Those Giant Hospital Ships Are A Messy Part Of The Solution

Illustration for article titled Those Giant Hospital Ships Are A Messy Part Of The Solution
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The USNS Mercy and USNS Comfort have literally steamed their way to Los Angeles and New York, respectively. They are the longest-serving hospital ships in continuous operation in the nation’s history, and in biological terms, old age is a liability for COVID-19 patients. In terms of Navy hospital ships, old is all the nation’s got.


Both ships have been deployed to the nation’s two largest cities. Their original mission was to treat patients that don’t have COVID-19, the deadly respiratory disease caused by the coronavirus, to free up medical workers on shore to focus on the pandemic.

That’s still the mandate for the Mercy. But the Comfort’s mission changed after news that it was receiving few non-coronavirus patients even as local hospitals battled at the front line of the nation’s coronavirus epicenter. The New York-berthed ship is now taking patients regardless of their coronavirus status.

The Boiler-Powered Hospital Ships Are Older Than Most Navy Vessels

Both ships started their lives as oil supertankers in the mid-1970s. The Navy bought them roughly a decade later, and in recent years has tried to retire at least one of them.

Few active Navy ships are as old as the Mercy and Comfort, except for some of the early Nimitz-class nuclear aircraft carriers and repair ships, said Lawrence Brennan, a retired US Navy captain and adjunct professor who teaches admiralty and international maritime law at Fordham University. He said it’s generally accepted that petroleum tankers, even the double-hulled ones in the era after the Exxon Valdez oil spill, have a useful life of around 25 years.

Both hospital ships are powered by outdated technology. While more modern ships run on gas turbine and diesel engines, the Mercy and Comfort are powered by steam-generating boilers. There are few licensed engineers who can operate a complex steam plant on a ship, according to Brennan, and many of them fall squarely in the age group most vulnerable to the coronavirus.


“The civilian mariners are older and may be in a higher risk group,” Brennan said. “Most licensed steam engineering officers are over 70 years of age.”

The Navy did not answer specific emailed questions about the age of the engineers or whether special precautions are being taken with them. On the Comfort, the area where patients are treated is completely isolated from the rest of the ship to “mitigate the risk of inadvertent exposure” for the crew, a Navy statement said. Both ships have infection control procedures like other hospitals on land.


Should Comfort and Mercy Have Been Retired?

In 2004, Vice Admiral Michael Cowan, the Navy’s surgeon general at the time, said the hospital ships would likely be retired in coming years, calling them “dinosaurs” and “obsolete.”


The Navy has wanted to retire both ships and replace them with smaller vessels that have much shallower drafts, enabling them to come closer to shore, said Kenneth Iserson, professor emeritus of emergency medicine at the University of Arizona. He worked aboard the Comfort during a humanitarian mission in 2009 and has sounded the alarm about the risk of coronavirus infection aboard the hospital ships.

In 2018, legislators balked at the idea of decommissioning one of the hospital ships to cut costs, citing domestic and international humanitarian missions and the national security need for two hospital ships. .


Mark Cancian, a senior adviser with the Center for Strategic and International Studies who took a tour of the Comfort when he was in the Marine Corps, argues that the hospital ships don’t get obsolete. Costs can be controlled by keeping them in a reduced status when they’re not active, he said. He thinks the Navy will keep the Mercy and Comfort going indefinitely while upgrading the medical equipment.

Grazier is skeptical about claims from military officials that ships need to be retired. He said the military is interested in giving business to defense contractors to “reinvent the wheel.” Promises that a new system will be cheaper to maintain are “usually pretty hollow,” he said. Still, ships sit in saltwater and are vulnerable to corrosion, and crew spend enormous amounts of time stripping rust, repainting and “just fighting the sea,” Grazier said.


