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Sharon Y. Kim is a Research Associate in the Department of Defense at the Uniformed Services University of the Health Sciences (USUHS). Second Lieutenant Kenny Lee, USA, is a medical student at USUHS. Colonel Jason B. Tussey, USA, served as the Deputy Chief of Staff at the United States Forces Korea (USFK). Colonel Eric J. Dougherty, USMC, served as the Joint Staff Current Operations Officer and is currently the Operations Chief for USFK. Colonel Derek C. Cooper, USA (Ret.), served as Commander of the 65th Medical Brigade, USFK. Colonel Douglas A. Lougee, USA, is the USFK Command Surgeon. Colonel Talib Y. Ali, USAF, is the Deputy Commander of the 51st Medical Group at Osan Air Base, USFK. Colonel Michael J. Fea, USAF, served as Commander of the 51st Medical Group at Osan Air Base, USFK. Colonel Michael I. Cohen, USA, is the Command Surgeon at Eighth Army, USFK. Major General Stephen C. Williams, USAF (Ret.), served as the special assistant to the Commander of Air Combat Command and Chief of Staff of USFK. General Robert B. Abrams, USA (Ret.), served as the Commander of USFK, United Nations Command, and Republic of Korea–U.S. Combined Forces Command. Brigadier General Clinton K. Murray, USA, served as the USFK Command Surgeon and is Commanding General at the Brooke Army Medical Center.
One of the keys to our success is that we operationalized our approach to combating COVID-19 from the very beginning. This is not an administrative task, this is not a medical task, and it’s not a routine event, but it’s an operation, similarly to how we operate in combat.
—General Robert Abrams
Commander, U.S. Forces Korea
As we face one of the greatest public health threats in recent generations, joint military commands all over the world have been forced to develop operational strategies that maximize force health while sustaining combat readiness. Within the concept of a joint force, however, there remain ongoing struggles on how best to prepare for health crises and how well military commands can work together to handle new stresses of sustaining combat preparedness amid the ongoing pandemic. Among a continuum of uncertainties, how well a joint force works together, learns from each other, trusts each other, and leverages efficiencies will determine the outcome of its cooperative efforts against enemy threats, whether transnational or biological in nature.
U.S. Forces Korea (USFK) with its allied counterpart, the Republic of Korea (ROK), have been particularly successful in harnessing and executing key principles of military joint doctrine to sustain combined defense posture. With the growing need to analyze and document key lessons learned from joint commands globally, this article highlights USFK’s success in operationalizing a health crisis response while strengthening its alliance with ROK counterparts.
Background and Context
South Korea continues to be one of the most important international and military U.S. partners in East Asia. The Mutual Defense Treaty Between the United States and the Republic of Korea, signed in 1953 following the Korean Armistice Agreement at the Korean War ceasefire, supports the mutual defense of both nations against external threats, particularly from the Democratic People’s Republic of Korea (DPRK), while promoting U.S. interests in the Asia-Pacific region and globally. Accordingly, USFK, a subunified command of U.S. Indo-Pacific Command (USINDOPACOM), supports the United Nations Command and Combined Forces Command to fulfill its mission of maximizing U.S.-ROK alliance readiness on the Korean Peninsula.
In December 2019, COVID-19, a viral respiratory illness caused by severe acute respiratory syndrome (SARS) coronavirus 2, emerged in Wuhan, Hubei, China, which was especially alarming to U.S. military units of proximity, including USFK. Given the need to maintain combined U.S.-ROK readiness, it was especially important for the joint command to maximize response efforts against COVID-19. Despite being one of the first countries outside of China to be affected by COVID-19 in January 2020, South Korea’s advanced health infrastructure and strategies gathered from prior public health crises, such as the 2003 SARS outbreak and Middle East respiratory syndrome (MERS) 2015 outbreak, enabled the Korea Disease Control and Prevention Agency (KDCA) to rapidly implement a successful emergency response (see figure 1). Given South Korea’s effective early response, USFK sought success within the host country’s health system. Forecasting the outbreak’s consequences on mission readiness, USFK in early February proactively formulated peninsula-wide preventative health measures to protect the force, eventually initiating Operation Kill the Virus. The operation galvanized all USFK personnel and affiliated individuals to join the frontlines in combating the spread of the virus. Despite a lack of established guidance from international partners, such as the World Health Organization (WHO) or the U.S. Centers for Disease Control and Prevention (CDC), USFK remained committed to collaboration with ROK counterparts to combat a new enemy and ultimately win the ongoing battle against the novel virus.
