WASHINGTON — As Dr. Deborah L. Birx was taking heat from both President Trump and Speaker Nancy Pelosi this week, the Democratic governor of Kentucky spoke up in her defense.
Dr. Birx, the White House coronavirus response coordinator, had visited his state in late July, after he issued a statewide mask order and was contemplating even more aggressive steps, including closing down bars, Gov. Andy Beshear recounted on a private conference call with Vice President Mike Pence and the rest of the nation’s governors. It was a difficult move for a Democrat in a Republican state, but Dr. Birx provided him cover.
“She stood in front of our press and made it very clear that she and the administration supported the steps that we were going to take,” Mr. Beshear said.
It was most likely welcome praise for the otherwise embattled Dr. Birx, a respected AIDS researcher who took her current post five months ago and increasingly seems like a woman without a country.
Old allies and public health experts have expressed disgust at her accommodations to Mr. Trump and, more so, at the performance of the federal response she is supposed to be leading against the most devastating public health crisis in a century. Ms. Pelosi said she had lost confidence in Dr. Birx, while Mr. Trump called her “pathetic” after she suggested the obvious: The coronavirus is in a “new phase” and is spreading rampantly.
“Her credibility, particularly in the H.I.V.-AIDS community, has taken an enormous hit in the last five months,” said Mitchell Warren, the executive director of AVAC, a global advocacy group fighting to end H.I.V./AIDS, who has worked closely with Dr. Birx. “She is absolutely data driven, so it is incredibly disappointing to see her coordinating a national response which has not at all been best in class, but has been a disaster on many levels.”
But beyond the cameras and outside the Washington media bubble, governors say she deserves praise for persistence and presence. Gov. Tate Reeves of Mississippi, a Republican, said she prodded him for weeks to institute a statewide mask order; this week he relented.
“She would have been more aggressive. I was a little less aggressive,” he said.
Dr. Carlos del Rio, an infectious disease specialist at Emory University who leads the scientific advisory board for a State Department AIDS program run by Dr. Birx, said, “I know that she told the vice president, ‘Enough is enough; you’re putting a mask on and appearing with a mask,’” adding that Mr. Pence followed the order. “It requires a lot of guts to do that.”
Dr. Birx declined to be interviewed for this article. Her defenders, and even her critics, say she is in a difficult spot, serving a mercurial president who has shown little regard for science.
“Sometimes, looking from the outside you will say she has been too cozy to the president in certain things, but also having talked to her, she’s pushing,” Dr. del Rio said.
Within public health circles, debate is raging over how much blame Dr. Birx bears for the virus’s spread. Some say Mr. Trump is responsible, but, they add, the dangerous misinformation he has spread has often gone uncorrected by Dr. Birx.
“Trump is like the reverse Midas,” said Gregg Gonsalves, a longtime AIDS activist and assistant professor of epidemiology at the Yale School of Public Health. “Everybody who is in his orbit, if they’ve had any integrity, it gets leeched away from them like some parasite.”
But some say Dr. Birx is at least partly responsible for mismanaging the government’s response. A report issued by the State Department’s inspector general in February relayed criticism of her AIDS program leadership team, which was called “dictatorial” and “autocratic.” She has been critical of the Centers for Disease Control and Prevention, and some public health experts view her as partly responsible for sidelining the agency.
Some also fault her for offering unduly rosy assessments of the pandemic — both in public and in private. In April, she told officials in the White House Situation Room that the United States was in good shape.
“I understand obviously wanting to highlight what’s working well,” said Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security. “I also think that failing to be frank about the shortcomings of the response undermines governmental credibility, and governmental credibility is so critical in getting people to take this threat seriously.”
From her office in the West Wing, Dr. Birx serves as a link between federal agencies — the Departments of Defense, Homeland Security, Health and Human Services, and others — engaged in the response.
She is also the point of contact for state and local officials, and oversees the drafting of detailed reports offering guidance to the states. She briefs Mr. Pence weekly and the president at least once a week, and must contend with competing forces on the task force, which includes Dr. Anthony S. Fauci, the government’s top infectious disease expert, and Dr. Robert R. Redfield, the C.D.C. director. She is often the only woman in the room.
In interviews with AIDS activists and public health experts, Dr. Birx drew unfavorable comparisons with the outspoken Dr. Fauci, in whose lab she trained. Mr. Gonsalves, who has long known both of them, said he wrote in March to Drs. Birx, Fauci and Redfield, as well as Adm. Brett P. Giroir, who oversees coronavirus testing, complaining that they were “parroting the president.” Only Dr. Fauci replied.
“Debbie is now in the position where she’s saying to the emperor that those new clothes look fantastic,” Mr. Gonsalves said.
But inside the White House, aides refer to Dr. Birx as “Dr. Doom” for her efforts to temper the president’s positive spin. And she and Dr. Fauci are not in the same situation. Dr. Fauci, 79, is nearing the end of his career and is a civil servant, which frees him to speak his mind. Dr. Birx, 64, is a political appointee who serves at the pleasure of the president.
“She’s one of the hardest workers, and she’s devoted to trying to get this pandemic under control,” Dr. Fauci said in an interview Tuesday night.
Dr. Birx was right for saying the pandemic is in a “new phase,” Dr. Fauci said, even if it meant she would be “blasted by the president.” That phase, “community spread,” means the virus is racing through the general population and is no longer confined to discrete outbreaks in places like nursing homes, factories and prisons.
