Panic state and related influencing factors among military personnel during coronavirus disease 2019 outbreak

Objective To investigate the characteristics of the mental health and the change of serum copeptin,cortisol and aldosterone levels of the soldiers in field army under military exercises stress.Methods A total of 294 soldiers were evaluated with the psychological stress self evaluation test (PSET) before the exercises and the soldiers whose PSET score were T ＜ 70 had to accept the survey with the general information questionnaire before the exercises, and another two questionnaires including PSET and Symptom Checklist 90 (SCL-90) after the exercises, the higher stress group and lower stress group were defined according to the PSET score, T≥70 and T ＜ 70 respectively.Meanwhile, we draw the venous blood of them in order to detect the serum concentration of copeptin,cortisol and aldosterone before and after the military exercise.Results ( 1 ) After the survey of PSET before the exercises,263 soldiers were determined to be the final research objects.According to the score of PSET after the exercises, 104 soldiers(39.5% ) were considered as the higher stress group,and the symptoms mainly included anxiety,hostility and poor sleep and appetite.(2) Compared with the lower stress group,the higher stress group were younger(21.51 ± 3.13 vs 24.09 ± 4.16, P ＜ 0.01 ), higher at the proportion of soldiers ( 68.27% vs 54.09%, P＜0.01 ) and lower at the proportion of soldiers who have experiences of military exercises(37.50% vs 57.23%, P＜0.01 ).(3) Compared with the lower stress group,the higher stress group had higher score in EPQN ( 10.43 ± 1.78 vs 8.77 ± 1.67, P ＜ 0.01 ).(4) The serum levels of copeptin ( P ＜ 0.01 ), cortisol ( P ＜ 0.01 )and aldosterone( P＜0.01 ) have increased after the military exercise.Compared with the lower stress group, the higher stress group have higher serum copeptin level ( 11.36 ± 2.21 vs 9.43 ± 2.34, P ＜ 0.01 ) after the exercises.( 5 ) The relationship between PSET score and the copeptin level after exercise can be expressed as a formula: PSET score = 27.909 + 3.669X ( X: copeptin level after exercise), and 11.472 pmol/L was considered as the threshold value.Conclusion As a strong stress agent, military exercises may cause obvious physiological changes and has notable effect on related hormones.The change of serum copeptin level can be used as a sensitive indicator to determine the degree of stress. Key words: Field army; Psychology; Copeptin; Cortisol; Aldosterone

Objective To explore the relationship among psychological stress, emotion regulation type and job burnout of military stationed in Xinjiang, and provide theoretical basis for intervening job burnout in military stationed in Xinjiang. Methods 757 soldiers were chosen by random cluster sampling method and measured with the job burnout scale for military personnel, the psychological stress self-evaluation test and the questionnaire of the soldier’s emotion regulation type. Results ①The scores of somatization, self-evaluation, passive work slowdown and job burnout of the only-child soldiers(respectively(6.34±4.86), (7.66±4.16), (5.00±3.51), (28.60±15.82)) were significantly higher than those of the non-only-child soldiers(respectively(5.34±4.51), (6.89±4.28), (4.25±3.22), (25.73±15.04) (t=2.804, 2.384, 2.950, 2.446; P<0.05 or P<0.01). For the score of the three factors (sense of achievement, somatization, and passive work slowdown), as well as the total score of job burnout, soldiers who had injury history were significantly higher than those who had not (t=3.471, 3.676, 4.222, 3.469; P<0.01). The total score and five factors scores of job burnout among soldiers who had high expectation were significantly lower than those soldier who had normal or less expectation (P<0.05 or P<0.01). ② Psychological stress, cognition attention, self comfort, training expectation and emotional appeal had significant predictive effect on job burnout (t=14.518, 8.241, -4.332, 2.990, -2.695; P< 0.01). ③Cognition attention played a mediating role between psychological stress and job burnout, and the rate of mediating effect was 18.8%. Self comfort played a mediating role between psychological stress and job burnout, and the rate of mediating effect was 4.4%. Conclusion Only-child or not, injury history and training expectation have important influence on job burnout.Cognition attention and self comfort play mediating role between psychological stress and job burnout. Key words: Military stationed in Xinjiang; Job burnout; Psychological stress; Emotion regulation type; Mediating effect

