The Long Shadow of COVID-19

Introduction

As the world lurches from one crisis to another, lessons learned from past crises are easily forgotten. In this vein, we can draw useful insights from Operation COVID-19 Assist (OCA) for future domestic operations and for their wider relevance to issues concerning operational readiness. Indeed, the shifting strategic climate referenced in the Defence Strategic Review (DSR) begs the question whether the Australian Defence Force (ADF) should be involved in a domestic emergency on the scale of OCA at the expense of readiness for conventional external threats. In our haste to shed the burden of pandemic countermeasures, we underestimated the longer-term consequences of COVID-19 and have yet to incorporate the lessons learned or adequately prepare for the next epidemic. 

What Happened?

As we reach the fifth anniversary of the COVID-19 pandemic, we need to progress beyond uncertainty over its origins, and recognise instead that some questions cannot be answered^[i]. In common with other rapidly emerging infectious disease epidemics, the initial phase of the pandemic generated a lot of confusion. During this stage, professional analysts talked-up the health threat with provocative terms normally reserved for conventional kinetic conflict^[ii]. The rapid international spread of COVID-19 escalated into a major societal challenge^[iii]. As the full range of SARS-CoV-2 virus effects came into view, COVID-19 undermined the social contract and demanded executive decisions from national leaders^[iv]. In Australia, Commonwealth and State governments put a hold on their traditional rivalry, realigned priorities, and quietly stole opposition policy to address the common threat. COVID-19 now ranks among the largest pandemics for its global impact.

The catchphrase in that first pandemic year was "an abundance of caution". However, the speed of SARS-CoV-2 evolution outpaced early countermeasures faster than public health authorities could target and implement harm reduction. The viral threat from overseas quickly broke through Australia’s border screen. From that point on, COVID-19 was among us, bringing the threat into our homes via our families and friends. Under public health emergency powers, inter-state borders closed, intra-state biosecurity zones sprang up, and selective curfews came into force with the intent of preserving social safety and business continuity.

At the start of the pandemic, only a few pessimists worried about maintenance of public order. Less than a month later, troops were deployed in a variety of support roles to help the Australian community cope with complex, ambiguous, and changing priorities. Much of their work lay outside conventional military core business.  Formal plans, orders and legal instruments for Defence Assistance to the Civil Community (DACC) were issued as the COVID-19 Task Force came into being^[v]. The rapid mobilisation of this joint task force was remarkable during the first critical weeks of the pandemic emergency, when decisive action was taken to protect the most vulnerable in our community, including indigenous communities, due to the assumption that a high incidence of chronic co-morbidity would increase the risk of severe infection. In the early stages of the pandemic, quarantine hotel cordons were supplemented with Defence personnel, though with notable reluctance in some states^[vi]. In hindsight, this appeared less critical once civil agencies had re-established control. As a result, ADF Reserve health specialists were in demand by both their civil employers and the ADF with implications for sustainability at both ends. Looking beyond the COVID-19 demands, extensive Defence involvement in a prolonged domestic emergency has the potential to adversely impact the ADF’s readiness for conventional external threats, including reduced availability of specialist health assets.

Operation COVID-19 Assist ran for almost three years, easing off into core headquarters functions as demand for ADF assistance tailed off. The end came with little mention or fanfare, as OCA merged into other domestic operations. During its life span, the COVID Task Force (JTF 629) accumulated a new set of skills through close liaison with civilian agencies, and used its conventional military expertise in novel ways such as real-time health intelligence^[vii] and just-in-time logistics^[viii].  Other opportunities to capture key lessons, and to find some form of closure on such a prolonged DACC task, were passed over in the rush to return to business as usual.

Operation COVID-19 Assist addressed a persistent threat to our own domestic population^[ix].  The twists and turns of the pandemic were driven by rapid virus evolution, forcing just-in-time adaptive countermeasures by public health authorities responsible for hazard management. State-based joint task groups (JTGs) provided inter-agency liaison and planning support to public health and other civilian agencies, often through Defence Reservists with relevant civilian skills, and were thus subordinate to local civilian control.  Tactical solutions from overseas operations in the recent past do not necessarily help us determine what we would do differently in another pandemic or in other forms of extended domestic operation, but repeatedly teach us the operational importance of preventive and other medical countermeasures for force protection.  

