Zheng (Jane) Li

Q: Today is Friday, March 4, 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 Dr. Zheng Li, who is also in Atlanta. We are recording through Zoom. Dr. Li, welcome to the project.

LI: Thank you Mary.

Q: Do I have your permission to interview and record this session?

LI: Yes, you do.

Q: Dr. Zheng Li is the associate director of science in the Office of Community Health and Hazard Assessment at the Agency for Toxic Substances and Disease Registry, or ATSDR, a part of CDC [Centers for Disease Control and Prevention]. She received her Bachelor of Science in chemistry [BS] from Wuhan University in China, and a Master of Science [MS] in chemistry from Mississippi State University. Dr. Li earned her PhD in environmental engineering from Georgia Institute of Technology, Georgia Tech, with a minor in environmental health from Emory University, and her MPH [Master of Public Health] in 00:01:00public health practice from the University of South Florida. In 2019, Dr. Li supported CDC's response to the outbreak of lung injury associated with the use of e-cigarettes, or vaping products. During CDC's response to COVID-19, Dr. Li has been deployed four times to support a wide range of functions, epidemiology, global health, health equity, healthcare stakeholder engagements, and scientific and regulatory reviews of COVID-19 documents. Dr. Li, welcome to the project! May I call you Jane?

LI: Sure! Happy to be here.

Q: Great. You have accomplished a lot, and so before we get into all your experience with CDC, I'd like to ask you a little bit about your family background, and the community where you grew up.

LI: Okay! I grew up in China, as you introduced. My family actually is very 00:02:00close to Wuhan, which is a big city, one of the biggest cities in central China. Growing up in China, I've always been interested in the environment and health since my youngest days. For me, I really have a close engagement with the environment, with both my parents working at the Environmental Protection Bureau as environmental engineers at the city. So, I know a lot about environmental engineering and environmental science. I started working in this field since I was in college days, doing my internship with my parents in multiple summers. 00:03:00This is the overall environment of my upbringing in China.

When it came to picking my major going to college, Wuhan is close to my hometown, Wuhan University is a top tier university in China, and has, as we proudly call it, the best and most beautiful campus in China. So, Wuhan University was my dream university, and I was very happy to join the university for my undergraduate, as well as two years of graduate work at the university. I made lots of friends, and I treasure my friendship for the rest of my life.

Then, near the end of my bachelor time, I think it was highly desirable to go to 00:04:00overseas, especially the United States to further your education, because you know, US has one of the best environments in pursuing academic advancement, as well as lots of opportunities to do research, and lots of resources as well. That's why I pursued, took the tests, and applied, and I was able to come over to the United States when I was twenty-three years old. That's a very brief background of my family background, and where I grew up.

Q: When you came over to the United States, you were in Mississippi State University?

LI: Yes, that's correct.

Q: Then how did you get from Mississippi State to Georgia Tech?

LI: When I went to Mississippi State, I majored in chemistry, and with a focus 00:05:00on environmental and analytical chemistry.

My work was mostly working on developing methods measuring environmental contaminants in the environmental samples. For example, soil sample, water sample, and working on some of the bird tissue sample, to study the contaminant levels in the environment. That's my main work ? going to a field, taking samples sometimes, doing the analysis, and developing method. I actually didn't go directly from Mississippi State to Georgia Tech, I went from Mississippi State to CDC first, and then went to Georgia Tech. There is a deviation that you probably cannot tell from my very short, brief file, that I actually came over to CDC and joined the CDC workforce after my master's degree from Mississippi 00:06:00State University.

Q: You were here at CDC and then going to Georgia Tech at the same time?

LI: Yes.

Q: Ah! That's a lot of work.

LI: It was, but I think, when you're young and you have all the free time, I'm happy that I was able to accomplish both, pursue a career at CDC as well as conducting my PhD work at Georgia Tech, so I was fortunate to have the support and have the time, too. Before kids.

Q: Oh, this was-- are you married at this time?

LI: I got married in, among that time, so yes, it's during that time period.

Q: Okay. Did you meet your husband here, or over in China?

LI: I met my husband here in Mississippi State University. He was a computer scientist, in IT [information technology], a computer guru in our department, in 00:07:00our building, so that's how we got to meet.

Q: He moved with you?

LI: I'm sorry?

Q: He moved with you to Atlanta?

LI: Yes, he did. When I received a job offer from CDC and then moved to Atlanta, so we moved here together.

Q: Okay. When we had talked before, you were telling me about a man who really got you interested in public health, and that's Dr. James Grainger, is that correct? Or did he just help you--tell me more about Dr. James Granger.

LI: Sure! I think that will have to go, date back to Mississippi State, and how I ended, how I landed a job at CDC.

Q: Absolutely.

LI: As I mentioned, for my master's thesis, my work and research were in 00:08:00measuring environmental contaminants in environmental samples. Then near the end of my master period, I went to a conference. While attending conference, there's a job fair there, and I came across this job announcement from the CDC, Centers for Disease Control and Prevention, seeking a candidate to fill a job in a biomonitoring laboratory. Biomonitoring is a terminology for measuring biomarkers, contaminants, and their biomarkers, in human bodies. This particular job was very interesting to me because I was working on those type of chemicals, even though not in human samples, but in environmental samples as well as some 00:09:00of the animal tissues. It was a great fit for my background, and so I was super interested, and I put in my resume that job announcement. Unfortunately, I didn't get to have an on-site interview during the conference with the person who put in the job, which later I found out was Dr. James Grainger. After the conference, he called me, and then gave me a phone interview. We had a great conversation, went over time, and then after that, he offered me an onsite interview. So, I came over to Atlanta for the onsite interview, which eventually led to him hiring me into CDC.

For me, Dr. Grainger is absolutely the one who has discovered me from a large 00:10:00number of candidates who he interviewed during the conference. He told me afterwards that out of all of the twenty or thirty-plus in-person interviews that he gave, he chose me, who he didn't get to meet during the conference, but had a talk over the phone after the conference, as the person who came over for the on-site interview-- because how well fitted my background, as well as how well we were able to talk to each other, and we talk about the passion of public health the lab technique, as well as the environmental health overall. Even though at that time I actually had not worked in public health arena with my work mostly focused on environmental side, he was the one who showed me the door to CDC and welcomed me into CDC workforce and CDC family. I forever owe to him 00:11:00to show me the door to CDC.

Q: When you came to CDC, what was your role here?

LI: My role here was working in the biomonitoring laboratory and developing methods to measure some of the toxic chemicals in human samples, mostly urine samples, sometimes blood samples. We applied the method in a lot of environmental health studies, including the NHANES which is short for National Health and Nutritional Examination Survey, to produce a national exposure report, which give a picture of what the exposure levels are in the US general population. That's my main job when I started at CDC, and that carried on for the next few years.

Q: Is NHANES part of ATSDR [Agency for Toxic Substances and Disease Registrar]?

LI: No, NHANES was not part of ATSDR. NHANES is a national survey that's led and implemented by the National Center for Health Statistics at CDC. At that time, I was at CDC National Center for Environmental Health. I wasn't at ATSDR, just for clarification.

Q: How did you leap to ATSDR?

LI: As I worked at the National Center for Environmental Health for about, over ten years, I applied for a job at the ATSDR as a team lead in the environmental epidemiology branch. This job offered me a bigger picture of the environmental health and public health program, and public health studies as a whole, versus in the past my previous job focused more on a smaller element of conducting health studies, which focused on the laboratory measurement management, and 00:13:00laboratory data production and interpretation. I was more interested in getting a bigger picture of running entire health studies, being able to run studies from the beginning to end, including the laboratory component. But more importantly, the designing of the study, the implementation of the study, and finally finishing with the result interpretation and communicating the result to the broader audience. That's why I moved over to ATSDR as the lead environmental health scientist at the environmental epi branch at the time, for several years.

Q: Okay, and what were you working on at ATSDR? The studies-- it's running from start to finish.

