Transcript: Webinar with COVID-19 experts from China, US

Chinese and US experts shared experience and insights on battling against the COVID-19 pandemic at an international online seminar on Friday. Here is the transcript.

>> Alex: First of all, good morning, good afternoon, good evening to everyone around the world. I'm Alex from Tencent Healthcare. I am honored to be the host of this webinar. Now, as we gather here today, we'll all be online while observing physical distancing. COVID-19 is still rampaging across the globe. We are close to 4 million cases confirmed and more than 270,000 deaths in 212 countries. Now, any individual practitioner, researcher, city or country cannot solve this alone. What we need is an unprecedented international collaboration. Unlike traditional wars with many sides, for COVID-19, there's only one side that we can take and that is humanity. Now, to facilitate this borderless collaboration and dialogue, the organizers include The George H.W Bush Foundation for US-China Relations, China Science Healthcare, Tencent Healthcare and China Investment Financial Holding. We have brought together six people, both researchers and practitioners in the US and China, for what I would call a virtual fireside chat to reflect on our experiences this far, and where our concerns are as we knowingly and unknowingly move to the world that we live in today.

Now this event would not have been possible without our collaborating partners: Harvard China Partnership, Peking University Education Foundation, NYU Langone Health, the Florence Fang Family Foundation, EMBA International Council and Tencent Trusted Doctors. Online with us here today are Dr. Zhong Nanshan from the Chinese Academy of Engineering, Dr. Sten H. Vermund from the Yale School of Public Health, Dr. Zhang Wenhong from the Huashan Hospital of Fudan University in Shanghai, Dr. Brain P. Bowsworth from NYU Langone Health's Tisch Hospital, Dr. Qiao Jie from Peking University Medical School and Peking University Third Hospital. Last but not least, we also have Dr. Barry Bloom from Harvard's T.H Chan School of Public Health.

>> We observed the first large outbreak of COVID-19 in Wuhan, which as of today, has detected no new cases over the past four weeks, which has been quite remarkable. To kick us off today, I would like to ask Dr. Zhong, who still heads the China COVID-19 response, to tell us the strategy to control and actually, more importantly, how to prevent the resurgence of COVID-19. Let me pass the mic to Dr. Zhong.

>> Zhong Nanshan: So good evening everybody, good morning here, everybody.

So actually, we are experts of public health, I just make some points for this series of topics. Can you see? Sorry, as I had mentioned here, I would like to talk about prevention. That's at the core of the control of the COVID-19 infection. So as you know, this is the data that Alex just mentioned. This is data (May 7): About 3.6 million people have been diagnosed, with the morality rate of 6.9, close to 7 percent. Here in China, so the data here. So we have the mortality of 5.5 percent. So it's such a pandemic really all over the world.

So the first point I would like to mention about the China strategy in controlling. This started with the community of experts. They announced that on January 20, they announced there is a definite human transmission. This kind of disease, that's a very important thing. This is the fact. So since then, how we can deal with these kinds of diseases? So I just quote the UK model. Everybody is very familiar with this.

So the new cases here are the kind, if we take no action, this would be going up out of the control of the so-called healthcare center capacity that would cause a big problem - the lack of medical materials and so on. I think if we have enough capacity, that would be much better. At that time in the UK they mentioned about self-isolating in the video and social distancing and isolation when one member has it. So what happens in China?

The natural control that exists - there's big difference between countries, so actually as you say, just two steps, one is really strong control, really strong action for inhibition and constant mitigation. Inhibition will stop the transmission and transformation of the virus. It would cause a great impact in the economy, and it depends on what kind of actions you are taking. So I think in China, so we just chose this direction. I support these measures. There is an allegation that the novel coronavirus broke out in China. I think this is not that correct. I think there is an outbreak in Wuhan in China. Just one place. This is very important based on this kind of evaluation. So it has been announced by the central government on January 23 "Don't go to Wuhan, don't leave Wuhan." That's the first.

And the second is transparent news on the daily number of new COVID-19 cases in each city.

And the third also is the most important. We call it '4-earlys': Early detection by early protection. That includes wearing masks, staying at home, not going to a meeting. Early protection is about distancing. And also early detection, early diagnosis, and early isolation. So early diagnosis is very important because of the time. In some countries, they need to be confirmed by the CDC, but in China, very early, the government decided every hospital could do the diagnosis of COVID-19 infection. So that makes it much faster to make a diagnosis. The '4-earlys' is down to the community level.

That means an RT-PCR check-up for all close contacts, including those without symptoms. So this happened in Wuhan on that day. I'm not going to talk too much about that. So what happened to the newly-diagnosed patients over time, so you can see. So in the data, the number of new diagnosed patients is going up, so two weeks later, in the middle of February, that was the peak. So in one day, there were 400 patients that needed diagnosis. And then it's going down. So in four weeks' time, it's going down altogether just to control the spreading so we can make a comparison. So this is happening already in early January and then February in China. That's the curve.

And then at the beginning of March, we hear some other countries have some outbreaks - Spain, Italy, Germany and France. And then the United States. So it is going up very fast. So just one month, six weeks or one month. Still, some of the countries are at a high level. So this is the situation. I think to control the transmissions, distancing, saying when you have a meeting and you gather, you each should wear a mask. This does reduce the people who transmit so you're not sick. So wear a mask so you can prevent yourself from transmitting to others.

