One of the new staples of the coronavirus outbreak here in the U.S. has been the nightly briefings from the White House Coronavirus Task Force. A regular at the podium, and often the only woman on stage, is Dr. Deborah Birx. In her role as coronavirus response coordinator, she’s become one of the most prominent voices of the administration around this crisis.
Her appearances are a cross between a war-briefing and FDR’s fireside chat. She mixes the minutia of disease transmission with deeply personal stories, then pivots to complex discussions of antibody testing for the virus. She scolds and reassures within minutes of each other.
Her presence on the Task Force as been well-received in the world of public health, though recently some comments have raised eyebrows.
Thursday night she admonished the media about dire warnings of hospitals running out of beds. And she warned against discussions that New Yorkers need to be drawing up Do Not Resuscitate orders because the region’s hospitals have run out of beds and equipment.
“There is no situation in the United States right now that warrants that kind of discussion,” she said.
Birx continued in that vein, attempting to assure Americans that large proportions of the public won’t get infected quickly. On the night when the U.S. surpassed China with the most confirmed cases globally, Birx’s comments drew sharp criticism on social media. The pushback came from some of the country’s top academic epidemiologists.
Marc Lipsitch, an epidemiologist from the Harvard T.H. Chan School of Public Health who’s worked on modeling this virus, tweeted a lengthy rebuttal to her comment that there isn’t currently data showing that 20% of population could get infected.
“The scenario Dr. Birx is ‘assuring’ us about is one in which we somehow escape Italy’s problem of overloaded healthcare system despite the fact that social distancing is not really happening in large parts of the US… That is unlikely,” he wrote.
Lipsitch called Birx’s characterization of the current coronavirus situation in the U.S. “rosy” and even “deceptive.”
“I desperately hope she is right, because much suffering will be avoided,” Lipsitch noted. “But reassurance that this is likely, or even plausible, with the disorganized track record of the US response, is false reassurance.”
These reactions to Birx come as something of a surprise because Birx isn’t just another random bureaucrat at a White House known for staff turnover.
She’s deeply respected in Washington diplomatic circles and among public health experts.
Prior to being assigned to the Coronavirus Task Force on February 26th (the same day Vice President Mike Pence was assigned to the body), Birx was the U.S. Global AIDS Coordinator. That’s an ambassador level job inside the State Department in which she oversaw the U.S. government efforts to combat the spread of HIV globally. She was appointed to the post by President Obama in 2014.
Interestingly she’s one of the few Obama-era holdovers at the Trump White House. Her job as AIDS Coordinator included running PEPFAR, the highly praised program launched by President George W. Bush that’s gotten millions of people with HIV around the world onto life-saving anti-AIDS therapy.
Prior to that she spent nearly a decade running the Centers for Disease Control and Prevention’s global HIV/AIDS division.
Officials in the White House say Birx was assigned to the task force because of her years of experience as an infectious disease expert, and her work using data to help with the U.S. response to the global AIDS epidemic.
And among many people who’ve worked with her on HIV, Birx is held in high regard.
“She is seen as somebody who is totally driven by wanting to end the [HIV] epidemic as quickly as possible,” says Jen Kates, senior vice president and director of Global Health and HIV policy at the Kaiser Family Foundation.
“She’s driven by data and results and getting the job done. I think the one thing probably a lot of people who know her well would say about her is she is driven to get the job done.”
Kates says Birx’s experience both in public health and as someone who knows how to work within the political structures of Washington make her well suited for her new job as the nation’s Coronavirus Response Coordinator.
“You know, to say this is a huge assignment would probably be an understatement,” Kates says.
She adds that Birx is good at connecting with a wide range of audiences. When she ran PEPFAR she knew how to make people care about those affected by HIV, Kates says.
“She’s always tried to bring it down to a connection on more of a personal level,” she says. “Sometimes she’ll talk about her own experience as a parent. Sometimes she’ll talk about her experience working 30 years ago in the military and seeing the first HIV cases. But she always does try to make that connection and I think that’s one of the hallmarks of her leadership.”
In the nightly briefings, Birx often compares attacking the current pandemic to tackling HIV.
On Thursday night she said she believes the U.S. can be using a “laser-focused” response to the coronavirus outbreak, attacking the virus on a county-by-county level and tailoring the response to each individual community.
“Why am I confident that we can do that? Because we do that in Sub-Saharan Africa right now for HIV,” Birx said. “That’s how we’re stopping the epidemic there. So we’ve done it. We’ve done it in resource-limited settings. So I do believe we can transpose that approach here to the United States and be able to have granular data down to a GPS coordinate of a site of a clinic and hospital.”
But even her fellow task force member Anthony Fauci from the National Institutes of Health who also is a specialist HIV has said that the country doesn’t yet have the data to do this.
At times Birx is the policy wonk. At times she’s the matriarch.
On Wednesday night in an appeal to young Americans to take social distancing seriously, she told a story about her grandmother during the 1918 flu pandemic. Her grandmother who was 11 years old at the time brought home the virus that ended up killing her great-grandmother.
“I can tell you my grandmother lived with that for 88 years,” she said, as she called again for people to stay home. “This is the message that is important to everybody. This is not a theoretic. This is a reality. You can see the number of deaths that are occurring. We all have a role in preventing them.”
One of her biggest challenges may be keeping President Trump focused on how serious this unfolding public health crisis is. Trump has been regularly saying how eager he is to get the economy up and running again. The president at times downplays how bad the outbreak is or might become. He hit on this theme again Thursday night, talking about how he’s heard of people who have COVID-19 who never went to the doctor or reported their case.
“You have thousands and — hundreds of thousands of cases like that,” he said. “So you have to add that to the caseload also. And the people that actually die, that percentage is — is a much lower percentage than I ever thought. That’s one of the reasons I say, Look, we’re going to beat this and we’re going to get back to work.”
Taming Trump’s eagerness to restart the economy and his focus on jobs numbers while hospital administrators are making desperate pleas for medical equipment, may be one Birx’s big challenges.
Birx has built up a reputation in the HIV/AIDS world as someone who is dedicated and trusted, says A. Toni Young, the head of Community Education Group, a non-profit that does a lot of work around HIV.
Young says in this current crisis, it was a relief was when she heard that Birx, along with Anthony Fauci from the National Institutes of Health, were on the White House Coronavirus Task Force.
“When I saw she and Dr. Fauci, I said, we have a chance. We honestly have a chance,” she says. “Dr. Fauci, with his scientific perspective and Dr. Birx with her robust knowledge of public health and systems– that’s what this is going to take. This is going to take knowing what all the systems do and how to pull the right lever at the right time.”
Now the question is whether Birx can keep the White House and the nation focused on getting the right resources deployed at the right time to get this health crisis under control.