Objective To understand Deyang people’s knowledge, behavior changes and psychological state during coronavirus disease 2019 (COVID-19) pandemic, and provide scientific basis for the government and individuals to take effective measures. Methods A total of 1 380 people in Jingyang District of Deyang City were investigated by online questionnaire. SPSS 23.0 software was used for statistical analysis. Results People’s mode of acquiring relevant knowledge through traditional TV, radio and newspaper has changed to TV, Internet, WeChat, and Tik Tok. In addition to ventilation and panic buying mask and disinfectant, the general public has positive behavior for COVID-19 pandemic, especially those with higher education and higher education level. The differences are statistically significant (all P <0.01). In terms of people’s psychological state, those who feel fear and pessimism and disappointment have lower education background than those of high school and below; those who are worried about infection, worried about family health, depressed mood, irritable and angry have higher education background than those of high school and below, with statistical significance (all P <0.05). There are seven main reasons for residents′ fear, the proportion of college degree or above is higher than that of high school degree or below in fear reasons of strong infectivity, long incubation period and infectivity, increasing number of suspected cases, lack of medicines and protective substances (all P <0.05). Conclusion During the epidemic period, there are panic, anxiety, pessimism and other psychological states in Deyang people. It is very important to take targeted health education strategies and measures to effectively prevent and control the spread of disease, and pay attention to the prevention and control of psychological diseases caused by the epidemic. 摘要：目的 了解新型冠状病毒肺炎流行期间德阳市民众掌握相关知识的情况、行为变化及心理状态，为政府和 个体采取有效的措施提供科学依据。 方法 采用网上问卷的方式调查德阳地区民众 1 380 人，利用 SPSS 23.0 软件进行 统计分析。 结果 人们由传统的电视、广播、报纸等途径获得相关知识发展为以电视、网络、微信、抖音等获得；除了通 风及抢购口罩和消毒液以外，普遍大众都持积极行为表现，尤其是大专及以上文化程度者明显高于高中及以下文化程 度者，差异有统计学意义（ P <0.01）;人们心理状态方面：感到恐惧和悲观失望者大专及以上学历低于高中及以下学历； 担心传染、担心家人健康、心情压抑、易怒发脾气者大专及以上学历均高于高中及以下学历，差异有统计学意义（ P < 0.05）；居民产生恐惧心理的主要原因有 7 项，其中传染性强、潜伏期长且具传染性、疑似病例增多、药品及防护物质缺 乏等项目上大专及以上学历者所占比例均高于高中及以下学历者，差异有统计学意义（ P <0.05）。 结论 疫情期间，德 阳民众普遍存在恐慌、焦虑、悲观等心理状态，应采取有针对性的健康教育策略和措施，对有效预防控制疾病传播非常 重要，同时还要注重防止因疫情引起的心理疾病发生。

Objective To investigate influence of the sea exercises on the soldiers' psychological and physiological indexes. Methods One hundred and twenty-six officers and soldiers were detected by the psychological stress self-evaluation test ( PSET) before and after the sea exercises. Contents of serum immunosuppressive acidic protein (IAP), soluble tumor necrosis factor receptor-1 ( sTNFR-1) , cortisol( Cor) and aldosterone(Ald) in 126 officers and soldiers were analyzed by radioimmunoassay (RIA). All datas were processed by correlation analysis with PSET. Results The contents of serum IAP, sTNFR-1, cortisol and aldosterone in officers and soldiers after the sea exercises were all higher than before(P <0.05) .especially in whose PSET data≥70. Conclusions As a strong psychosocial stress, the sea exercises may have some influences on immume system and level of endocrine krinin. It is necessary that the suitable psychological and physiological training be selected to strengthen competence of immune and psychological stress in officers and soldiers. Key words: Sea exercises; Military personnel; Psychological stress; Immune function; Hormon