I don't have data from all countries. You can just see in Guangdong province, where I am, which has 100 million population. So this is some data so you can see recently there are more imported patients coming in. That's a bigger problem for us. We have ease some travel curbs and we have more transportation which brought more import cases. How can we deal with this? That was the problem. So actually, that's the challenge of governance. So as you know, if you talk about reopening, that will of course recover the economy. But actually, on the other hand, it really increased the risk. If you continue observing a total lockdown, it will cause a great impact on the economic development, even impact the survival of the people. So this is, as I have mentioned, the big challenge for the government. So in China, first they were trying to lock down Wuhan city and now they are trying to ease its lockdown step by step. That's the current policy. That's really difficult as the whole nation has to face the problem.

So the second point I would like to mention about is herd immunity. As you know, there are two points across ideas in thinking about that. In the beginning, it was briefly mentioned, is natural infection. This is infection without any intervention, like smallpox and some other diseases, even influenza, but of course, with influenza, the mortality is much, much less than COVID-19 infection.

But if you use this to get herd immunity, based on our knowledge, we would have 60 to 70 percent of people getting infected. So I have listed this population that would be - I think it would be more than 40-45 million deaths globally. That's a great loss of the life. So I don't think in China, we'll take that strategy. I think the majority of the countries will think of massive vaccination. So really, we need time to complete this, 1 to 1.5 years, at least.

So we really need a great global collaboration, in particular between China and the United States. So actually now in China, we have three kinds of vaccines undergoing clinical trials. One is an mRNA vaccine of the Chinese Academy of Military and Medical Science.

And the other two, inactivated vaccines, one by the Wuhan Institute of Biological Products. And the other one is in Beijing. That was published yesterday. (in Science - "rapid development of an inactivated vaccine candidate for COVID-19"). I'm not going to talk too much about that.

Because the majority of the patients are mild and moderate cases, most would recover under health care. That would be OK. In China, quite a lot of people just take a medicine that we called Lian Hua Qing Wen Jiao Nang. The data will be published very soon, which I won't talk about it too much. This just shows some efficacy: High overall recovery and faster symptom recovery and a higher rate of improvement in chest CT manifestation over time. Anyway, this kind of medicine reduces the symptoms and helps patients to recover faster. That's good.

And the other 15 percent of these are so-called severe cases. We also have the idea in mind that we should have effective and cheaper medicine. In particular in developing countries, they should have some effective and cheaper medicine to prevent further deterioration in these kinds of patients. So we just take two examples that have been developed recently in my group. One is using recombinant human granulocyte colony stimulating factor. This is for patients with lymphopenia, because lymphopenia is correlated with the risk of mortality. We have 200 patients. In patients with severe lymphopenia, of course, we now have no mortality. Most of these patients used rhG-CSF. We had a remarkedly shorter time to clinical recovery and also a remarkedly lower proportion of patients with progression who died in the treatment group. So that's a very simple treatment. That is very valid for developing countries, as well as for the world. So, this is the new data we have summarized so far.

Another one is hydrogen or oxygen inhalation. As you know, 44 years ago, hydrogen or oxygen inhalation was the same. But now, we have a very simple machine. So the result shows a rapid and sustained improvement in clinical symptoms, in particular dyspnea. These findings are still valid in patients with different severity categories. So we should use some simple measures to prevent patients from developing critical situations. Because critically ill situations will make mortality pretty high, close to 50 percent at the moment.

So this is what I mentioned early, very briefly as a clinician. We should pay more attention to prevention.

And that's why one world, one fight! Thank you for listening.

>> Alex: Thank you, Dr. Zhong, for sharing with us. It was clear in the beginning and we are still trying to figure this out, how to manage COVID-19 clinically for the inpatients. But I think a point you mentioned quite well is that for us to manage going forward, we need to develop herd immunity and of course, the best way to do it is with mass vaccination. But it will take time and a lot of efforts across the world to develop an effective vaccine, as well as natural protection, too.

Let's talk about another topic: does natural infection and zero positivity equate to protection? Because that is actually one of the many questions that we will have.

Now, for this, I would like to now ask Sten to share with us. Dr. Zhong has shared with us some of the measures taken in China over the last few months. The US is still in a state of emergency right now, right? What's your thought? I look forward to hearing your views.

>>Sten:

Well, first of all, I would like to congratulate our Chinese friends for the remarkable public health efforts and clinical work that has resulted in nearly a month of COVID-free status.

This is something we envy because our epidemic is still the world's largest and it continues to rage. Here in Connecticut, we are not very far from New York City, so there was a wave of infection that sort of came up from our highway and our train line and caused tremendous waves of infection in our hospital. Our city is only 135,000 people, but we have had over 400 patients at any time for the past several weeks. And only the past couple of days has it been under 400. But we still have 100 people in the intensive care unit and 70 of them on ventilators. So, these are all historic highs. We have never had so many people requiring ventilators in our small city.

We are seeing a decline. We seem to have peaked and we are seeing a decline. And there is much activity in our state to discuss how to reopen the state, but the state lacks a number of criteria. First of all, we have not had 14days of a consistent downward trend, which the federal government guides us to suggest that only then should you contemplate a reopening.

