In the light of the COVID-19 Pandemic outcome, this article is an opportunity to evaluate and change old beliefs by restructuring our perspective and needs of preventive medicine/hygiene products and procedures. Military training environments when combined with less-than-optimal hygiene and psychological and physical stressors in the field make military personnel especially vulnerable to infectious diseases. Some of these diseases can result in large outbreaks that can and have jeopardized entire military operations. Furthermore, the constant changing environment makes military personnel immune system almost naïve to new pathogens. Such challenges are opportunities for the advancement of preventive and therapeutic medicine by taking it to a new level. These critical but simple changes are at the forefront of our military and the community at large in our fight against what we call “The Deadliest Enemy”.
Dr. Juan J Agudelo, C.O.O, United Spirit of America
As presented by many valid researches in the past 50 years, infectious diseases have killed more Soldiers/Sailors and Airmen that weapons ever did.
Our current Standard Issue products for each soldier/sailor/ airmen classifies chemoprophylaxis hygiene or its preventive medicine
products as “personal care”. Their acquisition depends on the individual soldier/sailor/airmen to purchase his/her “toiletries” within their allowance card; the problem is that it only takes one individual who “forgot” or “lost” his personal care chemoprophylaxis products to get infected to put the rest of his/her peers at risk. From a simple a common cold to Covid-19 to Ebola virus, contagious diseases come with a full array of debilitating and in many cases lethal variables. They can be sporadic, exotic, they can be airborne like all the corona viruses, water based or have a zoonosis, epizootic, or enzootic sources of infection… they can go from a narrow endemic event to a pandemic in a matter of days; in other words, the Deadliest Enemy is real and, in more cases than we would like, devastating.
Preventive medicine has many uses but most of it addresses similar pathways such as proper chemoprophylaxis hygiene, vaccination, and if infected, treatment with powerful antiviral and antibiotics. Reality has shown us that the source of vaccines and antibiotics are limited since “Big Pharma is not incentivized to develop them.” unless there is a full-blown epidemic like the COVID-19 that we are suffering worldwide now.
Infection, contamination, and infestation of contagious diseases have not only devastating consequences on our Military but run the cost of keeping our forces in a ready optimal state very high. The amount of medical personnel, doctors, nurses, aides plus number of beds, facilities, pharmaceutical resources, transportation units and equipment generate a very expensive and ever-increasing cost that affects all budgets; but most of all it has a direct effect on U.S. national security and defense capabilities. All these costs are not counting the potential of spreading the diseases to the civilian population and the devastating effect on national security.
From all preventive medicine possibilities, proper chemoprophylaxis hygiene has the biggest cause-effect on Transmission Probability Ratio (TPR) on direct and indirect transmission of contagious diseases as fairly documented by many reputable researchers throughout history.
Vaccination has also a direct control on the virulence, prevention and reduction on the case fatality rate but proper chemoprophylaxis hygiene as a preventive medicine tool is the one that produces the biggest and most efficient savings and cost control while enhancing thequalityoflifeofourmilitarypersonnel.
Strangely enough, the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) includes vaccines, drugs, diagnostic identification systems, training, and education as the core of their advances towards the control and treatment of infectious diseases but puts little emphasis on the most effective source of prevention, proper chemoprophylaxis hygiene and key new hygiene products.
The question is then, if the current procedure is to supply our warriors with the best, including the best uniforms, best weapons, best training, and best intelligence, why are they not supplied as part of their standard regular issued equipment with the best chemoprophylaxis hygiene preventative medicine products?
From the cost perspective in preventive medicine, chemoprophylaxis products and procedures are the best investment and the most efficient keeping the “Deadliest Enemy” at bay. Somehow our need to confront the reality of contagious diseases requires that the leadership of our Armed Forces see the acquisition and distribution of chemoprophylaxis hygiene preventive medicine products as a must instead as a “personal care” voluntary or optional option.
