For Dr. Deborah Birx, Urging Calm Has Come With Heavy Criticism - The New York Times

The White House’s coronavirus response coordinator drew criticism for comments she made about ventilator shortages, and for gushing praise of President Trump.

• Published March 27, 2020Updated March 28, 2020, 8:38 a.m. ET

WASHINGTON — The White House coronavirus task force has featured two trusted medical voices, diplomatic but authoritative, able to gently push back on President Trump without incurring his wrath: Drs. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, and Deborah L. Birx, the coronavirus response coordinator.

But this week, Dr. Birx’s comments casting doubt on talk of ventilator and hospital-bed shortages, and praising Mr. Trump’s attention to detail in lavish terms, have raised questions about her independence as the number of coronavirus infections in the United States has soared past 100,000.

Practically overnight, Dr. Birx has become a partisan Rorschach test. Conservative commentators have praised her as a truth-teller, pushing back on coronavirus hysteria. Critics of Mr. Trump accused her of squandering the credibility she had developed as a health official in Democratic and Republican administrations.

Dr. Birx’s comments, especially those dismissing ventilator shortages, startled some health experts. While most hospitals might have sufficient supplies at the moment, many worry about a crush of patients in the very near future.

Dr. Howard Bauchner, the editor in chief of The Journal of the American Medical Association, warned Friday of “a potential tsunami coming” on a video call with hundreds of other physicians about rationing ventilators and critical care.

Dr. Ryan A. Stanton, a board member at the American College of Emergency Physicians, said Dr. Birx sounded like “the builders of the Titanic saying the ship can’t sink.”

Public health officials have emphasized that regions of the country less urgently in need of more ventilators could donate some of their inventory to health systems in more desperate need, a point that Dr. Birx made Thursday night.

Mr. Trump on Friday, appearing to respond to widespread criticism from various cities and states, announced that the federal government would issue contracts to buy thousands of ventilators from a variety of large and small makers. But it appeared doubtful the devices could be produced in time to help the overwhelmed hospitals.

Dr. Birx has had to oscillate between occasionally competing forces on the task force, which features a set of doctors and scientists who have often registered skepticism with the White House’s attitude toward coronavirus policy. In private discussions, she has joined with members of the group whom she has known for decades to push the State Department to issue an advisory against traveling on cruises.

This week, she met with Drs. Fauci, Stephen M. Hahn, the commissioner of the Food and Drug Administration, and Robert R. Redfield, the director of the Centers for Disease Control and Prevention, where the group talked through concerns about the Trump administration’s embrace of malaria drugs as possible treatments for Covid-19, the disease caused by the coronavirus, according to a senior administration official.

Publicly, Dr. Birx has been a soothing constant next to Mr. Trump and Vice President Mike Pence in coronavirus meetings and briefings, where she has been one of the few regulars in a rotating cast of health officials perched behind the White House lectern. Mr. Pence, who is overseeing the government’s response, introduced her at the time of her appointment as his “right arm.”

But on Thursday, that delicate balance appeared to tip. After talking to New York officials, Dr. Birx said she had been told that there were still intensive care beds and “over 1,000 or 2,000” ventilators still available. She also dismissed news stories of hospitals drafting blanket do-not-resuscitate orders for critically ill Covid-19 patients.

“To say that to the American people, to make the implication that when they need a hospital bed, it’s not going to be there, or when they need that ventilator, it’s not going to be there — we don’t have evidence of that right now,” she said.

Just a few feet away stood Dr. Fauci, a longtime friend and mentor of Dr. Birx’s, who had his own message: hunker down. He said that the coronavirus could become cyclical. He cautioned that a vaccine was still many months away. And he said that therapeutic treatments, which Mr. Trump has eagerly pushed as a “game changer,” were still unproven.

“The best way to get the best drug as quickly as possible is to do a randomized controlled trial so that you know is it safe and is it effective,” he said. “If it’s not effective, get it off the board and go to the next thing.”