Similarly, we are not at capacity for contact tracing, and testing is still limited. So, we have a long way to go. Now, our state government is working diligently with some success to expand testing. We have a volunteer program with over 400 volunteers at the Yale School of Public Health that is doing contact tracing for two of our larger cities in the state. That's going well but it's not going to cover the needs for the entire state. We are sure that we're going to need the physical distancing for a month to come. That Dr. Professor Zhong has highlighted for us. We're also going to need the hand hygiene and face hygiene with soap and water or with the hand sanitizers.

We have now begun aggressive mask use and this took a lot longer than it should have. We know from our friends in Asia that masks have been used for many years to combat air pollution and it's kind of almost the norm in large Chinese cities to use masks, but it took a long time for that to become normative in our country.

And even today, I was going out for a walk. I had my mask and I came to our local high school, and young sports women, teenagers were sitting around, not physically distancing, not with masks. And I feel that many Americans are not yet disciplined to stick with these reasonable precautions. We have many clinical trials, over 120 of them in the US, for a variety of drugs. We're hoping that drugs can come along quickly compared to vaccines.

We have been working on an HIV vaccine for 35 years without success and the fastest vaccine I'm aware of was the one developed in Philadelphia for mumps. It took us about four years.

Now, it is plausible with global partnership, and 90 products that have been identified, and at least seven are in clinical trials. A product from China, a product from Europe, a product from the US, somewhere. We will have some success and we hope that it can be brought to scale. But I think it's improbable that we'll have a series of vaccines knowing it's safe and effective for a couple of years, and that would be if everything goes just perfectly.

We do also have the priority in the US of trying to recover our economy. Much health damage is done when you lose your job. What if you own a small business and it goes bankrupt? What if you are working for a large business and that goes bankrupt?

So, we know that there is harm in closing the economy. And a thoughtful, measured approach, for example, something that seven governors of seven of our states in the northeast are working together and collaborating. This is very wise because from Massachusetts down to Delaware, we are one coherent block in our country and we are connected very well by roads and airplanes and rail travel. So, it's foolish for our states to be operating in isolation and the fact is that the governors are coordinating well.

One of our faculty, Albert Coe, is coaching our state's advisory group and will represent the state in the seven-state group. That's a good sign. That's a logical, science-driven, metric-driven approach to reopening the economy. And I think the professor said it very well, this is a global partnership. I will end by just telling you a story. Our friends at Zhejiang School of Public Health called me and said, "Would you like us to have a telephone conference with some of your COVID researchers and clinical leaders and we can share with you the Chinese experience"?

And I said: "This is utterly delightful. This is fantastic! " This was about six weeks ago and we were just seeing our first cases. So we had a very valuable exchange where our Chinese friends presented to us their experience battling COVID-19 both on the public health and on the clinical side.

And we were so impressed that our Chinese friends would reach out to guide us in this way and we were so grateful that we are now doing the same for our African colleagues. We have had symposiums now with Uganda, Burkina Faso and Senegal and Sudan, and we have Cameroon coming up and a number of other countries. So we're trying to do a favor for our African friends, just as our Chinese friends did for us. So again, congratulations with the progress you've made and I know that all of you are hoping for the very best in the United States as we try to have the kind of public health and social discipline that you had that was able to control your epidemic.

>> Zhong Nanshan:

Thank you very much! So, I've been in Connecticut about 20 years ago, it's beautiful I think. I'm really appreciative about how much effort you have made. I really know what the situation is in the United States at the moment. So, if one country is still in a very high increasing [trend], the whole world cannot control [the spread]. So, no matter how well China has done, there is no way for a real control of the COVID-19 infections. So, I quite agree with your point. The collaboration is really necessary. One thing you had mentioned is that tracing is still very important. I think in Wuhan, a very important part was to set up some hospitals, just for trying to separate the healthy persons and the COVID-19 patients. So, separating them could prevent further infections. That's very important.

As to wearing masks, it depends on different situations. if you have a meeting, you had to have a mask. It's very important. If you are outside, that's no problem if you're not wearing masks. I suppose wearing a mask is really important because so far, as you know, the general mask is about 0.5 micrometer. That's impossible to prevent the virus from entering the mask. However, the COVID-19 virus cannot travel freely in the air. They must attach to something. So of course, the mask can prevent it. So that's most important. So that's what I mentioned.

So, you have made a great effort. I hope in Connecticut, the number of new cases will be going down in some days. There are cultural differences between China and the United States. Citizens in China, no matter how poor they are, they have some deposits, some money in the pocket, so they can sustain themselves. However, in the United States, a quite big number of people depend on their daily, weekly, or monthly income, so they have to work. That's the difference. I think you have done a great job. I hope that the situation in the state will get much better in the next few weeks, thank you!

>> Alex:

Thank you! And Sten, as you mentioned, I think this is why we're here, talking across the Pacific Ocean. All of the progress we have made today here in Wuhan, Beijing or New Haven could not be possible without the efforts at the front line. Now, I would like to ask Dr. Zhang Wenhong, who is in Shanghai, with a population of more than 20 million people. How does Shanghai manage and contain COVID-19? What has been your experience?