Objective To investigate the public psychosocial status and regional differences of Chinese residents during the outbreak of the novel coronavirus pneumonia epidemic. Methods A convenience sampling method was used to distribute online self-assessment tools of mental health including the Self-Reporting Questionnaire (SRQ-20), 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7) scale through WeChat and other self media platforms from January 30 to February 13, 2020. A total of 14 592 people from 31 provinces (autonomous regions, municipalities) in China were evaluated on mental health. The positive detection rate was regarded as the primary outcome measure. Results The positive detection rate of SRQ-20 was 33.2% (4 840/14 592), and that of the PHQ-9 was 53.5% (7 503/14 037), with 29.3% (4 115/14 037) for mild, 14.0% (1 967/14 037) for moderate and 10.1% (1 421/14 037) for severe depression. The positive detection rate of GAD-7 was 44.6% (6 196/13 904), with 27.8% (3 862/13 904) for mild, 10.2% (1 413/13 904) for moderate and 6.6% (921/13 904) for severe anxiety. Except for a few areas, the positive rates of these three scales were almost the same all over the country, and the anxiety level of the inhabitants in Hubei province was significantly higher than that in other provinces. Conclusion As a Public Health Emergency of International Concern, Corona Virus Disease 2019 (COVID-19) has brought obvious psychological impact to the nationwide people, with more prominent in anxiety and depression. The public is in a general group crisis in the early stage of the outbreak, especially in areas with serious epidemic situation. It is suggested that great attention should be paid to public mental health while fighting against the epidemic situation aiming at ensuring their life safety, so as to implement effective psychological assistance and timely psychological crisis intervention. Key words: Public Health Emergency; Corona Virus Disease 2019 (COVID-19); Mental health; Chinese residents; Cross-Sectional Study

Risk Communication During COVID-19

Objective To study the effects of resilience training on work fatigue,psychological stress and mental health in warship soldiers.Methods 100 warship soldiers were selected and divided randomly into training-group (n=45) and control group (n=55),and the training group was divided into two groups by casting lots ( n t =22,n 2 =23 ).The shedding rate of the training group was 13％ (6 out of 45 ),while the control group was 10％ (5 out of 50).All of them were tested by the Resilience Scale for Adults ( RSA),Newly Developed Questionnaire for Work Related Fatigue Feelings (WRFFQ),Psychological Stress Self-evaluation Test (PSET) and Symptom Checklist (SCL-90) before and after training.According to resilience theory and its elements to design the group-training,10 times resilience training was arranged 2 hours once per week for the training group.The aim was to train members' self-awareness,emotion management,interpersonal communication,problem solving and social support and other capabilities.Before training there were no significant differences between the training-group and control-group in age,military service,job and education level and total average score of RSA,WRFFQ score,PSET standard scores and the SCL-90 total average score (P＞ 0.05 ).Results ①Compared with the pre-test resuits,the RSA ( 2.90 + 0.47) scores of training-group ( n =39) significantly increased after training,but the scores of WRFFQ(33.62 ± 11.24),PSET(47.80 ±9.09) and 5CL-90( 1.14 ±0.09) significantly reduced (P＜0.05) ;For control group ( n =50),no significant differences were found in scores of RSA (2.56 + 0.57 ),WRFFQ (42.38± 17.76),PSET( 53.70 ± 13.25) and SCL-90( 1.43 ± 0.45 ) (P＞0.05 ) ; ②Compared to the control group,posttest scores of RSA significantly increased,but the scores of WRFFQ,PSET and SCL-90 significantly decreased for the training-group(P ＜ 0.05).Conclusion Resilience training can effectively improve warship soldiers' resilience,increase their anti-stress ability and mental health level and reduce fatigue symptoms. Key words: Resilience training; Work fatigue; Psychological stress

