Ruoran Li

Q: Today is Wednesday, February 23rd, 2022. This is Mary Hilpertshauser for the COVID-19 Oral History and Memory Archive Project. I'm in Atlanta, Georgia, and I will be talking to Ruoran Li, who is in another part of Atlanta. We're recording through Zoom. Ruoran is a member of the 2020 Class of CDC's [Centers for Disease Control and Prevention] Epidemic Intelligence Service [EIS]. She received a BA [Bachelor of Arts] in Natural Sciences and an MPhil, a Master's in Philosophy in Epidemiology from the University of Cambridge. After completing her masters, Ruoran was an intern at WHO [World HFealth Organization] working in the Global Influenza Programme, and a research epidemiologist at the London School of Hygiene & Tropical Medicine. In 2020, she completed her doctoral degree in Infectious Diseases/Epidemiology, focused on quantifying risks to help inform the control of 00:01:00infectious diseases, including tuberculosis and COVID-19 at the Harvard T.H. Chan School of Public Health. Currently, she is an EIS [Epidemic Intelligence Service] officer assigned to Division of Healthcare Quality Promotion in Atlanta.

Ruoran, welcome to the project. Do I have your permission to interview you and record this session?

LI: Yes. Thanks.

Q: Right. Great. Before we delve into the details of your path to CDC and COVID-19, could you tell me a little bit about your family background and the community where you grew up?

LI: Yes, sure. I grew up in China, and I was actually part of the very first SARS [severe acute respiratory syndrome] outbreak in 2002 and '03. I was back in middle school then and living with my parents, who are both civil engineers. Back then, yes, I was experiencing firsthand 00:02:00how a potential pandemic pathogen's effect on people's lives, and as a middle schooler, it's quite eye-opening as my first experience of public health reaction.

Q: You were experiencing H1N1 [pdm09 virus] when you were how old?

LI: No, not the H1N1, the SARS-- one before that.

Q: Sorry --right.

Q: How old are you then?

LI: I was thirteen, I think, around that age, and in middle school. I remember--it's a boarding school that we usually go back home every weekend, and I remember the school definitely got closed in, so we stayed in school for quite a long time, several weeks at least. The first time we were allowed out of school, picked up by my parents. Then we were driving home and the streets were empty. I think that was the first time, obviously, 00:03:00before COVID that I experienced the emptiness of street and the whole-around effect of pandemic on people's lives.

Q: Where are you in China?

LI: I was in Shenzhen, so it's a city in Guangdong province. Guangdong is one of the epicenters of SARS back then.

Q: Yes. What was the feeling like in your school, and where you were growing up, about SARS?

LI: It was interesting. It's definitely a lot of fear and uncertainty, especially among students. Back then we don't use internet, and I think every news source--like the TV 00:04:00would have some news, but usually not that helpful, so we would hear rumors from our teachers, who were part of kind of a texting network, where all the rumors and information gets shared around through text. I do remember, back then, that the general kind of treatment going around on the internet, text network is that steamed vinegar is something that's helpful to prevent SARS. Our teachers would use a rice cooker to steam vinegar in the classroom while teaching us, while we were quarantining in the schools. I remember the air being full-- like dark vinegar colors, it was kind of a mess of vinegar while we were learning.

Q: Oh, wow. Does vinegar to this day inspire you to learn?

LI: Maybe. I don't know, I haven't tried after that.

Q: 00:05:00Interesting. Well, vinegar is good for some things like that. After boarding school, where did you go next?

LI: I actually went to the U.K. [United Kingdom] and did the rest of my education there. When I was choosing which career I would want to follow-- that experience definitely is one of the doors that opened for me, thinking about how to use my math skills as well as my interest in something that's medically-related. Some of my family is medical doctors, so kind of linking those interests. I [thought] epidemiology is probably something I would work [in] long-term. I went in to do a master's degree on epidemiology, and realized that's, yes, something that I would like to spend more time in my career working on.

Q: Epidemiology is a lot of 00:06:00data gathering, and can you explain to the general public, because many people will be listening to this, what exactly epidemiology is?

LI: I think one of the official definitions is that it's about studying or describing the distribution of diseases and risks for diseases in the population, and understanding the causes of this distribution of diseases, and trying to figure out ways to lower the burden of the disease in everyone around us. But for me, my understanding of epidemiology is scientific disciplining within the whole bigger field of Public Health, where epidemiology is more about understanding data and what biases of data-- how do you want to collect the best data to 00:07:00inform some public health policies or actions to do, to prevent or control these burden[s] in the population. It's the subfield of the bigger field of public health.

Q: Thank you. Do you think it was SARS that actually--not pushed you, but suggested you go towards public health, or was there someone in your background that influenced you and opened your eyes to public health? Or was there somebody who was an influencer on you?

LI: Yes, there were--SARS definitely. Well, I was looking back and thinking SARS could be the trigger, but I didn't know what public health was while I was experiencing SARS, I just [knew] there were people who work on this. There are several influencers-- one is while I was in university, my aunt sent me a 00:08:00 book as a present, Mountains Beyond Mountains [Author Tracy Kidder]. It's a biography about [Dr.] Paul [Edward] Farmer, who passed away, unfortunately, very recently. But he worked very--I was reading his work on global health and thinking through his lens about how human rights issues can interact with health, and how health is affecting every aspects of the lives of people that he work with. Him, himself, as a person who's working on public health is something that kind of drew me into the field a little bit. That's one' influence.

Another influence is that while that made my wish to work in public health more concrete is, while I was in WHO, I worked with a past Epidemic Intelligence Service officer from CDC, who's seconded to the WHO, whose name is Tony [Anthony W.] Mounts. 00:09:00He is one of my mentors that I really look up to. He suggested with someone like my background, EIS is something that is one career path forward that I would get the training that I need if I really want to work in the field of Public Health.

Q: Okay, so can you describe your time at the University of Cambridge while you were doing your MPH in Epidemiology?

LI: Yes--

Q: Then if that kind of gets you into your internship at WHO, I'm assuming that's what happened.

LI: Yes, that was.

Q: If you could describe that for us.

LI: It's an interesting experience, because before my master's degree in epidemiology, I worked in kind of a pure--I studied pure sciences, so basic sciences. I started with Physics, then they turn out some more, like the biological sciences, like 00:10:00experiments and experimental psychology and neuroscience, all those things. Everything is very basic science focused.

I enjoyed those, but I don't see myself as a scientist at that stage. It's interesting, while I started my MPhil, master's degree, in Cambridge, I realized, everyone--I finally find a group of people, all the classmates and teachers, everyone thinking about things and what they want to contribute in a similar way than I am. I find my kind of cohort, it feels like. It's a very nice feeling to finally find a group of people who's working on things, seeing things and wanting to contribute things around the same ideas as you, and I do feel that's one of the major influences of me deciding to stay in the field. The learning definitely 00:11:00get--I got exposures to the different aspects of public health, both chronic diseases, prevention, but as well as infectious disease outbreak monitoring--all this kind of training prepare me, at the least foundation of what public health and epidemiology is, and which I took in my later career.