>> Zhang Wenhong:

Okay. Hello, everyone! It's my great pleasure to have the opportunity to exchange our views with all of our colleagues in China and the United States. Previously, just like Professor Zhong mentioned, in China, almost all of the city took the similar strategy except for Wuhan. For me, as a leader of the COVID-19 expertise group in Shanghai, which is a city with over 20 million people, we [I] started the combat against COVID-19 in late January. I remembered that I went to the hospital on January 20. Our experience up to today, I can say, was mainly concentrated on three key elements. We took aggressive testing, extensive tracing and maximum hospitalizations. Actually, we calculated the ICU beds previously and we compared the capacity of ICU beds with that in New York City. If there is an outbreak in Shanghai, I would have a great concern about the overwhelming number of patients with critical illnesses. So, we had to take very serious measures in a very early stage.

So actually, I think, [the situation in] Wuhan is totally different from [that in] Shanghai. Wuhan, like Professor Zhong mentioned, is an epicenter in China with rapid growth of the epidemic. Therefore, strict measures should be taken to control the local transmissions. In regions where the epidemic burden is relatively lighter just like in Shanghai, I think, more focuses should be put on early diagnoses, treatment, and trying to find all of the patients to stop the local transmissions.

In China, for instance, in Wuhan, we know that with a rapid progress of the outbreak, they took strict lockdown measures, including traffic control within the city and the province's border was temporarily closed. We know just after two months, on April 8, China opened Wuhan again. So therefore, the strict social distancing and the stay-at-home regulations carried out in Wuhan hurt the economy there, however, the situation only lasted for a short time, just two months and such an outcome is only possible, I think, if we took very strict measures there. We should also take community-based strategy, the strong community support, for example. In the Wuhan city, fresh food, vegetables and fruits were delivered door-to-door by community workers.

And other life necessities were delivered, if asked. So therefore, I think, community support is one of the biggest advantages in China because we have lots of community workers and also, we have a lot of community volunteers. In China, we almost have 50,000 healthcare workers that went to Wuhan and also there are countless volunteers that went there to help the community to do the jobs I just mentioned. Shanghai, of course, is totally different. We are in the center with a lighter epidemic here. I think we had a lighter epidemic burden and tackled it early.

Therefore, we were mainly to control importation from Wuhan. Shanghai government took lighter control methods here. Actually, we did not take the strict shut down here. We just asked our citizens to stay at home but it was not mandatory. The citizens could go out for food, shopping, banks, hospital and etc. All of the facilities here remained open for normal life. So, in Shanghai, we took a massive effort in aggressive COVID-19 testing. We took aggressive COVID-19 testing at a very early stage, just at the end of January.

Also, our CDC staff accompanied community workers about tracing patients' close contacts. The home quarantine worked out with the assistance of primary care physicians and social workers. So timely and extensive testing, tracing for every patient and home quarantining for close contacts are expected operations and very crucial, according to our experience in the prevention and the control of COVID-19.

So therefore, the timely diagnosis protocol and timely quarantine measures here, effectively stopped (the progression of the epidemic), and the strategy did not cause an overwhelming impact on the normal citizen's life. So I think we took every method in the early stage of the epidemic, of this disease, that was very, very important.

In Shanghai, of course, recently, we still face a great challenge of imported cases. So therefore, we recently set up a network of nearly 300 fever clinics and hospitals. We just wanted to collect samples from all suspected patients in the future.

All suspected patients who met the criteria could be tested freely here and admitted to a hospital in the quarantine ward.

In every hospital, we had a quarantine ward just to quarantine the suspected cases. I think the elements are just what we took in our city to control the disease. Recently, actually, we have already reopened the city for three months and no further local cases were detected here in the recent two to three months.

In the next few months, just as Professor Zhong mentioned, we will open the city and we will face the challenge of the imported cases. The world is also very eager to reopen their business and their society. I think in the coming next months, Europe and the United States will also open up the border, so therefore, I believe that it's highly likely that we might live with the COVID-19 instead of eradicating it in our country. I do not think we should keep the zero cases here. The challenge here that we are all facing is still very great challenge. How should the world cope with the new society under the shadow of the COVID-19 epidemic is a very important issue for all of us. We will enter the new normal. In the near future, we will face the challenge of the important cases, I think, it is very important for us to take more measures to in the next stage, thank you all. Thank you.

>> Alex: Thank you Dr. Zhang! it seems that Shanghai has taken a similar approach as what Dr. Zhong mentioned: Early protection, early detection, early diagnosis and early isolation.

Now, someone has referred to New York as the Wuhan of China, being the epicenter of the outbreak in the US. How is NYU prepared for this? And what is it like on the ground right now?

>>BrianB: So, I think what was so valuable now is learning from the early experiences coming out of Wuhan and as soon as the reports came out, we mobilized our emergency management and enterprise groups and began having daily meetings in the very beginning throughout the month of January, as we were following very closely on what was happening in Wuhan and the other cities in China, both on the measures they were taking and the preparations for what was to come.

So we created a very detailed script in the hospital about what we would do when we first saw a patient in New York City, what that would do and what measures we would take and when we first had a positive patient in our hospital.

In part, we were hampered by testing and I think that's a story that to me has played out in a number of other cities and it wasn't until we had our own in-house test, which took a good week or two to get it really up and running, that we were able to have an idea of the magnitude.

Once the patients were coming in, it didn't matter to us what their test should be. Because the syndrome is what looks like COVID-19.

So we very quickly, once we had our first patient, cleared out a whole floor of the hospital. And then we're planning on basically every 12 hours what the next move was going to be and how we could reshape our institution to be able to first move all of the non-COVID-19 positive patients to other locations and then very quickly, the entire building was overwhelmed with patients and we transformed one of our towers into ICUs.

