Dr. Deborah Birx Is Worried

Phase I reopening was supposed to be like driving in a 25 mile-per-hour zone, says the White House's Coronavirus Response Coordinator. That's not what happened.

Dr. Birx on a Second Wave
Photo: Washington Post/Getty Images

Ambassador Deborah Birx, M.D., wakes up at 3:30 or 4 a.m. most days. That’s when the White House Coronavirus Task Force Coordinator begins reviewing data she receives overnight about COVID-19 infection rates across the country, on a county-by-county level. In two hours she’ll prepare a deck for the Vice President with what she sees as the most important points to inform the White House’s plan of action, and then head into the office for a roughly 12-hour day. Once home, she dives into late-night data from overseas. “I’m not a big sleeper,” she laughs. But she certainly doesn’t take her role leading a team of data analysts, on detail from the State Department to the National Security Council and reporting to the President himself, lightly.

“I can’t tell you how stressful it was and how many all nighters [it took] to create the data for the President to come out with the recommendations of really sheltering in place as a country,” the Pennsylvania native says, reflecting on the early days of the pandemic when she was consulting with leaders in Europe about the impact the coronavirus had on older populations there, and how effective lockdown measures had been. “To know your data had some small part of the decision that the President had to make is kind of an enormous responsibility, so it’s incredibly humbling and also very worrying. You hope that you get it right and you worry that you didn't get it perfect.”

These days, the COVID-19 infection and mortality numbers across the U.S. show that someone is not getting it perfect.

“We are starting to see some upward trends in cases or test positivity in cities that had previously been stable and low,” Dr. Birx says via follow up email after the July 4 holiday weekend. How did this happen?

Phase I Reopening Is Like a 25 MPH Speed Limit

“I can tell you, the way I looked at it, the guidelines the President put out in Opening up America Again [were] very clear, with science-driven evidence of where you needed to be,” Dr. Birx said over the phone on June 16, citing criteria that had to be met before it would be safe for a state to move onto phases that allow, say, salons, bars and schools to open. According to Dr. Birx, those Phase I reopening criteria (published on the White House website) include continued social distancing, wearing masks, no gatherings of over 10 people, and that non-essential travel is to be avoided.

Plus, as Dr. Birx mentioned in her email: “Schools and organized youth activities (e.g. daycare, camp) that are currently closed should remain closed.” This message arrived on Monday, July 6, less than two hours before President Trump himself tweeted in all caps “SCHOOLS MUST OPEN IN THE FALL,” which he followed with Tweets condemning the CDC’s “tough” guidelines on school openings, causing consternation among parents trying to sort out what to do with their kids come September.

The White House’s Phase I criteria also state that bars should remain closed, and crowded businesses, including restaurants, movie theaters, sporting venues, and places of worship, should “operate under strict physical distancing protocols.” Again, the guidance seems clear, except when taken together with the President’s own statements about it. As the New York Times reported on July 8, weeks after President Trump demanded houses of worship be able to reopen, as many as 650 new coronavirus cases were linked to church visits in states like Texas, where stay at home orders ended on April 30, and businesses were allowed to reopen. Governor Greg Abbott has since urged people to resume staying home, wearing masks, and distancing.

“In my mind, we were all thinking the President said ‘you can now get in your car and you can start driving,’ but [we were] really hoping that people would realize we were in a 25 mile-an-hour speed limit and do all the precautions needed for being in a 25-an-hour speed limit zone,” Dr. Birx said. “I think some Americans decided to go 75; some went 30. Many areas speeded up to Phase III without completing Phase I and Phase II.” This, she said, is causing some problems.

Dr. Birx on a Second Wave
Mandal Ngan/Getty Images

“Even before opening, the infections were increasing in California, particularly in LA County. They were increasing in Phoenix, a major metro; they were increasing in Montgomery, Alabama. And so I worry every day about some of these smaller metros,” she says.

As Americans began puzzling over whether a second wave was coming or if we’d even made it through a first wave of infections yet, Dr. Birx explained that the wave metaphor doesn’t quite hold water — it’s an example of the “tyranny of averages.” Meaning: We can’t look at infection rates across the country as a whole; investigate more granularly and you’ll see that every city or town has faced its first, fierce confrontation with COVID-19 at different times. That’s what she wakes up thinking about and combing through the data to parse. While the Eastern Seaboard was ravaged first and hardest, and still is home to the most obscene case and mortality numbers, other parts of the country are just now seeing their numbers boom.

Tulsa, for example, reported a record number of new cases on Monday, July 6, according to AP reporting. The City-County Health Department Director Dr. Bruce Dart said the President’s June 20th rally there, which thousands of people attended, “likely contributed” to this bump.