LI: Yes, I worked on several large-scale studies, for example, one of the big 00:14:00studies or programs, is called Biomonitoring of Great Lakes Population program. ATSDR established the program before I came over, I came in the program at the second wave of the program, and until the end of the program. For that program, we established cooperative agreements with state health departments in the Great Lakes region, for them to carry out biomonitoring studies, focusing on susceptible populations in the Great Lakes region who may be exposed to higher contaminant levels by eating locally caught fish from contaminated waterways. They recruit participants into the study, ask questions about fish consumption and many other elements, collect blood and urine samples for measurements for a large number of and different types of environmental contaminants found in the 00:15:00local waterways.

Then we do analysis, look at exposure level, and the connection with fish consumption as well as with other lifestyle and risk factors. That's one example of the study that I did when I was in that job.

Q: What year was that?

LI: That program, the Biomonitoring of Great Lakes Population program, ran from 2010 to 2020. I came over to ATSDR in 2014, so I was here right in the midst of it, and until the completion in 2020.

Q: When we spoke, we were talking about that you were working on EVALI, or EVALI, depending on how you want to say that, but it's the e-cigarette or vaping product use associated lung injury. How, after this other, the first study, the 00:16:00population program, how did you get involved with the e-cigarette? This is still part of ATSDR?

LI: It's not "part of ATSDR", it's actually a part of CDC emergency response. CDC response to public health emergency actually on a continuous basis, because you never know what kind of threat that come our way. We have seen a lot of different public health emergencies, like the EVALI [e-cigarette or vaping use-associated lung injury], we call vaping response. EVALI is short for E-cigarette or Vaping Product Use-Associated Lung Injury. In short, we call EVALI, but informally we always call it vaping response. This is a public health emergency that came up during 2019, when there were reported cases of severe 00:17:00lung injuries that were associated with using e-cigarette product, or vaping product. The outbreak was quite broad, covering many states in the United States, and really flaring up in the, I think, in summertime 2019.

So, CDC stood up an Emergency Operating Center in response to the e-cigarette, the EVALI outbreak, then they recruit people to participate in the response, in order to carry out many functions, just like any other public health emergencies. For example, conduct epidemiology and surveillance to count the cases, how many outbreaks, how many cases, what are the severity of the cases, 00:18:00and who are them? Tracking the trend. Also, of course, as with many new public health emergencies, you have to figure out what's causing the damage, the health outcomes. In this case, for EVALI, it was a lung injury, what could cause the severe lung injury in mostly young folks who are using those vaping product, in the teen or young adult phase.

That's what led to many CDC staff or CDC/ATSDR staff, to assisting and participating in responding to different types of public health responses. That's why it's not an "ATSDR work", but it's really a CDC/ATSDR and FDA [Food and Drug Administration] response to understand and to curb and reduce the 00:19:00vaping, the lung injury associated with using e-cigarette or vaping product. I think just like any other EOC [Emergency Operations Center] operations, they were asking for staff or volunteers to be part of, to support the response. Specifically, for the role that I was tapped into, they were looking for an epi-lab linkage liaison who are very familiar with epidemiology as well as laboratory analysis, so the person can liaise with FDA, with CDC labs, and as well as the epidemiology and surveillance task force, to carry out some of the key functions. I was recommended to be a candidate for that role, and that's how 00:20:00I entered into the vaping response and supported the vaping response.

Q: How many days were you working in the EOC for EVALI?

LI: For that one, I think it's about just shy of two months. About seven, eight weeks.

Q: Right around this time, in January, there is a HAN [Health Alert Network] that goes out? Can you explain what a HAN is?

LI: Okay! Yes, that's right around the time. I was in vaping response in December 2019 through January 2020. For those who are familiar with COVID-19, that's around the time when there's reporting coming out of China, specifically 00:21:00coming out of Wuhan, of a cluster of cases of what, at that time, was called "pneumonia with unknown etiology." That was being reported at the end of 2019.

For me, being from Wuhan, I was really keen in anything that happened from my hometown. Also being in the EOC, working the vaping response, we also are very tuned into any other potential, new public health threats that may be coming up on the horizon. It was during that time at the beginning of 2020, when I really start paying attention to these new reports coming out of China, specifically coming out of Wuhan, about a cluster of the PUA, pneumonia of unknown etiology. 00:22:00What really triggered my personal sensitivity to this is when CDC released its first Health Alerts Network announcement on the Wuhan PUA at the beginning of January eighth. That's when I realized that CDC has an eye on this, and is closely watching this, which really made me become more interested in this topic and tracking the development of this disease cluster coming out of Wuhan.

Yes, HAN, it's called CDC's Health Alert Network, which is, my understanding is a prime method of sharing information about upcoming or urgent public health incidents with the public, mostly with federal, state, and local health 00:23:00departments, clinician practitioners, hospital network, as well as public health laboratories. CDC give out this HAN, the Health Alert Network notice, any time when there's a new or incoming threat, as well as if there's any new updates, guidance, or updating guidance on some, on the topic of broad public health concern.

Q: This one struck you personally--because your family is in, lives in and around Wuhan?

LI: Yes, that's correct. I think when the new disease cluster coming up, I was interested, but it didn't really raise alarms for me at the very beginning, because Wuhan is a big city. As I mentioned, it's one of the biggest cities in central China with over eleven million people. At the beginning, when there's 00:24:00news coming out that, I believe at the end of 2019, maybe the last day of 2019, China reported to WHO [World Health Organization] about this cluster of, I can't remember, whether it's twenty-nine or forty cases that had this pneumonia with unknown etiology that mostly seemed to be related to a seafood market.

I was interested, but I would never in my wild dreams that this would become a global pandemic. Sometimes disease pop out, and you know, especially when new disease pop out, it takes effort to detect and takes effort to track. Is this a real infectious disease, how severe that the disease can be, is this person to person, or there has to be direct contact? There's a lot of things to be sorted out. At that time, I just was watching.

But what really raised my alarm level, is when CDC start releasing the health alert to the US health network, that's when I realized that this potentially could be a major concern.

Q: That was in January of 2020 that a HAN came out. Then you were tracking this because your family is in that area, and that's where you grew up. Then, you get deployed, your first COVID response deployment, which is the International Task Force, in March and April of 2020. Explain to me what that deployment was like.

LI: Sure! Yes, as I mentioned, I was very interested in this, in the--now we 00:26:00know it's COVID. But at that time of course, it's not "COVID", since COVID has changed the name multiple times as more information was found about it. I actually put my name into the hat to be deployed for the COVID response in January, three days after I came back from the vaping response. After vaping response was completed, the whole response was standing down and transferred to a program level.

At that time, CDC was doing airport screening of incoming travelers, and you know, they routed most of the international travelers from China to several major airports in the United States. Also, near the end of January, CDC set up an EOC, Emergency Operating Center, for COVID response, and started recruiting volunteers to support the response effort. I volunteered, I put my name into the 00:27:00hat to be deployed to support the CDC COVID response.

My original hope actually was, maybe because of my home connection, and my language skill, that I may be able to help with communication, facilitate with communication-- that my language skill, as well as my technical background, can be put to use. Long story short, I was tapped in to support the International Task Force starting in March. The time was set in March, mostly because of cross-coverage with my own job at that time, my supervisor, who's a Commission Corps [Commissioned Corps of the US Public Health Service], was deployed to conduct quarantine and help with airport screening. I had to cover for her as the acting branch chief, and therefore my deployment was pushed to March, and 00:28:00situated at the International Task Force at the CDC EOC.