We increased our ICU capacity 11-fold so at our peak, we had 196 ICU patients and today, we're down to under 100, low 90s,which is terrific, and we have about as many patients who are positive on the regular floors as well.

In order to do that transformation in addition to the physical plan, we needed essentially an army of people to come in and take care of them. The normal operations of the hospital, both the surgical procedures, transfers and elective procedures, and all of the other medical diagnoses suspended as people are all under the virus threat.

So we used trainees from other departments. We used a whole slew of volunteers from both within New York state and really from around the country who were flying to New York to help care for these patients, and that was really an incredible outpouring that we saw as we were really trying to just take care of the never-ending stream of patients that were coming through.

As we had the volume of patients, there were a lot of clinical observations that really did occur: Certainly a recognition of hypercoagulability and clotting; the need for increased access to renal replacement therapy, dialysis, and continuous renal replacement therapy; perioneal dialysis for acute kidney injury and really having to mobilize and having to create a new team to be able to focus on particular problems that those patients had, both related to the dialysis, as well as some of the ventilator management.

So whole teams were coming in to do deep suctions regularly and removing the mucus plugs that were affecting a lot of the patients severely.

Throughout all of that, I think in order to try to attack the problem, we needed that close collaboration between the individuals and the teams in our hospitals, as well as with our system and within the city. So the five major hospital systems in New York had daily calls at the senior leadership level; the medicine chairs tried to share ideas and figure out ways that would be best to take care of those patients.

Because there was such a strong psychological toll, that the number of patients and severity of illness really took on all of the different staff members, it was important to really do a lot to try to keep up morale, to celebrate the victories, that of the other patients who were successfully discharged. Those who were able to be transitioned out of the ICU back to the regular floor and that, I think, is an important component to the response and really making sure that we pay attention not just to the physical health of the patients but the psychological health and safety of the caregivers.

We spent a lot of time working on that. When we discharged our 1,000th patient and it seemed like we had the whole lobby to watch her leave, and it was quite a dramatic and striking moment.

That type of care really needs to be paid attention to. And the other piece I think, also is very inspirational in the caring for patients, was that with all of the different teams that were coming in, we graduated our medical students early. Six weeks, you know, like, two months earlier than their normal graduation date. They volunteered to come in and work on the floors, and seeing these newly-minted students come in is a real source of pride and it showed their education wasn't just about the path of physiology and taking care of disease, but it was about being a physician.

And really instilling in them the ethics of a profession and you have to rush in to take care of those who are in need, and that also was a point that was truly energizing to the entire staff. What I think one of the struggles is going to be is maintaining that. So, we were past the peek but we're certainly not at the nadir. So, we're coming down in our ICU numbers, new admissions, but it's not a uniform drop. Just as Sten has said, we haven't had 14 consecutive days of decreased hospital admissions.

We had a significant spike on Monday, for example. But being able to sustain the care and you know, adapt and really figure out what the new normal state is going to be in the hospital environment and city environment, especially as some of the social distancing and restrictions become relaxed as the world is trying to reopen the economy.

We're worried that it's going to really cause a resurgence in cases and so being on guard and not contracting too fast, that we'll be able to have the strength of fortitude and the teams and care to be able to meet them, and confident that we'll be able provide medication and do it as we have before.

>> Alex: Thanks, Brian! You have shown a very human and morale side to this. There are some unprecedented changes you guys have made with the medical students. Now, so I would like to actually turn the microphone to Dr. Qiao. You were in Wuhan for the thick of things for 66 days and now you're back in Beijing.

Do you see any equivalency in terms of what has happened in Wuhan and Beijing, because you also manage a very large hospital in Beijing, as well as being the vice-dean of the medical school, right? What has it been like from your point of view?

>>Qiao Jie:

All right, thank you for organizing this platform to share the experience between the United States and China. And as we go through this pandemic, [we] share a lot of thinking about this whole procedure. Actually, [I'm] working in the Peking University Third Hospital, that's the No 1 outpatient clinic in Beijing city. Every day my hospital has 13,000 to 15,000 outpatient clinic visits. So actually every winter fever and influenza are happening and the hospital is really crowded with patients there.

And this winter, we did more about that. Before I went to Wuhan, our hospital already had 10 patients diagnosed. But in Beijing, we already had a designated hospital. Once the general hospital had a patient, we just transferred them to the designated hospital. So I mean Beijing was quite responsive for everything. In early January, we already heard about this kind of unexplained pneumonia, so we monitored that and any suspected patients. We just did the screening at that time.

So before Spring festival, we did a lot of job about prevention. Wuhan was the key area at that time. Professor Zhong and Professor Zhang already talked about that. And all public places in Wuhan were closed and all patients were isolated at home. Actually, what I mostly felt is that Wuhan is a hero city. The doctor who first found the suspected novel coronavirus-infected patient and reported that, and on January 23, [Wuhan] hit the pause button that locked down the city. I believe it was a very, very difficult decision for the city.

When I arrived there, on February 1, you know, it was an empty city. I have been there several times in the past. Yeah, it's a very beautiful city, but at that time, I felt very sorry and pessimistic. It was really difficult. But the capital, Beijing, was also a key area calling for prevention and control of the epidemic. In order to effectively reduce the gathering of people and stop the spread of the disease, employees of many enterprises and public institutes were required to work at home through the internet, like what most countries are doing now. And also, working at different times of day would likely help minimize the cross infections risks.