And not only that, but the ships’ origin as oil tankers doesn’t do them in favors in the hospital design department, either, as the Verge noted:

But as a converted oil tanker, moving patients around can prove difficult. The bulkheads used to separate the oil weren’t removed during the retrofitting, nor were hatches added to improve horizontal movement through the ship. Most of the movement of patients from one area to another must be made by going up to the deck first and then back down.


Brennan thinks the hospital ships’ ages and outdated propulsion systems are arguments in favor of their retirement, saying that the Comfort and Mercy are nearing or at the end of their useful lives. But because of the pandemic, he said, it seems likely that the Navy will defer a decision to retire either or both ships.

The Navy – which does have other ships with medical capabilities but that are not dedicated hospital ships – did not provide answers to emailed questions about the potential retirement and replacement of one of the two hospital ships.


The Hospital Ships Aren’t Immune From the Coronavirus

Each ship has a 1,000-patient capacity, but neither has come close to filling that on their current missions. As it now takes on COVID-19 patients, the Comfort will only make half that capacity available so patients can be spaced out. As of noon Thursday, the Mercy had treated 34 patients while as of Friday afternoon the Comfort had treated more than 80, navy spokespeople said. About half of those treated on the Comfort have been coronavirus positive.


Several crewmembers assigned to the Comfort have tested positive for the virus, according to the Navy. They weren’t in contact with patients and as of Tuesday were being kept in isolation aboard. Other crewmembers who were in contact with them will remain separate from patients, have their temperature taken daily, be screened for COVID-19 symptoms, and continue to wear proper personal protective equipment.

To spread out the living quarters and eating areas on the Comfort, around 800 medical, nursing and staff personnel who have significant contact with patients are now being housed at a local hotel, where they are bussed from the ship. While ashore, they won’t be able to leave the hotel.


“It’s important to stress that the level of care on Comfort is very high – for instance we have conducted more than 18 surgeries, some lasting as long as ten hours, and many on COVID-positive patients,” Navy spokeswoman Lt. Marycate Walsh said in an email.

The Mercy has also had a crewmember test positive for the virus. The person wasn’t in contact with patients, but was in contact with some other crewmembers. The involved crew were to be isolated and removed from the ship.


If a patient on the Mercy tests positive for the virus and are healthy enough to be transported, they would be moved off the ship and taken back to the referring medical facility or another appropriate place of care, the Navy said.

Rewards in Addition to the Risks

Despite the risk of infection, Dakota Wood, senior research fellow for defense programs with the Heritage Foundation think tank and retired Marine, said dispatching the ships under these conditions is a good idea.


“It’s managed risk,” said Wood. “You can’t be so risk averse that you refuse to go into a dangerous situation”

The public relations aspect shouldn’t be discounted, he said. It wouldn’t look good if the medically capable military that the U.S. spends hundreds of billions of dollars on every year wasn’t responding to the pandemic in some way, he said.


“You often hear about ship deployments being a show of force,” said Dan Grazier, who served in the Marine Corps and is now a defense researcher with the watchdog group Project On Government Oversight. For example, moving aircraft carrier strike groups into position is often one of the first moves in tense international crisis situations, he said.

Indeed, unless you’re talking about speed, the hospital ships are impressive. At nearly 900 feet long and more than 100 feet wide, they are among the largest ships the Navy has. Each displaces nearly 70,000 tons of water when fully loaded. And they’re painted white and emblazoned with giant red crosses.


The hospital ship deployments not only help relieve local hospitals, they also offer military medical staff an “excellent exercise” to deal with a real-world situation on American shores, Wood said.

The deployments also help reveal the medical capability of the military to help with more than just combat wounds, Wood said. That could help counter pressure to cut back the military’s non-combat medical capabilities, especially as the coronavirus pandemic shows how stretched the civilian medical community can get, he said.


Ash78, voting early and often

Fun idea: Make the ships into Children’s COVID Hospitals. Smaller patients, easier to transport, and would generally think it’s a kickass idea to be ON A BOAT instead of in a boring, stuffy old hospital.

Lonely Island could do visits to boost morale.