Q: Now you worked as an intern. When you were an intern, you will still at the University of Cambridge or were you somewhere else?

LI: I was intern, so I finished my master's thesis.

Q: Okay.

LI: Yes.

Q: Tell me about your internship at WHO, and how did you get a great internship like that?

LI: I think it's one of the very active classmates of ours that actually organized a visit to WHO during our master's degree, and 00:12:00who--yes, thinking about it, I don't even remember who organized it. That classmate organized that for us, and we were exposed to the different centers within WHO, and we got talks by multiple people who talk about what they do within WHO, and the different types of things. I was interested in infectious diseases back then. I think my interest in infectious disease was definitely stemmed from SARS-- I already know, [that] infectious disease is something that's super-interesting and fast-moving, and I'd like to work on. Tony Mounts presented to us, actually, about his work in WHO about--that was the tail end of the H1N1 pandemic, and they were working on monitoring the global trends of influenza, but also studying, understanding more about the risks of different populations to the H1N1 pandemic.

I 00:13:00heard his talk and decided, that's something I'd like to work on. I emailed him and that's where that internship started.

Q: Okay. How long did that internship last?

LI: It lasted around two to three months. I think it's several months after I finished my master's thesis, I was living in Geneva, which is very expensive, so did all my shopping in France, like, took a long bus trip. But anyway, worked in person with the team there.

Q: That's where you were working on global influenza?

LI: Yes.

Q: Okay. Then after that, you became a research epidemiologist at the London School of Hygiene and Tropical Medicine.

LI: Yes.

Q: Tell me more about that, and how long were you there?

LI: Yes, that's my first proper paid job. Learned a lot from the team. 00:14:00I was in London School of Hygiene & Tropical Medicine-- I think my interest was still in infectious diseases but couldn't find a job about infectious diseases in epidemiology, so I was saying let me just work at the institution with epidemiology, the skills I learned, just understand the broader picture of public health. I worked with the team whose main role is looking at disparities within cancer survival, so survival of cancer patients after a cancer diagnosis-- how they have different treatment and different outcomes following their cancer diagnosis. I worked there for four and a half years, and it's a great experience really working with routine surveillance data-- that means the data collected as a part of the healthcare system.

We worked with cancer registry data, so whenever patient was 00:15:00diagnosed, their basic information about their disease is in this registry, and those are great resources for researchers to understand what their cancer is and the treatment history and their outcomes and thinking about how we can compare between the different geographical areas and thinking about how we can reduce inequalities and improve the survival of all patients. That's the job of the team, and [I was] fortunate to work with a good team there.

Q: That's kind of interesting, because, you know, the pandemic has really highlighted a need for more work within health equity. You know CDC has always been involved with health equity. We could talk about this a little bit later, about noticing that when you come to the EIS program. But it's interesting that you started there with the London School of Tropical Medicine.

Okay, so you're here at the London School of 00:16:00Hygiene and Tropical Medicine.

LI: Yes.

Q: Then Tony gets you interested in EIS, and that's in the back of your mind for a while. Tell me how you got from, what is it, 2009 to now at 2019, you were on to become an EIS officer. There's a ten-year gap there. What were you doing?

LI: I was working and just getting my feet wet. Definitely if I start[ed] EIS [then], I wouldn't even get in EIS ten years ago.

Q: Yes?

LI: But even now I wasn't prepared enough for it. I think just getting all this experience and understanding the healthcare system a little bit more, and just social skills and people skills is important as an epidemiologist and public health practitioner. I was preparing myself slowly. I did do a doctoral degree from Harvard. I think one small 00:17:00reason of that is the EIS program actually required a doctoral degree. I think, well, I don't really want to be a doctor, I fancy more the data and research side, so didn't go to the MD [Medical Doctor] route but stayed with the science and public health doctor's route, PhD [Doctor of Philosophy] route. I did a research degree.

It's nice, I transitioned back to infectious diseases within my doctoral thesis, and I was mainly working on tuberculosis [TB] back then. TB is kind of a disease the general public don't hear that much in developed world. Even in my home country, China, even though the burden is still a lot, people don't really talk about it. People think it's a disease of the past, but 00:18:00actually it is just a disease of the poor. It's really unfortunate, I think, especially with COVID coming on and the TB community at very early COVID stage, even predicted that it will become the disease of poor as time goes on. As time goes on, we do see that start to happen [for COVID]. I think TB, because it's such an ancient disease, it's at the back of people's mind, and people accept, almost, the general population accept that it's just, we're not going to get it. Some people do get it, and it's very high mortality and morbidity burden on the people that they do affect.

I worked on TB with my advisor, Megan Murray, in Harvard for quite a while in Harvard. I took some classes, but also started work on 00:19:00research and designed my own research study, research question. That's great training, thinking about, from scratch-- not working on someone else's idea, but how can I refine my own ideas and talk to people, think about how my ideas can help others within this whole network of research. I did some of that before COVID hits. I was still in graduate school while COVID hits, so I think the whole infectious disease community in early 2020 started to pivot towards COVID, at least in the very early emergency response phase, because I'm from China and I do read Chinese social media and news, so pivot my work to COVID back then, before coming to CDC.

Q: What was that work like? You were doing your PhD and you were doing your research on TB. Are you actually working within the 00:20:00U.K. on that research topic and living there? Or you're actually in the United States now?

LI: Yes. Yes, I mean, I wasn't--

Q: You're going to the United States, you're in Harvard, you are doing a TB study on the United States or the world?

LI: The world.

Q: Okay.

LI: Yes, our focus was in Peru as well as in India, so countries especially India, there was so many cases, and also many of the undiagnosed cases, [I was] trying to think about how we can improve the diagnosis, but also accurately address, estimate the burden in different places to have accurate public health response there. It's more of global health work I was doing back then.

Q: All right. Your research on TB, was that to inform ministries of health about the TB burden and perhaps 00:21:00recommend certain things for them? Or what was the purpose of your research?

