The men and women of the U.S. armed services have certainly captured many recent news headlines. The National Guard were deployed to combat wildfires raging along the west coast. Over 200 retired generals and admirals signed a letter supporting Joe Biden for president. In addition, the United States Postal Service (USPS), which delivers more than 90% of veterans’ prescription medications, is currently being overhauled by Postmaster General, Louis DeJoy,
And here’s yet another news story involving veterans with Covid-19. A recent study conducted by researchers at the Veterans Affairs (VA) Puget Sound Healthcare System and the University of Washington in Seattle sought to identify excess risk and risk factors among veterans infected with SARS-CoV-2. Previous studies were local or regional and did not typically evaluate a wide range of clinical outcomes such as the three measured in this study: hospitalization, mechanical ventilation and death.
Research thus far has shown that Covid-19 infection is associated with a wide spectrum of clinical outcomes, ranging from asymptomatic infection to life-threatening illness. But we still don’t know why some people who test positive for Covid-19 feel healthy as a horse while others are tethered to life support, battling septic shock and multi-organ failure.
This national cohort study of 88,747 veterans, published in the Journal of the American Medical Association (JAMA), found that hospitalization, mechanical ventilation and mortality were significantly higher in patients who tested positive for the novel coronavirus than those who tested negative.
What are some of the key risk factors for death among Covid-positive veterans? Older age, fever, shortness of breath and higher coronavirus disease 2019 burden were a few risk factors identified by the authors. The JAMA study specifically found that most deaths were among white men over 50 years of age with a high burden of disease. Interestingly, the following were NOT associated with higher mortality: hypertension, smoking, COPD, obesity, Black race or Hispanic ethnicity.
From a broader perspective, this pandemic continues to wreak havoc in all corner of the planet, approaching one million deaths globally. At 7.2 million cases and 209,000+ deaths, the U.S. continues to carry the greatest burden of Covid-19 disease and mortality worldwide. Older adults and people with chronic medical conditions have been identified by the CDC as vulnerable populations. But many veterans fall into this category, too.
According to a report published by the Bob Woodruff Foundation, there are approximately 18 million veterans in the U.S., comprising 7.1% of the population. Half of all U.S. veterans are aged 65 years or older. Among those between ages 18 to 64, 77% are in the labor force, actively employed or seeking work. The other 23% consist of students, and disabled, retired or unemployed veterans. As of this writing, the VA medical system has recorded over 58,000 veterans with Covid-19, according to the U.S. Department of Veterans Affairs. Among these cases, 3,301 men and women who have served in the nation’s military have died from this preventable infectious disease.
So, how are we addressing the impact of this public health crisis on the country’s veterans? The VA is banning visitors at its 134 nursing homes and 24 spinal cord injury centers in an attempt to protect some of their most vulnerable patients. VA medical centers nationwide are also screening patients, staff and visitors for Covid-like symptoms. In addition, veterans are being encouraged to use the VA’s telehealth and virtual care system so they can undergo a clinical evaluation without leaving home.
But the community at large must play a key role in protecting veterans. Widespread, evidence-based preventive health measures must be adopted by ALL of us: masks, physical distancing and hand hygiene. This includes our elected officials who should be leading this charge. Military leadership have been critical of the federal response, including retired Lieutenant General Russel Honoré who labeled the White House pandemic response as “slow and not decisive.” Appointed by President George W. Bush to lead a unified Hurricane Katrina taskforce, Honoré – who relies on the postal service for prescription medications – emphasized that the “Trump Administration has all the tools it needs for a robust response to the coronavirus crisis, but it has failed to use them.”
Without these “tools” in place – guided by science, leadership and compassion – everyday citizens including veterans will continue to be at risk for a lethal yet preventable disease.