The realities on the ground appear to favor the tone of Dr. Fauci’s warnings. Dr. Mahshid Abir, an emergency physician at the University of Michigan and an expert on hospital preparedness, said on Friday that shortages are inevitable. Hospital systems not only in New York but Atlanta, Seattle and New Orleans are already warning that they have or will reach capacity in the coming days.

“No matter what assumption you use, even on the lower end, the ventilator capacity is just not going to be there,” she said.

The United States currently has 160,000 to 200,000 ventilators, but as many as one million patients might need to use one of the machines during the outbreak, according to the Society of Critical Care Medicine.

Dr. Birx, who has built a well of bipartisan admiration in her years as a health official, has more recently accommodated herself to the political winds with the kind of presidential flattery that Mr. Trump demands from aides.

“He has been so attentive to the details and the data, and his ability to analyze and integrate data has been a real benefit during these discussions about medical issues,” she gushed in an interview with the Christian Broadcasting Network on Wednesday.

To some extent, public health professionals have expressed sympathy for her position.

“Harnessing political will to implement recommendations from the country’s top respiratory disease public health experts and organizing the government to manage the response effectively is hard,” said Dr. Thomas R. Frieden, who worked with Dr. Birx when he ran the Centers for Disease Control and Prevention and she oversaw its division on global AIDS. “Many lives depend on getting that balance right.”

A colonel in the Army, she 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. In 2014, President Barack Obama put her in charge of addressing the global AIDS epidemic. She also created a program called DREAMS, a public-private partnership to reduce rates of H.I.V. among adolescent girls and young women.

In her current role, Dr. Birx’s appeals have extended to some of Mr. Trump’s favorite conservative media personalities. She appeared alongside Mr. Pence in a private White House meeting earlier this month to update figures as divisive and confrontational as Dan Bongino and Eric Bolling.

And she has introduced herself to new crowds, giving advice on self-quarantining this week on “The Morning Toast,” a talk show on YouTube that is popular with a young audience.

In meetings, Mr. Trump appears to prefer Dr. Birx’s genial approach over Dr. Fauci’s blunt talk.

Mr. Trump and several White House officials view Dr. Fauci with some level of skepticism, believing he tends too much to his own public persona and has gone “rogue” on messaging. Dr. Birx, they think, is more willing to be patient with the president’s interruptions and theorizing about medicine.

Among Mr. Trump’s frustrations with Dr. Fauci has been his unwillingness to embrace the malaria drugs that Mr. Trump has celebrated, chloroquine and hydroxychloroquine. Dr. Fauci has been much more vocal about their risks, and dismissed potential evidence of their success in treating the coronavirus as anecdotal.

Noah Weiland reported from Washington, and Maggie Haberman from New York. Sheri Fink contributed reporting from New York.

• Updated March 24, 2020

  • How does coronavirus spread?

    It seems to spread very easily from person to person, especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.

  • Is there a vaccine yet?

    No. The first testing in humans of an experimental vaccine began in mid-March. Such rapid development of a potential vaccine is unprecedented, but even if it is proved safe and effective, it probably will not be available for 12 to18 months.

  • What makes this outbreak so different?

    Unlike the flu, there is no known treatment or vaccine, and little is known about this particular virus so far. It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions — not just those with respiratory diseases — particularly hard.

  • What should I do if I feel sick?

    If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

  • How do I get tested?

    If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.

  • What if somebody in my family gets sick?

    If the family member doesn’t need hospitalization and can be cared for at home, you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to guidelines issued by the C.D.C. If there’s space, the sick family member should stay in a separate room and use a separate bathroom. If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don’t forget to wash your hands frequently.

  • Should I wear a mask?

    No. Unless you’re already infected, or caring for someone who is, a face mask is not recommended. And stockpiling them will make it harder for nurses and other workers to access the resources they need to help on the front lines.

  • Should I stock up on groceries?

    Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.

  • Can I go to the park?

    Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.

  • Should I pull my money from the markets?

    That’s not a good idea. Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.

  • What should I do with my 401(k)?

    Watching your balance go up and down can be scary. You may be wondering if you should decrease your contributions — don’t! If your employer matches any part of your contributions, make sure you’re at least saving as much as you can to get that “free money.”