The Mission Continues

Alumni in Action in the Fight against COVID-19

In an instant, Captain Jeffrey J. Tomlin ’76, USNR (Ret.), switched from concerned to inspired.

The CEO of Evergreen Health in Kirkland, WA, wasn’t sure how his staff would respond to learning two patients had tested positive for COVID-19 in the acute care hospital. It was 28 February 2020. Staff had treated them for a week.

At the time, only 16 positive cases were known in the United States. Uncertainty about the virus swirled. Despite the gravity of the situation, Tomlin was impressed by the professionalism and commitment his staff displayed in that moment. There was no fear or panic, he said.

“That can be destructive to a team,” Tomlin said. “It was about problem-solving. They put their equipment on and went back to work, just like our brave military personnel.”

Tomlin attributes his staff’s response in part to a culture—nurtured over years—that built trust and confidence through training. When crisis hit, they were prepared to respond with poise and purpose. Tomlin’s example at the original epicenter of the United States’ COVID-19 outbreak is indicative of experiences many Naval Academy alumni have encountered since the pandemic upended societal normalcy.

In hospitals, research labs, private industry and in the fleet, alumni are at the forefront, combating this unprecedented outbreak. Cleveland Clinic Chief of Operations Captain William M. Peacock ’81, USN (Ret.), helped convert academic space into a 1,006-bed surge hospital in less than a month. Lieutenant Commander Kevin Ringelstein ’07, USN, has provided air support to hospital ship Mercy as part of Helicopter Sea Combat Squadron FOUR.

Captain Carl June ’75, USN (Ret.), is working with researchers at Penn Medicine to identify existing medicines to treat COVID-19 patients.

As the pandemic’s impact swelled in the United States, Naval Academy alumni were answering the call to assist from the front lines.

‘Never Overwhelmed’

Evergreen Health’s response was immediate and measured, Tomlin said. Instead of airing personal concerns about the potential dangers of treating previously undiagnosed COVID-19 patients, staff fired practical questions at the former Marine Corps aviator. Questions like, “What do we do with pregnant women who test positive?” and “How do we adjust facilities to ensure optimal safety?”

Tomlin credits annual training trips over the past decade to the Center for Domestic Preparedness in Anniston, AL, for preparing a successful strategy for dealing with COVID-19. Each year, Evergreen sends 20 staff members to Alabama for training that focuses on handling extraordinary circumstances, which could include chemical spills, mass shootings, crashes or pandemics.

“It was almost as if people fell into their roles because of that training,” Tomlin said. “You’re going to bring the team to the fight you have when the crisis raises its head.”

Once the outbreak was confirmed, Evergreen staff leapt into action. Tomlin said they tapped their extra supply of personal protection equipment, established a drive-through testing center for employees and adjusted their facilities to accommodate an anticipated surge in patients. That included creating quarantine areas and reversing air through the HVAC system so they weren’t pushing out potentially contaminated air to other caregivers, patients or families.

The 300-bed, 5,000-employee hospital system had treated 423 COVID-19 patients as of 12 May. More than 129 have been discharged from inpatient care, and more than 111 discharged from emergency department care. More than 70 of their COVID-19 patients died.

Advanced planning and training paid invaluable dividends during Evergreen’s response, Tomlin said. Tomlin said emergency training taught them to have enough equipment and supplies on hand to last five days, until federal resources could be deployed.

He said he contacted classmates who were still active duty to request participation in the medical cells that were part of their exercises. NATO, EUCOM and PACLFLT exercises provided me the opportunity to observe how these very high level commands and their staff conducted military and crisis operations. He said his experience at the Naval Academy, as part of the Navy Medical Corps and his eight years as chief medical officer at the health system in Washington state prepared him to act decisively when COVID-19 hit. He praised his staff for developing a climate of trust and mutual respect. In 1984, Tomlin received an inter-service transfer to the Navy Reserve Medical Corps. Evergreen employees leaned heavily on those attributes during the initial outbreak.

“You have to make sure your teams know how to respond and confront whatever that hazard was,” Tomlin said. “We were never overwhelmed.”

‘Leaned Forward’

Naval Academy graduates have provided air support services for Mercy as part of Helicopter Sea Combat Squadron FOUR (HSC-4). Mercy, a 1,000-bed hospital ship, docked at the Port of Los Angeles on 27 March to care for non-COVID-19 patients in order to relieve some of the strain on local hospitals.

The officers and sailors of HSC-4 are accustomed to responding to crises around the world, said Lieutenant Commander Kevin Ringelstein ’07, USN, in an email to Shipmate. When natural disasters strike, MH-60 Sierras are there to pull survivors off rooftops, transport supplies and provide aerial reconnaissance.

Ringelstein said the HSC community “leaned forward” to assist with the COVID-19 response as it would for any Humanitarian Assistance and Disaster Relief (HADR) or Defense Support of Civil Authorities (DSCA) missions.

However, he said it was immediately clear the COVID-19 response would be “unprecedented” and require “outside-of-the-box thinking.” HSC-4, led by Commanding Officer Commander Jason Budde ’00, USN, and Executive Officer Commander Thomas Murray ’03, USN, has served as the air support element for Mercy and laid the groundwork for safely transporting patients via air.