The Fight For Information

No domestic emergency is the same^[x]. A once in a generation event such as the COVID-19 pandemic is easily dismissed as unlikely to recur in the near future, while broader lessons hide in plain sight. The domestic emergency prism provides a useful insight into future operational sustainment^[xi]: as COVID-19 demonstrated, the rapidly evolving epidemic demanded an agile, adaptive approach to response planning. This was evident in how specific countermeasures, applied with good intention, served as potential evolutionary bottlenecks, forcing the virus to take the line of least resistance. The resultant progressively complex range of SARS-CoV-2 variants contributed to increased virus transmission,^[xii] further complicating responses. Adapting to such an agile opponent demands data-driven respect for the adversary, its critical vulnerabilities and strengths, and access to a full range of countermeasures to secure defeat in detail^[xiii]. Thus, in the early stages of an epidemic, critical health intelligence is time-sensitive; and yet, by the time JTF 629 gained access to reliable bio threat assessment updates, their relevance had already diminished. It was thus impossible to track the day-to-day variation of this pandemic risk in real time until all jurisdictions standardised their daily data feed within months of the pandemic's onset^[xiv]. As a supporting agency outside the public health system, jurisdictional state-based joint task groups had varied information demands and lacked the in-house specialist expertise to convert a national health data feed into an ADF-friendly risk management tool. Our national shortfall in operational health intelligence and bio threat risk assessment during the pandemic highlights the need for sharing accurate and timely intelligence with all hazard management agencies as a critical risk management enabler.

Real-time health risk assessment became a useful aid to command decision making^[xv], where geographic isolation was exploited during the first year and a half of the pandemic. The logistic demands of civil COVID response agencies exceeded pre-pandemic capacity. Military logistic insight was in demand from the earliest stages of the pandemic a to sustain thecross the nation, supply chain for COVID diagnostic tests, antiviral treatment, and vaccine rollout^[xvi]. Movement restrictions such as security zones, border closures, cordons and curfews varied by jurisdiction. These were introduced to curtail virus transmission before mass vaccination came into effect. ADF personnel were required to support civilian first responder agencies, and had to move personnel and materiel in this evolving pandemic-restricted environment. Interstate and international travel needed risk assessment, mitigation, and approval, adding another layer of complexity to an already difficult task.

The Need To No

An important lesson for unit, group, and task force commanders was the need to say ‘no’; the ability to understand when, where, and how to reject a request for Defence assistance and grounds for legitimate refusal. The national military task force JTF 629 did not have an endless supply of personnel to fill all the gaps in civil agencies, or a blank cheque to underwrite every conceivable support activity. JTG commanders had difficulty fending off demands for unsustainable support, and used SMART (sustainable, measurable, appropriate, realistic and time limited) principles to triage support requests. In domestic emergency operations, avoidance of mission creep and the early development of an exit strategy are key parts of support planning^[xvii]. Since these operations are a battle for maintenance of civil order, the locus of control remains with civil government. In the COVID pandemic the response was whole-of-government, and required close co-operation with state and territory health services^[xviii]. During OCA, this created tension between JTF 629 command and operational level liaison with state and territories causing potential rejection of local level support requests.  

What If We Had To Go Again?

In the aftermath of OCA, questions still need asking about what would or should be done differently in a future pandemic. In other words, is there scope for a strategic level refusal? With the passage of time, it has become clear that heavy reliance on Defence personnel came at a cost to conventional operational readiness. Despite a lesser COVID-19 impact than many other parts of the world, Australia has experienced similar long term post-pandemic disruption, including loss of experienced staff, vaccination fatigue, and a heightened risk of periodic surges in COVID activity.

Clearly, any repeat of the pandemic-assist task force could be leaner, raised with more tightly defined objectives, more straightforward lines of operation, and better definition of early exit triggers. Close ties to civil response agencies formed during OCA present an opportunity to refresh the DACC repertoire and align it with the two phases of civil emergency response, i.e. crisis and consequence management. Subject to government direction, the ADF can restrict its role to crisis management tasks and honourably decline subsequent consequence management that the civil authority recognise as a job for civilian hands as originally intended.  As ADF assistance is best targeted when data-driven, the fight for actionable information must begin during the earliest stages of planning. There are data science tools for collaborative multi-agency planning. The historically inflexible constraints of public service processes should be relegated to the pre-pandemic era.

Key decision points, lean thinking and an early exit pathway via efficient handover and hand-back procedures will speed up mission completion and orderly withdrawal. Small operational units can be an effective role model for the civilian agencies they support. No matter how small the task, or low the rank, task-assigned Defence personnel have the training and mindset to understand main effort, command intent and implied tasks. In future domestic operations they can demonstrate how to cope with uncertainty, ambiguity, and complexity.

