NAMRU-3 Tests Us Every Day

Story by MC1 Natalia Murillo and MC1 Jacob Sippel; Photos by MC1 Natalia Murillo, Camp Lemonnier, Djibouti

The gray paint on the sign is peeling a little. It sits on an old, faded yellow, double-stack tucked unique in that it’s the only forward-deployed research platform in the Department of Defense. From here, between the chapel and the Red Cross. ‘NAMRU’ is written in white. If you didn’t know what it was, you would walk right by it, never knowing who was inside or their importance to every resident of Camp Lemonnier, Djibouti (CLDJ).

Last year, as COVID-19 crippled the world as we knew it, camp leadership realized they didn’t have capacity to meet what they saw was going to become a huge demand for testing. They called on the U.S Naval Medical Research Unit-No. 3 (NAMRU-3) for backup. NAMRU-3 was already here, but not testing for COVID-19.

In March, 2020, NAMRU-3, regionally based in Sigonella, Italy, quickly answered the call to aid Camp Lemonnier’s Expeditionary Medical Facility (EMF) in responding to the COVID-19 pandemic. NAMRU-3 deployed a senior microbiologist and a hospital corpsman, sent additional equipment and supplies for COVID-19 testing, and realigned their research mission to primarily support the COVID-19 testing and mitigation mission. Since March, NAMRU-3 has rotated through four additional science officers to ensure continued testing operations. The Expeditionary Medical Facility (EMF) also dedicated two hospital corpsmen to be trained to conduct COVID-19 testing and to support NAMRU-3’s testing mission.

In total, the small team in the faded double-stack has tested 20,000 samples for COVID-19 since the pandemic began in spring 2020, and also continued research and testing for other infectious diseases as well.

The Camp Lemonnier NAMRU-3 laboratory is unique in that it’s the only forward-deployed research platform in the Department of Defense. From here, NAMRU-3 provides state of the art laboratory research and analysis and forward-deployed military population research. They also quickly react to outbreaks, monitoring and detecting infectious disease threats before they get out of control.

Before COVID, NAMRU-3’s focus was on longterm surveillance of enteric diseases, respiratory illnesses, acute febrile illness, and sexually transmitted infections in the Horn of Africa. “We primarily deal with research and surveillance in terms of infectious diseases,” said microbiologist Lt. Jae Dugan. “For example, we work in Djibouti to understand what infectious diseases are present and how to combat them in order to ensure mission readiness and force health protection.” He added, “Obviously, the focus has changed since last March.”

In 2020, they added COVID-19 testing. Early on the number of swabs they received to test was low, but they did always had a 24 hour turn-around time.

“What is notable and impressive is that our small lab was able to process large numbers of COVID-19 samples, comparable to large medical centers, with a less than 24 hour turn-around time,” said Lt. Cmdr. Stephen M. Eggan, who serves as Research Science Director at NAMRU-3. He was deployed to CLDJ through the winter months of 2020 into spring, 2021. “That is unrivaled even in the private sector.”

“One-day turn around on COVID-19 PCR (polymerase chain reaction) testing is a keystone of EMF’s success in supporting operations in this AOR,” stated Cmdr. Brian Ellis, Michaud Expeditionary Medical Facility officer-in-charge. “Our ability to reliably and quickly detect the presence of SARS- CoV-2 in large sample sizes allowed us to rapidly isolate those who were infected and trace contacts to contain the spread. Without this ability, every line of effort in East Africa would have experienced delays and interruptions that would have caused ripple effects well outside of Camp Lemonnier.

This small, unassuming shop off the main street is one of the key reasons why, despite COVID-19 challenges base-wide, CLDJ is able to get troops back into the fight quickly.

“What’s impressive is that our small lab is able to process large numbers of COVID-19 samples, comparable to large medical centers, with a 24 hour or less turn-around time. That is unrivaled even in the private sector,” said Eggan. “We are on call 24-hours a day, seven days a week supporting contingency operations and the thousands of people who live on and travel through Camp Lemonnier.”

The lab is unique because they perform the CDC molecular PCR (polymerase chain reaction) test with pooled sample testing – a complex laboratory process being executed out of two metal containers. In pooled testing, respiratory samples from several people are combined into one and the combined pool of samples is tested for the presence of SARS-CoV-2 virus. This is done using a PCR machine that amplifies viral ribonucleic acid (RNA) in the samples, allowing the detection of extremely low levels of virus. If a pooled test result is positive, each of the samples in the pool is tested (re-tested) individually to determine which individuals are positive. The PCR machine used by NAMRU-3 and the pooled sample technique can screen 100 samples for COVID-19 in a single test that takes about three hours. This process allows the lab to do hundreds of COVID-19 tests daily.

In 2021, they have already completed over 10,000 tests.

With the world looking ahead to the next chapter of the COVID-19 pandemic, NAMRU is looking ahead as well.

“Our team was very well prepared for COVID-19 testing, we just had to put some of our other studies on hold for COVID,” said Dugan. “The research and surveillance of all infectious diseases is something that we hope to come back to real soon. There’s a few studies we have for COVID that we’ll move forward with, as well as other infectious disease studies we can resume.”

One COVID-19 effort NAMRU-3 is moving forward with is identifying the COVID-19 variants that are circulating in Djibouti. This information could support the potential development of vaccines and add to an understanding of how the virus mutates within a geographical region.

“Besides respiratory and enteric studies, we are working on tick and mosquito surveillance, militaryto-military engagements with countries in the AFRICOM and CENTCOM AORs, and increasing partnerships with host nation agencies,” explained Dugan.

All of the research done at CLDJ NAMRU-3 provides significant data to commanders both locally and up the chain.

Dugan went on to say that though COVID is still ongoing, they are a better unit because of the challenges COVID forced them to overcome.

“With all the testing, it has improved our testing efficiency and overall training. If another outbreak were to occur, we’re much more prepared because of everything we’ve been through during COVID.”