Mitigating SARS-CoV-2 in the Deployed Environment.

INTRODUCTION: Unlike other communal living environments (universities, boarding schools, and camps) that have been suspended during the COVID-19 pandemic, the deployed military force must continue its mission. Early challenges in the 2020 deployed environment included limited availability of living and quarantine space and limited testing capacity. This is a brief report of stringent quarantine strategies employed to newly arriving cohorts at a NATO and U.S. military base to prevent release of SARS-CoV-2 into a larger base population. METHODS: With awareness of the worldwide pandemic, beginning in late February 2020, all personnel arriving to the Hamid Karzai International Airport NATO base were quarantined for 14 days to prevent interaction with the wider base population. Testing capacity was limited. Names, locations, and dates of those within quarantine were tracked to improve contact tracing. Between February and April 2020, the first cases of SARS-CoV-2 were diagnosed on a military base in Afghanistan within quarantine. RESULTS: Within quarantine, 11 males became PCR positive for SARS-CoV-2 during April 2020. Five of the 11 were PCR tested for symptoms of fever, cough, or loss of taste. A sixth individual, who had been asymptomatic upon leaving the base after completion of quarantine, later developed symptoms and tested positive. Another five asymptomatic individuals were found with antibody testing just before planned release from 14 days of quarantine post-exposure and confirmed with PCR testing. All PCR-positive individuals were diagnosed before being released into the general population of the base because of strict screening, quarantine, and exit criteria. CONCLUSION: Quarantine creates significant strain on resources in a deployed environment. Group quarantine facilities where social distancing is limited allow for the possibility for intra-quarantine transmission of SARS-CoV-2. Ideally, PCR testing is done upon entry into quarantine and upon exit. With the possibility of false-negative PCR or limited PCR testing, we recommend daily symptom screening, pulse oximetry, temperature checks, and small quarantine groups that must "graduate" together-all meeting exit criteria. Any introduction of new individual, even with negative testing, to a group increases risk of SARS-CoV-2 transmission.Upon exit of quarantine, testing should be performed, regardless of entry testing. If PCR is limited, serology testing should be done, followed by PCR, if positive. Serology testing can be combined with clinical judgment to conserve PCR testing for quarantine release of asymptomatic individuals.