A Joint Force Response Against COVID-19
Under the leadership of General Robert Abrams, USFK treated its campaign against COVID-19 as a full combat operation in terms of tempo, unit involvement, and spectrum. Operation Kill the Virus consists of eight principles, each of which contributes to USFK’s capacity to test, trace, treat, and logistically support all personnel (see table 1). Senior leaders from both U.S. and ROK commands significantly emphasized risk assessments to develop precautions for every event, training, or activity undertaken to maintain a solid defense posture and enable a predictable process throughout the pandemic.
With escalating COVID-19 cases in South Korea and USFK’s first positive case in February 2020, USFK immediately organized a clear leadership structure and implemented a public health emergency (PHE) that established authorities needed to take action. The declaration of the PHE unified all USFK personnel, including civilians, contractors, dependents, and Servicemembers, under the overarching authority of the commander who then directed consistent regulations and procedures to maximize force health protection. USFK also worked closely with the USFK Health Protection Council (HPC), which develops preventative policies and protocols with all USFK components, as well as the USFK surgeon, who collaborated with the ROK Armed Forces Medical Command and local governmental health agencies, including the KDCA, to assess, plan, and direct health policies through joint full-spectrum military operations. While the USFK HPC coordinated with elements internal to USFK, the USFK surgeon and component surgeons collaborated with relevant ROK stakeholders to maintain open communication and a flow of critical information.
Close collaboration between South Korean and U.S. health authorities was key to accurately reporting health data to the WHO and CDC and, in turn, receiving the most up-to-date status on the pandemic. Likewise, as U.S. military units globally remained vulnerable to the COVID-19 outbreak, it became a priority for the USFK surgeon to closely correspond with the military research and medical community as well as with international partners, such as USINDOPACOM, U.S. Forces Japan, DC Liaison Officer, U.S. Transportation Command, and the U.S. Embassy in Korea. With increasing demand for medical and laboratory assistance, the USFK surgeon requested an endemic infectious disease team from the 1st Area Medical Laboratory. Additionally, Eighth Army requested 65th Medical Brigade personnel assigned to the Modified Table of Organization and Equipment who were not stationed in South Korea to deploy in support of Operation Kill the Virus, augmenting care at the 549th Hospital Center/Brian D. Allgood Army Community Hospital. These personnel were employed to augment the medical brigade response efforts across the peninsula, but specifically the hotspot region of Daegu in the early phases of the operation (see figure 2). Essentially, through the HPC, USFK was able to coordinate with multiple components and agencies to acquire a holistic understanding of the resources required and prioritize the distribution of logistical support, including personnel, administration, installations, supplies, and necessary infrastructure.
To streamline communication among all HPC and leadership components, USFK leveraged the “break glass bridge” tactic that assembles all members and experts to review initial reports, build contact trace history, conduct surveillance, and execute preventative measures. This tactic also provided the most comprehensive information to USFK’s public affairs officer, who would not only advise senior leaders on ROK’s current public health status but also assist them in making well-informed decisions and translating them into effective public affairs operations. Finally, the tactic enhanced communication by allowing the USFK commander to drop down to lower echelons and receive updates from all USFK components through daily reporting with commander’s critical information requirements criteria and Department of Defense (DOD) databases, including SharePoint and non-classified Internet Protocol Router Network.