My role at that time on the International Task Force, I was serving as a team lead for the Epidemiology Situational Awareness team. Our team was tasked with the keeping track of the global pandemic development, analyzing data on the spreading of the global pandemic. By that time, it, was already declared as a pandemic, it has a name of COVID-19, and the spreading was quite rapid during those few months from late January, to February, to March. We practically "see" every day new reporting from countries that did not have reported cases. With 00:29:00new reports, new cases were discovered in a particular country. We were tracking the development of all of the reporting from different country, we're tracking what each country was doing in order to slow down or prevent the spreading through the country. We also did a lot of data analysis on what kind of strategies they were taking in order to inform not only the global pandemic development, but also to inform our response for domestically. What are some of the countries are doing that may be working, and that may work well, that may inform our own domestic response in the United States? How do they track, how do other country do contact tracing, for example, what are the mitigation strategies they're using that may be working well?

That's a very short description of our job over there at the International Task Force.

Q: This task force is really tasked with--well it's like epi 101, where you don't really know what the thing is, and you have to find out what it is. It's basics of epidemiology, you get your data, and then start to see trends. This was early on, so there was really no way to prevent--put interventions in, because you don't know how it spread, you don't know what it is. All you're doing is getting data to see how it is moving around, there's no testing-- there was testing, it's-- we're in March and April-- yes, there was testing. What was the--what was testing like at that time? Just to keep track of this, I mean 00:31:00testing was only done by CDC, or was it by also the other ministries of health around the world?

LI: Yes, so these are still the early days of the pandemic. Well, you're absolutely correct, yes, there's limited testing, and there's practically no therapeutic drugs that can effectively gear towards COVID, and definitely no vaccine at that time. I think you put it down really well, back to public health 101, epi, infectious disease 101. To contain it, like what we watch in movies, to really contain new emerging infectious disease that we've never seen before, there's some basic strategies that we are trying to follow, trying to implement, 00:32:00especially before any serious clinical measure that can be involved, including drugs, medication, or vaccination being developed specifically for this agent. Before the advancement of those kind of countermeasures, we are reliant on some of the basic public health interventions to fight incoming or emerging infectious disease, and those are infection control, travel restriction, social distancing, quarantine, isolation, in order to contain the virus from spreading to other--or from spreading to other regions very fast.

That's why, at that time, we were tracking, what we were collecting information 00:33:00on, to look at what are some of the infection control, border screening, border closure, travel restriction, whether they are effective in slowing down the infection, and what are the transmission pattern on the international stage. Because I was in the International Task Force, we really focused on the global stage, what are, how are the, how fast are the transmission, and what are the strategies that each country are taking to prevent the introduction or to slow down the introduction of the virus into the country, into the border.

It is very difficult. It's like what you alluded to, that during the early stage, the testing was so limited. Early on, it was done by CDC, and it had in 00:34:00turn lots of hurdles, and you know, challenges, CDC was trying to do all the testing. I think by March, April, the testing has been opened up within United States, to other laboratories that can conduct the testing.

On the international stage, we also monitored the testing availability. Some of the countries were better equipped to implement the testing, but some, many other countries had very limited testing capacity. Based on some of the information that we saw, as reported by different country governments, they may 00:35:00have a very limited amount of testing, and so they mostly rely on the symptom reporting, and sometimes they have to export the testing to a different country to do.

It's very, very difficult at that early time. I think for any country to understand a new virus, to understand how they transmit, to develop enough testing, and basically, we learn as we respond on the spot. During that time, that's also when we started learning more and more about asymptomatic cases and transmission around asymptomatic. The situation was changing almost on a daily basis. I think we all, the whole global community are learning as we are responding.

Q: In this International Task Force, who were the international partners in the task force, besides CDC?

LI: For the International Task Force, yes, CDC was working closely with WHO, as well as the WHO regions. I remember when we were preparing daily international COVID situation report, we would distribute to not only within our task force, within the CDC COVID-19 response, but we'd also distribute to our CDC staffers who were stationed with WHO headquarter, as well as with different countries, and the WHO regional offices. CDC worked really closely, hand in hand, with our partners, global partners in other country, at the WHO headquarter and the 00:37:00regionals, where the staff are actually stationed in those offices.

In addition, I remember seeing a report that CDC also sent staff to other countries to help with their response in the country, . to help coordinate the pandemic response. We have a large network of partners on the international side, to work on this all together.

Q: This was all coordinated through our [CDC] EOC?

LI: Yes, I believe mostly through EOC, through the International Task Force, since the task force was stood up specifically for the international stage, 00:38:00especially early in the pandemic. How it was started in Asia, in different parts of the world, International Task Force did play a very heavy role in the early stage of the CDC's response.

Q: The EOC is typically on-site people in one big room. This must have changed a little bit as we transitioned to telework.

LI: Yes, you are absolutely right. I think we all have seen the beautiful picture of CDC's state of the art, large room of the Emergency Operating Center, in the Clifton campus, or Roybal campus, with lots of computers, rows after rows of computers, and stations where the staff are sitting, manning, working on 00:39:00different function and capacity. That was how traditionally, EOC were set up. When I first started at the COVID-19 response, because of the size of response, that one room cannot handle all of the staff who are manning the EOC. Specifically for my team, we were actually set up, stationed in conference rooms throughout the buildings at the Roybal campus. Pretty much all, large conference room and small conference rooms, were set up to house all the different task forces and different teams to carry out the coordination and response function.

In March, before the full transfer to a hundred percent teleworking, we were--our team were setting up in a building on Roybal campus in a conference room. If we need to go to a bigger meeting, we could go to a bigger conference room to participate in the incidents command meetings. When I started at the EOC, the rest of CDC had starting to move to a more full-time teleworking, so I was lucky in that I didn't have to worry about the parking, as you know, the CDC Clifton, Roybal campus, because the regular staff, most of them had already started transitioning into teleworking. In my first weeks or 00:41:00two at the Roybal campus in office, we didn't have to worry about the parking or large crowds from the regular workforce. We still worked in an in-person capacity at the EOC, and in all of the conference rooms throughout the buildings on our response work.

It's pretty interesting in that, we, at that time, are well familiar with transmission, that it was quite transmissible from people to people, and the CDC was giving out guidance to the country on the importance of social distancing, and hand sanitization, hand washing. So, those are the two main strategies, which 00:42:00is keep your hands clean and wash your hands and keep a social distance. But on the other hand, at the EOC, we were still working in a highly in-person capacity, which was very helpful, because you know, with a lot of communications and a lot of changes, it's just very easy that we can walk across room or talk to our folks sitting two computer stations next to us about some of the daily time essential activities. But on the other hand, we were aware of the closeness, the close quarters, how we were sitting, so we're getting really good at bring our own hand sanitizer, bring our own Clorox wipes. And when we got there, all of us, the first thing we do would be clean our station, wipe down 00:43:00our table and chair, and sanitize our hands.

EOC also evolved during that time. When the rest of the workforce, regular CDC staff changed to teleworking, that means that more conference rooms became available, so we went through a transition stage of start decreasing the capacity, following the six feet rule. Instead of before there may be twenty people sitting in a particular conference room, we transitioned to maybe only five sitting in the conference room, so you can maintain six feet distance from each other. We had a sign-up list for who would like to go into office, and who would like to start working from home on a part-time capacity. Then eventually I 00:44:00think within another week or so, the CDC response leadership made a decision to transfer most of the response staff also to a full-time, 100% teleworking.

I think within about two or three weeks amount of time, we changed from all being in the EOC and very close quarters, to become 100% teleworking at our own homes. We all are very adaptable, and you know, since all of our work can be carried out on the computer and through phone, so we were able to adapt really quickly, and there's practically no disruption in the type of work that we carried out, as well as the CDC.

Q: Yes, I notice that--a lot, it just kind of goes to show you how fast this virus spread around the world, and how people had to really adjust their own 00:45:00situation and how CDC was able to be so quick to change.

