New York Gov. Andrew Cuomo wants the Army Corps of Engineers to build overflow hospitals. Bernie Sanders wants to call up the National Guard. Joe Biden says "call out the military — now."
But the military isn't a cure-all, and there are significant legal and practical limits to what the armed forces can do during the coronavirus crisis.
“The Department of Defense is ready, willing and able to support civilian authorities to the greatest extent possible at the direction of the president,” Pentagon spokesperson Jonathan Hoffman told reporters Monday. “We just want to make sure that the conversation that we have is informed by the facts of what is possible and what is not and what those tradeoffs are.”
Here is a rundown of the different ways the military could be used in the crisis, along with jobs that should be left to others.
Current and former officials have proposed tasking the Pentagon with growing the capacity of the health care system to treat the sickest patients, specifically by deploying field hospitals and constructing care facilities.
On Sunday, Biden said the armed forces "have the capacity to provide this surge help that hospitals need and that is needed across the nation. They have done it. They did it in the Ebola crisis.”
But Defense Department officials stressed that while the military does have some experience deploying what they call “tent hospitals,” these facilities are limited in size and capability. Most are small community hospitals tailored for the military’s disproportionately young, healthy community and their families, said Air Force Brig. Gen. Paul Friedrichs, the Joint Staff surgeon.
The field hospitals, while they range in size from 25 beds to “much larger,” are designed to support trauma patients and combat casualties, he told reporters Monday.
“What we are trying to be very careful about is not over promising,” Friedrichs said. “There are not thousand-bed medical centers all over the U.S.; they are for the most part small community hospitals.”
Retired Vice Adm. Matthew Nathan, the former surgeon general of the Navy, said there are some things the military could do to ease the medical burden, but agreed it could only do so much.
"What we are really good at is ramping up trauma capability in a hurry," he said in an interview. "If we just need beds, we are good at that, too."
But he pointed out that even in the worst circumstances such as widespread battle injuries, the military commonly deals with patients who are otherwise healthy and don't suffer from underlying conditions that make them more susceptible to infectious disease such as the coronavirus.
"As far as setting up ICUs to take care of the roughly 6 to 7 percent of patients who will need intensive care and ventilators long term, we don't prepare for that," Nathan said.
But he stressed that there are other strategies to "expand the surge of our hospitals." Instead of treating infected patients, the military could take care of limited numbers of others "who just need regular hospital care because they are not severe" in order to free up beds and staff.
The Navy’s two medical ships, the USNS Mercy and the USNS Comfort, can handle large-scale medical emergencies. Both contain 12 fully-equipped operating rooms, 1,000 hospital beds, digital radiological services, a medical laboratory, a pharmacy, an optometry lab, a CAT-scan and other capabilities, according to the Navy.
But that only helps in areas near the water.
"If for example a community has a large outbreak and there's a need for emergency room support or trauma support, a hospital ship is perfectly designed to do that,” Friedrichs said. "It’s hard to get the hospital ship to St. Louis, but along the coasts it is an option to use."
Another problem is that these vessels are not conducive to containing infectious disease outbreaks.
“You have litters that are stacked toward the ceiling with individuals, you have open bay rooms — they are intended for trauma not for infectious disease environment,” Hoffman said, adding that “there are some beds for that, but at much smaller numbers.”
Teams of Army researchers are helping to develop a vaccine and other countermeasures for the virus at installations around the country, including Fort Detrick and the Walter Reed Army Institute of Research, both in Maryland.
The teams have identified a potential vaccine that targets what doctors called the “spoke” or “spike protein” that helps the virus attach and enter human cells, Dr. Kayvon Modjarrad, director of emerging infectious diseases at Walter Reed, told reporters at the Pentagon last week.
The Army is testing the vaccine candidate on mice and will next move to testing on larger animals and humans to determine whether it is safe. But the earliest the vaccine would be available to the general population is 12 to 18 months, Modjarrad said.
More long term, Nathan also says the military has a number of research centers around the world that specialize in disease surveillance "before they can get a toehold on our troops,” including in Egypt, Peru and Singapore.
Perhaps the most famous military doctor, Walter Reed, made scientific breakthroughs in treating communicable diseases in the tropics. "Why was Major Walter Reed down there? Soldiers were dying of yellow fever."
National Guard call-ups
The National Guard is playing the largest role when it comes to the military's response. As of Monday, some 650 troops have been called up in 15 states to help operate drive-through virus testing facilities, staff emergency operations centers, clean public spaces and transport health care personnel.
The biggest contingent to be activated so far is in New York, where as of Monday 516 part-time soldiers and airmen have been called up. In Colorado, 145 National Guardsmen were assisting with drive-up Covid-19 testing centers and helping to plan future screening missions, according to the National Guard Bureau in Washington.
Smaller continents, such as eight troops in West Virginia specializing in biological defense, have been activated to train civilian first responders on how to mitigate the exposure to the virus of paramedics and fire and rescue personnel.
"Bottom line, our force must remain flexible, innovative and ready to help America mitigate the impacts of this virus," Gen. Joseph Lengyel, chief of the National Guard Bureau, said in a statement Monday.
But so far, Guardsmen have not yet been “federalized,” or called up on a national scale. That could mean siphoning them away from their civilian jobs where they may already be helping their communities to counter the virus, said Friedrichs. Nor have separate military reservists been called up.
“If we mobilize the Guard and Reserve medical personnel from their civilian jobs, they are no longer in their civilian jobs and that directly impacts the community where they work — that’s the tradeoff,” he said.
The military does have some options to more efficiently deploy Guard and Reserve personnel, said Hoffman, pointing out the commander of U.S. forces in Korea, one of the global epicenters of the virus, has enlisted Guard and Reserve doctors.
Yet there are only so many trained medical professionals in the military to go around. The hospital ships, for example, are currently manned by merchant mariners. The medical personnel to staff them would have to come from elsewhere, Hoffman said.
Talk of curfews
The White House has denied rumors that President Donald Trump is considering a national curfew to limit social interaction until the outbreak is under control.
If such a decision were made, however, any military role would likely be limited. And it would fall to the National Guard.
The active-duty military is barred from conducting domestic law enforcement under the Posse Comitatus Act of 1878.
The only circumstance in which the active-duty could be called upon to provide security would be under the Insurrection Act to suppress a revolt (a Marine and Army division responded to the 1992 Los Angeles riots, for example).
As of Monday, the active-duty military has been asked only to make available a trio of military bases to quarantine cruise ship passengers exposed to the coronavirus. And a spokesperson said no military personnel are involved.
“We have a lot of different capacities and we don’t speculate on how or if we'd use it," said Stacey Knott, a spokesperson for U.S. Northern Command in Colorado, which is tasked with homeland defense and to support civil authorities in responding to natural disasters such as hurricanes, floods and earthquakes.
The National Guard Bureau says it is not planning to play any law enforcement role at this time.
"We have the capability to do something like that but we are not burning calories on something that may or may not be happening," said Army Master Sgt. Michael Houk, a Guard spokesperson. "At this point it looks like it is not happening. We are addressing existing needs."
But if a national curfew is necessary to enforce, the best way to do it is to empower individual states to carry it out. That would fall to traditional law enforcement agencies, not troops, said retired Army Lt. Gen. Steven Blum, former chief of the National Guard Bureau and deputy commander of U.S. Northern Command.
"It depends on how the president sets up the curfew," Blum said in an interview. "Does he set it up where the governors are responsible so they can use the state police to enforce? If all the state governors agree to it and support it then it would be pretty easy.
"If I were advising the president," he added, "I would advise them not to federalize the response but to coordinate the response and allow the states to tailor the response within their guidelines."