Nowadays hospitals have been at the forefront fighting against novel coronavirus pneumonia, with diagnosing and treating of patients as a top priority. In order to ensure the smooth progress of diagnosis and treatment, and prevent the occurrence of nosocomial infection, logistics support needs to make allowances for the isolation ward in time from the perspectives of logistics, facilities and equipment, and to transform the in-and-out double channels of ward access as required, thus setting up the partition of the three zones. Secondly, logistics support needs to optimize the logistics service workflow, including the medical waste management, the environmental disinfection isolation, and to optimize the catering service within hospitals to reduce the gathering and flow of personnel. Thirdly, logistics support needs to increase personnel training, and to eliminate psychological panic as well as to stabilize the logistics support team by putting logistics management cadres on the front line. Meanwhile, the logistics department needs to take over the hospital access screening work, strictly manage those who enter the hospital, maximize the safety and reliability of the logistics support within the hospital, and ensure the smooth progress of the epidemic prevention work. Key words: Hospitals; Novel coronavirus pneumonia; Logistical support; Process reengineering; Epidemic prevention

Objective To investigate the psychological status of clinical nurses in a class A hospital facing the novel coronavirus pneumonia (NCP), in order to provide effective psychological and social intervention. Methods A total of 867 clinical nurses were randomly selected from the Mianyang Central Hospital. The general information questionnaire, standard self-assessment anxiety scale (SAS) and crisis intervention classification assessment scale (TAF) were used to conduct self-assessment questionnaire survey. Then the data were analyzed by the SPSS22.0 software. Results 38.8% of the nurses had a low risk of infection, 18.0% of them had a medium risk, 29.6% had a medium high risk, and 13.6% had a high risk. The SAS scores of clinical nurses in this hospital were statistically significant different, compared with the Chinese norm value (P<0.05). The difference between TAF score and the degree of crisis response of nursing students in SARS period was statistically significant (P<0.05). The majority of clinical nurses had less crisis response to NCP, with 80.7% of them suffered mild cognitive, emotional and behavioral damage, and only 2.0% suffered severe damage. Analysis of related factors showed that department, self-test risk of infection, length of service had significant influence on SAS and TAF scores of clinical nurses (P<0.05). Conclusion During the period of NCP prevalence, no obvious anxiety and crisis reaction among clinical nurses is found in the third grade hospital. However, the psychological changes of clinical nurses with middle-age, from key epidemic prevention departments and in high risk of self-test infection are more likely to produce anxiety and crisis reaction. Therefore, appropriate and timely psychological intervention should be given. Key words: novel coronavirus pneumonia; clinical nurse; psychological status

Purpose: In China, the coronavirus disease 2019 (COVID-19) pandemic has been under control and entered the normal prevention and control stage. For medical college students, many studies have analyzed their knowledge, risk perception, and prevention behaviors of COVID-19, but only a few pieces of research explore the content structure of COVID-19 risk perception and the influencing factors. This study measured the students' risk perception of COVID-19 and its dimensions and analyzed the influencing factors of risk perception among them.Methods: The online questionnaire survey was conducted at Hangzhou Medical College in Zhejiang Province among undergraduates and junior college students. A scale was formulated to precisely measure and analyze the COVID-19 risk perception among medical college students. The factors affecting the COVID-19 risk perception in medical college students were analyzed using the multivariate linear regression model.Results: A total of 810 medical students participated in the survey. Results show that COVID-19 risk perception among medical college students was divided into four dimensions: perceived health threat, perceived severity, perceived controllability, and perceived infection possibility. The results showed that income, education, major, and COVID-19 knowledge were the important factors affecting the COVID-19 risk perception of medical college students. Related factors have different influences on the various dimensions of COVID-19 risk perception. COVID-19 knowledge was significantly related to all dimensions of risk perception.Conclusion: This study evaluates the content structure of medical college students' risk perception of COVID-19 precisely and related influencing factors. It is necessary to grasp the risk perception, prevention, and control behaviors of medical college students of different backgrounds, education levels, and majors. Further knowledge training should be conducted for students majoring in clinical medicine, especially the pandemic prevention and control measure training to enhance their sense of security at work.