In some ways, that quickness of changing was us still trying to figure out the virus itself, but it's also trying to protect the people who are trying to protect the other people. We can keep our doors open and keep our work going. You were part of this Joint Coordination Cell too-- later on. But before we go onto that, I want to ask you, what was the advantage of actually, besides health--but there's a disadvantage to teleworking as well, as you said, you could just stand up and walk across the room and ask a question of someone who was in a different task force, but when you went to teleworking that was a little bit different, you had to really set up a call, or set up a something-- 00:46:00it wasn't as easy-- it became a little bit more complicated. The internet, and your computer became your lifeline to your work, and the lifeline of each of our work-- CDC's work.

LI: Yes, it is. That is a major change, I think. But as you said, it's amazing how we have all adapted in a minimal amount of time imaginable. We changed, really within a few days went from in-person to fully teleworking. You can definitely see that there're a lot more email communication, as well as phone activity, from understandably relying all on email and phone to replace the previous talk across the room about something essential. But I think, especially 00:47:00for people who work at EOC, who are very used to very rapid communication, very used to the workload, and to the almost hour-to-hour change of situation, I think it's a pretty smooth transition, at least for me, and for my team. The biggest, the hardest part is, yes, as you said, sometimes, for some staff, if they don't have a very stable internet connection, that would be a major hurdle. Another hurdle is at work, we all have the great large monitors set up at work. We do so much data mining and reporting, and writing, and analysis. All this work were easy, much easier on a big monitor. But with the rapid transfer into 00:48:00teleworking, most of the folks work on small laptops, that's another major disadvantage when you have to work on a small laptop, on a small screen. Those are the two major ones, but I think we do work with a group of highly motivated and highly efficient staffer who can really overcome many of the difficulties, and to get the work done without being affected by this teleworking change.

Q: It was very adaptable, but, and I do agree that it was very difficult to go from many screens to one tiny laptop screen.

LI: Yes.

Q: Then also, try to figure out when does my workday start in my home, and when does it end, or does it ever end? It seems like there was not a lot of difference between my work life and my home life.

LI: Yes, I think that's another challenge. Well, it's a good and bad. It's good thing with this whole hundred percent telework, there's really not off time, because it's just really easy when you have your station set up, get up first thing in the morning without having to drive and going to work. You can really hop on work right away, and you can respond to things, any inquiry, and get any work done at any hours of the day. Especially over here at my team, the team that I was leading, the Epi Situational Awareness team, we compiled around-the-clock data from the world, updated our data sets on a rolling basis, and especially during the early time when there's rapid change on the international stage, both on the number of countries affected, as well as the 00:50:00number of cases reported from each country.

The teleworking really makes it really helpful in helping with around the clock coverage on any activity that needs the off-hour support. But on the other hand, yes, we are definitely-- murkier the lines between work, your family, and the work-life. All the lines get blurred, but you know, I think that's just the nature of this major change that's affecting many of us.

Q: It certainly has changed the workday for people around the world. I mean that, the ability to work anywhere at any time has become almost the standard, which also, you see that no time off feeling.

LI: Yes, it is. For me, for that particular deployment, we do have activity that's scheduled for, let's say, nine o'clock at night-- for me, I would make an effort, once I finish that work, I'd shut down my phone and computer so that I can have somewhat division between work and personal life. Yes, I think it is a new era with the working, and we're so used to it, some of those might become more permanent going from here on.

Q: Yes, I think office space is going to shrink. You went on to work with this Joint Coordination Cell, with HHS [Health and Human Services] agencies, FEMA 00:52:00[Federal Emergency Management Agency] and the like. You led that external engagement team. Can you explain what that was, and leading that team?

LI: Yeah, that's my second deployment. That's in the fall of 2020, near the end of 2020, in September to November. At the time, I think many people may not be aware, that there's actual huge government coordination at a very high level, that's coming from the top of the government. Starting from White House--so there's a Joint Coordination Cell, which is an interagency effort that's led by Department of Human Health Service, as well as FEMA, and incorporating other US departments.

The goal of that Joint Coordination Cell is really to put all the US government resources, and the coordination together, to ensure all elements for combating and responding to the COVID pandemic in the United States can be as streamlined as possible. You probably can remember, at the time, there were a lot of challenges facing the United States. Even though at that time, testing was not as big an issue as early on from my first deployment, but there were a lot of concern about availability of PPE [personal protective equipment]--N95 masks, needed in the healthcare resources, in healthcare setting, as well as there's a lot of effort to streamline-- to provide support to the US healthcare system, 00:54:00because there was a heavy strain placed on the healthcare system in the United States.

I was tapped to join the Healthcare Resilient Working Group, which is one of the five working groups underneath the Joint Coordination Cell. The working group is to lead the US federal government response to help strengthening the healthcare resilience, and to optimize the delivery of healthcare service, given the tightened resources, and the stress placed on the healthcare system. The Healthcare Resilient Working Group was actually led by a Dr. [Bich-Thuy] "Twee" Sim who is an infectious disease doctor under Department of Defense.

It's a very eye-opening experience for me, being that this is really, the first time that I fully supported a public health response in a broader scale beyond CDC. As you mentioned, I was leading the external engagement team underneath the Healthcare Resilience Working Group, and the team really covers the function of communication and external engagement, or external affair, for the working group. Our team makeup is quite diverse, very different, again, from my experience of working for CDC response. The team was comprised of deployers from many different US agencies, including Department of Health and Human Service, 00:56:00different offices, different agencies, FDA. Also, the background of the staffer was not mainly comprised of epi or health scientists, but made up from diverse backgrounds, such as external affairs specialists, congressional affairs, global affair officer, as well as communication specialists. It's a major change for me, coming from the scientific world, and doing a lot of epi and surveillance, to stepping to a more coordination and external engagement function. Our team really, is helping the entire working group to engage with external partners, both within the United States government, but also outside of government, with a 00:57:00lot of organizations that feed into the healthcare system.

For example, we have regular calls with different professional organizations, such as organizations that support hospital, pre-hospital, ambulatory care, and nurses' association, and etc. Our team is trying to facilitate the engagement and collaboration between the federal partners and with the healthcare providers and systems, in order to provide resource, provide help, provide guidance to help the healthcare system in the United States as much as we could to help them do the work, and to help them boosting their needs - whether it's guidance needed; or whether it's related to supporting the resilience, the behavioral 00:58:00health, the mental health support; or whether it's to help with coming up with a more innovative way of doing the healthcare. I think that's when there's a major push on the telehealth. Our Working Group and our team facilitated in many of those effort, in order to strengthen and to help the healthcare systems in combating the COVID pandemic.

Q: I'd forgotten about telehealth, and how that became a thing during this period of time, and still is in some respect. How it opened up a lot of space for people to actually talk to a doctor when they couldn't get to a doctor.

LI: Yes, I think this is a major--I do feel this, again, is a major development 00:59:00on how to do the medicine. The telemedicine, I think, really has flourished from the COVID response, and I fully believe that it will continue to--it will continue to be part of our regular healthcare provider approach going forth, since we've learned so much from it, on how useful it is in order to boost the capacity of providing healthcare. Telehealth, I think, will be a major, will not exist in this stage, but I think will be continued to use going forth, after demonstrating how efficient and how helpful it is to deliver the healthcare. Yes, so I think that will stay to beyond COVID pandemic.

Q: The September/November is right around the time and like everybody--we had PPE shortage, and there was guidance-- and are we wearing masks, do we not wear masks?

The masking situation kept changing. Then we're building up to like, we're almost to the point where we're going to have a vaccine, and everybody's excited about that.

LI: Yes.

Q: Really anticipating that. That must have been interesting to be in that team, because those guidances--yes the guidance changed very quickly, because the virus was being understood more. Can you talk about how quickly you guys changed your guidance and may have confused some people at the time?

