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Today is July 7, and we're here today with Dr. Leann Liu to do the Houston Asian American Archive interview, for the special COVID collection. So, first, I want to ask Dr.

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Leann Liu, as the Deputy Manager of Surveillance and Epidemiology at the Harris County Public Health Department, can you talk a little bit about your job and what your team has been doing? Well, the surveillance and epidemiology program

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is responsible to monitor reportable diseases in Texas around 80 of those diseases, such as salmonella, measles, West Nile virus, now COVID-19. We identify cases, report cases to the state and we

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implement preventive measures. We control outbreaks. We provide technical support to providers, healthcare providers. We analyze and disseminate data.

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We also respond to public health emergencies, such as COVID now. In addition, we monitor chronic diseases and environmental public health issues.

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My job is to oversee a team of epidemiologists and investigators to carry out these activities. So at this time, of course, we focus on COVID-19.

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Okay, yeah. And so can you talk about what your team has been doing on a day-to-day basis since the COVID pandemic has started? We investigate cases, the reports we

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receive, we make sure they meet criterias-criteria to for our case. We isolate patients, do contact tracing to find people that are exposed.

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We notify them of the potential risk. We asked those contacts to quarantine. We help people to get tested.

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We analyze data and report cases to the state. So those are the day-to-day activities. That is quite a lot, right?

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So yeah, tracing people's lives can be very, very complex. So how extensively are you guys able to trace? Like a single contact. Yeah, it is a complex process, not

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an easy task. So we try to keep it very private. To respect confidentiality. Our target is to investigate 100% of cases.

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Cases are those tested positive. And we call, we, we aim to call all-every single one that was in close contact with a case patient. Of course, you know,

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it's not possible to reach every case patient, every contact, but our team does our best to try to reach people. And how do a lot of people contract the virus just like from the community or?

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COVID, SARS-CoV-2 is the virus that causes the COVID-19. This is a new called novel virus. So the population does not have immunity. At the same time, the virus is quite contagious.

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Averagely, two to three persons can contract it through one person that has been infected. And sometimes people infected,

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they don't show any symptoms. So but they still can be contagious. So that makes it very challenging to control it. And it's—so it's not

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easy to identify the illness and prevent it because, you know, some people don't have any symptoms but they still, they're infectious. In addition, you know, the world is highly mobile, people travel everywhere all over the world.

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So, you know, this virus got spread rapidly all over the places. Recently, have a lot of people you guys have been contacting have they been young people? In recently, we have seen we have seen increased

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cases in a younger age that we did not see before. You know, at the beginning and usually, you know, people are older were the populations that, that was

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impacted the most. But recently we have seen uptick in younger population. Mmhmm. And, in your opinion, was Houston prepared to treat Coronavirus patients before the first

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cases were reported? Well, you cannot be a hundred percent prepared to something that you don't know much. Well, actually, you know, for COVID-19, it's completely, it's new.

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It's a new virus. However, public health always prepares for emerging threats. Such as Ebola and MERS.

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And this time COVID-19. We have made emergency plans, we conducted an exercise, we prepared response structures, prepared teams, etc.

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So we had closely monitored the outbreak in China, actually, since January this year, since the very beginning. So we were preparing all this. Yeah. Okay. And when your office first received the reports of COVID-19 cases,

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what did you personally feel? Were you like, "Oh, there's I'm about to be very busy for the next few months?" We knew it would come. So although SARS-CoV-2 is new, but public health

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emergencies are not. We have experienced a lot in the past, we know what it would look, what it would look like. But for–for COVID-19 even we

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knew it would come, we just we didn't know when. You know, you couldn't predict that. So when we receive the first report, it felt like, well, here comes.

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Now this is real. It's not drill. You know, it's not a drill anymore. So the atmosphere in your office

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was heavy. Now we knew what we would expect. But you really, we didn't have time to think about much. You just have to take action. Quick. You just have to

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start gear up. There's no time to–to worry about it. Mmhmm. I see. Okay. And how does your response, your team's response to COVID, does it can you compare it with previous responses to other emerging diseases like Zika?

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I would say COVID-19 is unprecedented. The scale and complexity of this response is something

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you know, we have never seen before, at least you know, as I know. So the disease is much easier to spread. It's not like Zika. You know, Zika primarily, is spread by a mosquito bite,

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or sometimes you know, from from mothers to babies, or even through sexual contact, but COVID-19 is primarily transmitted, you know, through air,

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through air droplets. So it's much more challenging to contain than many diseases, and it is new and we don't know much of it. So I feel you know, our response to COVID-

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19 is more like, like a war, not just a battle, you know, a battle to something short. It's like, it's like a war like a marathon.