LI: Well, thanks for asking, that's very astute questions about in terms of what the research is doing. Yes, part of my research is--the target audience is not ministers of health, but actual health providers and public health workers who are seeing TB patients and seeing their families. One aspect of TB is, because it's an infectious disease and it does transmit to people around you, like, COVID. But something that's different is that TB is a very slow disease, and not everyone who's exposed gets active disease, because if you are super-healthy, you are very unlikely to get TB. But if you have diabetes [addition from Ruoran: and especially if you are malnourished], you have some other underlying conditions, depending on age as well, your chance of 00:22:00getting disease can differ by all these personal characteristics as well. [My] role is to design a method or tools for public health practitioners to use to better-prioritize their investigation of context of people who have TB. Because we do have medication, it's called "latent TB treatment," that can treat people who are at high risk of developing disease. If we just treat those people who have high-risk context and are likely to get disease, then we can potentially prevent them getting TB themselves. The reason is the TB disease itself--it's the treatment course, first, is very long, and the drug itself can have a lot of side effects as well, so we don't really want people to get to the stage where they have active disease that needs treatment. It's all to prevent active disease. It's about developing 00:23:00tools to do that.

Q: The treatment is what, is usually antibiotics, a long course of antibiotics? Is that very expensive?

LI: Usually many countries it's part of the public health program, which means that it is freely provided. There's no--I wouldn't want to say for all countries, but theoretically there's no barriers to accessing those treatment. What is very prevalent in many, many settings is that there's, what is it called, sorry--we might need to cut this--what's the word? It's not discrimination, but--

Q: Disparity?

LI: Not disparity. 00:24:00The-- sorry, let me think.

Q: We can get back to that. It's more of a --

LI: No, no, like the word that describes that people, if you have a disease, people look down on you.

Q: Discrimination? Is that it?

LI: There's another word that specifically, like there's a taboo about getting that disease. Yes, maybe discrimination. We can back it. [the word is stigma]

Q: We'll go with that, and when we think about it, we'll put it back in later. We can put that into the transcripts, and that is fine to do that. This TB has really set you up for becoming part of the COVID response, because now you're the liaison between U.S. academia and then Chinese 00:25:00responders, and you're in the perfect position for that then. Can you describe exactly how you got into that? Or did you just volunteer while you're doing your doctoral work?

LI: Yes, volunteered, in a word. Yes, I volunteered. But it's not even volunteering, I think everyone just got put into it, one way or the other. The way I got put into it was that I think it was in mid-January, I was in between some meetings. I was due to meet my advisor for a quick checking about finishing up my doctoral thesis, and I was just on my phone, looking at social media and all these things, waiting for that meeting to happen. I noted it has blown up on Chinese social media about there this mysterious respiratory illness 00:26:00that may lead to pneumonia, and there's some in Wuhan and some local government that's not reporting how many cases there are, and they're still hosting festivals, no one knows what's happening. There's a big investigation by the national government into exactly what's going on. I say, huh, this is interesting. Let me look at the data of what's happening back then. That was I was trained to do, so I looked online a little bit about looking at what has been published online. Back then the municipal departments at the province-level health departments did have press conferences, and also online data reports, about--I think the first one I saw was December 30th or early January about, oh, 00:27:00we are investigating a cluster of pneumonia of unknown origin. Then they stopped reporting what's happening, or how many cases they had for two weeks.

Then when I was checking, they started reporting again, and the case numbers were rising quite fast. I plotted an epi curve, which is essentially just bar charts of day-by-day number of cases that's being reported by the government. I had that in front of me. Because Chinese social media was blowing up, I was, like, oh, there might be something here, big. Because this is respiratory and because this is unknown, and people are already throwing SARS around. If this is as transmissible as it's it is suggesting, a lot of people are getting it and not getting diagnosed, it might be something worth looking at. I did that very quick, a plot in excel. Then I met with my advisor as our usual check-in meeting, 00:28:00talked about my thesis a little bit, and then showed her the figures, saying, huh, this is something in China. That's how I got into it.

Q: Yes. This is about January of 2020?

LI: Yes.

Q: This is right around--also, this is all happening, we forget the Chinese New Year was happening, and everybody is coming together for parties and celebrations, and that didn't help.

LI: You're absolutely right. That was--I think it was--I'm blanking on the dates a little bit, but I think it's the 25th is the Chinese New Year holiday, and they decided to have the whole city lockdown on January 23rd, but we need to check the dates. It's a very quick decision, and I think in retrospect, probably an adequate--well, not adequate, but timely decision to 00:29:00prevent the spread from that city to elsewhere, by disallowing people to go out to their homes for Chinese New Year, which is a very courageous decision, I think, back then. I don't know personally if I would, in that situation, would make that decision. I think in retrospect, that's definitely a lot of information coming out around that period of time, and a lot of action in the ground by the government, but also by people around who's trying to help to decide what to do, and how to care for a lot of patients in overwhelmed hospitals back then.

Q: Yes. You started working as this liaison. Can you tell me a little bit about what you did liaising?

LI: Yes, I think very early on--it's a lifetime ago, almost, thinking back from here.

Q: Yes, it does feels like it.

LI: 00:30:00Very early on, the focus is mainly on helping the Chinese response. In January, there was just so much unknown about what's happening, and how do we treat patients, especially in mid to late January when the local data is not suppressed anymore, and there are a lot of social media posts about, "my family has this, it's coughing, and their oxygen level is going down, and we can't even get into hospitals, there are so much long lines". Everything is overwhelmed. Back then, the decision is to, I think, especially within the American academic community, I was in back in Harvard, working in the School of Public Health, is to try to help any way that we can to help the local responders. There were some things I 00:31:00helped with-- one is to think about what data is useful for others around the world to understand better this virus. Because it's just so new and so urgent, the data that's coming out of China [are] quite different-- like different provinces would report different levels of different data, different data from the patients that they've seen. Because at very early on in pandemic, it's very important to get accurate count of cases and when their symptom onset is, and how many--do they have contacts with others. All this, try to understand how transmissible this disease is, and also how serious this disease is. What kind of data that would inform the whole international community trying to understand what this disease is, that's the first step where I was part of the team that kind of help write out some key 00:32:00line list items, and suggested to the Chinese government, thinking about how to harmonize the reporting of different provinces to face the international community, and try to share all the information that can be physically collected in the field, but also in the first-time, quickly shared with international community, understand it. That's the first part.

Later on, I think when we get to February, when China is on full response, we resolved the data issue, like case definitions still changing over time, but I think the data that they are reporting every day, all the cases they can count and all the suspected as well as confirmed cases. The international community actually--or the scientific community actually had a very good idea about what this disease is like, in terms of 00:33:00transmissibility, and kind of virulence, how deadly it is. But back then I think there's a disconnect between what this disease is versus what this disease can do to a country. I think in February, especially, in China everyone experienced--it's a very hard month, I think, for a lot of my family and peers, not because they, themselves are affected by COVID, because of the early lockdown [they were not in] Wuhan and Hubei province, like most people didn't have COVID, so they're not affected. But within Wuhan, the message that's coming out and on social media, but also just on news, that there are just so many people with disease that couldn't seek treatment. Many people that do not have enough resources and could not get enough 00:34:00medical resource to push them through, just for them to recover. A lot of not just mortality from COVID, but also that people with other diseases, those kidney patients who need constant medical care, cancer patients who need early diagnosis, or who are in the middle of chemotherapy, heart attack patients--all the other patients also not getting the care that they need because the whole system is paralyzed by the amount of cases that came from COVID. I think back then it was quite prevalent, quite apparent in China, and everyone in China knows about this. I think there is a misconnection between that, what's happening there and what my scientific Harvard 00:35:00colleagues are thinking about, like the future of COVID, thinking about, could it happen somewhere else?

