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• If the virus comes aboard the ship, the results can be devastating in terms of the ship's ability to complete its missions. The most immediate impact is on the ability to man watches in confined engineering spaces, but the cascading effect on training, maintenance, and repair can affect numerous readiness areas.
• The implications extend to other units that may have schedules disrupted. For instance, deployments could be extended because of the unavailability of the infected crew to meet commitments.
• Although the Navy clearly imposed mechanisms to control exposure, these mitigations affect other aspects of unit readiness, including schedule, maintenance, morale, retention, and mental health. This history is still being written, so the full effects are not yet known. It seems imprudent to assume that these extraordinary measures can be adopted as a matter of routine.
• The lessons of COVID-19 must be evaluated in terms of whether the Navy can successfully deal with an out-of-the-ordinary medical and/or mass-casualty event. This requires not just that procedures exist in writing but that they be tested above the unit level in training exercises. It also implies a degree of coherence between operational and medical priorities, which was clearly not present in the initial phases of the outbreak.

Like the rest of the world, the U.S. Navy scrambled to react to the sweeping effects of the early months of the coronavirus pandemic and take steps to mitigate longer-term effects even as the service continued to meet its mission requirements. The early outbreak on the USS Theodore Roosevelt and how that situation was handled received a great deal of public attention. It illuminated fissures in the Navy's readiness to respond to major medical events. The shortfalls highlighted and discussed in this report apply not only to the spread of infectious disease aboard a ship but also to a mass-casualty event or large-scale trauma care — circumstances that may be a more likely outcome in future warfare than has been experienced in the recent past. Drawing from the challenges presented by COVID-19 and the Navy's response, the authors examine broader implications for readiness in the Navy.

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