USFK directed the development of consistent policies that reflected the immediate operational environment of the host country and that applied to the joint force. As a subunified command, USFK consists of various components including Eighth Army, 7th Air Force, U.S. Naval Forces Korea, Special Operations Command Korea, and U.S. Marine Corps Forces Korea. With each element belonging to various departments under DOD, USFK directs consistent policies for all U.S. forces on the peninsula that reflect the immediate operational environment of the host country. Some USFK preventative policies included a 14-day quarantine and two COVID-19 screening tests on days 1 and 12 of quarantine for Servicemembers and affiliated individuals arriving from outside of the Korean Peninsula. Additionally, USFK pragmatically adjusted policies and restrictions according to health protection condition (HPCON) levels defined by DOD Instruction 6200.03, which provides guidelines on readiness during a public health emergency.
USFK also learned from ROK health agencies about effective surveillance strategies of positive COVID-19 cases. The USFK surgeon collaborated with ROK-augmented intelligence to gather assets and secure USFK testing capabilities. All positive cases would be communicated to the ROK within 1 hour of confirmation to better monitor the situation. With each spike in positive cases in the ROK, USFK considered ROK risk assessments and social distancing recommendations when determining and adjusting HPCON status. While USFK assessments focused primarily on the local threat to each installation, ROK assessments accounted for data across the entire peninsula to determine general trends. Based on the difference in scope of responsibility, USFK generally implemented restrictive measures ahead of ROK to establish safe zones on and around installations while taking a more conservative approach when it came to lifting restrictions by allowing ROK to lead.
The pandemic has undeniably affected many families across the enterprise. For instance, schools and daycares were temporarily stopped early on due to the low risk tolerance policy of the USFK commander. Consequently, Servicemembers with children, especially single parents and dual working parents, have simultaneous responsibilities to both occupational and family duties. Acknowledging these hardships, USFK continually follows incidence rates within various regions to justify HPCON levels and policies. Under HPCON Bravo, for instance, families had outdoor daycare and activities available for children during parts of the day. With growing pandemic fatigue, USFK endeavored to meet the increased demand for mental health services and developmental support for children who have difficulty adjusting to virtual education during HPCON Charlie.
Finally, Operation Kill the Virus encourages community members to cope with uncertainty through creative avenues, including poster contests, yoga classes, or outdoor activities, while empowering community members to adhere to all preventative measures at the individual level. Indeed, the initial onset of the pandemic required extremely risk-averse and draconian measures that limited civil liberties and individual privacy to keep control of the emergency. Both USFK and ROK acknowledged the limitations and hardships that come with such measures and, throughout the pandemic, have aimed to relax measures in various forms and fashions to alleviate economic and mental strains. Ultimately, by showing empathy and compassion to its personnel and their families, USFK encourages everyone’s vigilance and support of the mission of Operation Kill the Virus: protect the force to protect the mission.
U.S.-ROK Joint Planning Process
Given the Korean Peninsula’s unique operational environment, it remains imperative for USFK to adopt a planning approach that scrutinizes the immediate situation, compounding risk factors, national/international policy changes, and latest surveillance data. USFK’s J5 Office of Primary Responsibility Working Group managed the joint planning process with four assessment stages, including the planning approach, the operational environment, the campaign to contingency, and the contingency to campaign. From the start of the pandemic, the joint planning process was judiciously expedited through continual operational design and briefing of the course of actions and mission status. Joint Publication 5-0, Joint Planning, recommendations were also leveraged to guarantee continual interaction among key elements of the operational environment, strategic guidance, and problems at hand to ultimately calculate portended impacts on mission readiness. Some risk factors of interest included COVID-19, diplomatic changes (for example, the Korea Special Measures Agreement [SMA] on military cost-sharing between the United States and ROK), key political events, strains on the U.S.-ROK alliance, ROK National Assembly elections, U.S. Presidential elections, economic effects nationally and locally, strategic industrial base impacts, and global supply chain disruptions. Finally, the third and fourth stages of joint planning were aimed at smoothly transitioning USFK back to campaign normalcy through contingency plans that resolve or mitigate compounding risk factors. USFK assessed various factors and their impacts on its overall campaign, including:
- mission readiness: Unit training, personnel, logistical support systems, manpower, sustainment enterprise, administrative systems.