It's very easy, I think, even me, back then sitting in Boston, I didn't think that it could happen here, even though there's really not much difference between Wuhan and Boston. If anything, Wuhan has more population, and more dense population, so it's more like New York than Boston. It's that connection between--like, in several months' time, it could be us--that piece is a little bit missing. I think what my experience back then, especially in February, is that a lot of [Western] media, as well as the scientific community is very scientific, in that they focus on, aha, there's a disease. It's 00:36:00also very political--aha, this is what the Chinese government did. There's a very few focus on what the people actually experienced, and the experience of the people is actually quite independent of--it's quite universal, thinking back now with the hindsight. It is universal that how this one pathogen can have similar effects on a lot of populations around the world. I and a lot of my Chinese colleagues did back then, those of us who are in the U.S. [United States] and in other countries outside of China is to try to convey that sense of urgency and that sense of, it's not something different about China that's making this something that couldn't happen elsewhere.

The one work that we helped back then was to estimate the demand for 00:37:00 intensive care units, as well as inpatient beds within Wuhan, to just estimating--by estimating I mean just collecting those data which are in Chinese, and not in actual data form, just online tables and people trying to find out where they can go to hospitals to. Calculating and summarizing all these bed needs and numbers, and then translating that, so standardizing that to a different population. For example, to New York City, to say if uncontrolled outbreak that happened in Wuhan--so the outbreak hasn't been controlled for at least a month after it has community transmission among different people--so if the same thing happened, would the healthcare system in New York City be overwhelmed. Doing that translation, and having things on paper and plotting the curve, and yes, the 00:38:00ICU [Intensive Care Unit] capacity would be overwhelmed if we do nothing--is something that our team did. Because of the platform that Harvard has and the connections, our advisors and supervisors had with the different health departments, around the U.S. we were able to put these figures on this Health Department's desk and see, look, this is just one estimate. There are a lot of other models and estimates as well, but it's part of the evidence that, hopefully, have convinced some people to think, we need to act earlier, in March.

Q: Okay. I have so many questions. One, this is an amazing collaboration, which I didn't know anything about. How was this--I mean, you sort of mentioned that the professors at Harvard had a lot of connections to the ministry of health in China, and that was an active, collaborative environment. Is that how you 00:39:00exchanged data, because getting data, there was always a problem in getting data out of China and then getting it published, and it changed so quickly that--well, you just mentioned you found out in January, and then February you're working on this, that's a huge amount of--very little bit of time and a lot of change, and how it constantly changed. Who started that collaboration, and where did you publish your recommendations that you were talking about?

LI: That side--I think many of these collaborations happens on the students' side. Whether it's a very niche thing that happened, which is--so a classmate from Harvard 00:40:00who's also epidemiologic student with me, but not infectious diseases.

I was talking to her about my interpretation of COVID back then. She said, "My boyfriend is another graduate student at a Chinese university working with a team who's writing this recommendation to submit within the Chinese government about communications and media, about COVID"--back then it wasn't called "COVID," but "about the pandemic, about how to communicate all this data and information from China to outside. Would you mind talking to my boyfriend," this PhD student's boyfriend. I said, sure, because there are not that many infectious diseases epidemiology-trained Chinese people in Harvard, so I became the 00:41:00person. I talked to that group who's already started to write on this. They don't have the infectious disease training, and they don't have the epidemiological training to judge what kind of data is useful to publish out. They have the media and the communications side of the picture, and I contributed some of the epidemiological knowledge from my side to that group. That's how that collaboration came about. There's a lot of this kind of conversation going on, because everyone lacks information and lacks expertise, and every different group is trying to help. I think that's what made a lot of collaborations, especially in early pandemic, happen, back then.

Q: It sounds very organic. And who knew? Did this get published somewhere? Did the Chinese government publish this? Did we publish 00:42:00this, meaning CDC? Where did all this data go?

LI: There are several things. One piece is our recommendation about how the data should come out. That is the internal--do we call it whitepaper, I don't know, but internal report that's been submitted within the chains of Chinese government. We do know that it got to the desk of the health departments back then. I think with a lot of other suggestions, it did help shape what data is coming out from China after that point. That's very late January, early February timeline, around that.

Then that doesn't generate from our side data, but it does help the local and the provinces and the national government kind of external-facing website, and what data they are collecting and publishing out. Those data are available on 00:43:00the Chinese government's website, which is the daily counts by provinces the number of cases, severe cases, suspected cases--and it's still ongoing up to today. We did use that data. That's this one piece. It forms part of the official data streams that came out.

The other piece, though, is the kind of hospitalization and the ICU use, estimating use--that piece is something that did not come out through official report to Western media, almost. Where it did come out is that the government was publishing data to their own citizens in Wuhan and trying to direct flows of patients. For example, in February, they were dedicating hospitals to 00:44:00 treat COVID patients. The city's government would publish on their internal, so facing the residents in Wuhan, data about how many beds were still left at each hospital. [For example, the government would say that] there are twenty plus hospitals, and this hospital we have three hundred beds, and then we are already using three hundred and five beds, meaning, there were people in corridors, so it has zero beds available. If you have COVID, or you suspect yourself to have COVID or are already dying, you can't even come to this hospital.

They publish all these data online as a way to help manage the whole COVID situation in their city. These kind of data, although freely available and public and open online in Mandarin, not English, but it's something that has not been picked up back then--well, it has been picked up by our group, but it hasn't been picked 00:45:00up by Western media.

I don't know about CDC back then because we didn't work with CDC then.

Q: You also did this modeling that was about the spread. Was that used in any way or was that not used? It seems that you already had a model, like if it happens here in Wuhan, it could probably happen here in New York-- it's a pathogen, it's not going to stop at the border.

LI: Yes, so there are a lot of different models happen, like was made by a lot of infectious disease experts around the world. Ours, it's not even the only one in Harvard, there are multiple different ones. Ours is a very simple model. I wouldn't even call it an infectious disease model, because it's essentially just mapping what happened in Wuhan, and then copy and paste in another city, but standardized, so taking into account the population age structure can be a little bit different. It's very 00:46:00broad data, and that broad data, and slightly modeled broad data. We very quickly realized-- I think it's in early March. I was working with Dr. Marc Lipsitch back then, who's leading this Harvard's communicable disease modeling center [Center for Communicable Disease Dynamics]. He knew I was collecting data on hospitalizations and then trying to write something out of it. One day, he said to me, "Ruoran, you have to get that out, because I think people around the country are deciding whether to do lockdowns or other mitigation measures this weekend."