In a statement, Alyssa Farah, the White House director of strategic communications, said, “Dr. Birx is an American hero, and the president has great respect for her.”
The Coronavirus Outbreak ›
Frequently Asked Questions
Updated August 6, 2020
Why are bars linked to outbreaks?
- Think about a bar. Alcohol is flowing. It can be loud, but it’s definitely intimate, and you often need to lean in close to hear your friend. And strangers have way, way fewer reservations about coming up to people in a bar. That’s sort of the point of a bar. Feeling good and close to strangers. It’s no surprise, then, that bars have been linked to outbreaks in several states. Louisiana health officials have tied at least 100 coronavirus cases to bars in the Tigerland nightlife district in Baton Rouge. Minnesota has traced 328 recent cases to bars across the state. In Idaho, health officials shut down bars in Ada County after reporting clusters of infections among young adults who had visited several bars in downtown Boise. Governors in California, Texas and Arizona, where coronavirus cases are soaring, have ordered hundreds of newly reopened bars to shut down. Less than two weeks after Colorado’s bars reopened at limited capacity, Gov. Jared Polis ordered them to close.
I have antibodies. Am I now immune?
- As of right now, that seems likely, for at least several months. There have been frightening accounts of people suffering what seems to be a second bout of Covid-19. But experts say these patients may have a drawn-out course of infection, with the virus taking a slow toll weeks to months after initial exposure. People infected with the coronavirus typically produce immune molecules called antibodies, which are protective proteins made in response to an infection. These antibodies may last in the body only two to three months, which may seem worrisome, but that’s perfectly normal after an acute infection subsides, said Dr. Michael Mina, an immunologist at Harvard University. It may be possible to get the coronavirus again, but it’s highly unlikely that it would be possible in a short window of time from initial infection or make people sicker the second time.
I’m a small-business owner. Can I get relief?
- The stimulus bills enacted in March offer help for the millions of American small businesses. Those eligible for aid are businesses and nonprofit organizations with fewer than 500 workers, including sole proprietorships, independent contractors and freelancers. Some larger companies in some industries are also eligible. The help being offered, which is being managed by the Small Business Administration, includes the Paycheck Protection Program and the Economic Injury Disaster Loan program. But lots of folks have not yet seen payouts. Even those who have received help are confused: The rules are draconian, and some are stuck sitting on money they don’t know how to use. Many small-business owners are getting less than they expected or not hearing anything at all.
What are my rights if I am worried about going back to work?
What is school going to look like in September?
- It is unlikely that many schools will return to a normal schedule this fall, requiring the grind of online learning, makeshift child care and stunted workdays to continue. California’s two largest public school districts — Los Angeles and San Diego — said on July 13, that instruction will be remote-only in the fall, citing concerns that surging coronavirus infections in their areas pose too dire a risk for students and teachers. Together, the two districts enroll some 825,000 students. They are the largest in the country so far to abandon plans for even a partial physical return to classrooms when they reopen in August. For other districts, the solution won’t be an all-or-nothing approach. Many systems, including the nation’s largest, New York City, are devising hybrid plans that involve spending some days in classrooms and other days online. There’s no national policy on this yet, so check with your municipal school system regularly to see what is happening in your community.
Outside Washington, governors said they appreciated Dr. Birx’s forthrightness and her attention to detail. She has traveled to more than a dozen states by car to get a sense of what is happening and is about to head out on another six-state swing next week, officials said.
Gov. John Bel Edwards of Louisiana, a Democrat, said Dr. Birx “knows what’s happening in Louisiana in real time in terms of our tests results, our positivity numbers” — down to the parish level.
Mr. Reeves said Dr. Birx had been unfairly tarred by liberals who despise the president — the same people, he said, who “have said for months that no one should question the scientists.”
Dr. Birx has drawn criticism for what she has said — and what she has not said. She remained virtually silent while Mr. Trump suggested from the White House lectern that exposure to ultraviolet light or household disinfectants might cure Covid-19. Her lavish praise for the president on the Christian Broadcasting Network in March still rankles.
“He’s been so attentive to the scientific literature and the details and the data,” she said then.
Dr. Ashish Jha, the director of the Harvard Global Health Institute, who has known Dr. Birx for at least a decade and regards her as “a genuinely smart and caring person,” initially gave her the benefit of the doubt on that interview.
“A bunch of people in the public health world just lost their minds on that one, but I said, ‘Look, if she has to praise the president to get him to do the right thing, I can live with that,’” Dr. Jha said. But now, he said, “she has to ask herself whether she’s being effective in protecting the American people, and I would argue at this point that it is not clear that she is.”
Dr. Birx, a colonel in the Army, began her career in the early 1980s as an immunologist at the Walter Reed Army Medical Center and spent part of her training as a fellow in Dr. Fauci’s lab. She was on the cutting edge of research and won the respect not only of fellow scientists but also of evangelical Christians devoted to stopping the spread of the disease.
In 2005, Dr. Birx moved to the C.D.C., where she remained until President Barack Obama appointed her to the State Department as his global AIDS ambassador. When Mr. Trump was elected, she told friends she wanted to keep the job; the next day, she flew to Boston to speak at Harvard University’s Institute of Politics, where she was circumspect about her future.
“We were all like, ‘Oh my God, the devil just got elected,’ and she did not ditto the language,” said Peter Staley, a longtime AIDS activist, who was then on fellowship at Harvard and hosted that November 2016 visit. “I could see the gears in her head moving a million miles an hour wondering, ‘How can I survive?’”