In other words, even with all the evidence of the devastating effects of contagious diseases throughout history, the ever increasing cost of bringing sick soldiers back to health, and most of all, the immense risk to U.S. national security, our military leaders continue to rely on the nation’s warriors to purchase these critical preventive medicine products despite the fact that they may only minimally understand the negative exponential magnitude of getting infected by a transmittable disease which can be easily controlled by up to 80% with proper chemoprophylaxis preventive medicine products.
VALIDATION BY HISTORY
In 1997, Dr. William Foege from Harvard University, one of the leading epidemiologists in the field, published an article in the Oxford University Press supporting the fact that throughout history, the number of soldiers worldwide killed by infectious diseases outweighs the number killed by weapons, bringing to light the obvious: infectious diseases are the “Deadliest Enemy” with devastating consequences on national defense and military effectiveness.
The spectrum of contagious diseases is not only big and wide but has made grave marks from military ancient history to contemporary times. History recorded the Plague in Athens in 430 BC as a major event of the Peloponnesian War and the Antonina Plague, a couple of hundred years later during the Parthian War. One of the worst events in military history came during the Thirty Years War from 1618 to 1648 where typhus and Plague caused 10 million deaths, outweighing the 350,000 combat casualties sustained in battle.
The unbalanced effect of contagious diseases and non-battle injuries (DNBIs) is very much relevant today, even in peacetime. The Salmonella outbreak in 2011 at a military base in India due to contaminated food, the “traveler’s diarrhea” outbreak also in 2011 in El Salvador among U.S. troops while deployed on a humanitarian mission, or the scabies epidemic in 2013 within the Queen’s Guards in the UK that started in Germany after military training exercises, are recent examples showing that although we have advanced in the treatment of contagious diseases, we are still very much vulnerable in the preventive medicine arena.
In 2014 at the Military Health Systems Research Symposium (MHSRS) in Fort Lauderdale, FL, Col. Michael Kozar, director of Military Infectious Disease Research Program, U.S. Army Medical Research and Materiel Command (USAMRMC), Ft. Detrick, MD, stated “The fact is, there is no bathroom in a tank” show, first hand, how difficult is
to stay clean and healthy, and the challenges to prevent and control infectious diseases while deployed.
Part of the military reality is that deployment to foreign territories exposes personnel to local endemic diseases. Statistics show as an example that malaria clocked 124,109 cases during WWI and 24,606 among U.S military deployed to Vietnam.
We could safely say that infectious or contagious diseases have a direct impact on our national security and readiness of our defenses. They also have a direct and overwhelming effect on the cost of keeping our forces healthy and battle ready.
A WAY FORWARD
The epidemiology of contagious diseases and its data shows that the best way to deal with an infectious disease is by not having it in the first place.
Even though the infectious diseases landscape keeps changing and harsh operational and training environments bring unique challenges to our military organizations, we can use the data recorded throughout history to make scientific and behavioral gains against the devastating “Deadliest Enemy” by bringing standard issued chemoprophylaxis kits to military personnel.
In terms of human life and security, the risk is too high and the consequences too expensive not to have a standard issued hygiene kit for every soldier/sailor/airman on a regular basis. Our military and national security cannot be dependent on whether a young private decides to purchase these preventive medicine products or not.
One of the greatest military challenges throughout history was to provide food and water to soldiers on the training and battlefield. The logistics of mobile kitchens, tables, tends, utensils and fresh produce to the battlefield were solved once all the military adapted Meals Ready to Eat (MRE).
Just as Meal Ready-to-Eat (MRE) kits revolutionized performance, endurance, and readiness during battle and on training grounds worldwide; getting a standard issue chemoprophylaxis preventive medicine kit to every soldier on a regular basis will generate a new layer of protection against the “Deadliest Enemy of all”.
The cost of these preventive medicine kits will pay untold dividends by keeping our forces healthy and significantly reduce the as much as 80% of visits to a military hospital that have nothing to do with battle inflicted wounds. The future of our warriors’ health and our National Security cannot be left to chance and getting a standard issue chemoprophylaxis hygiene preventive medicine kit will change that forever.