“I think the visuals that were on social media really created the sense that large social gatherings were now acceptable even in Phase I,” Dr. Birx said, referring generally to photos of people hanging out in groups over Memorial Day weekend, at bars, restaurants, beaches and beyond. She noted that she didn’t yet have data on the virus-transmission impact of Black Lives Matter protests which were still new when we first spoke, though other reporting more recently hasn’t found a link between protests and areas where cases have increased.

"You Have to Focus on the Underserved Communities"

When I speak to Dr. Birx on the phone, she’s calling in from the D.C. home she shares with her husband, parents, daughter and son-in-law, and her baby grandson. “So the household goes from under 1 to 96; it’s a very exciting place,” she says. This isn’t a COVID quarantine pod, but just the chosen arrangement for the “very family-oriented” clan. Dr. Birx, who has two daughters in their 30s, the second of whom lives five minutes away, says she always wanted to have girls, and when they began to have children, she wanted to be there, physically, to help. “It’s good to be there emotionally, but it’s really important to have someone there because being a parent for the first time is tough; you’re worried about your children — every single fever, every single rash.” And now, with the pandemic going on, she’s worried about her parents, too.

“If you’re in a multi-generational house, and you know the risk for particularly those over 80, or you’ve seen the nursing home data and realize the number of elderly that we’ve lost through this pandemic, [they] really make it clear you have to focus on the underserved communities but also the significant vulnerable communities that had comorbidities,” she says, adding that Native Americans and “all of our communities that had less access [to health care],” need to be top of mind.

But that doesn’t mean the highly publicized higher risk groups are the only people catching and spreading the coronavirus, which Dr. Birx reiterates many times to make clear we’re all responsible for stopping the spread. “I think what Americans still need to understand is a significant amount, and maybe a majority of individuals who get infected, are asymptomatic or so mild they didn’t notice it,” she says. “So no one’s intentionally transmitting the virus to others, they just don’t know they’re infected, so they wouldn’t even think of getting tested.”

Wear a Mask and Get Tested, Doctor’s Orders

Adding that her department has worked over the last month to expand testing across the country, Dr. Birx says it’s incumbent on all of us to wear masks when out in public to protect one another from further spread. This is far from over, and perhaps we could all stand to be a bit more vigilant than we have thus far.

“I think those that say that we overreacted will look back when we finally find out how much asymptomatic cases there were, and how much mild spread…” she trails off and then adds, “I believe we saved hundreds of thousands of Americans [with shelter-in-place guidelines] and will stand by those decisions we made early on.” Now? She has demonstrated how to continue saving lives by, as White House Correspondent Franchesca Chambers pointed out in a tweet, accessorizing with a mask. Much has been made of Dr. Birx’s penchant for a patterned scarf, from a dedicated Instagram account, to a spoof SNL ad starring Chloe Fineman — but no other accessory suits her job, and her data, quite as well as that mask.

“I just ask all Americans to really assess the risk to the others that you encounter. We still ask for everybody to wash their hands, use hand sanitizer, wear a mask when you can’t socially distance, and really focus on ensuring that we protect those that need our protection,” she said.

“Listen to the Data”

A global health expert and physician with a four-decade career in immunology, vaccine research, and HIV/AIDS as well as other international epidemics, Dr. Birx says she likes to let the research speak for itself — and usually, that’s enough to get people to listen. “I just have always told people the best information with the best data and really let the data speak, and use the data to speak for those who don’t have a voice.” And while the mixed messages about mask wearing coming from President Trump (who wouldn’t, and didn’t, then came around to the idea) seem like they’d rankle any medical expert charged with getting messages to him about proper protocol, Dr. Birx says she has felt heard working under him, as well as previous administrations where she ran the nation’s HIV/AIDS task force, and focused on empowering women while fighting disease overseas.

“I have to say both sides of the aisle and this administration has respected the voice of a woman. Sometimes if I’m out and about and there’s a male and a female that can both equally answer questions, people will tend to ask the male’s opinion first. And I think that really tells us, even today, we have small amounts of gender bias out there, but across administrations, I always tell my daughters, they didn’t treat me like a girl and I know what that's like [laughs].” She did not mention the other famous White House-adjacent physician, Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Disease, who has had quite a media moment amid the coronavirus pandemic. Though it doesn’t seem like the spotlight is what Dr. Birx is after anyway.

She is leading our country’s response to a pandemic the likes of which modern society has not seen; she wants faith in the facts which she faithfully presents every morning: “No just means it’s not a yes until tomorrow," she says. "It means that you never give up. I am relentless and I think in general women need to be relentless in continuing to communicate. I never take no as a real no. I always come back with another graph, another piece of data, and I think that's what we all should be doing.”

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