But [in] Wuhan, as I mentioned, it was difficult to prevent the virus spreading from Wuhan and other cities in Hubei to other provinces. [So the government] formed programs [of controlling] the spreading of the epidemic and stretching the prevention and control of the big area as a solution and ensured that's all suspected cases are managed.

Great sacrifice was made, but the epidemic was still not brought under control at that time. So [still] many patients [were] coming [to the hospital]. At that time, there were not enough beds and medical staff in Wuhan. So that's the reason the Peking University Third Hospital and another two hospitals that belong to the Peking University formed a medical team and went to assit Wuhan. Actually, in one month, about 324 teams from across the country went to Wuhan to help fight COVID-19 by dividing the patients into two groups: patients with mild symptoms to be treated at mobile cabin hospitals and severe and critical patients to be treated at general hospitals.

For our three hospitals affiliated to the Peking University, one hospital was responsible for one ICU unit. Our ICU ward included 50 beds and 100 nurses and 30 doctors responsible for that. So we very quickly enlarged the ward from one to three and more. Many other assitance teams followed our suit. So two weeks after we arrived, we changed the situation from where it was difficult to get one bed to [the situation where] the beds were waiting for patients. And then we were waiting for patients. Yeah, at that time, we hoped more patients transferred to our treatment unit, so we could treat more patients and after finishing the work, we could go back to Beijing and back home. I believed the situation was better and better.

Since April 8, Wuhan has been restarted and people have started to go back to normal life and work as usual. At that time, I was under isolation in Beijing's suburban Yanqing district. Our medical staffs in the team were all in tears upon hearing the news. We think it's an hard-earned outcome.

So, in summary, my biggest lesson from helping Wuhan's epidemic fight is that all cases should be screened, found out and treated, and never forget the principle of controlling infectious diseases which are controlling the source of infection, cutting off the transmission routes, and protecting the vulnerable people. And everybody should try their best to help each other.

>> Alex: Thank you, Dr. Qiao. I think it's very clear from your description. This is an emotional journey for you personally and your team to travel from Beijing to Wuhan and back to Beijing and return to normal life. That has changed and will continue to change our professional and our personal lives.

There are a lot of people talking about the term new normal and it's like the theme of this Webinar today. As we look forward to the months and perhaps even years ahead, what will decide what this new normal will look like? What are the decisions that will be made by leaders around the world and also by individuals that would actually determine what this new normal will look like?

>> Barry B: First let me say it's an honor and a pleasure to be invited and I really have little to add to the wonderful medical presentations and experiences from all of the other speakers.

What I was asked to think about is what is the world likely to look like after COVID-19 is in most places, no longer peaking but in some degree of control or eliminated.

Alex, if I could show the first PowerPoint.

>> Yep.

>> Barry: I have given that some thought and my sense is that COVID-19 is a pivotal event in what will be perhaps, the new normal. If you could move to the next slide and then the next. Did you do the next? Next, please.

So a long time ago after many years in working in global health, I've come to a very simple view. Go back one, please. Basically all healthcare is local. People relate to their communities and their local hospitals. Again, can we go back please? But health research, the new knowledge, could we go back one please? It is absolutely global and that has certain requirements. That we are at a pivotal moment where the future in my view is very unclear.

Every country in the world will have had COVID-19 by the end of this year probably and that's a shared experience that each country in every way, and in a similar way has had to face.

The question is, will it motivate us to renew multinational global cooperation in healthcare and health research and hopefully if we can establish and maintain the exchange of information, transparency, circulation of knowledge and data in the realm of public health, that's perhaps the stimulus to do sharing of ideas and thoughts and collaboration beyond even epidemiology, public health and medicine.

I have to give thanks to my colleagues and many friends in the early days of this that published the DNA sequence or cDNA sequence, so that every country in the world could create a diagnostic test, of the publications from the NIH that describe the disease so any clinician in the world could recognize COVID-19 if it walked into their door, and my colleagues in Hong Kong who presented the models that told the world that this was going to be a pandemic by the 28th of January that would probably, unless we intervene, go around the world.

And that's the kind of openness and sharing of data that has made possible a possible effort that we are engaged in at the moment to develop drugs and vaccines in greater knowledge.

Now, the alternative is that the world would become more polarized with a nationalist competition between the US or China or Asia or European countries.

And that competition may have certain values but not in the realm of global health and global knowledge. And I am concerned that unless the health community and many other academic communities share our efforts and commitment towards working together, there will be a fragmentation of science that would not be helpful. May I have the next one, please?

So, what in my view will the new world look like? I think that this epidemic has at least in our country which is the only one at the moment that can speak about it with any confidence. It has created concerns that this richest, most prosperous country in the world has never had to face since the great depression in the 1930s. There will be continuing concerns about infection, whether COVID-19 comes back in the fall? Whether it comes a seasonal disease? Whether we have a new strain of influenza that rises to which we are not partially immune. I think we have a public concern for many years about health security and infectious diseases and I think that will reinforce already existing concerns about cyber security, being spied upon or having our private conversations in the social media picked up and misused, and threats to privacy, and will raise the question about what are trusted information sources.

I would like to believe, the world would believe that the most trusted or one of the most trusted is that of science, but we do not always have friends that support and trust science. But they can be very damaging to the efforts of science and the efforts to create trust in science.