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Mmhmm. And has the Coronavirus pandemic spread, how has your team changed and expanded especially with the recent increase in cases? As the virus continues to spread, we have, we face more challenges in response.

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We have expanded our team to respond to the increasing number of cases. We have grown a lot from a team of 25 now to more than 400 staff members.

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Wow, okay. And with the amount of increase in cases in the Houston area, do you ever feel that there isn't enough manpower? With an enemy like COVID-19, you feel like you

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never have enough manpower. However, with the support we have received from the community, from different level of government and leadership, we

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have expanded our team. So far, you know, we have been able to manage investigations and conduct tracing and being able to stay on top. Okay, I see. And how has your job changed since the most

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recent spike of Coronavirus cases? Well, obviously we're busier. We work longer hours. Because of this pandemic, we have worked

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under ICS structure. That's called incident command structure for public health emergency response. Our team has grown a lot.

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We have done numerous trainings for new staff members. We have larger team to manage, a lot of coordinations with our partners at different level. So, obviously, you know, our

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scope has expanded a lot, and work has increased a lot significantly. I see. Do you think the current administration in the state of Texas provides clear enough guidelines for all of us?

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You know, as we mentioned, COVID-19 is unprecedented. It's so complex, the response is enormous. So governments at different level have worked very hard to try to protect people.

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Actually, CDC sent first health alert back in January, and subsequently CDC has issued enormous guidance over time. So the virus is new,

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you know, as knowledge of this virus evolves, the guidance has changed. So sometimes, you know, there might be confusion you know, about the mess-the message, different

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agencies sent out or the guidance, but overall I think, you know, public health has provided abundant guidance for our communities to guide the response to help people to protect ourselves and our loved

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ones. And if there are any lessons that we can learn from the COVID-19 pandemic, what do you think they are? COVID-19 pandemic, it has,

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it has had a profound impact on everyone's life, I would say. There are lots of things we can learn from it. One thing I think, important is that we have to

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recognize that we live in one world and we share one health. So it's a world and health shared by people all over places.

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So no matter where you live, who you are, what you do, we are all connected to each other. So your health is not just yours. So they may impact others, far in the world

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that you never thought about it. So we really need to take care of each other and take care, the shared environment, the world we have. That makes sense.

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Yeah. And what do you think the future of this pandemic will be like? Like, will we be able to reopen for college campuses in the fall or what thoughts do you have? Yeah. It's, it's hard to say.

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But one thing for sure we will overcome it as we did in the past for SARS for influenza pandemics in the past-in the past. It is hard to predict, you know, what it will look like this

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fall. However, as a society, we I think we we will learn how to live with this virus and how to balance our life between reopening economy

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and reopening businesses, schools. Gradually going back, try to go back to normal life and at the same time when you protect our communities, protect ourselves and our families

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with the help of vaccine and treatments that are on the way. So hopefully, you know in fall, or this year our situation will get better.

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And I imagine that the impact of COVID-19 can be very overwhelming at times, how do you stay focused and not get too overwhelmed? Yeah, the responses are overwhelming.

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But we have to stay focused to just fulfill our responsibilities. It is a time that we are needed the most. We have to stand at the front line to protect

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our communities and do our job. I think our training and then the response experience in the past that help us to carry out our

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jobs. Actually, you know, I don't think we really have time to think about other things, to worry, there's just so much work. You have to keep, keep going.

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I have to stay focused. Okay, and how else has your personal life been impacted by COVID-19? I know you mentioned longer working hours and like the ICS you guys

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are currently working under. Right. We have been so busy, not just me, the whole team. We're very busy. So personally, I have

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not spent much time with my family, especially at the beginning of the response. That time we worked perhaps 15 ish hours a day.

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Yeah, we work from morning until midnight. So I barely saw my son and my family. When I got home, he went to bed, of

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course. And I just disappeared from my social media chat groups. I don't I didn't have time.

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So all the time, you know, I felt tired and it's just not me, you know, many of our team, we felt tired and we had to drag ourselves to go to office. However, at the same time, I'm proud of what we are

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doing and proud of our team. And we just, we–we are continuing to do our job. Okay. And how do you think the pandemic has impacted the

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perceptions of Asian Americans and the Asian American community? Well, because this pandemic started from Wuhan, China as we know.