I was, like, "Okay." I forgot which day it was in the week, but that night--I had already collected all the data--but that night I wrote the paper. We had several collaborators who checked the data and then checked the paper, and then 00:47:00we got that onto a pre-print server the day after, I think. Then later on it was published, a month later. Back then it was on a pre-print server, and then the figures were shared through email from Marc's computer to the contacts he knew was asking him for suggestions or modeling of what could have happened. [Ruoran's note: Marc also shared all these preliminary data on a Twitter thread.]

Q: Do you know who those contacts were--Marc's?

LI: I know he was actively talking to Department of Health, New York City Department of Health, but also L.A. County, and there were other contacts I don't know of, but I do know, those were shared to them.

Q: It sounds like the large port areas. You also mentioned social media at this time. I mean, this is where you were first finding out about it. Do you think--this is kind of a general question--do you think social media 00:48:00 actually helped or harmed the response or the sharing of data, or even--no, I'll just leave it there.

LI: I like to hear what do you think. I think it both, definitely both. At very early on, it definitely helped. I do think--so there are several stages. At the very early one when the government is not publishing official data, so early January, and its social media that's been kind of pushing this, almost whistleblowing outbreak on social media, and help--does catch the attention of a lot of us, like even me, to put my attention on this. It helps then. I think what 00:49:00really helped is after the government started to actively control the disease situation. I think there was at least a week or two of very intense social media, I would say, like, boiling presence back then, because is such a large situation. The government itself didn't have the capacity to handle everything, and it was through the kind of community groups that's formed on social media that was helping sick patients to get treatment, kind if filling the gaps of what government has left out. The government response definitely didn't consider, for example, that their hospitals would be full so quickly. Then without social media, it's hard to push for more hospitals to be open to taking these patients. Without social media, it's hard to 00:50:00know there are so many other patients of other diseases that needs treatment that are just being shut out of hospitals because the hospitals are full with COVID. There are a lot of community support groups because of social media, and also operate on social media that actually helped ordinary people around, to deal with the situation, and actually forms part of the organic government response that Wuhan is doing. That piece, I feel that it helped a lot.

Q: I was going to ask you, when you say government, which government are you speaking of?

LI: All governments.

Q: Oh, okay.

LI: City--both the local governments as well as--

Q: Yes.

LI: Yes.

Q: You're talking China as well as U.S.? That has UK, Europe?

LI: Yes.

Q: Okay.

LI: Yes, I think all of them, but I definitely have a lot more firsthand experience, meaning that I was following, very real time, the 00:51:00Chinese response.

Q: Okay.

LI: Later on in March and April, later on, I didn't follow that much of American or Europe social media, because it just felt like major-- already happened in China.

Q: True.

LI: I don't want to re-expose myself again to--yes, more of a self-protection.

Q: It was more like almost a PTSD [Post Traumatic Stress Disorder] reaction to seeing that again, as you see it--as the wave kind of takes over the world, and you're going, oh my gosh! We could have stopped this. Or maybe we couldn't have stopped it.

LI: I like to hear what you hear about kind of social media have helped or not, but--

Q: We can talk about that elsewhere. This is all about you.

LI: The one way--I do want to mention this, though, the one way I do think social media didn't help or had the opposite effect of helping 00:52:00was--I can only talk about kind of the early Chinese social media. There was definitely a time where there was a lot of--I think because it's such a huge situation, and of course the government response is not adequate at the early stages in treating more patients and getting the disease controlled. There was a lot of negative social media about Chinese CDC colleagues in terms of that, oh, you're only--they're only focusing on publishing English language papers, which they did. That's a great help to the international community, so I think in late January, there were several Lancet papers, for which there's a very 00:53:00 prestigious infectious disease Medical Journal. There were several papers published by Chinese CDC colleagues about describing the early cases of SARS-CoV2 [Severe Acute Respiratory Syndrome Coronavirus 2], and also clinical presentations and case counts over time, and how they're transmitted, and helped a lot about our understanding of COVID. It was not perceived in a positive light by [Chinese] social media, which is no one, but everyone, in a country, because they feel like as a Chinese CDC scientist, their main role should be to protect the Chinese citizen who's still suffering a lot, and haven't been helped in this epidemic. Now they're publishing papers that we don't even read to outsiders. Very unfortunate, and actually, I think it did contribute to very few 00:54:00 English language publications from this Chinese CDC group, because of the backlash of those [early] publications. I don't think it's the only causal factor of fewer publications, or fewer communications about later on, when there were very few publications about what China was doing to contain the epidemic, which I think is super-useful to others, and what the toll of the SARS-CoV-2's effect on the healthcare system and people. There was nothing that came out, I think partly because of this backlash from social media about why they're not helping their own people. I think that's important and interested, and not appreciated a lot by my Western colleagues.

Q: I did not know that. That's a good thing to know. All right, I think we can now pivot to your 00:55:00EIS time, which is really just two years. But you were applying during the first wave, am I correct? When is it you applied, in April? You applied in April of 2020--well, you applied there before.

LI: In 2019. Yes.

Q: Twenty nineteen, so you found out probably in October of 2019. Then you're coming up in April, or you're matching. Is that when you match, or something like that? Tell me about your--you tell me your experience, not me. Go ahead, sorry.

LI: Yes, I always want to do EIS. I applied while I was finishing up, I knew I was finishing up my doctoral thesis in 2020, so I applied the year earlier to get into the 2020 cohort. I think it's fortunate that all the paperwork application happened well before 00:56:00COVID. Then the acute phase of COVID response within China died down, like, it's contained and managed well in April and May. I think we were still working a lot of other things related to COVID, and I was finishing up my thesis. Then there's some matching process within the EIS program, where we matched online, so there were several weeks of matching process. It was surreal, because no one knows what's happening, like in terms of what work we'll be doing, because everyone we talk to during the match process, what the supervisors were already working in CDC, their life had been turned upside down as well with COVID response. It's a very interesting experience, trying to gauge what their usual work is, and are we going to return to our 00:57:00usual work? Are we even going to do our usual work, or is it just COVID response? Yes, I was fortunate to actually have been told by some friends that the Division of Healthcare Quality Promotion, which is where I am now-- it's a great place to get trained into outbreak response and working with stakeholders in health departments and going out to field to [investigate] outbreaks. I kind of knew this is somewhere I'd probably want to come to, to just complement my data skills with this more response piece I matched with this on this program here.