I think the issue of climate change which will have many manifestations in weather, once again, will make people insecure about living near water. Whether there will be floods, whether crops will die off? Whether there will be droughts and we haven't had to worry about that in a practical sense. It was once an academic discussion but it will become a real concern that people will carry with them.

And finally one of the consequences of the shutdown whether in Wuhan or New York, is many jobs are being created or changed so that many industries who have workers that have gotten ill and stopped the ability to have companies, particularly manufacturing, continue, will be to put in more and more automation which will threaten the jobs of people both in my country and perhaps in other places around the world.

So there will be a continuing level of insecurity about many, many areas of life that probably wouldn't have happened at least in the time frame I anticipate without COVID-19. At the same time, we will not go back to where we were before, but we will become accustomed to a new world, of social distancing not for one month or two months. Maybe restaurants will open but people will have tables farther apart and schools will have chairs farther apart and social distancing will be released at least intelligently in a very gradual way and the concern is when it is not, as it wasn't in Hong Kong, for example, the epidemic flares up again and one has to reconstitute social distancing measures which is hard to do, is costly and becomes very politically unpopular.

So getting this right, the appropriate step for the release of various businesses is something that we can learn from China and we will have to learn from other parts of our country.

People will now be used to repetitive testing and I feel very strongly that the tests we have are totally inadequate with the purpose and there's a major effort to develop fast, fifteen, eighteen-minute molecular test using high-tech stuff that produces a color test like a pregnancy test within fifteen or twenty minutes and would be very cheap and can be done every day.

There's a major new NIH effort launched one week ago to select for the best ideas for changing the way we do testing so it's cheap and fast and sensitive and specific.

People will have to be able to walk around for very long periods of time in countries like the US that never wore masks and there will be resistance to that and it will not be a pleasant circumstance demanding of our people, and workplaces are not just places where people can go to sit at their computers but they will have to test the people who come in and leave to be sure that they are not infecting and not putting everyone else in large companies at risk.

This will be a new world of continuing testing and social distancing. When China opened Wuhan and relaxed the social distancing and allowed travelers to come in, as you know better than I, almost all of the new cases in China, in Hong Kong, in Singapore with one exception, came from travelers. The ones in Singapore were workers that didn't fly in but every country is now going to have to be concerned once they reduce the level of this disease on how to prevent it from being reintroduced.

And the United States has fifty states and each of them is different and health is a state responsibility in America. Not a federal one in general. And so if one state does a great job of reducing the numbers, it can be overwhelmed by travelers and visitors and trucks and buses and cars from another state so we will have to have some constraints and some concerns about travelers over the long haul.

We will have a vaccine in perhaps two years. It will take another year to get it produced in massive amounts, probably. But then the question is, who gets the vaccines, who decides that and for every step with vaccines as you all know, there is misinformation about vaccines. People will be hesitant to take them and hence, will we ever get to a level of herd immunity? That remains unclear.

We will live in a level of surveillance, particularly if there are electronic methods for identifying cases that have been used effectively in China, Hong Kong and Korea. That would be new in the United States. There's resistance to that from the people who value civil liberties and will they become accustomed to that?

And then finally in the balance that we saw from the very beginning presentation of Professor Zhong, there's a balance between the economy and health and will we become accepting of a high level of deaths justified by the ability to move the economy and will that lead to our accepting increasing continued deaths from infection by COVID-19 just as we accept deaths in many countries with food insecurity and in our country, with gun injuries. That would be crazy because they are preventable but people have learned to accept them. Finally, if I could, on the last slide, please, Alex, I see some positive changes not only negative ones. I believe at least in any country and I hope in China and other countries there is a renewed appreciation of what scientists have done to understand, model, predict and intervene and create new tools so that the science, public health and medicine will have a new respect and would become heroes to the public that has not previously really understood what we did.

I hope the rush for vaccines and drugs will continue and investments in science for new innovation in all kind of areas that will make life safer and easier and more rewarding for people. Innovation is the way to fix the problems of the world, but it's often only invested in after a tragedy or an outbreak or a natural disaster.

I think in our country, I'm hopeful there will be a recognition of the important work of people we call essential workers These are not just academics, professors and CEOs of industry, but these are the people who drive the buses and sell fruit in the fruit market and brought the fruit in chains to Wuhan in the middle of the epidemic. These are the heroes within this epidemic. I hope they get recognized in a continuing way and respected and rewarded for their effort and that includes vulnerable people, particularly people in nursing homes and the elderly who have been enormously vulnerable with this.

And finally, realizing that the most vulnerable people at least in my country, and I would be surprised if it were different in China, are the people on the bottom of the socioeconomic ladder. The poorest people who live in the most crowded housing, have the fewest resources and we see those dying in two and three times a greater rate than those that are more affluent and live in a better condition.

And I hope this epidemic will renew this movement of renewing our commitment to decreasing societal inequities and making it a fair and more equitable society. So those are my thoughts for the future. I hope some of them are wrong and I hope some of them are right.

>> Alex: Oh, thanks, Barry! As we look forward to the new normal, sometimes it can be quite gloomy and thank you for taking us to a more positive spin.