LI: Yes, so I think during that time, I think you're absolutely right. And as I said early on, when you're facing a very challenging emerging infectious disease, and I definitely think COVID can definitely make one of the top lists 01:01:00in history as far as the type of the challenge, and how infectious, and how damaging it can be. We really are trying to, all of us, all of us, on the global stage, both within United States and outside United States, both working in the public health front, as well as in the therapeutic clinical front. We really are learning as we go, trying to understand the virus, and trying to develop guidelines on how to help us, how we can maintain a control, or keep it under a manageable situation for our country as a whole, as well as provide guidance to public, to different scenarios, different workplace, and you know, to different healthcare systems how to handle COVID. That's definitely a major challenge 01:02:00facing CDC, and you know, over there also facing our Working Group as well.

At that time, our Working Group, the Healthcare Resilience Working Group, the main goal is to develop a comprehensive strategy for healthcare systems to help them to be responsive and resilient. We have different teams in in the Working Group that target different parts of the healthcare system. In other words, there's a team on hospital, a team on prehospital, there's one on ambulatory care, and there's one on long-term care settings. We also have teams who are specifically on the PPE preservation, and you know, other teams that facilitate all of the different functions. Each of the teams are developing guidance and 01:03:00resource to help different healthcare settings in handling different situations, and then my team, external engagement, will be helping amplify, or promoting the guidance, by working with the stakeholders, by giving out words, and using different channels to communicate the new guidance that the working group developed to help promoting, to help make sure the healthcare system are receiving the guidance.

We are also receiving feedback from the stakeholders as well. I remember this one time, and that I remember really clearly, that we received feedback from American College of Emergency Physicians about some of the challenges facing the 01:04:00emergency departments, infections control, and the concern of emergency department as a potential hotspot for COVID. Because emergency department has, sometimes falls into a gray zone, sometimes it's part of the hospital-- however, it may be designated as an outpatient facility, rather than the same as the rest of the hospital. Many of the guidance, infection prevention control for hospital, may not be applicable to emergency department, and you know, some--the stress placed on the hospital, hospitalization, inpatient hospitalization, had also put an emergency department at a very difficult situation, that leading to some of the people going to the emergency department to get treatment for COVID-19, but have to be, spend an extended amount of time in emergency department.

In that case, we were able to put together many different partners together, including the American College of Emergency Physicians, including CDC guidance development team who are specifically developing or updating guidance for hospital settings, definitely including our Working Group, and the different multiple teams from Working Groups, so that we can get the people at the table--those who are developing the guidance, as well as the end user the emergency physicians together, in order to come up with a solution, promote a better guidance and more inclusive guidance, promoting the understanding of the guidance, and you know, taking the feedback from stakeholders in order to revise it furthermore, to learn the lesson from the field.

That's an example of this constant trial-and-error, and that really leads to more changing guidance. I understand we have heard many times about the changing guidance from CDC, or from the US government. But this is really an extraordinary situation that we are learning as we go, we have to incorporate, not theoretical what we could do in an ideal situation but understanding that when there's a stress placed in the healthcare system, many of the guidance are not optimal, you have to adapt as we go.

Q: (Crosstalk) --go ahead.

LI: Yes, I hear this feedback a lot from my friends who are not closely involved 01:07:00in the response, definitely from my friends who are from outside of CDC, but even within, from CDC, who are not closely involved into many specific works about the changing guidance, about the insufficient communication. But knowing, working through the different functions, from the International Task Force early on, to now at the higher level, at the higher US government coordination level, with all the different agencies, different departments, and working with the stakeholders, who are at the frontline of battling, at the clinical frontline of providing healthcare, it is a really extraordinary situation that we all are learning. Doing our best at the time, giving the knowledge at the time, and 01:08:00developing the guidance on the spot, and in order to help as much as we can to contain, not just contain the virus, but also contain, mitigate the outcome of the infection, mitigate the stress placed on the healthcare system, and the stress placed on the country. It's very challenging and very extraordinary.

Q: Yes, I think it's hard, because we are such an interconnected world, and we want answers right away, and it's not that simple when it comes to something that is a new and emerging infectious disease. But that is the culture we live in right now, where we want an answer right away. You were--

LI: Yes. I do want to also put a plug that I do feel that usually, a lot of the 01:09:00development take a long time. Personally, having been through all of this response, I do feel that there's a lot of manpower, a lot of dedication, a lot of money going into where we are now. One thing that I do remember that I was involved in when I was deployed for this role, back near the end of 2020, is you know, witnessing on the peripheral level, the development, the rapid development of therapeutic treatments for COVID-19, as well as the vaccine development. In the old times, it would take years, or decades, to develop a really good vaccine or drug to treat a certain condition. But you know, for COVID, basically within a year, less than a year from its first report to the world, it was--or 01:10:00discovered in the world, we have multiple highly effective vaccines being not only developed but also went through phase one, two, three clinical trials, and to be approved for use. And we also have really good, effective, therapeutic treatment such as monoclonal antibody treatment that were developed within less than a year of time. There's a lot of work behind the scenes that I think US government are putting a lot of resource during the, in the year of 2020, to streamline all of the efforts, in building a public and private partnership, in order to develop a coordinated research strategy to develop all of the vaccines and treatment, medicine and treatment. So I think this is one thing that I do 01:11:00feel very impressed about, knowing that, usually how long this take, but in this case it is amazing that we had great vaccines in less than a year from this virus being discovered.

Q: Yes, it was amazing how quickly that was created, and I think that because of its quickness it also made a lot of people feel uncomfortable, because they weren't so used to a vaccine so quickly. You have--

LI: Yes.

Q: --somebody saying, yes it was quick, and great, but people thinking well, that was too quick, and not so great.

LI: Yes, and I completely see that, as well. Especially from a lay audience, it's very logical to draw this conclusion. For me, because of working in my 01:12:00capacity, for example, I know that the, some of the vaccine development and therapeutic development did go through all of the phases, and did have a large sample, number of participants for the clinical trial, in order to gather strong clinical trial data that led to the approval, and all of those were done in a very innovative way. When I was deployed over there, this one time I was helping, assisting Operation Warp Speed in one clinical trial to conduct outreach for recruitment, to recruit people into participate in the clinical 01:13:00trial that put, that streamlined all the different trial phases, and evaluating multiple drugs in the trial, and have a simultaneous outreach at the country level, in the whole country. It's actually quite substantive effort going behind the scenes to ensure that all of the drugs and vaccines developed does go through all of the entire stringent process, even though at a fast track, but it still goes through all the proper process, and gathers sufficient data to prove the effectiveness and safety. I know that some drugs did not make it, some of them make it. What we see here actually is, it is really a part of a quite 01:14:00systematic process into the final development and approval of the vaccines and the therapeutics.

Q: We really did hang that hat with Operation Warp Speed really helped clear the way to make it quicker.

LI: Yes, I--

Q: --Yes, it was--you had so many hurdles just to get a drug out there, because you have to go through so many different agencies to get it cleared, and you have so many things, but because Operation Warp Speed was already there, it helped pave that way to make it faster-- is that am I understanding that correctly?

LI: Yes, I think that is true. There is actually a paper published about Operation Warp Speed, in The New England Journal of Medicine, explaining the whole process.

I think that is a very brief way of--from my, as I said, my understanding from a peripheral level, I do feel Operation Warp Speed did smooth out and brought all the parties together to jump through all of the hurdles administratively, financially, and you know, process, as well as the scientific go-through. And make sure that all of the other processes are in place to ensure that they, these drugs can be developed, can be--and go through all the clinical trials without being delayed by those processes, and requirements, and hurdles. It really streamlined the process. But still going through the same type of vetting process as do other developments, even though it's on a very fast track.

Q: Yes. The other part of what COVID has done is really shine a light on social vulnerability. I know you had another deployment, is that--

LI: Yes.

Q: Do you want to talk about that one, the--

LI: Sure! Yes, it's interesting, I know that probably for people who are not familiar with CDC deployments, we all get, most of us get deployed for weeks or so, a month at a time. For me, I think the longest deployment was two months. Most of my deployment are about, around a month, two months period. Then, because we still have our jobs, so we go to deployments, work very intensively for two months, and then we come back to our own job to carry out some of our regular duty, as well as allow some of the other colleagues to get out on deployment as well. Then come back, it could be the same role, or different 01:17:00role, just depend on the deployment.