Q: Okay. Can you just explain to everybody what the Division of Healthcare Quality Promotion actually does do?

LI: Oh, they were going to not like this--I don't have official answer, but my understanding, my 00:58:00 experience--

Q: You're within the bounds of COVID. Everybody during 2020 and most of 2021 were responding to COVID. You are working on COVID, but you are in the Division of Healthcare Quality Promotion. What was their response, and what were you working on? Because nothing was normal.

LI: I think--yes.

Q: Nobody was in the office. This is all by telework.

LI: It is, and I'm hopeful to be able to go in the office next month.

Q: Oh, yay!

LI: That's the date when everyone was 00:59:00returning. The Division deals with anything healthcare setting related. By healthcare setting we mean hospitals, but also long-term care nursing homes, residential care, also outpatients, and really anywhere a healthcare procedure is being performed, was considered a healthcare setting. There are multiple things that could happen in healthcare setting, and both in terms of infection prevention control, like how to prevent spread of COVID or other diseases in healthcare setting, because we have so many vulnerable patients around who were at high risk of getting bad outcomes if transmission happens. There is a very strong component on that, infection prevention control within the healthcare setting. There is also other components, including longer trends and [what] COVID's impacts are on the 01:00:00practices of doctors, nurses, other healthcare providers, and how does that affect other diseases, both in terms of quality of care, but as well as with inpatient transmission because of COVID.

So, there are many things that's related COVID that people work on.

Q: Okay-- all right. Let's talk about your EIS class. Were you able--I know that you guys meet, or did you meet? Because it's totally different, it's COVID world--did you guys meet for seminars during COVID, or did you do everything virtually in your training? Because there is a training process to EIS, not just you go in, you get assigned and somebody else trains you. There is EIS training. Can you talk about that?

LI: Yes. At the very beginning, there's a very intensive phase of EIS training in two to three weeks. We did that 01:01:00completely virtually, which is interesting. It's the first time the program is doing this. I didn't get a chance to meet many of my fellow officers in that several weeks. That being said, because especially my division, which is, we have four EIS officers in my year, and similar numbers in the year above me and below me. There are a sense of a cohort of EIS officers in my division that's working together. Together we have also a laboratory leadership fellow officer, for leadership service officer (official name: Laboratory Leadership Service), who's within my division as well. Because we joined at the same time in these fellowships, so we do meet up in person, off work, grab some 01:02:00drinks together and chat about life and work. We do have these informal meetings. Other than that, everything's virtual.

Q: When you were matched, you were still up in Boston?

LI: Yes.

Q: Then you moved down here to Atlanta in July?

LI: Yes, so my partner and I drove down from Boston to Atlanta in July, late June, early July.

Q: Okay, so you've been down here ever since, but you've never been to the campus, or you have been to the campus other than today? I saw you.

LI: I've been to the campus three or four times to get health checked, fit-tested for N95s, and that's about 01:03:00 it.

Q: Okay. It'll be interesting when you do come back. It's a whole other world.

LI: I look forward to it.

Q: Yes, good. I'm looking forward to seeing people back on campus. It's been lonely here. Part of EIS training is also part of--you go out on these deployments for investigations. You were deployed a couple of times. Do you want to talk about the first one, which has to do with MDROs, which is Multi-Drug-Resistant Organisms, correct?

LI: Yes, right.

Q: I forgot this. We had a pre-interview, for everybody who's listening, we did talk before this, there was a pre-interview where we talked, and you had mentioned this. Let's talk about your first deployment to L.A. [Los Angeles].

LI: That was, I think, September or October 2020. I was brand new, just 01:04:00 joined. In case you didn't get it from earlier conversation, I had more of a pure research background beforehand. I was not that good with dealing with new situations with lots of stakeholders. I was working with Maroya [S.] Walters, who's the AR Team lead, the Antibiotic Resistance Team, within the response branch, who is leading this project, working with the L.A. County, where they're having almost a resurgence of Candida auris, which is a drug-resistant fungal organism. Candida auris clusters in multiple healthcare facilities in the county. We were invited by the health departments to go as a team, and I followed along 01:05:00to essentially assess a visit to different health facilities, and to assess their infection prevention control practices, and understand what's happening that is leading to this emergent clusters of Candida auris spread within the county.

Thinking about how COVID was affecting that transmission, because the pandemic did lead to a lot of changes and practices in terms of how people were using gowns and the gloves to care patients, how patients are being cohorted differently, so they were being in separate areas, and how they're moved around, intake, outtake--all these things could have affected transmissions of these kind of multidrug-resistant organisms. Our goal is to try and do that.

Q: 01:06:00Okay. Did this involve meeting with people? You said there were a lot of stakeholders. Who are those stakeholders, besides L.A. County?

LI: Oh, there's another EIS officer in California, who's also working on this project with us, as well as another EIS officer in DHQP [Division of Healthcare Quality Promotion], my division, Alfonso [Claudio] Hernandez-Romieu who's also working on this. I think he's doing one of these oral histories as well. In our team, we also have people from the Mycotic Diseases group, who's working on fungal diseases, so related to Candida auris, as well as many kind of subject matter expertise within the CDC. On the county side, I think we visited dozens of hospitals in total, or even more, and over a quite short period of time, so it's hospitals 01:07:00as well as nursing homes, ventilator-capable nursing homes, long-term acute care settings, as well as just acute care settings. Different types of hospitals, healthcare settings, and it's within the different healthcare settings that I do find it's the first time I'm actually in a long-term care setting, and trying to figure out who's doing what, and how did different practices change, like who's in charge of this but also knows what's happening and thinking about the staffing changes as well. There are a lot of moving pieces in this investigation.

Q: There had to have been a lot of logistics that you were learning, and then how the steps of an investigation actually run. That's really important for each EIS officer to actually experience this, because this is what you're going to be doing.

Then you go on to your 01:08:00second deployment, which I find--you will have to explain. I'm not going to steal your thunder on this one. This one's interesting.

LI: Yes, it is. It's a COVID deployment that--

Q: Oh, anchor us in time, where are we here? It's a Christmas tree, so I'm assuming it's around December of 2020?

LI: Yes, so it's early January that we received news, or maybe during the Christmas-January time. As part of my training in DHQP [Division of Healthcare Quality Promotion] as a EIS officer, each one of us are in charge of monitoring outbreak influx every week. Essentially all the states and local health department will contact us on that mailbox if they need help or consultations or on-site assistance regarding a healthcare-related outbreak that's happening in their 01:09:00jurisdiction. I was on call that Christmas-New Year week and received this interesting note from California about COVID outbreak that's potentially related to inflatable Christmas tree costume. The outbreak itself was already on newspapers being reported as this Christmas tree costume leads to this large outbreak. It's a slightly delicate situation because of that, because of this media involvement. The request from the health department is for us, CDC to send a team of, yes, officers as well as the medical officers and other staff.