Supporting in a myriad of ways, pilots at HSC-4 have stood a 24/7 alert and flown missions up and down the West Coast. These efforts include Lieutenant Sarah Alexandre ’14, USN, and Lieutenant Zoe Macfarlane ’16, USN, who are surveying and landing in unprepared landing sites in Los Angeles and San Diego as part of the COVID-19 response.

Lieutenant Commander Brendan Rok ’07, USN, and Lieutenant Commander Ian Gill ’08, USN, researched, identified and acquired proper personal protective equipment to safely transport COVID-19 patients and helped put into practice a COVID-19 decontamination process for aircraft, gear and personal flight equipment.

“Throughout the battle against COVID-19, squadron leaders at HSC-4 have relied on their training from Annapolis,” Ringelstein said. “The experiences at the Naval Academy prepared us to calmly and resolutely respond to real-world crises, to rely on and trust our teams, and to persevere and remain focused despite the uncertainty and fears all around us. The foundation the Naval Academy provided us has enabled our squadron to meet any threat head-on.”

“Rehearse, Rehearse, Rehearse”

Time was not an ally as COVID-19 swept into the United States. Reacting to models predicting severe shortages of hospital beds and respirators, Captain William M. Peacock ’81, USN (Ret.), began orchestrating a major overhaul of the Cleveland Clinic’s Health Education Campus. Peacock said in mid-March, they expected to have about three weeks before COVID-19 cases were predicted to peak in northeast Ohio.

After discussions with state, local and federal officials, the challenge was creating a temporary surge hospital to meet anticipated patient demands. By mid-April, the Hope Hospital was ready. Fortunately, original dire predictions did not materialize. Peacock credits lower-than-expected COVID-19 cases to aggressive efforts by state officials to close schools and nonessential operations and businesses.

The 4,200-bed health care system in Ohio put a hold on non-essential surgeries, which average about 1,150 per day.

Peacock said that was instrumental in extending their supply of PPEs. Cleveland Clinic also began reprocessing up to 4,000 PPEs per day, which helped safeguard caregivers, he said.

Although grateful the need did not match projections, Peacock said the experience underlined the value of proper preparation. They communicated and coordinated with supply chain partners, local communities, clinical and non-clinical personnel and information technology staff to create a system to move patients safely in and out of Hope Hospital.

“In the three weeks we put this together, we used the time to rehearse, rehearse, rehearse,” he said.

Preparation, combined with lower COVID-19 patient levels, allowed the Cleveland Clinic to share its resources with harder-hit communities. More than 500 health professionals volunteered to work at New York–Presbyterian Hospital and the Henry Ford Hospital system in Michigan. In late April, Peacock said he was working to send volunteers to aid hospitals in Abu Dhabi.

“Our youngest doctors and nurses always rise to the challenge, just like sailors and Marines,” Peacock said. “The courage and nobility really makes it a pleasure to serve in the health care domain. It’s very parallel to the service I felt when I served in the Navy.”

Peacock predicted the pandemic will leave a lasting impact on the nation’s health care system. He expects advances in social data and artificial intelligence might be mined to improve care for patients in a future national emergency.

Public health research will be integral to preventing the surge of a future pandemic, Peacock said.

“Care givers will be more respected and depended on than ever,” he said. “Our enterprise operates a lot like a battle group. Integrated health care delivery will be more focused on the safety of patients.”

Developing Treatments

Captain Carl H. June ’75, MC, USN (Ret.), is pursuing treatment options for COVID-19 at the University of Pennsylvania.

The 2016 Naval Academy Alumni Association Distinguished Graduate Award recipient is director of the Center for Cellular Immunotherapies at the Perelman School of Medicine, and director of the Parker Institute for Cancer Immunotherapy.

June said rheumatoid arthritis drug Actemra is undergoing clinical trials at Penn as a possible treatment for COVID-19 patients. He has also proposed a clinical trial for cyclosporine, which has been used to prevent organ rejection in transplant patients. His proposal for a trial to determine if delivering cyclosporine to patients soon after hospitalization can prevent the immune overreaction was under consideration by Penn’s ethics review board as of press time.

Penn Medicine is part of an international network of researchers seeking treatment solutions to the COVID-19 pandemic. At the end of April, there were 16 trials testing Actemra worldwide. June credits technological advances over the past 40 years for making such collaborations possible.

The speed at which partnerships and testing can occur are light years ahead of where they were when June was working to combat the AIDS epidemic in the 1980s, he said.

A French research team reported data on 27 April that showed positive results using Actemra to treat seriously ill COVID-19 patients. During the trial, a significant decrease in the number of deaths or life-support interventions was found in patients treated with Actemra, compared to a control group. The trial is in the early stages and still needs peer reviews.

The results of global partnerships can fast-track results as collaborators work in unison.

“It’s very rapidly breaking,” June said of trials for COVID-19 treatments. “The internet has made things possible that were inconceivable [40 years ago]. This normally would’ve taken years and years [to accomplish].”

June has a track record of cutting-edge discoveries. His research for the Navy showed bone marrow reconstitution through gene therapy after radiation damage could cure leukemia. He patented his initial technology for the therapy, which is owned by the Navy and licensed to Novartis. Before that, he did graduate training in immunology and worked on malaria treatments at the World Health Organization.

While the COVID-19 pandemic has had an unprecedented impact on the United States, June’s background puts him in position to help produce life-saving treatments.

“I had a very unique background that would be hard to duplicate these days,” June said. “I was trained in things that I never would have been otherwise.”