Now, actually, as we look at the new normal, I think one of the jokes and I'm not sure how big of a joke it is, but some say during the 14-weeks lockdown, many babies may be conceived. This is still unknown at this point, right? I just want to ask Dr. Qiao, a reproductive and maternal and child expert, a question. Life as we know will continue and people will continue to have babies. Expectant mothers may be feeling anxious during pregnancy. Now with COVID-19, I'm sure they're even more anxious. How much do we actually know about the effects of COVID-19 on pregnancy and maternal-child transmission, for example?

>>Qiao Jie: Until now, in our experience and summary from Wuhan also from China, we found pregnant women with similar symptoms as the general population, not more severe. So that's lucky. As good news, until now, nearly 100 infected women have delivered and the babies are healthy. We had several cases after delivery which became severe and now critical. But now we have seen them already recovered, back to home. But for the effect on reproduction of those infected, until now, we have little evidence to show effects on ovulation -- and for males, the reproductive system may be affected in some way. So now we suggest if you have already been infected with COVID-19, it's better to wait until after three months and best for half year to get pregnant. And others who just observed no severe fever and other symptoms can continue to have a baby.

>> Alex: Thanks, Dr. Qiao. And I think, I was just looking through all of the questions from viewers. This is livestreaming on both Tencent classroom and on YouTube. I was just going through some of the questions. I think there's one or actually two very common questions that came up. The first one is to Dr. Zhong is about antibodies. Now, hang on a second.

>> Zhong Nanshan: Excuse me, the internet (connection) is bad, and I could not catch your question.

>> Alex: Dr. Zhong, you mentioned about herd immunity. Of course, we can get it through a safe and effective vaccine. Now, there's always been a question about whether natural infection and natural antibody generation equate to protection. Now, do we have any evidence that natural infection will actually lead to infection which will contribute to the development of herd immunity?

>> Zhong Nanshan: I don't think so. I think there's some evidence hundreds of years ago. Like smallpox and polio with high fatality and very high reproductive numbers. In Spain, there were still rather massive infections of smallpox after several generations. They take a longer time to get herd immunity by natural infection.

Eventually, we developed a smallpox vaccine and then everybody should receive smallpox vaccine as a newborn or in childhood. So I don't think that herd immunity will be achieved in that way.

Now, after several hundred years and several decades, vaccines are much improved and in these days we need to develop vaccine. Of course, developing a vaccine is not that simple. So some domestic patients may need to wait for 1.5 years. In terms of the massive vaccination, we are looking at the so-called NDE or others.

We have been thinking that we need much more time to develop a vaccine in emergency, in particular, for the target population. I really appreciate that Barry just now mentioned the sentence that all healthcare is local and all healthcare is global. I really appreciate this sentence. This is what we have proposed in a conversation between the Guangzhou Institute of Respiratory Health and Harvard Medical School. We have already communicate and discussed 11 times in terms of different topics and how we can collaborate with each other and all other things.

In terms of vaccines, people may be more concerned about who will be the first to develop the vaccine. I'm more much concerned about which vaccine will be more effective in terms of safety and efficacy. So a good collaboration among countries is needed to develop a vaccine to contribute to mankind. So going back to your question, I suppose, the herd immunity can only be achieved by vaccination, massive vaccination. It will take time, it will even take several years to further confirm whether this vaccination will be effective or not.

>> Alec: Thanks Dr. Zhong. I think it's clear, I think the endgame for us against COVID-19 is a vaccine and how we can balance it. The next question on the new normal is, hopefully, there will be more than one vaccine candidate. There's a lot of questions about supplies and the prioritization of these supplies. Not only across countries but also within countries to the point that Barry mentioned, which is the subpopulation that we should protect first?

The most vulnerable like the high-risk healthcare workers? The most vulnerable people but I'm sure this will create some tension. I think this is one where all of the researchers do have to work together to actually overcome this. There's one quick question I want to ask. Probably directly to Brian. As you do the management in the front line, I think various states including New York have talked about lifting the lockdown in different activities, right? Given the risk, do you foresee any problems if New York reopens?

>>Brian: Well, because they're opening up New York state in regions. So New York City which is really the epicenter and with Queens, Bronx having the highest concentrations in the country and surroundings areas, it's really going to be phased. In New York City and the surrounding suburbs will be opened up much later. I think it needs to be done in a very cautious and stepwise manner. Part of it is the reduction of cases and monitoring that and then also the testing and the contact tracing.

And the question actually that I have because Barry mentioned it in the beginning and Sten mentioned it and they have been doing it more in China is contact tracing. This is very important component. How does it work and how do people deal with it with the threat of privacy because that's really something that, if your phone beeps that you have come in contact with somebody who is at risk or is positive, how does that impact the society?

>> Alex: Well, I guess the contact tracing will be key for us going forward. Both Google and Apple have developed an initiative to tackle with the need to contact tracing and to protect the privacy. I think this is a very contentious issue and we have seen Europe and different countries/regions have taken very different approaches to this. China has, of course, developed the health code digitally to actually allow people to move and travel while knowing what their quote-unquote health risk and status is. Otherwise, I think the already over-stretched CDCs  across the globe will have to take on more work to trace patients' close contacts.

This is literally like herding cats. When we, a lot of the time, we don't know what the cat looks like. We can find the cat most of the time and the cats sometimes look different.

I believe our time is up. Now, I think we do have a lot more questions than answers. And I want to borrow Barry's quote, healthcare is local and all healthcare research is global. That's why we have the Global Alliance to Combat COVID-19.