What Does This Tell Us About Other Domestic Ops?

We should take care to avoid any suggestion of Australian exceptionalism regarding the ADF’s domestic operations during the COVID-19 pandemic operations. The recent deployment of ADF capabilities to conduct domestic emergency operations in response to Cyclone Alfred builds on a long tradition of service to the wider Australian community. Past decades of deployment overseas in support of coalition partners, such as in counterinsurgency operations, have been a poor preparation for domestic operations, particularly the unprecedented scale and duration of the COVID-19 pandemic. The ADF's contribution to the national pandemic response assisted the civil power address the internal threat from COVID-19 in its overall aim to blunt COVID's impact on the population's health and safety, reduce disruption to the national economy and enable a return to business as usual^[xix]. The continuing waves of lower impact COVID left no clear-cut measure of success or final victory. For those who have experienced the cumulative combat stress of more conventional operations^[xx] there has been little opportunity for closure. 

The shifting strategic climate with its increased threat of near-peer adversary conflict overshadows domestic emergency operations. Nevertheless, insights developed by the ADF through OCA represent a timely reset of expectations. Infection often follows in the footsteps of armies, and has an ugly manifestation in the ongoing battle casualties from Ukraine^[xxi].  A deteriorating international rules-based order should make us wary of the potential for deliberate use of infectious diseases by future adversaries and the blurred lines between crisis and consequence management of emerging infectious diseases arising in our region.

Conclusion

During the COVID pandemic, the ADF gained new tools to handle domestic threats to the Australian community. Though COVID-19 continues to cast a shadow over the Australian community, emerging strategic priorities dictate that the ADF incorporates lessons learned during OCA to develop a more sustainable niche contribution to protracted domestic operations limited to the civil authority's initial crisis management phase. High quality intelligence should be provided to domestic task force command from the earliest stages of planning.  A carefully targeted campaign plan should avoid competition with civilian agencies for key personnel.

Key lessons learned

1. The ADF contribution to protracted domestic operations is only sustainable if limited to the crisis management phase.
2. A repeat of the pandemic response could be leaner, raised with tightly defined objectives, more straightforward lines of operation, and better definition of early exit triggers.
3. An evolving epidemic demands an agile, data-driven, adaptive approach to response planning. The fight for actionable information must begin during the earliest stages of planning.
4. A carefully targeted campaign plan must avoid competition with civilian agencies for key specialist personnel.
5. The continuing waves of lower impact COVID-19 left no clear-cut measure of success or final victory.

Endnotes

1. Canuti M, Bianchi S, Kolbl O, Pond SLK, Kumar S, Gori M, Fappani C, Colzani D, Borghi E, Zuccotti G, Raviglione MC, Tanzi E, Amendola A. Waiting for the truth: is reluctance in accepting an early origin hypothesis for SARS-CoV-2 delaying our understanding of viral emergence? BMJ Glob Health. 2022 Mar;7(3):e008386. doi: 10.1136/bmjgh-2021-008386. The emergence of the SARS-CoV-2 virus remains a matter of debate. The authors review evidence for its circulation prior to the start of the pandemic.

[i] Inglis TJJ. A systematic approach to microbial forensics.  J Med Microbiol. 2024 Feb;73(2). doi: 10.1099/jmm.0.001802. This paper describes an approach to assessing whether a biological threat is the result of deliberate use or not, using an assessment of   COVID-19 as a worked example. This method was first described at the South African National Institute of Communicable Diseases in June 2022.

[ii] COVID Crisis Group. Lessons from the Covid War. An Investigate Report. 2023, Public Affairs, New York. This report recognises the need to rethink how the American health care system works, as well as public health care policy. One of its authors stated that “When you go to war, you go to war with the army you have, not the army you wish you had. We found that the operational capability for fighting this war ... was at the state and local level, across the 2,800 or so state and local health departments

[iii] Inglis TJJ. Pandemic planning: plotting a course through the coronawars.  J Med Microbiol. 2020 Jul;69(7):920-923. doi: 10.1099/jmm.0.001217. The application of a military appreciation process to public health epidemic response planning.

[iv] Inglis TJJ. 2020: the year of living cautiously. J Med Microbiol. 2021 Mar;70(3):001307. doi: 10.1099/jmm.0.001307. A strategic review of the first year of the COVID-19 pandemic.