Q: That's important too-- that's very important to say, because you are still doing your old job, plus now you have these special assignments or we call them deployments.

LI: Yes, because we still have our work, the other part of the work still needs to return, we still have our old regular job that needs to be carried out. All of these are done, are conducted, the deployments are conducted almost simultaneously-- on top of our regular job. To do that, I think you know, all of us have to tag team --we take turns--we work closely with our colleagues, cover each other when some of us need to be deployed to support the emergency response. Then, we do this on a rotating basis, one to allow more people to support the response, two is also to avoid burnout from responders, because as 01:18:00you can imagine, all of the emergency response, by design, we're responding to emergencies, so pretty much everything is time sensitive, and every minute counts, so it's very intense around the clock, and it's very hard to have off-day and on-day. By doing so, setting up this way, I think, even though people may not understand oh, how can, what can you do in two months? But we actually can get a lot in a week or in a day in that kind of setting.

But anyway, so this is a side-track.

Back to your question about social vulnerability and health equity. I think, by now, we know that health equity, there has been health equity facing the US, 01:19:00facing many countries, because of the many different factors and the COVID response, COVID pandemic really had put the health equity to the front of the public health, to the public health field. I think we see very often, even you can see it on the news, you don't have to get it from CDC, you can hear from the news about the disparities of COVID-19 cases, when you look at the different between races and ethnicity. It really depicts to that there's a deeper issue that drives the health equity and COVID response that's exasperated the health 01:20:00equity facing the country.

My third deployment, which happened in about a year ago, in March to April of 2021, I was deployed to support the Chief Health Equity Officer at the COVID-19 response as a senior science subject matter expert for special studies, focused on health equity. I was keenly interested in health equity because of the data I've seen, because of report I've seen, and I really just want to get a better understanding of the health equity, understand what drives it, and what we can do about it, even if it's not now, then what we could do it in the future. That's why I joined force with the health equity officer units, and really look 01:21:00at, closely at the disparity and the equity issue related to COVID-19 response.

While over there, I developed a collaborative study with the Epidemiology Task Force, using a nationwide serological survey data to look at the relationship between seroprevalence and the social vulnerability, as well as race, ethnicity, and other factors that may be impact in the health equity. That's my main accomplishment, or my main work when I was doing my third deployment on the health equity.

Q: This is based on a blood donor study?

LI: Yes. This is based on a nationwide blood donor study measuring antibody levels in the blood specimens that are collected all over the United States. This is a, I think this probably is one of the largest serological survey that CDC has implemented, conducted. The goal is to track the seroprevalence of, to SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2], which is the virus that causes COVID-19, to track the prevalence of the antibody presence in the United States general population in different regions, different states, and over time, so we can see the development over time. Also study what are the factors that are related to the seroprevalence and what drives the change.

Q: Okay, so then you can target and prepare for future outbreaks, vaccination strategies that can help you prepare for future outbreaks. This may not have worked here, but in the future we can do this. It's more of a lesson's learned, what can we do better in the future? We see there is a problem, is that what I'm understanding here on this study?

LI: It's related, but not, that's part of the goal. I think that the first goal really is, we first want to understand exactly what is the prevalence, how widespread was infection? I think we learned early on that, shortly after the pandemic, three months, or two-three months after it was first reported, that we 01:24:00discovered that there are a lot of cases that never had any symptoms. That leads to one issue in that, in counting cases, or in surveillance, which is when you do the case reporting, it's not just here, but it's really everywhere, you have to be able to report case based on the detection. In this case, based on testing conducted. But you know, people usually will get tested only if they're triggered, either they have symptoms, or they know there's a reason, they're close contact, or it's required. That leading to an issue on this kind of case reporting, in that we know that there's a large number of asymptomatic cases, and we know that you're not just going to--you know, people are not, are to get 01:25:00tested only if they get triggered, most likely by symptoms.

That means reported cases are a severe underrepresentation, underreporting of the actual infection. We also know that even if a person does not have symptoms, but if he or she is infected, they can still pass and transmit the virus to others. Understanding the scope of the infection is key for us to understand, really to get an understanding of what is the spreading, what is the extent of the infection in the country. We know that the case reporting does not reflect that. That's where the serological survey comes into play. If you are able to detect prior infections, regardless of whether you have tested or not, and 01:26:00regardless you have access to tests or not, this would be a much more accurate way to track the infection, and to track the development of the progression of the pandemic in the country. That's, yes I think that's really one of the main reasons why this serological survey was conducted.

Also, of course, if we want to understand the health disparity, equity related to the infection, relying on case reporting would not be accurate as well. That's why we tap into this nationwide serological survey, in order to first understand what is the true picture of infection, secondly we want to understand what are the factors, which demographic, which group of people have higher seroprevalence, and then we can use that information to inform strategy, whether 01:27:00to boost vaccination efforts, , to improve education outreach in a more targeted way, as well as more long-term informing future outbreak. Informing future outbreaks, that's really the long-term, but our short-term is still really to let us know what is true infection, the picture in the country, as far as infection, past infections, and current. And allude to what is the current vaccination status, in order to develop more targeted strategy to mitigate infection, helping mitigate the health severity from the SARS-CoV-2.

Q: Another tool, this is really another tool to track.

LI: Yes. It's a much more accurate tool to track. It's -- we know that that's why SARS-CoV-2 is such a difficult virus, as I said, it can definitely make the top of the list, it can be very damaging, it's very infectious, and there's all those asymptomatic cases that you cannot be detected without having active testing. If you're just testing based on the needs, or symptoms, then there's a large proportion, the bulk of the infection are never found, are not reported, unknown.

Q: Did the variants change the seroprevalence? Did that do anything to the study?

LI: Yes, the variants, so when we're testing seroprevalence, we cannot test the 01:29:00variants, because seroprevalence tests for the presence of antibody, a protein formed in response to the main virus. We can't distinguish whether the infection is because of variant A, Delta, or variant Omicron. But you can definitely be able to track the effect of variants on the seroprevalence. We can see, like, in our study, look at social vulnerability and race and ethnicity associated with the seroprevalence, we are able to see that the prevalence of infection in the population, changed from early, the data started in mid-2020, so still kind of 01:30:00early on in the pandemic. The prevalence at that time in the United States was less than ten percent, about six percent or so. Then, by the end of 2020, increased, has doubled to twelve, thirteen, fifteen percent, I don't remember the exact number, but it has, it definitely has multiplied over that six-month. Then when we look at, in the mid-2021, the infection continued to increase rapidly across all of the segments, across all geographic areas, all demographic groups. We can definitely see, even though the later last year, it was not part of the project that I led, but the data that's released from the study still 01:31:00show that with the Delta coming into play, the seroprevalence continued to increase, infection continued to increase, because of the Delta wave. It is quite astonishing to see how rapid, and how extensive the infection is in the country.

Q: Yes. I'm going to move onto your last deployment, I believe this is when you were deputy response Associate Director for Science. This is November to December in 2021. Once again, you're just a one-month deployment, but this one is a lot of work. Well not that they all weren't a lot of work, but this is a lot of content, you might say, coming at you. Can you describe it a little bit?

