Located at Naval Station Rota, Spain, the Navy Environmental and Preventive Medicine Unit Seven (NEPMU-7) has been one of the Navy’s standard-bearers in the war against COVID-19 across Europe and Africa.

The unit, which was originally founded in Naples, Italy in 1957, and later re-established in Rota in 2013, is the smallest of the Navy’s four NEPMUs, but its mission remains equally as robust.

In a typical year NEPMU-7’s 20-person team, consisting of nine officers, 10 enlisted and one civilian, are actively engaged in providing “boots on the ground” assessments, testing, and providing mitigation recommendations while continually serving as subject matter experts in safety and occupational health, environmental health, integrated pest management, disease control and prevention, health promotion and wellness, and Force Health Protection for the Area of Operations (AOO).

With Italy and Spain in its AOO, NEPMU-7 had a unique distinction among Navy activities directly impacted by COVID-19.

“We were not the first NEPMU to deal with coronavirus, but we were one of the first one to deal with the community transmission happening in the population where we lived, and the population where our supported units were,” said Lieutenant Commander Eric Larsen, head of NEPMU-7’s Threat Assessment Department.

The first COVID cases appeared in Europe weeks prior to reaching the United States. NEPMU-7 kept in regular communication with its parent command, the Navy and Marine Corps Public Health Center (NMCPHC), as well as its sister NEPMUs in Norfolk, Virginia, San Diego, California, and Pearl Harbor, Hawaii, on what they were dealing with, what to expect, and what practices worked best to mitigate the spread. Data collection and analysis were a big part of this effort.

“From early on we were forced to critically analyze all the data we were seeing in a much deeper fashion than, I think, everyone in the U.S. was,” said Commander Tammy Servies, NEPMU-7’s Officer in Charge. Servies noted that at the start of the pandemic virus symptoms lulled people into believing it was just another cold virus. Through data analysis NEPMU-7 personnel began noticing atypical patterns.

Using collected data, NEPMU-7 developed some of first Google-based “heat maps” for identifying regions in Italy and Spain with high case counts and then made recommendations to Navy Commanders to make these places off-limits to travel. This effort ultimately led to Northern Italy and Northern Spain becoming off-limits to military personnel weeks before the national and regional governments began instituting travel restrictions.

In March, as NEPMU-7 began to see COVID-19 numbers in Spain grow exponentially, the unit increased focus on data analysis.

“We determined, like any good epidemiology team, that we needed to have an understanding of the data,” said Larsen. “Data drives a lot of the decisions that we make and can help you come up with interventions, whether it’s shutting down or opening up, or making physical distancing recommendations. But in order to make those decisions at the line commander level, leadership needs to be informed.”

NEPMU-7 provided key personnel support to Naval Hospital Rota. These included a biochemist to set up their BioFire Next Generation Diagnostic Machine (used to detect coronavirus through nasopharyngeal swab) and help the local diagnostics; and a preventive medicine technician to support contact tracing and assist with inspections to ensure mitigation guidelines were being followed.

COVID-19 also forced NEPMU-7 to further adapt in order to accomplish essential tasks like requisite shipboard inspections.

A Navy and Marine Corps Public Health Center (NMCPHC) notice dated March 30, 2020 authorized NEPMUs to inspect and issue Shipboard Sanitation Control Exemption Certificates for Navy, Army, Military Sealift Command (MSC), Coast Guard, and National Oceanic Atmospheric Administration (NOAA) vessels through virtual means in light of restrictions of movement. NEPMU-7 navigated through limitations of live video conference tools and uncertain internet connection speeds to devise a way of capturing the data through a secure messaging system.

“We settled on the best method that ships are actually capable of doing—taking pictures and e-mailing them to us, either by the DoD SAFE or secure email,” said Lieutenant (junior grade) Alexander Bulger, NEPMU-7’s Environmental Health Officer (EHO). “And we used the same method for transmitting the completed forms back to them.” On April 24, 2020, NEPMU-7 became the Navy’s first unit to conduct a virtual inspection during the pandemic.

From early on, NEPMU-7 was heavily involved in contact tracing training with a goal of establishing a group of contact tracers who could follow protocols to notify, interview and advise close contacts of patients infected with COVID-19.