On Wednesday, March 18, President Trump announced that Military Sealift Command’s two hospital ships, USNS Comfort and Mercy, would join the response to COVID-19 by deploying to the West Coast and to New York City, respectively. The ships, emblazoned with large red crosses, vividly represent an accelerating mobilization against the ongoing pandemic. Moreover, even as public trust in institutions declines, the ships’ deployments visibly connect one of the country’s most well respected institutions — the military — to a contingency response that has struggled to soothe national anxieties. Yet even as the deployments are important symbols of mass mobilization, their role in increasing healthcare capacity is likely very limited.
Context on Hospital Ships in COVID-19
Before considering the question of capacity, it is valuable to clarify two of the key limitations that Comfort and Mercy face in the aftermath of the White House announcement.
First, it is important to note that while the vessels are well-suited for scheduled humanitarian assistance missions, they are not always available for surge deployments. While Mercy was underway from San Diego in a matter of days, Comfort may need weeks to transition from its scheduled maintenance period to a deployment. This means that at least one of the ships is not immediately available to alleviate local fears of overrun hospitals.
Second, the prospective deployments are best understood as adding general capacity to the local healthcare systems they will be supporting. The ships are not specially equipped to handle quarantined patients and are likely to help offset demand for other hospital needs in New York and the West Coast, instead of directly serving individuals sick with COVID-19. This is surely a valuable service — imagine the sudden emergence of a trauma center in downtown Manhattan — but does not add to the stockpile of some of the key capabilities hospitals are lacking, namely ventilators.
It is difficult to understand exactly how hospital ships change the capacity challenges that coronavirus presents, and examples from past domestic deployments are only partially instructive. In the aftermath of September 11, USNS Comfort deployed to Manhattan to provide medical aid and humanitarian assistance through Operation Noble Eagle. Comfort also provided surge assistance after Hurricane Katrina, which CNA helped document. What these and other responses have in common is the need to augment capacity in a defined geography, with demand somewhat static in the rest of the national system.
Those are not the same conditions facing the United States right now, where demand for medical capacity is rising across the country. This opens questions about resource allocation at a scale far wider than previous domestic deployments have needed to address.
Staffing is probably the most difficult example. The medical personnel who serve aboard hospital ships have to be pulled from somewhere, including shore-based DOD medical facilities, which are then likely backfilled by reservists or private providers. While hospital ships can increase the number of beds available to the overall healthcare system (about 1,000 per ship) and certainly increase the number of medical staff in a specific location, they are not ordinarily permanently manned and thus do not increase the overall quantity of healthcare workers in the national pool.
Think of it like musical chairs for medical personnel. In an acute crisis in a specific location, shifting personnel from, say, Baltimore to Miami to meet the need can be a huge boon. In the current situation, shifting personnel can risk burdening the shore institutions from which they are pulled, or from which their replacements are pulled. A hospital somewhere may end up with a missing provider at a time they cannot afford to lose one.
Observers should remain clear-eyed regarding the larger context of hospital ships in the story of this response; never in living memory have we had to assess the role of these assets against such a system-wide demand for capacity. Yet despite their modest contributions, the deployments of Comfort and Mercy remain important symbols of the seriousness of government’s role in alleviating the pain caused by COVID-19 — only a handful of national crises have ever called upon these ships. Most of all, the addition of 1,000 beds to treat patients with other diseases or injuries will undoubtedly save lives in the few cities they serve.