[v] https://www.defence.gov.au/operations/covid19-assist (accessed on 28th September, 2024). Operation COVID-19 Assist is described here as the Australian Defence Force contribution to the whole-of-government response to the COVID-19 pandemic

[vi] https://www.smh.com.au/lifestyle/health-and-wellness/coronavirus-victor…. Despite escalating numbers of COVID cases, the Victorian state government held back on offers of Defence Force assistance, while other states gladly accepted additional personnel to staff hotel quarantine. As the Australian public health is delivered at a local level, operational decisions inevitably differed between jurisdictions

[vii] Inglis TJJ. Pandemic planning: plotting a course through the coronawars.  J Med Microbiol. 2020 Jul;69(7):920-923. doi: 10.1099/jmm.0.001217. The application of a military appreciation process to public health epidemic response planning.

[viii] Paton TF, Marr I, O'Keefe Z, Inglis TJJ. Development, deployment and in-field demonstration of mobile coronavirus SARS-CoV-2 Nucleic acid amplification testJ Med Microbiol. 2021 Apr;70(4):001346. doi: 10.1099/jmm.0.001346. Logistic obstacles had to be overcome in order to deploy a fly-in-fly out molecular diagnostic laboratory to the Kimberley region of Western Australia. These specialist health logistic skills were originally developed during Exercise Talisman Sabre in 2009.

[ix] https://www.defence.gov.au/operations/covid19-assist (accessed on 28th September, 2024). Operation COVID-19 Assist is described here as the Australian Defence Force contribution to the whole-of-government response to the COVID-19 pandemic

[x] COVID Crisis Group. Lessons from the Covid War. An Investigate Report. 2023, Public Affairs, New York. This report recognises the need to  rethink how the American health care system works, as well as public health care policy. One of its authors stated that “When you go to war, you go to war with the army you have, not the army you wish you had. We found that the operational capability for fighting this war ... was at the state and local level, across the 2,800 or so state and local health departments

[xi] Inglis TJJ. Pandemic planning: plotting a course through the coronawars.  J Med Microbiol. 2020 Jul;69(7):920-923. doi: 10.1099/jmm.0.001217. The application of a military appreciation process to public health epidemic response planning.

[xii] Markov, P.V., Ghafari, M., Beer, M. et al. The evolution of SARS-CoV-2. Nat Rev Microbiol 21, 361–379 (2023). https://doi.org/10.1038/s41579-023-00878-2.

[xiii] Inglis TJJ. Pandemic planning: plotting a course through the coronawars.  J Med Microbiol. 2020 Jul;69(7):920-923. doi: 10.1099/jmm.0.001217. The application of a military appreciation process to public health epidemic response planning.

[xiv] Inglis TJJ. Pandemic planning: plotting a course through the coronawars.  J Med Microbiol. 2020 Jul;69(7):920-923. doi: 10.1099/jmm.0.001217. The application of a military appreciation process to public health epidemic response planning.

[xv] Inglis TJJ. Pandemic planning: plotting a course through the coronawars.  J Med Microbiol. 2020 Jul;69(7):920-923. doi: 10.1099/jmm.0.001217. The application of a military appreciation process to public health epidemic response planning.

[xvi] Inglis TJJ. Pandemic planning: plotting a course through the coronawars.  J Med Microbiol. 2020 Jul;69(7):920-923. doi: 10.1099/jmm.0.001217. The application of a military appreciation process to public health epidemic response planning.

[xvii] https://www.armyupress.army.mil/Journals/Military-Review/English-Editio…; Kilcullen D. “Twenty-Eight Articles”: Fundamentals of Company-level Counterinsurgency. 12. Prepare for handover from day one.

[xviii] https://www.health.gov.au/topics/covid-19/about/what-we-did#working-tog… (accessed 28th September, 2024).

[xix] https://www.wa.gov.au/government/media-statements/Cook-Labor-Government… "WA was nearly COVID-zero during the first two years of the pandemic and our COVID-19 fatality rate of 0.074 per cent was the lowest of all the States and Territories."

[xx] Headquarters, Department of the Army, Department of Defense, US Government. FM 3-24  MCWP 3-33.5 Counterinsurgency. 2006. 7. Leadership and ethics for counterinsurgency. "Soldiers and Marines must have outlets to share their feelings and reach closure on traumatic experiences. These psychological burdens may be carried for a long time."

[xxi] Hodgetts TJ, Naumann DN, Bowley DM. Transferable military medical lessons from the Russo-Ukraine war. BMJ Mil Health. 2023 Jul 3:e002435. doi: 10.1136/military-2023-002435.