved in the day to day operation of a ship at sea, and the medical personnel who were treating them. It was very possible to keep them roughly together, and the Marines in that berthing who hadn’t been infected yet just got to watch the train roll toward them until they were infected. But these Marines could be kept isolated from the rest of the crew, and the medical staff that were infected moved into the medical ward on the ship, and they became the primary Sailors to conduct any treatment of infected Marines.

Aircraft Carriers are different to Amphibious ships. All members of the crew are involved in daily operations, and a spreading infection, particularly one that has taxing effects on the infected, would rapidly inhibit the Carrier’s ability to conduct its mission. Captain Crozier has suggested that the Roosevelt pull into Guam to offload as many personnel as possible (up to 4000 by some estimates), and quarantine them for an undetermined period. This effectively pulls the carrier off of her current deployment, and sidelines one of the US’s most valuable strategic assets.

Having been involved in many of the decisions facing the USS Fort McHenry, with a fairly benign virus, and in a world not shaped by an ongoing pandemic, I am aware of the difficulty of the decisions being made. That the letter from Captain Crozier was leaked to the San Francisco Chronicle has made these decisions much more fraught. We were fortunate that we were able to keep everything under wraps for several months before it was made public, and make decisions without the added pressure of public scrutiny. There are no good decisions to be made here; it is merely minimising damage across the public and military domains.

The Commander of Pacific Command has already shot down a majority of Captain Crozier’s requests, and the Governor of Guam has expressed significant reluctance to risk stretching their limited medical capability on the island even thinner. There will be some offloading of affected personnel to Guam, but not in the extreme levels the CO requested. But as we have seen with the international spread of COVID-19, early and significant actions are required to effectively slow the spread.

Without drastic measures right now, it could just be delaying the inevitable, and putting them in a more remote position where they don’t have the luxury of entering an American territory to seek treatment and medical support.

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Anthony Clay is a Surface Warfare Officer in the United States Navy who has served in every operational fleet, and most geographic Combatant Commands. He has an International Relations Degree from Tulane University and a Operations Research Masters Degree from the Naval Postgraduate School. Anthony is currently assigned to a staff posting within a numbered fleet.

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Photo: USS Theodore Roosevelt, U.S. Navy photo by Mass Communication Specialist 3rd Class Victoria Galbraith