LI: Sure, yes. That is, yes, I had a 45-day deployment for the latest deployment as the deputy response Associate Director for Science. This is really, the place where it offered me the most comprehensive view of all of the productions that CDC had released. My role was to--and our team as a whole, is to conduct scientific review, and regulatory review, to ensure that all CDC public facing documents, such as manuscript, webpage, MMWR [Morbidity and Mortality Weekly Report], presentations, communication materials, fact sheets, interview scripts, anything that may be public facing, have to be reviewed and approved by our 01:33:00team, as part of the clearance process, before it can be released to the outside. We, I was able to see a broad range of contents produced by CDC during that forty-five-day period of time. Yes, as you said, it's very intense, not to say the rest aren't intense, but this one definitely is probably out of the top--my four deployments, one of the most intense ones. We have emails coming in basically round the clock. After a meeting you will get thirty more emails into the inbox, with different contents coming into the chain that will have to be triaged and reviewed and approved. And if there's an issue, we have to meet and discuss, and give our feedback on the content to authors, and those authors 01:34:00mostly are from the task forces. In order to ensure that the contents are consistent, of high scientific quality, I think CDC had one of the most stringent clearance processes, which are probably more than the journal peer review, because we have so many pair of eyes on all of the contents that are produced from CDC.

Like all the other deployments I had, this is, again, it's an eye-opening experience for me. It really allowed me to see the breadth and the depth of the documents that CDC are producing on a daily basis, and in a rapid, very short amount of time, in a highly intense environment.

Q: Was there an effect of misinformation from the media that also sort of spurred your need to get this information out faster?

LI: Yes, I think misinformation, one thing we've learned from the whole duration of COVID-19 pandemic, misinformation has a constant presence in our life now. The media, the criticism that CDC has endured really from the get-go, from the beginning of the pandemic until now. We get lots of media coverage, but there are many of them are very critical of CDC's work, and CDC's continuous changing 01:36:00guidance is very common. CDC's not being, sometimes, you know, mistakes, CDC's mistakes, and sometimes talk about how a particular website gets updated with certain new content only for it to be taken down. All of these are definitely on our mind when we are working in this capacity, because we know that we are one of the last reviewers--there's additional reviewer above our level, but still, we play a very critical role in ensuring the consistency of all the documents.

One thing keep in mind that the guidance does change quite rapidly, sometimes it's really governed by the development. For example, when there's new, not only new vaccine being developed, but when there's changing vaccine guidelines, 01:37:00availability to a different age group, or additional booster shot, things like this, they happen fairly rapidly. After FDA approves it, CDC goes through our process of approving, giving a recommendation for the changing guidance on vaccination, then pretty much almost overnight, all of the webpages and the public facing material will have to be updated to reflect the updated guidance. That's where, when you combine the frequency of the change, the type of change, the implication of the change, meaning it affects the entire country, and the number of documents that may be impacted, and the short amount of time that we 01:38:00have to make those changes and get them reviewed and approved, and then get the website updated, all within a day or so, you can imagine the challenge and the logistics, and the stress it plays on everyone involved. I think we definitely are trying to do our best to make sure that all of our documents are cohesive and consistent, but I can also see that it is easy to make a mistake, since very often we update things more on a piecemeal, when you have very super long guidance, and one thing change, we change one element, where the rest remain the same, it inevitably can create lots of challenges. Good things that have in 01:39:00place on review process, clearance process, most can get them to cover it, but still, it is still, it's a very, very intense process, and very challenging situation, just like everything else that we talked about.

Q: Oh yes. Well, the other thing is that all of these deployments, all the things you worked on, have been sped up in time that you have to respond so quickly. Where in the past you did not have to respond, well, our response time was not that quick, I feel like this was a lot faster response, and everybody needed an answer right away. Usually, when you are reviewing manuscripts, you have a period of time that you can do it in, but this, it seems like it was shortened up to the very limits of humankind.

LI: Yes.

We definitely, we have a tier system on time, for turnaround time for the documents. Some of the documents, I think the longest time that we had, it would be three business days, those are, for example, you mentioned manuscript. If some of the manuscripts take time to be developed, it does not need, it's not so urgent to be pushed out the door, then we have three days to review. However, there are some of the really time-sensitive document, like the webpage update after a major change in guidance; the vaccines, for example; or, for example, some of the new threat coming in. I remember when Omicron was first reported by, and first found in the United States, the amount of work that goes into finding those Omicron cases and then write it out and publish it, those are record 01:41:00amount of time, sometimes we only have two hours, we may be getting an email at 7:00 P.M. with a due time of 10:00 P.M. of turnaround, and finishing our review and turnaround.

Because as I said, things are evolving even as of now, we're more than two years into the pandemic, there's still things that are happening, new things are happening right in front of our eyes. I think Omicron was a clear example of how it really shattered the transmission of the previous variants, despite whether you have vaccination, whether you're vaccinated or not. There's continuous challenge and continuous urgency in learning as we go, and develop guidance, and share information, and update guidance all in real-time, right in front of our eyes.

Q: Yes. I'm going to shift over to one little question, and then I want to talk about how your personal and family life, and mental health, but before we get to that, you experienced a leadership change at the federal and the agency level during this pandemic. Did that affect how your role, did it change how you worked? Did it have an affect on your job? There's my question.

LI: Yes, I did experience the change since I was in the response from early 2020 to end of 2021, over two years, there were leadership change from both within CDC as well as above CDC. I think to answer your question, in my direct daily 01:43:00job, working in various response roles, I think two of them e were in 2020, two of the response were in 2021. Direct effect is, I don't see major direct impact on my daily job. I think that's because we work in a very large structure, well organized structure with very well-defined roles and responsibility for each of the deployments. And for each person, deployer, will have very clear roles and responsibility. The change in the leadership, to me, it did not change how I personally do my work, or how, my approach to my work, or in our team.

Having said that, I do feel a change in how, in the role that CDC is playing in 01:44:00the pandemic, and more in a public facing way. I think when the new CDC director, Dr. [Rochelle] Walensky started, you can clearly tell that CDC's presence in the public media, in public eyes, have drastically increased compared to 2020. Dr. Walensky has regular interviews with news media and trying to communicate to the public when there's a major change, a major update on CDC guidance. And she's a great communicator, she will explain it to the public, and then we can all see it on TV. I think it does boost the, somewhat it does, boost the presence of CDC in this pandemic response.

I think clear communication is a key in any work, in all of our work, and especially for something as complicated as COVID-19. It doesn't say that, it may not change public's opinion on CDC, but at least I think have an open channel of communication, direct dialogue, you know, face from Dr. Walensky to the public, I think it does help with sending the message out.

Q: Thank you for that. Now we touched a little bit on the mediation of home life and work life, and how was it to navigate the pandemic as a parent, and work from home? You have children.

LI: Yes.

Q: And a husband, and you were working from home, and they--assume they teleworked for a while too? What was that like to be in that time?

LI: Yes, I think it's definitely a very interesting time. I've always said it's pretty much overnight-- our ways of life were changed completely. I mean for me, I had about two-week transition, from shutdown to fully changing to 100% teleworking. But for kids, yes, they're pretty much overnight changing from going to school every day to, "oh, you have to start getting schooling from home". We--I think like all the families, we were scrambling trying to find a 01:47:00place for everybody to sit. Even up until now, maybe I can send you a picture later on, my work at home is, I converted my formal dining room, which was underutilized anyway, other than parties, and now we don't have parties, right? I converted my formal dining room into my office, so I set up my computer, and we bought a big screen monitor, so I can work because I cannot work off a small monitor. So I just set up a station here, right here in the formal dining room. Then my son will be sitting across from me on the same table, but diagonally from the big table. My daughter is set up in a room, in a spare room, where she 01:48:00can be separate from the rest of us. My husband will go to the basement.

We are fortunate to have a house that's big enough to have somewhat separation from each one of us. Even though my son, especially during deployment, and when he's at home full-time, he does have to take his lesson in his own room, since I was on the phone constantly, so there's no way he can study across from me. He had to move up to his room, which become an issue as a teenager, so he closed the door, supposed to be taking lessons from the computer, from teacher, or maybe not so much lesson at the time, because the school was adjusting. So it was definitely a challenging situation for the family life. Just because we all have moved from our own work and school to all being at home, and trying to be 01:49:00separate from each other, and trying to adjust to the time. I think it is definitely a bigger adjustment for the kids. I have two, one is right now a new high schooler, but when this started he was seventh grade, and my daughter was a fourth grader, when they move onto full-time remote schooling. It was stressful in that, I think I have control of my work, I know exactly what I need to do, and I was able to do, without any interruption. If any, actually putting a lot more time and more output at work because of more working hour, and no driving, and no commuting needed. But worrying about children is something that's 01:50:00constantly on the back of my head, in that the schools were not--nobody was prepared for this kind of new schooling.