Objective: To explore a practical system of precision prevention and control against Corona Virus Disease 19 (COVID-19) for eye hospitals by emphasizing on systematic and standardized virus RNA detection procedures. Methods: To include standardized virus RNA detection along with blood routine test (BRT), C-reactive protein (CRP) and serum amyloid A (SAA) into preoperative screening test items for ocular surgical patients and to provide virus RNA detection for returned employees between 24 February 2020 and 2 March 2020. In addition, a questionnaire is designed to investigate the acceptability of nasopharyngeal swab sampling and the influence of virus RNA detection results on mental status of the examinee. Result: 99 examination results showed a certain percentage of abnormal, among which 13 cases showing increase in SAA, 12 cases showing decrease and 5 cases showing increase in lymphocyte count (LYM), 1 case showing decrease and 11 cases showing increase in white blood count (WBC), 2 cases showing increase in CRP. All cases showing negative in COVID-19 RNA detection, including examined patients and 33 employees of the Eye Hospital.11.7% of respondents reported a low acceptance score for nasopharyngeal swab sampling. The proportion of the examinees with higher mental stress scores before and after the virus RNA detection was 46.7% and 6.7% respectively. Conclusion: The detection procedures can offer objective basis for preoperative screening and differential diagnosis, whilst largely eliminating the possibility of transmission via asymptomatic infected individuals. On the other hand, the negative result of virus RNA detection is beneficial in adjusting patient’s preoperative psychological state and relieving the mental stress of medical staff during the epidemic. Key words: COVID-19; Infection; epidemic prevention and control; RNA detection; ophthalmology; effectiveness