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So it definitely has a negative impact on perceptions of Chinese Americans, further Asian Americans. Now there is a stigma on Asian or

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Chinese communities as we have seen from social media, from news, which is very unfortunate. And it shouldn't be the way. Okay, I see and yeah, there have been many reports about like,

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anti-Asian and xenophobic discrimination and harassment, like you mentioned on social media and stuff. What do you think about this? That was very,

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that is very unfortunate. Some people they are narrow-minded and biased. So when a disease such as COVID-19 happens, instead of trying to find a solution, save lives, protect

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each other, some people choose to blame on each other. And instead of, you know, helping each other, they choose to hate each other. So this is very sad and unfair.

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So, hopefully, you know, people learn from this and moving forward, you know, hopefully, it will, it will be a better response than this. Right. And, personally, how

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does it feel to be a member of the Chinese American community right now? I'm very proud to be a member of Chinese American community. We experienced the pandemic that has impacted everyone's life and communities so much in

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every angle. However, during the difficult time, our community unites and people watch for each other. And Chinese community, Chinese American community has reached out to other communities to offer

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help. We have seen those on news, you know, those activities organized by Chinese American community to help others in this difficult time. And we ourselves as the community has overcome

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a lot of difficulties. And I think we become stronger and we are have set a positive image of Chinese American community to others during this pandemic

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and during this challenging time. Right, yeah. To switch gears a little bit, many doctors and frontline workers have been received a lot of recognition for their efforts, such as donated PPE and food.

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Has your team of frontline workers received any donations or other forms of help from the community as well? We're very grateful that we have received a lot of support from our communities.

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For example, we received thank-you letters from elementary school students, with very cute pictures, handwritings. They were they were so touchy to read especially when our

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team went through at the most stressful time, and it was very difficult. It was very stressful. And we were reading those letters.

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And we were, our team were many of us were in tears to read those. We said those were the best gifts we have received. So, in addition, I remember Asian,

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Asian Chamber of Commerce, they came to visit us and they donated lunches. Our team was very excited. And we were very appreciative of those support. Yeah, it's really adorable to hear about the cards.

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Right. It's from, from young children. Yeah, the kids were very cute. And to switch to another topic, I wanted to talk about your current position working in public health.

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What was your trajectory going from medical school to where you are now? Yeah, I graduated from China Medical University. I completed my residency in pediatrics in China. So after that, my husband and I moved to Houston because of his job.

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Then I became interested at population health. So when you are a physician, your focus is individual health. However, public health

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public health gives you a larger picture and perspective of health. So I went to UT School of Public Health and got my master's degree in epidemiology and became an epidemiologist.

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At the beginning, I was an epidemiologist and biostatistician and later on I joined Harris County public health, became an infectious disease epidemiologist.

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And over the past 15 years, I have worked in infectious disease and chronic disease surveillance both of them, epidemiology studies, different public health emergency

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responses, such as West Nile virus outbreak, Ebola response, Zika, Hurricane Harvey response and recently measles resurgence, chemical fires, and

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now COVID-19. So that's pretty much my life. Yeah. And to add on a question, how does your team deal with, for example, when you're contacting

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people who have gotten COVID? And if they don't like work with you guys, or if they don't really listen to you guys's advice, is there anything that you all can do or

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are able to do? That's right. Most people are very cooperative with us, but not everyone wants to participate in the process. So we as

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epidemiologists explain, explain the risks and the benefit. You know, the risk of not following guidance and the benefit, you know, working together, following guidance, you know

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quarantine, isolation, why we do those, how that would benefit this response of COVID-19 and how that would help not only the patient, him or herself and also people, this person who

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was in close contact with and further the community. We just explain the process. Usually, you know, people will come forward

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after we explain all this. Then, you know, very occasionally, you know, if not, actually, you know, COVID-19 is notifiable condition, we call it, we call it a reportable disease.

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That means it's under the Texas Health and Administrative Code. It's under Health and Safety Administrative Code.

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So it's required by law that we have to investigate, we have to report. So there is also, there is also, you know, a legal requirement. So we just explain all this process to get people to work with us. Okay, that's good to hear.

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Um, do you have any other thoughts you would like to share? No. No, I really I just hope you know, I just hope we overcome all this. So, and and so people can go back to normal life. And I am and I really appreciate what you and

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your team are doing. It's very meaningful. I never thought about it. I wish you the best of luck of your project.

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Oh, the archive. Thank you. Thank you so much for your hard work for the community and making sure to protect everyone's health. Thank you for

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you and your team. Okay.