Nutritional Epidemiologist’s Encounter with Coronavirus (COVID-19) in Wuhan, China

An Pan, PhD, is an ASN member and Associate Editor for The American Journal of Clinical Nutrition. Dr. Pan is from Wuhan, China, where the recent novel coronavirus (COVID-19) outbreak first appeared in December 2019. We reached out to Dr. Pan to learn more about his experience dealing with the virus in China, how his background in epidemiology and nutrition has contributed to his experience, and his advice for others currently dealing with the impact of the pandemic.

The Wuhan experience has taught us that we will beat the virus, if we stand together and follow the scientific evidence.

An Pan, PhD, AJCN Associate Editor

ASN: What has the situation in Wuhan been like for you and your family?

I was not in Wuhan for the whole period, so I would not know the exact situation after the city lockdown. Before the cordon sanitaire, people were just living their normal lives. Because it was approaching the Chinese Lunar New Year (January 25), most of the schools were closed in early and middle January. The 1-month winter break started on January 11 for our university, and students went back to their hometown so there was massive migration during the Chunyun period starting from January 10. The faculty were not required to go to the office and most of us worked from home. For the other people, they needed to work until January 23 or 24. People were purchasing food and preparing goods for the Lunar New Year — no major differences from other years. Although there was news about an outbreak caused by a novel coronavirus, people did not pay enough attention to this and it was claimed that there was not sufficient evidence for human-to-human transmission in early and mid January.

Everything changed on the evening of January 20, when the human-to-human transmission was announced and also news that there were more than 10 healthcare workers who had been infected. People started to wear masks, stockpile foods, and tried to stay at home, but no one expected that the whole city would be closed. The city lockdown was announced the morning of January 23.

We all read the news that there were thousands of patients with fever or respiratory symptoms who went to hospitals in late January and the hospitals were all crowded, just like what’s happening right now in many other countries. The doctors and nurses did not have enough supply of personal protective equipment (PPE). Many people and companies donated money and PPE to the hospitals, and even many people in other countries purchased maks and even medical equipment and sent them back to China. It was very touching.

Many healthcare workers from other provinces were deployed to Wuhan and Hubei Province to fulfill the shortage in manpower and support the local colleagues. The government issued a number of containment and mitigation measures in a short time to control the outbreak. New hospitals were built, wards were reconstructed, exhibition halls, stadiums, schools, and public facilities were also reconstructed to host patients with mild symptoms and exposure to the virus. A compulsory stay-at-home policy was implemented to all residents in the city. Life was tough, but many community workers and volunteers were called upon to deliver foods, drugs and necessary goods to the residents in the community. People were helping each other.

I think there might have been some chaos at the beginning, given that this large-scale quarantine had not been seen before and the policies might not have been perfect at the beginning; but things were getting better. People started to get accustomed to the home confinement, and they started to cope with the new lifestyle and spent more time with their family.

My family and I were in in Nanjing with my parents for the Lunar New Year holiday. Since we were from Wuhan, we were also required to stay at home and report to the local authority our temperature and any symptoms twice a day for 14 days. Every three days, two healthcare workers from the local hospital came to our house to check our temperature. The local community workers also came to our house and asked us whether we needed any help in purchasing foods or drugs. We were not allowed to go out to the supermarket, and if we needed anything, we could call them and they would buy for us and deliver to our house. Luckily, we were all okay.

After 14 days, we were given a paper certificate that we had gone through the quarantine period and could go outside of the house if necessary. But by that time, people were required to stay at home anyway, so we continued to stay at home. Different cities and communities might have had different policies depending on the local situation.

ASN: How did your background in nutritional epidemiology and your research interests impact how you prepared and managed throughout this situation?

I was trained in biochemistry and molecular biology for my undergraduate, and then nutrition and epidemiology for my PhD. Although I do not work on infectious disease epidemiology, I have some basic knowledge about the infectious disease, how to control outbreaks, and how to protect ourselves. I think the basic principles apply everywhere: keep social distance, wash your hands whenever necessary, particularly when coming back home, wear masks when going out, try not to touch anything and do not touch your face before washing your hands, and cook your food well. 

ASN: With social distancing and quarantines in place around the world, how is this pandemic affecting your professional life? Has it interrupted your research and any studies, and how have you adapted?

Most of my work can be done remotely so there has not been a major impact. But I am running two cohort studies in other cities, one is in Shiyan City in Hubei province, and the other one is in Chengdu City, Sichuan Province. The field work had to be stopped, and no new participants were recruited. The follow-up appointments had to be rescheduled. The good news is that the field work can be done after April, so I am dispatching my students to the field now.   

ASN: A lot of your research is focused on non-communicable diseases. What role do you think nutrition has related to infectious diseases and epidemics such as this?

I am not an expert in the field of infectious diseases, but there are a lot of studies about nutritional factors related to immunity status. I saw some studies about vitamin D, selenium and other vitamins or nutrients. The causality may need to be done in clinical trials, but it is certainly not impossible to do such a trial in the current public health crisis. Nutrition is also very important for treatment and management in patients with COVID-19. I am not a clinical nutritionist, and I would expect to see more papers and reports on this aspect. I think those are important clinical and scientific questions.

ASN: Has the experience piqued any new scientific interests for you, particularly related to nutrition?

Yes, I have been involved in some studies to analyze the epidemiological data of the COVID-19 patients from Wuhan, studies related to diagnostic tests, patients with both COVID-19 and diabetes, etc. We are also planning to do a large-scale serologic epidemiological survey, given that people are very curious about the proportion of asymptomatic cases nowadays, as well as what populations are susceptible to the infection. We might be able to also measure some nutrition related biomarkers in the study. If possible, we want to follow up with some COVID-19 patients as a long-term cohort study.

ASN: What advice would you share with the other parts of the world currently going through what has already taken place in Wuhan? Do you have any nutrition-related advice in particular?

Well, I think we will get through this crisis. The Wuhan experience has taught us that we will beat the virus, if we stand together and follow the scientific evidence. Meanwhile, we need to support each other, and spend more time with our family and loved ones. We may not have appreciated how important they are before this pandemic. My parents told me that this is the first time I’ve stayed at home for such a long time since I graduated from high school 20 years ago. It is true. In the past 20 years, I may have spent a few days with them every time I came back to Nanjing. I did not stay with them for the Chinese New Year since I went abroad in 2009. I just realized that how much they missed me over the past 20 years. Spend more time with your kids and play with them, read books with them, watch movies together. Pick up an old hobby, and maybe read some of your old diary, contact and talk with some old friends. Don’t just watch TV or check the news every hour, it will drive you crazy. Try to slow down and cope with it.

As for nutritional advice, I think it is very easy for people to eat junk food when doing nothing or watching TV at home. So eating healthy foods is very important during this period, otherwise you will find out that it is so easy to gain a few pounds after two weeks of quarantine. Eat more fruit and nuts, not chips or soda, avoid eating too much, do some exercise (like muscle strengthening and yoga if you cannot go out) if possible (but of course, avoid contact with people).