They hardly were learning anything, and combining that with my kids going through teen, and just entered into teenager phase, or about to enter teenage phase at that time for my son, very challenging, it was very challenging.

Q: As a parent, it's hard too, you want to keep--

LI: It's very hard.

Q: --your children safe, but you also want to make sure that they're safe online as well, and that was a hard one to navigate, because you're online too, and they're online, and you can't monitor their presence online.

LI: Yes, it's absolutely, I think that is, to me as a parent, that's the biggest 01:51:00challenge, and it's even true now, I have the same concern. I know, I mean I think, I'm sure my kids are not the only ones, but I know that many kids, their school, or you know, performance were affected in a big, major, in a--significantly. Kids being kids, being online, we know there are many other things online, so when they have all the freedom and computer to themselves in their own room, it's just very tempting to get distracted by something else. I just found out the other night that, my son said oh, I watched all of this anime, and I said, when did you watch all this anime? Oh, well during the quarantine when we were doing--I said, you are very honest now.

Q: Oh man!

LI: Oh, it is. I think it definitely affected the whole country, affected every one of us. But it definitely, I think children are the group that were affected the most during the last two years of time.

Q: Yes, those two years, I wonder what the long-term effects will be on that. How did you keep your mental health up and your morale up while you were in the midst of all this?

LI: I think for me, it's easy, I was so busy, and I did not have time to feel bad, or feel--yes, I do have stress coming from, mostly from--my biggest stress is balancing the home, the work, and the worry about my kids. I'm very busy at work, but even if I have to put in sixty hour per week at work, I'm happy, because I know that I'm actually doing my part, and maybe a small part, maybe 01:53:00I'm just a small screw on a big machine. I do believe I contribute to the fight against COVID-19 in the United States. The knowledge generated can be applicable to the world, so I feel a great sense of satisfaction from the intense work. My stress, I do have guilt of not spending enough time with my kids, because they're definitely under-supervised during all this time when we were busy, my husband's busy with his work, and so, the kids are free flow for a while, definitely during all of the deployments.

That's a guilty side to that, that is a constant reminder. Stress about their, 01:54:00about the children's academic and mental development, so that's also a part of stress coming on me. For me, I actually, developed a new activity. I started yoga after the pandemic. My personality, I'm always on the go, and when I used to do workout, I loved workout that get you totally sweaty, like Zumba, all the high-impact workouts. Yoga was never on my radar because I felt like I would fall asleep, not workout, you know? But what I found out is, after the pandemic, with everything, we don't go to gym anymore, we still go out walking, but I discovered the comfort in doing yoga.

I started trying to fit into thirty minutes yoga several times a week, whatever time I have, patch of time I have. That's one thing that I feel it can really help with both physical fitness as well as mental stress. And I was wrong, yoga is a workout. I was wrong before! I also talk to my family and friends very often. One thing I didn't, we didn't get to, I talked to my parents regularly throughout the whole time. They lived in Hubei province at the beginning of the pandemic, but they also lived with my sister in Wuhan, they're actually living in Wuhan right now. They are my strong support at any given 01:56:00time. Regardless of what is their status over there, they always supported me. My husband is a strong supporter as well, so. I have friends too, to support each other. That's, I think that's how I am able to keep my mental health in check, by doing all of this.

Q: Yes, I think the family in Wuhan would be a big stressor on myself, just being so far away and not being able to help if they do get in trouble.

LI: Yes.

Q: You are handling it very well.

LI: Yes, it is. I think it's really, to me personally, I feel this whole pandemic, it's like a roller coaster, it really is. Having this virus, first reporting in Wuhan, I know there's a lot of dispute. But you know, I think 01:57:00there're latest, I just, two paper coming out, linking the origin of the COVID pandemic to the seafood market in Wuhan. I really kind of lived through it remotely with my family through the really difficult time early on. Before US flareup, back in the early, in January, February, March, that time, when the situation was very difficult in Wuhan, and the Hubei province, when there was a lockdown in the city, when there's so much unknown about the virus, everything we heard was if you get it, you are, the person may have very dim outlook on survival, or coming out of it without long-term impact.

It was very stressful, I think for me early on. Living through the time during 01:58:00the early stage, worrying about the family. But later on, the worry actually eased up a little bit, I think the worry really is early on, when we first found out about it, CDC gave out the HAN notice, and you know, Wuhan and Hubei province all had strict lockdown, and strict to the point that you cannot even go down--my parents all live in those big apartment buildings which are common all over China. You cannot really even get out the neighborhood. There're checkpoints inside and outside neighborhoods. There's very strict lockdown in order to contain the virus in an effective and rapid way at that time when you 01:59:00know nothing about the virus. Yes, I was really, especially the first few weeks of, the first couple weeks of the lockdown, I was worrying, because I didn't know if my sister, who lives in Wuhan, had the virus. The time was near Chinese New Year, the biggest holiday, so there were lots of gathering, there were lots of parties, there were lots of gathering, shopping, eating out with family and friends. It was all-- everyday citizens in early January was just go about your regular business getting ready for the biggest holiday, and getting ready to go home, and so, the first couple weeks of the lockdown, once we realized how severe it is, I was really tracking with my family to make sure that they're 02:00:00measuring the temperature, they're okay because you don't know whether you're infected. But after the first couple weeks, I wasn't worried so much about they may be getting the virus, because there's no way they would be getting it. By that time they didn't get it, then they should be safe because everybody stayed at home, you have zero chance of getting infected, because you have no contact with others. But then the worry became, do you have enough food to eat? Are you okay? I was calling them every day and my dad said, why are you calling us every day? But you know, I was calling to make sure they are, they have somebody to talk to, that I can talk to them every day, even if just, just to see their face on FaceTime.

It was really a roller coaster. But the funny thing is, of course later on, when it gets into 2021, when China really has zero cases for months, for month after 02:01:00month, and when the US had this ravaging pandemic increase, and you know, in 2022-2021, it became the other way around. My parents started to really worry about us: "are you safe?" "Oh, are you--don't go out!" "Try to wear your mask, and be careful, wash your hands." "Don't, don't talk to any, don't see anyone!" It's the other way around, they start to worry about our situation, especially for them to see the case count, and the number, the deaths and the case reporting coming from the United States, the numbers were so high that they--so anyway, it was just--yes, it's really, over the last two years, it was really a roller coaster ride.

Q: Yes. When you were explaining the early weeks in China is the classic 02:02:00containment surveillance epidemiology.

LI: Yes.

Q: Right. Well we've come to the end of our time, and I just want to ask this last question. Is there anything we haven't covered that you'd like to share before we stop recording?

LI: Yes, I just want to make a comment that I think we are living through an extraordinary event. We're witnessing a once in a lifetime, once in a hundred-year global pandemic, at a scale and a severity that was really unmatched by other recent public health emergency. I really feel that, I see a lot of good things out of this, out of not only colleagues from CDC, but out of 02:03:00the humanity, and that we are trying to do our part in the global fight against COVID. I'm proud of being a part of the, as I said, living through the era and play my part in helping, however small it is. It is a more complicated global situation, even with the recent conflict between Ukraine and Russia. I do feel a sense of urgency that I'm hoping that our humankind can work together and prosper together. And you know, I'm just thinking recently, I'm thinking about 02:04:00the words from Miss Congeniality, Sandra Bullock said what she wants is World Peace, and that's something that's been on my mind recently.

Q: It would be nice. Very nice.

LI: Yes. Yes.

Q: Well, we'll stop here.

[END OF INTERVIEW]