This would be to help investigate what 01:10:00exactly happened in this hospital, and also provide guidance on infection prevention control to prevent things like this [from] happening again. I think we departed the week after, or two weeks after that, and sent a small team. It's me, a first-year EIS officer in DHQP [Division of Healthcare Quality Promotion], and we have a second-year EIS officer in the division and a staff lead who's accompanying us, and three of us went. There's another EIS officer in California who joined as well.

Q: Okay, so what was the lessons learned from that investigation?

LI: It was a lot of lessons learned [personally], but in terms of public health, the lessons learned was that we discovered that there were multiple healthcare personnel who was 01:11:00working potentially infectious, or some of them were working while they were symptomatic from SARS-CoV-2, which means that there is a lot of ongoing transmission were already happening in that hospital, and Christmas Day was just a unfortunate situation where there's lack of social distancing among [healthcare workers on] Christmas Day. Back then no one was fully vaccinated-- vaccine was just being rolled out. There was a sense that because of the holiday season, I think there's a lot more transmission going on back then. Also, there's some practices in the hospitals that failed to identify who was close contacts with someone who had COVID, or that 01:12:00failed to stop those symptomatic healthcare workers from coming to work. There are some systematic issues that leads to this outbreak that's waiting to happen, and Christmas is just a time where everything came together and happened. The Christmas tree costume really is almost like the--it's not the smoking gun, so it's not--potentially it could [facilitate transmission], but we did kind of purchase a similar-looking Christmas tree costume, and looked at whether it could be an aerosol-generating device that could disburse SARS-CoV-2 more effectively, but didn't really think that's the case, and especially because the person who wore the Christmas tree only wore it for around five minutes at one time, on Christmas Day. A lot of people who got infected didn't get exposed to 01:13:00that time.

So that's a lot of different data points coming together for us to get that. Yes, that's an interesting outbreak. From personal perspective, I did learn a lot in terms of how data could help or could not help in situations like this, where more data were collected with this Christmas tree costume in mind. It was very hard to assess transmissions outside of Christmas Day, and think about all the practices, observations we were making in hospital, so for me to learn how to pull everything together, to form a bigger picture of what's happening and to give some recommendations to health departments.

Q: Plus-- you had to walk that delicate diplomatic area between the media, I think--because of the Christmas tree, it sounded like a really interesting story, so the media picked up on 01:14:00it. I know you guys in EIS had media training. Did your media training help you with that at all?

LI: We didn't [talk to media]--well, it helped me in other ways. In this particular outbreak, I think the media was happy they got the Christmas tree story out of the way even before health departments came onsite and do all these visits. We weren't approached by media-- to kind of correct that story, but we did send our recommendations in terms of what system factors the hospital could improve to prevent further transmission events like this. Those were picked up by one of the local media, who published that--I don't know where they got that, but [they] published [the report]. The title is not the "Christmas Tree."

Q: Okay.

While we're on the topic of 01:15:00media, I wanted to talk a little bit more about media as a whole for CDC. Now media has had a high profile during the pandemic. I know we talked about the social media help or harm, but while you've been here at CDC, there's been a lot of media directed at CDC and how we ourselves responded, and then a lot of the misinformation that has come out during this time. How has misinformation, or media actually impacted your EIS time?

LI: I think it definitely have impacted. Well, I stopped using Twitter. I think that's a good impact, I guess, because it's just so much information. I do appreciate--I forgot who it was, one of the Twitter 01:16:00followers, a Twitter person I follow who said that really, many people who are actually working in public health don't have time to go through all the news reports that are coming out of COVID, and probably even less informed than the general public about what's the latest topic in COVID. It does impact me that way, in that I think it's hard, almost, to get the salient news or information out from that, from a personal perspective. I haven't dealt with media on a personal level. Yes, and I really feel for those who do, because it's such an important task, and I do think we should be better at it.

Q: Right. We had some interesting 01:17:00guidance policies, and it makes sense because this is new and emerging infectious disease, the guidance is going to change as we know more about it. I think that sort of helped and hindered CDC a lot. Misinformation has also been one of the harder things to combat, the science versus politics.

LI: Yes.

Q: It would be nice to separate those, but sometimes you can't because public health is almost hand-in-hand with politics sometimes.

LI: Yes. I do think that a lot more communication is probably useful. It goes back to my Chinese story that, well, at least in China there's not a direct communication between China CDC [Chinese Center for Disease Control and Prevention] who are working on the science and 01:18:00responding to the pandemic, and the media. I think that partly contributed to all the misconceptions of what the CDC is doing, and why they're not helping the pandemic. A lot of misunderstanding is because of this lack of communication. I do feel like in CDC here--U.S. CDC as well, more communication is definitely better in that sense.

Q: Another overarching [topic]--and we highlighted it earlier--was health equity. I know your work has touched on so many topics that have health equity embedded with them. You worked with TB, COVID. They are hand-in-hand. Can you talk a little bit more about how those global inequities have come about, even in the early pandemic work where you were, that sharing science to 01:19:00solve the greater--for the greater good?

LI: I'm still thinking about topics like this because I don't think I'm fully understanding how public health can really work with the different inequities in health outcomes. Personally, I'm still thinking through these questions. The one reason I'm conflicted is because I sometimes feel like--for example, in my early COVID Chinese response piece, the reason that I personally got super--took COVID seriously and realized it could have a big impact on everyone in the world is because I saw on Chinese social media that even people with 01:20:00connections, and high-income people with connections in the government, in the hospitals, even those people couldn't find hospital beds.

That kind of is highlighted, oh, the situation really is dire. If that didn't happen, if people with connections and with money and social status could find a bed and it's the people [who did not have connections and money] who didn't have beds, would that have the same amount of impact on me? Because it's happening every day, everywhere. For me, this is something I'm still kind of thinking through and thinking about, it could be how it has helped--the inequity actually helped almost in realizing the severity of the situation. I didn't want to say it helped--we should scratch that. Also, now everyone's saying is--let's 01:21:00move on from COVID. I know all the public health practitioners would not move on from COVID. We do want the population--like in a sense, people will move on, and COVID will become something that is like TB, where if you're not working in public health, you're not thinking about it, unless you yourself get it. I'm not sure this is where--like, I don't think the solution lies in public health practitioners, working in health equity would solve this whole bigger issue. These things exist, and it's a much bigger political question. Not even political, but how people think they, themselves in society and how those interact with each other. Yes, this is not a response, but I do feel like I'm sad that this is going to happen to COVID, in that it will become something like 01:22:00TB. Personally, I myself, and I know all the colleagues I work with who's in public health is going to work on COVID as they have worked on other diseases before COVID, and other factors, and effect [of] these diseases before COVID, going forward. I'm glad there are many people who's interested in infectious disease, and aware that there are infectious diseases that could affect everyone. But understand on the other side of the coin, I'm quite pessimistic that things are going to change, because likely they're not-- probably smaller steps by smaller steps. It's a very hard topic.