Objective To describe digital media use in college students during the coronavirus disease 2019 (COVID-19) outbreak. Methods A structured self-administered electronic questionnaire was designed and admin istered during February 4 to 12, 2020, collecting information on the use time of digital media and anxiety symptoms of college students in China during the COVID -19 outbreak. Data was analyzed by Chi-square test, univariate and multivariate Logistic regression models. Results A total of 11 787 university students were recruited. The detection rate of anxiety symptoms was 17.8%. The percentages of screen time ≤2, >2–4 and >4 h/d were 21.3%, 31.4% and 47.3%. The proportions of mobile phone use time ≤2, >2-4 and >4 h/d were 14.6%, 33.2% and 52.3%. The proportion of browsing information regarding COVID-19 ≤ 1, 1-2 and >2 h/d were 66.6%, 19.4% and 13.9%. The results of Logistic regression analysis revealed that the detection rate of anxiety symptoms was lower among the students having 2-4 h/d of screen time ( OR = 0.70, 95% CI = 0.61-0.81), but higher among the students having more than 4 h/ d of screen time ( OR = 1.13, 95% CI = 1.00-1.28) compared with those having ≤2 h/d of video usage time. Compared with the mobile phone usage ≤2 h/d group, the detection rate was lower among >2-4 h/d group ( OR = 0.78, 95% CI = 0.66-0.91). However, anxiety symptoms were more likely to occur in the group of > 4 h/d ( OR = 1.20, 95% CI = 1.04- 1.39). The detection of anxiety symptoms was higher in the group with more browsing time. The OR for anxiety symptoms detection rate was 1.55 (1.38-1.75) among the students with > 1-2 h/d of browsing information regarding COVID-19 and 2.15 (1.89-2.44) among the students with >2 h/d of browsing information regarding COVID-19 compared with those with ≤1 h/d of browsing information regarding COVID-19. Conclusion During the epidemic period, the use of >2-4 h/d digital media helps to reduce the occurrence of anxiety symptoms. But the use of computers and mobile phones for more than 4 h/d is associated with higher level of anxiety symptoms among college students. Less screen time spent on fact-checking on COVID-19 might help reduce anxiety sympotoms among college students. 【摘要】 目的 了解新型冠状病毒肺炎 (COVID-19)疫情期间大学生数字媒体使用情况, 为缓解大学生焦虑情绪提供参 考依据。 方法 设计并发放结构化自填电子问卷, 2020 年 2 月 4—12 日收集疫情期间中国 16 个省、市、自治区大学生数字 媒体使用时间与焦虑症状自评等信息, 采用妒检验、单因素和多因素Logistic回归模型分析不同类型数字媒体使用时间与 焦虑症状的关联。 结果 11 787 名大学生焦虑症状检出率为17.8%, 视屏时间 ≤2、>2~4 和 >4 h/d 的比例分别为 21.3%, 31.4% 和 47.3%;手机使用时间 ≤2、>2~4 和 >4 h/d 的比例分别为 14.6%, 33.2% 和 52.3%; 浏览 COVID-19 相关信息 ≤1、 >1~2 和 >2 h/d 的比例分别为 66.6%, 19.4% 和 13.9%。多因素 Logistic 回归分析结果显示, 相比于视屏时间 ≥2 h/d 组, > 2 ~4 h/d 的大学生焦虑症状检出率更低 ( OR = 0.70, 95% CI = 0.61 ~ 0.81), >4 h/d 的大学生更容易发生焦虑症状 ( OR =1.13, 95% CI =1.00~1.28); 相比于手机使用时间 ≤2 h/d 组, >2~4 h/d 的大学生焦虑症状检出率更低 ( OR = 0.78, 95% CI =0.66~ 0.91), >4 h/d 的大学生更容易发生焦虑症状 ( OR =1.20, 95% CI = 1.04~ 1.39); 随着浏览时间的增加焦虑症状检出风险增 髙, 浏览 COVID-19 相关信息时间>1~2 和 >2 h/d 组 [ OR 值 ( OR 值 95% CI )分别为 1.55 (1.38 ~ 1.75), 2.15 (1.89 ~ 2.44)]。 结论 疫情期间>2〜4 h/d 数字媒体使用有助于减少焦虑症状的发生, 但电脑和手机使用时间>4 h/d 均会增加大学生焦 虑症状的发生风险, 每日浏览 COVID-19 相关信息的时间越少越好。

Background: The wide scope and spread of Coronavirus Disease 2019 (COVID-19) could lead to a true mental health disaster, especially in countries with high caseloads. Very few studies have assessed the impact on hospital staff. This study aimed to assess mental health changes in health-care workers (Northern Area Armed Forces Hospital-Kingdom of Saudi Arabia). Materials and Methods: This is a cross-sectional study. A survey questionnaire was designed and distributed among the participants, and the survey contained demographic questions and questions related to anxiety, worries, and fears, in addition to depressive symptoms and basic sleep profile. In addition, the psychological impacts, feelings, fears of developing COVID-19, and symptoms of posttraumatic stress disorder were assessed using the Impact of Events Scale-Revised (IES-R). Results: The mean age of the staff was 38.2 years. The examined staffs showed high levels of anxiety and depressive features: 19.3% had crying and depressed mood and 2.4% had loss of motivation; they depended mainly on social media as a source of COVID-19 information. Moreover, these features correlated positively with their Post-Traumatic features measured by the IES-R. Nearly 27.3% of the participants had their duty impacted by COVID-19 and 40.6% were affected financially. Conclusion: Our study identified a vulnerable group susceptible to psychological distress. Psychological support could also be included as counseling services and development of support systems among colleagues.