- U.S.-ROK alliance: Friction from operational environment, including COVID-19, SMA, and unknowns. USFK’s commanding general implements fourth line of effort to continue to train and fight with allies and partners, integrating U.S.-ROK forces into training events that increase interoperability.
- peninsula-wide logistics: COVID-19 impact on peninsula-wide logistics and sustainment enterprises. Component SMA mitigation strategies may reduce risk, but residual risk and impacts remain.
- assignment of choice: Impact of HPCON levels, summer transition disruptions, and perceptions of safety and quality of life in South Korea may be negatively affected by COVID-19 and restrictive ROK and U.S. policies.
The goal of this joint planning strategy is to protect the force and preserve the USFK “fight tonight” posture against all immediate and portended threats of the peninsula’s unique operational environment.
Enhancing Medical Capacity and Vaccination Through Joint Efforts
The continued success of Operation Kill the Virus is evident in the overall low number of COVID-19-positive USFK personnel throughout the pandemic. Whenever a positive case is identified, USFK implements a 14-day quarantine, isolation at a designated building, random screening of essential personnel, and a tightly streamlined surveillance protocol that provides real-time data accessible to the public. Inevitably, USFK still experienced seasonal spikes. For instance, USFK experienced an anticipated spike of imported positive cases that coincided with large turnovers of personnel in August and October of 2020 (figure 1). In response to these setbacks, USFK extended the PHE, which gave the USFK commander the authority to continue to enforce preventative measures. USFK also ensured that all new arrivals received mandatory training on Operation Kill the Virus principles and preventative protocols, especially for post-holiday travel returnees who could contribute to new COVID-19 spikes.
From the most recent MERS experience in 2015, ROK enlisted the private sector to ramp up its diagnostic testing capabilities and led the world by running more than 10,000 tests daily by February 2020. A small but significant element of this COVID-19 testing system applied to the U.S. military’s contracted TRICARE facilities and College of American Pathologists–approved reference laboratory in Seoul, significantly increasing USFK’s testing capability early in the pandemic before it was available at the military treatment facility. USFK also enhanced its readiness with ongoing vaccination efforts with the Moderna vaccine for its military personnel (including Korean augmentees to the U.S. Army), mission-essential civilians, healthcare personnel, and TRICARE beneficiaries.
In particular, the 549th Hospital Center/Brian D. Allgood Army Community Hospital, one of the largest medical assets aligned with USFK, was crucial in streamlining U.S.-ROK COVID-19 testing and vaccination of Servicemembers. The center also serves as a linchpin for promoting medical information exchange among USFK, KDCA, and ROK military counterparts. Through facility tours and virtual conferences with KDCA and ROK military medical teams, USFK continues to share information on COVID-19 testing capabilities, management, vaccination, and treatment to all relevant stakeholders. Information exchange on key planning factors and lessons learned have been fundamental to the operation’s success in promoting mission readiness.
U.S.-ROK Joint Military Operations Amid the Ongoing Pandemic
Since the beginning of the alliance, USFK has conducted joint military exercises with the ROK to maintain operational competence, promote solidarity, and support a robust deterrence posture. For the past decade, exercises have included a variety of training events throughout the year, with the largest combined exercises held each fall and spring, involving thousands of U.S. and ROK personnel across all branches of the military. However, these exercises have inevitably been affected by the pandemic, raising concerns over military readiness. Accordingly, USFK closely monitored HPCON changes to assess the status of U.S.-ROK military drills. For instance, USFK’s peninsula-wide implementation of HPCON Charlie in February 2020 prompted the delay of the U.S.-ROK annual joint training exercise held in the winter and spring seasons (see table 2).
As the HPCON level was lowered from Charlie to Bravo on May 18, 2020, USFK again decided to postpone and modify the annual summer drill, which was eventually held in late August 2020. To adhere to COVID-19 preventative health measures, USFK scaled back the summer 2020 drill by including fewer military personnel, replacing all associated field exercises with mostly computer simulations, and changing the utilization of usually crowded workplaces to ensure effective infection prevention and social distancing. Of note, computer simulations have been proposed and infused into past exercises to avoid provoking the DPRK. Amid the pandemic, these simulations continue to serve as integral training components that mitigate the spread of the virus. The modified summer joint drill was successfully completed with minimal complications and zero COVID-19 transmission, demonstrating USFK’s capability in preserving military readiness while maximizing defense posture against COVID-19.
