Emerging acute respiratory diseases (ARDs) pose a significant threat for the US military,
especially among those in training environments where crowded living conditions and
demanding multi-factorial stresses exacerbate infection exposure and suppress immunity,
respectively. Consequently, ARD rates are routinely reported higher in recruits than
older military personnel, which have a detrimental effect on operational readiness.
Although significant steps, such as surveillance and vaccine programs, have been taken to
minimize the impact that ARDs have on military recruits and newly mobilized troops,
hospitalizations among recruits still exceeds that of comparable civilian population in
the United States by at least 3- to 4-folds, accounting for almost 30% of all infectious
disease associated hospitalizations. In 2018, respiratory infections like respiratory
syncytial virus (RSV), accounted for an estimated 50,000 medical encounters affecting
about ~35,000 recruits that resulted in 1,000 hospital bed days leading to significant
loss in training time and cost. In addition to annual respiratory infections, the
on-going COVID-19 numbers rising again, continues to threaten to further degrade
operational readiness. Thus, inexpensive, rapid, and more reliable diagnostics are
continually required to better treat and prevent ARDs to preserve military readiness and
decrease disability adjusted life years.

Current CLIA laboratory diagnostic procedures, such Enzyme Linked Immunosorbent Assay
(ELISA), Reverse Transcriptase Polymerase Chain Reaction (RT-PCR), and bacterial
cultures, are costly, time-consuming, and operator sensitive. It has become apparent that
during the COVID-19 pandemic, these approaches were and continue to be insufficient in
meeting diagnostic needs as they are difficult to scale-up and lack logistical
flexibility. Furthermore, due to the invasive nature of active clinical sampling, there
is a critical need for accurate and rapid passive surveillance as to screen for
SARS-CoV-19 as well as other hazardous chemical and biological agents. To address this
capability gap, the current project will: 1) modify and operationalize existing
innovative passive surveillance systems that can be deployed in the near-term; 2)
leverage revolutionary technologies that will enhance current diagnostic systems to meet
mid- and far-term gaps in CBRNE gaps.