The Coronavirus epidemic has become a pandemic. The induced crisis has had a global impact. Moreover, there is an uncontrollable interplay between the coronavirus, panic as an emotional virus, viral communication, and the economic and political borderline experience. The world is facing an unprecedented factual and psychological challenge. People are therefore seeking emotional orientation and protection above all in their own group, family, close friends, and nation. However, this often leads to radical dissociation from other groups or nations. This functions in the sense of a psychological defense as a group and is a normal process during an epidemic. In the past two decades, globalization has focused on boundless performance and efficiency increase. In doing so, it has not sufficiently taken people into account; one could say that globalization does not respect humans as humans. It is in danger of succumbing to a narcissistic fantasy of omnipotence. The current virus crisis is holding up its own mirror to the world. It therefore functions as a psychological disillusionment that seems to have the entire world under control. People and nations feel the limits of what is possible. They experience their powerlessness and fall into a state of panic that seems to paralyze people. There is no doubt that medical, economic, and political action is absolutely necessary. A far greater challenge is to reach people with their very own concerns and needs. This cannot be achieved through political war rhetoric. It can only be done if people and nations become aware of the competence of ambiguity tolerance. This, combined with the development of an experienceable and visible sense of community, strengthens resilience, namely, one's psychological resistance.

This study estimated the direct medical and indirect costs associated with coronavirus disease 2019 (COVID-19) diagnoses among U.S. active duty (AD) Army service members (SMs). These cost estimates provide the U.S. Military with a better understanding of the financial burden of COVID-19 and provide a foundation for cost-effectiveness estimates. The study was approved as Public Health Practice (#17-605) by the U.S. Army Public Health Center, Public Health Review Board. U.S. AD Army SMs with COVID-19 were identified using an Army COVID-19 testing and surveillance database. Encounters for these SMs were captured from medical record where International Classification of Disease Tenth Revision, Clinical Modification code U07.1 was in the first or second diagnostic position. Analyses were conducted on SMs with COVID-19 who either had no healthcare encounters in the Military Health System (MHS); at least one MHS COVID-19 inpatient hospitalization; or at least one MHS outpatient COVID-19 encounter. Coronavirus disease 2019 (COVID-19) costs captured from the encounters were used to develop direct medical cost estimates. Literature on COVID-19 recovery post-hospitalization, along with the number of COVID-19 hospitalizations and outpatient visits from encounters were used to describe the intensity of COVID-19 care. Estimates of the indirect cost of lost duty were based on SMs salary information, along with recovery time, bed days, or outpatient visit time. The indirect cost of limited duty was estimated using the time associated with the Department of Defense (DoD) COVID-19 pandemic mitigation strategies in place when these SMs were identified as positive for COVID-19. Coronavirus disease 2019 (COVID-19) cost estimates were developed for the Army using data from 19,086 SMs identified as positive for COVID-19 between June 1, 2020, and December 31, 2020. Direct medical costs, or the amount paid by the DoD to facilities for COVID-19 care, averaged $606 per SM with an encounter. Indirect costs for lost duty or the cost for recovery and the time taken to seek care for COVID-19 averaged $319 per SM, while indirect costs for limited duty or isolation associated with COVID-19 averaged $4,111 per SM or $411 per day. Service members (SMs) with an inpatient hospitalization averaged 4.8 bed days (range 1-43) and 266 recovery hours while SMs who sought outpatient care for COVID-19 averaged two outpatient visits (range 1-60 visits). The direct medical costs of a COVID-19 encounter in the MHS ($606) are a small portion of the costs for a SM with COVID-19. Indirect costs of lost and limited duty associated with COVID-19 averaged seven times higher ($4,331) and accounted for the vast majority of costs. Recognition of these costs is important especially given that soldiers in the hospital or in quarters being quarantined are complete losses of manpower to the Army. While the COVID-19 pandemic is ongoing and prevention, treatment, and mitigation efforts continue to evolve, having reliable estimates of direct medical and indirect costs from this study allows the U.S. Army and MHS to better account for the cost of this pandemic for its population.