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Ohio National Guard Solider packages up a completed COVID-19 test.
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Why was it necessary to use the National Guard?
Based on the responses of soldiers, the National Guard was called in because the States of Nebraska and Ohio needed to subsidize work and aid in many state institutions. The specific need for the National Guard in Healthcare was for the administration and delivery of free COVID tests.
Why does cost matter?
Systems of structural violence became evident in the ethnographic data collected. When soldiers were asked about the fears they saw expressed by the populations they tested, it wasn't the fear of COVID itself (despite its terrible symptoms and high hospitalization rates) but the fear of monetary loss in many forms that scared them. In Nebraska, soldiers tested many working class populations that were required to test in order to work. Many of these populations were illegal immigrants that also feared deportation and wouldn't have health insurance to pay for tests on their own. Free testing everywhere has allowed for low income, unemployed, or other struggling populations to be tested and for more accurate COVID rates to be tracked by public health departments. Free tests allowed many to continue working and also forced employers to allow employees time off and compensation without consequences in the case of a positive COVID-19 test.
In what other ways did the National Guard help with costs?
The following information is conjecture based off of the researcher's own experience as a National Guard member and how funding works within the military. This information is learned through experience within the organization.
Activation of a state's National Guard for a state or federal emergency can draw emergency funds to the state or allow for access to budgeted funds that cannot be touched prior to activation. The military is well known for designating 'pots' of money for specific uses and events and activation is a possible way to access some of these funds. Activation is also a way to force federal aid and funding, especially if a state can send or assign soldiers to missions outside the state (for example, deployments overseas from a state's national guard get compensated in many ways by the federal government). In this way, though military activations can be costly, there can be economic and political gains to using the military in the 'right' way.
Why does cost matter?
Systems of structural violence became evident in the ethnographic data collected. When soldiers were asked about the fears they saw expressed by the populations they tested, it wasn't the fear of COVID itself (despite its terrible symptoms and high hospitalization rates) but the fear of monetary loss in many forms that scared them. In Nebraska, soldiers tested many working class populations that were required to test in order to work. Many of these populations were illegal immigrants that also feared deportation and wouldn't have health insurance to pay for tests on their own. Free testing everywhere has allowed for low income, unemployed, or other struggling populations to be tested and for more accurate COVID rates to be tracked by public health departments. Free tests allowed many to continue working and also forced employers to allow employees time off and compensation without consequences in the case of a positive COVID-19 test.
In what other ways did the National Guard help with costs?
The following information is conjecture based off of the researcher's own experience as a National Guard member and how funding works within the military. This information is learned through experience within the organization.
Activation of a state's National Guard for a state or federal emergency can draw emergency funds to the state or allow for access to budgeted funds that cannot be touched prior to activation. The military is well known for designating 'pots' of money for specific uses and events and activation is a possible way to access some of these funds. Activation is also a way to force federal aid and funding, especially if a state can send or assign soldiers to missions outside the state (for example, deployments overseas from a state's national guard get compensated in many ways by the federal government). In this way, though military activations can be costly, there can be economic and political gains to using the military in the 'right' way.
How did using the military compare to universal healthcare?
Using the military to provide free COVID tests to civilians is a form of socialized aid. This is a universal service (depending on the state) that is provided by the government for those that need it. The differences between military provided testing and universal healthcare begin after test results are provided. The majority of civilians would not see a National Guard member following their test results and all medical care would then fall to the normal US medical system. Some special populations, those in long-term care facilities and state correctional facilities with large staff COVID outbreaks, may have seen further healthcare provided by the National Guard and the state but the majority of civilians didn't. The state depended on employers to react to positive results provided by the National Guard test. Utilization of the military was highly limited.
What could have been done better?
One: The military could have tracked their own rates and better surveyed their own populations. Interviewee 1 mentioned the moral dilemma in using the same traveling team to test multiple populations without COVID screenings. Though he agreed that PPE likely mitigated most of the risk, it would still be better for the National Guard to monitor and protect both their own population and the public that is being exposed to them.
Two: The State Governments and the State Public Health Departments could have better coordinated with the National Guard and better utilized them for public health. Considering the large numbers of populations that National Guard members tested, they could have been also used to better screen and track COVID cases. Yet, no contact tracing information was collected.
Three: The National Guard could have been provided with better communication assets. This could include translators (a large issue for many of the teams in Nebraska), and public health educators at each site. Ethnographic data showed that the Guard was not instructed to inform anyone they tested on what they should or should not do while waiting for their COVID results or once they received their results. This lack of communication was a wasted opportunity to push public health policy and limit COVID spread.
Two: The State Governments and the State Public Health Departments could have better coordinated with the National Guard and better utilized them for public health. Considering the large numbers of populations that National Guard members tested, they could have been also used to better screen and track COVID cases. Yet, no contact tracing information was collected.
Three: The National Guard could have been provided with better communication assets. This could include translators (a large issue for many of the teams in Nebraska), and public health educators at each site. Ethnographic data showed that the Guard was not instructed to inform anyone they tested on what they should or should not do while waiting for their COVID results or once they received their results. This lack of communication was a wasted opportunity to push public health policy and limit COVID spread.
Did the National Guard have an impact on public health control of COVID-19?
The biggest impact on public health control that the National Guard has was increased testing. They did help to determine the best process to use to test, which tests worked best, and train civilians to take over the mission. Their involvement, based on rates though, did not seem to have a large quantitative impact on the rates of COVID. Their involvement was very limited.
Other missions, such as the Ohio Food bank mission, may have had other impacts on public health control. The service provided by the National Guard in running the food banks does reduce the number of volunteers and workers of higher risk populations from exposure to COVID-19. Providing foods to local communities also helps to ensure overall community strength and health (as those that go hungry tend to be more susceptible to disease).
Overall, the direct impact of the National Guard involvement on public health control of COVID has been limited. Much more needs to be done to limit the spread of COVID and stop the pandemic and much of this falls on the government. Leadership and collaboration failures were major themes in the ethnography results as they have been across the nation.
Other missions, such as the Ohio Food bank mission, may have had other impacts on public health control. The service provided by the National Guard in running the food banks does reduce the number of volunteers and workers of higher risk populations from exposure to COVID-19. Providing foods to local communities also helps to ensure overall community strength and health (as those that go hungry tend to be more susceptible to disease).
Overall, the direct impact of the National Guard involvement on public health control of COVID has been limited. Much more needs to be done to limit the spread of COVID and stop the pandemic and much of this falls on the government. Leadership and collaboration failures were major themes in the ethnography results as they have been across the nation.
More on Leadership
The blame does not seem to fall to the National Guard and the Soldiers, but to the larger members of government that have failed them in providing them an accomplishable mission. For the best summary of these direct failures of leadership read the story below from the New England Journal of Medicine. This ethnographic study, in many ways, supports many of their claims.
