Before the COVID-19 crisis, Army Col. Brian Keller, a nurse with the North Dakota Army National Guard, was quietly at work, doing what he always did.

“I’m a full-time National Guardsman, so I was working on readiness, making sure soldiers are deployable,” he said. “That’s my full-time job.”

But early in 2020, his other titles came much more into play: Deputy state surgeon, and deputy commander of the State Medical Detachment for North Dakota.

“From Day One when we stepped up to do the testing for the community, we did have [help from] some public health people from [the Southwestern District Health Unit Medical Center in Dickinson, North Dakota], but we didn’t know what we didn’t know,” Keller recalled. “We just knew we had to jump into this battle and start testing and see what we could find. That’s if we could find any of the virus, and that’s why we picked that small town.”

That would be the town of Amidon, a tiny blip on the southwestern part of North Dakota. In March, when Keller and his team started there, they were filling out three pieces of paper per person tested – outside, in winter, on the prairie.

“It took a long time,” Keller said, with distinctive Midwestern understatement.

These days, people coming for testing simply hand over their driver’s license so that an electronic tablet can do that work for them, producing a bar-coded label that goes right on a patient sample. Another system involves a pre-registration site where people drive up and simply give their names and birth dates.

“We can do 1,000 tests in just a couple hours,” Keller said.

Just months ago, it took six to seven hours for 300 tests, tops. It was an example of ingenuity taking place all over the country, with members of the Military Health System partnering with civilian hospitals and clinics.

Around the nation, by mid-March there were 18 labs performing about 10,000 tests per week for DOD beneficiaries receiving care at military medical treatment facilities, Deputy Secretary of Defense David Norquist said in remarks at the annual AMSUS meeting, The Society of Federal Health Professionals.

“The department is now completing 70,000 tests per week, operates 158 operational laboratories and has completed over 1.7 million COVID tests on DOD beneficiaries,” Norquist said. “This is thanks in part to our National Guard members who provided testing support in multiple states.”

He added that more than 60,000 service members have been involved in the fight against the virus in all states and territories.

Other examples of large efforts that involved unusual mission shifts in 2020 include the deployment of U.S. Navy hospital ships (the USNS Comfort and USNS Mercy) that provided support to Americans in New York City and Los Angeles, respectively, who were affected by the pandemic. Navy medical professionals on both ships assisted local health care providers by offering care to patients who did not have the virus — freeing local hospitals and clinics to treat COVID-19 patients. The operation was led by the Federal Emergency Management Agency (FEMA), in coordination with U.S. Northern Command and Military Sealift Command.

In Mississippi, the Air Force had to develop a new process to ensure the prevention of COVID among service members set to be deployed into the U.S. Central, Africa and European commands’ areas of responsibility. The Gulfport Combat Readiness Training Center was tasked with assisting in restriction of movement operations so that service members could comply with specified Center for Disease Control and Prevention guidance before departure. Personnel from multiple units in multiple states contributed to the effort, including Reservists and those coming from many Mississippi Air National Guard units, according to Col. Berry McCormick, the Gulfport training center commander.

Another individual on the battle lines has been Army Reserve Sgt. Major Glenn DelRosario, a registered critical care respiratory therapist. In the spring, he finished up a three-year stint with the Army Reserve Medical Command but was mobilized again in July to fight COVID and found himself in Harlingen, Texas, as part of an 86-person Urban Augmentation Medical Task Force (UAMTF).

There is a critical shortage of respiratory therapists throughout the Army, he said, so even though he worked as the chief medical NCO to the commander, he worked in a clinical role, too. The UAMTF worked with the staffs of two hospitals.

“We were working hand in hand with FEMA nurses, hospital staff, and an active-duty Navy unit that got called in as well,” said DelRosario, who added that they needed every doctor, nurse and therapist, military and civilian.

“Serving as a respiratory therapist in the Army…you knew what to expect anywhere you went,” said DelRosario, a veteran of Iraq. “Going to the civilian sector, the integration was different because they had multiple types of equipment and different protocols. Scopes of practices are different.

“You’re not carrying your M-16 and your ammo around and your body armor,” he added. “And you don’t have the extra threat level of enemy forces around you.”

“One thing about the Army Reserve is they are a special group of people,” DelRosario said. “They really are citizen soldiers who answer the call. They drop everything and go into a place they don’t know much about and overcome and get the mission done. And the community in Texas was very supportive. They did everything to take care of us, with open arms.”

The story of DelRosario and his unit in Texas would not surprise Keller, who realizes he’s still in the fight.

“Our hospitals are full, we just got some [DOD] nurses that came in to help that are working in our major cities and major hospitals,” Keller said. “The [recent spike in cases], I don’t know if it’s is just people thinking, ‘Is it the time of year again?’ People may have just got COVID fatigue and had enough of this, and not followed guidelines.”

“It’s getting overwhelming, and it’s busy and I think we’re all going to be happy when this vaccine comes out and it starts to work, and we can get back to semi-normal life. But as the North Dakota National Guard, we start something and we start hard, and we finish hard. We’re right in the middle of the whole thing, and still doing testing today.”