Q: It is. This brings up another topic that COVID has also brought to the forefront, and that is people's mental health and the repercussions for future generations-- burnout of people working on COVID, 01:23:00people recovering from COVID. You can see it now. Not many people are sharing those things right now, but I think that is going to be one of the--I hate to call it this, but a legacy of COVID is mental health. Hopefully people will put more emphasis and importance on that. I don't know how your mental health was during this period of time, that's a very personal thing to ask you. But did you do some things for yourself to keep you--lack of a better word, here--sane and human, and healthy, mentally?

LI: Thanks for asking. Definitely still human, probably not sane, but like everyone else. Yes, I do personally feel the toll of just remote work--I don't know what it is. It's remote working, but also a slight 01:24:00PTSD, I don't know how slight. I haven't been talking to anyone, but from the early COVID response [in the U.S.], I was almost cruising a little bit, especially when I first joined EIS, just recovered from the early Chinese COVID response, and now working out what are things [that are important in life]--while going out for a walk is my way of trying to counter this, and hopefully everyone will be much better once many of the in-person social activities starts to come.

Q: Yes, this is a little isolating for a lot of people. I have to ask you, your home life, you were working from home, and teleworking as part of that. Do you think teleworking kind of changed the ways we, as an agency, or even people are going to be working now? There'll be a lot more remote work, or do you think it also is 01:25:00changing in the way that people collaborate?

In some ways we connect more with people from farther distance away, and some things even the people that are closest to us are further away because we can't get close to them. Now it's weird, because I can talk to people across the pond, but I can't really talk to my friends. Early on, that was hard. Then having your family and friends far away, too, that was hard. What was that like for you?

LI: I do think it--I don't know what it's like before COVID, especially in kind of outbreak response work, where many different people work together. I do appreciate now that I feel like I'm in the same room as a state health department colleague who's just calling in to chat. I do feel 01:26:00there's this kind of homogenous effect almost of Zoom meetings where, yes, no matter where you are, you are in the same room, and we're connecting side by side. I think that's a really good element coming out of this. Not sure how the social aspect works, we'll see when we return to work next month.

Q: Has it affected your relationship with friends and family? Do you have family close, or are they still back--?

LI: I have some family in the U.S.--my cousin visited last month, which is great. Most of my other families are still in China. I mean, it's not about Zoom meetings or online, but it's the fact of the global travel situation and still hard for me to go back and see them. That's definitely something I'm hoping to work towards to 01:27:00in the new year to come.

Q: Are your parents back there?

LI: Yes, so my mom died, but my dad is back in China, as well as my grandparents, and other aunts and cousins and people.

Q: When's the last time you saw them face-to-face, in person?

LI: That's summer of 2019, I think, or even spring of 2019, I forgot. Yes, I'm glad I went back in 2019.

Q: Yes. Is there still a two-week quarantine period that you need to do when you go back? Okay. That does sort of limit your time.

LI: It does.

Q: Did you have anybody that you know that has gotten sick during this period of time, from COVID? We've all gotten sick from something.

LI: Yes, I think the Omicron wave 01:28:00definitely, leads to everyone--many people around me had Omicron. No one was hospitalized, so that's great. I do know in one of the earlier COVID waves, one of my elderly relatives, my grandma's brother's wife died from COVID, which is quite sad, sorry-- in the U.S. actually. They were a family I was meaning to see sometime after COVID, but didn't get the chance to.

Q: I'm sorry to hear that. I lost my train of thought there--so I do have a couple more questions. We are coming up on time, I want to be cognizant of that.

All 01:29:00right--future. Let's turn towards the future. What do you think will permanently change in our society as a whole? What do you think will permanently change?

LI: Many things, permanently. There will be--people will get COVID at some time, but as we discussed early, it will be like TB. I think I remember back SARS in 2002 and '03, well, I experienced it. Because I was in middle 01:30:00school, I was learning different subjects, and because of SARS, the city decided that there won't be exams on non-essential subjects-- meaning that we'll only learn Chinese, English and Math in that year of SARS.

I never learned world history in that year, never learned other things that's associated with that year of middle school. I do remember seeing our school has already purchased history textbooks, and was lying on empty corridors in the school, like flying away, like the pages are flying away because it was never even handed out to us, because we were not supposed to learn history.

Q: Oh, that's an image.

LI: I think the [effect of] COVID [pandemic]-- like, people now, especially kids, 01:31:00will be much longer-lasting than my missed year of international history, which is sad. I hope people can regain some of those in other ways. I do think a lot of my colleagues, and me included, and doctors and healthcare workers, public health workers in the front line are--potentially there is mental health issues coming in terms of PTSD and other things that's related to their experience. I don't know what impact those will have on us personally, going forward. I do think that--but I am optimistic, I think because of the experience of SARS in China, there were things in terms of public health infrastructure did get built up 01:32:00quite a lot, following things like this. I am optimistic that the whole infrastructure of public health will change for the better after COVID.

Q: Here was the question I was trying to remember a minute ago--are you vaccinated? When you got your first vaccine, what did that feel like? What did you feel like after you got it in your arm, and you were walking away? Or sitting down for fifteen minutes, sorry. We all had to sit down for fifteen minutes. When you were sitting there for fifteen minutes, what was going on in your mind?

LI: I wish I could say it's a feeling of relief, because I know a lot people feel like the pandemic is over. I didn't. What was I thinking? I think one of the reasons, it's just my 01:33:00retrospective reasoning why I didn't feel relieved, was--I have family in China who are still quarantining. It's my personal getting vaccine doesn't really change anything for me. I think I was a little--can I say--I think I'm still--

Yes, so, yes, I don't remember. I'm quite amazed and glad, that afterwards I read people who said, oh, feeling relief. I think partly also because I belong to this low-risk group where even before vaccination, probably my risk of COVID is not that high. Because I worked on TB before, and cancer before. It's already had a preconceived level of risk. I already accepted COVID into the risk of my life, 01:34:00so it wasn't--there was nothing personal in terms of how it has changed me, but more thinking about the broader scale.

Q: Well, we are on time, and I want to just ask you this last question. It's really not really a question, but I just want to make sure that we have covered everything that you wanted to share. Is there anything that we haven't covered that you wanted to share?

LI: No. I think we've covered everything. Yes, thanks for having me, glad to keep in touch later on. Let me know if you have any questions about what I've talked about just now.

Q: All right, well, thank you. I'm going to stop the recording now.

[END OF INTERVIEW]