Be prepared, says epidemic control expert

Former Shanghai CDC chief attributes good control of COVID-19 to long-term planning

Wu Fan remembers the first university class she attended and a story her lecturer told the students about how thankless working in public health can be.

The teacher shared a story from the Han Shu, the official history of the Han dynasties (206BC-AD 220), which tells the tale of a villager who built his chimney completely upright.

When another person reminded the villager to bend his chimney at the top and remove the pile of timber at the bottom to reduce the risk of fire, the villager ignored his advice. A fire started and his neighbors came to the rescue.

To show his gratitude, the villager prepared a feast for all his neighbors, except the person who offered the advice.

"By telling this story, our teacher was conveying the message that we should lower our expectations of receiving social recognition as a public health worker," laughed Wu, vice-dean of Fudan University Shanghai Medical College.

Wu, who has worked in disease control and prevention for nearly 30 years, said she is glad to see public perceptions are changing because of the COVID-19 pandemic.

"Never before has society attached so much attention to disease prevention and control," Wu said. "That's a big step forward for public health in China."

The 51-year-old earned the nickname "epidemic control wonder woman" earlier this year for the poise she exuded when fronting news conferences as the leader of the Shanghai COVID-19 task force.

In the early stages of the outbreak, when little was known about the novel coronavirus, Wu had an inkling that the virus could be easily spread among people and suggested that local authorities immediately implement measures such as contact tracing and enforcing quarantines.

In recognition of her contributions, Wu was among 10 people recently honored as one of Shanghai's "most beautiful scientific and technological workers".

She said she sees the award as recognition of Shanghai's public health emergency response system, which the city has been improving for more than three decades.

"Public health doesn't work without a properly functioning system," Wu said.

Lessons learned

According to Wu, many Shanghai residents initially associated COVID-19 with the hepatitis A epidemic the city experienced in 1988. During that epidemic, about 300,000 people out of a population of 12 million were infected.

As a student at Shanghai Medical University, the predecessor of the Shanghai Medical College, Wu volunteered to assist at local clinics at that time.

"The Shanghai government has always been very rational in that it learns from its experiences," Wu said, referring to the fact that Shanghai has since invested significant resources in improving its public health management and epidemic control capabilities.

In 1991, Wu joined a local team specializing in disease and epidemic control. In the first few years, she found herself spending most of her time in Pudong, where millions of migrant workers helped transform a vast expanse of farmland on the east side of the Huangpu River into what is known today as the Lujiazui Financial Center.

"With the influx of millions of migrant workers, prevention of diseases such as cholera became a new public health challenge at that time," she said.

To prepare for the new challenges, Shanghai set out to build a comprehensive public health network that allows for quick emergency responses.

In 1998, the city amalgamated several public health facilities into the Shanghai Center for Disease Control and Prevention.

The Shanghai CDC was the first center of its kind established in China and is considered a symbol of the beginning of the reform of the country's public health system. It was the forerunner of the Chinese Center for Disease Control and Prevention, which was created in Beijing in January 2002. Similar disease control centers have since sprung up in province-level regions across China.

Be prepared

The creation of the centers reflects more than just organizational restructuring, said Wu, who served as the director of the Shanghai CDC from 2007 to 2017.

"It was a policy response to the shifting of disease patterns, perception of disease, and governmental changes in China," she explained.

"One major challenge of public health is that the resources you have are always limited and you should always be prepared for the unexpected. That was why we had to build a system that was as responsive as possible."

Wu has said on many occasions that Shanghai's success in curbing the spread of the novel coronavirus was down to early detection, widely available and timely testing, effective contact tracing and 100 percent isolation of close contacts of infected people.

"This success could not have been achieved without the comprehensive public health network that the city has built over recent decades. Primary health care centers in communities have been very important," Wu said.

While the epidemic has also exposed gaps in the public health management system, Wu is confident that officials at all levels, including herself, will work together to quickly address the deficiencies.

She said nothing pleases her more than the fact that the public is now more willing to invest in health prevention, as evidenced by the heightened interest in flu vaccines ahead of the flu season.

"Public health measures cannot succeed without the contributions of every person in society," she said.