Additionally, the joint biannual military 2021 training event, known as the Combined Command Post Training, started March 8, 2021, in the context of the ongoing pandemic and COVID-19 vaccinations. However, the training only lasted 9 days, which is substantially shorter than previous springtime drills that normally run for 2 weeks. Furthermore, the training did not simulate a full-war scenario and involved only computer simulations of joint responses to emergency situations with no outdoor drills. The pandemic has restricted the number of available troop augmentees and reduced the overall scope and size of the spring 2021 joint exercise. However, progress has been made given that the spring 2021 exercise consisted of a normal number of augmentees compared to fewer augmentees in the summer exercise of August 2020.
It was easier for USFK to receive augmentees in March 2021 compared to August 2020, which coincided with permanent change of station season that led to a spike in COVID-19 cases. To control risk of infection on the influx of incoming augmentees, in addition to COVID-19 testing in predeparture, arrival, and quarantine-isolation stages, USFK implemented preventative measures, including thermal scanners on entry, hand sanitizers at every entrance, daily health questionnaires, plastic shields between computer stations, and thorough cleaning of workstations every four hours. These control measures were maintained for the August 2021 Combined Command Post Training, which was also scaled back and based primarily on computer simulations, with no field training.
These modified exercises, however, limit growth in the cultural and interpersonal aspects of readiness by minimizing face-to-face interaction between U.S. and ROK personnel. Full-scale joint exercises foster the relationship-building, common understanding, and trust that are crucial during wartime operations, while scaled-down exercises with fewer troop participants may hinder camaraderie and cultural competence among members of both militaries.
Finally, while the postponement, cancellation, or modification of drills may appear to arguably diminish military readiness, it is imperative for USFK to continue the utmost defense posture against COVID-19, as an infectious outbreak can prove just as detrimental to not only the overarching missions of USFK but also the local host nation. Despite unavoidable limitations, these altered exercises at the very least provide opportunities to visualize the operational environment through computer simulations and secure alliance solidarity amid pandemic limitations.
Conclusion and Lessons Learned
The pandemic has inevitably invoked new challenges for military commands to protect the force and to preserve the defense posture and mission readiness. This reality demands that joint commands evolve effective response strategies that reflect the changing nature of the operational environment with its influx of unknowns and complexities. USFK targeted COVID-19 as a battlefield enemy and successfully initiated Operation Kill the Virus that engaged all community members, both national and international. Key to the operation’s ongoing success is USFK’s steadfast engagement with ROK counterparts to ensure alliance readiness and a joint fight tonight posture.
Despite ongoing restrictions and challenges, USFK continues to leverage the pandemic’s times of uncertainty to open new opportunities for collaboration with the host nation. U.S.-ROK alliance readiness now encompasses a broader set of missions than ever before, with tight COVID-19 surveillance, information exchange, medical capacity augmentation, and community involvement as vital keystones for pandemic cooperation. USFK also expedited the joint planning process to ensure that the U.S.-ROK alliance has robust military capacity to conduct combined combat operations. Essentially, what USFK has demonstrated for military commands all over the world is that such capabilities do not come automatically and that high standards of “practice makes perfect” joint planning and execution are a prerequisite for success.
Wisdom dictates that rather than waiting and reacting to immediate problems, military leaders should proactively prepare by looking to exemplary cases of effective response strategies and asking the difficult questions on how mission readiness can be preserved against all threats. As this article demonstrates, ongoing joint planning and identifying areas where planning and execution may fall short are fundamental for navigating through countless unknowns. USFK continually evolves its health response, contingency, and joint operational planning with its alliance partners to rise to the pandemic’s challenges. Ultimately, the USFK story is now relevant and useful for anticipating new unknowns that lie ahead for joint commands within their strategic environments, as the pandemic continually challenges the military in both predictable and unpredictable ways. JFQ