Dr. Deborah Birx emerged from a meeting at the White House one day in late summer with a new resolution: Never again would she sit in a meeting with Dr. Scott Atlas and listen to him pontificate on the pandemic.
That’s when she went all-in on a plan to essentially abandon the White House and avoid the growing influence of Atlas, a radiologist with no expertise in epidemiology who was nevertheless rising in influence with President Donald Trump.
Birx, a physician with decades of experience in global health, told a friend that she would take her message directly to the people and simply sidestep the kind of misleading messages she’d just heard from Atlas in that meeting. The friend requested anonymity to discuss the exchange with CNN.
Now Atlas is Trump’s single go-to adviser on the coronavirus. And Birx, one of the most prominent figures of the early pandemic, is in North Dakota.
She has now been to 40 states and logged more than 20,000 miles, many of them since that fateful August meeting. She tours the country by commercial air, advising small groups of state and local officials on combating transmission. She pulls a small suitcase packed with essentials and an array of the signature scarves she wears each day. Her friends call it her “self-exile.”
“Her personality is to pick up and go where the fight is,” said a colleague of hers for many years. “She always told us – keep your bags packed. She’d say if you’re assigned to another country, don’t sit in the embassy – go to the distant villages. You need to go where the action is, see what they are doing.”
It’s a handy personal credo given that Trump hasn’t consulted in person with Birx in months. She still belongs to the White House coronavirus task force, but it rarely meets these days and its reports aren’t widely disseminated. The President isn’t deploying her to anything, so she’s deploying herself.
“I’ve known Debbie a long time,” said Dr. Jerome Kim, the director general of the International Vaccine Institute, and a former colleague at the Walter Reed Army Institute of Research. “She really is completely driven by getting things done and being effective, and I think she’s frustrated.”
“If she can’t get it done in the White House, the way to do it is go into the field and use personal diplomacy to convince politicians there is a right way to do this and a right way to approach things, and the consequences of failure are significant,” Kim said. “Without an authority coordinating things centrally, the only thing you can do is make people aware of the facts and the truth, and my guess is this is her solution,” said Kim.
Finding her lane
For months, Birx put up with Trump’s rhetoric about the pandemic. She told friends she could live with it, though, as long as she could occasionally get a chance to weigh in with the President.
But soon after Atlas was formally named to the task force on August 10, Birx told friends, it became clear that she wasn’t going to get much time with Trump – if any at all.
After that August meeting, she came out of the room and told a friend Atlas was “not going to tell me what to do,” the friend said, recounting the conversation.
She felt even further vindicated recently when Atlas tweeted about the folly of requiring mask-wearing and Twitter removed the tweet. She said to a friend that she wished the administration would take the same editorial approach to his statements.
Birx’s own future is uncertain, like so many in the federal health bureaucracy. She’s on the outs with the current administration and, if former Vice President Joe Biden is elected, it’s not clear if she would be invited to stay on. Though it’s a move she has successfully navigated before, working first for President George W. Bush, then President Barack Obama and now Trump. Some prominent health officials may have harmed their credibility with Biden by working to remain relevant in the Trump orbit all these months.
But even if Birx no longer has Trump’s ear, she still has a public persona. And plenty of officials around the country – struggling to deal with the pandemic in the absence of a coordinated national strategy – are more than happy to have her help.
On Monday, Birx was in Bismarck, North Dakota, where coronavirus cases are on the rise. She spoke with local, tribal and state health officials in a closed-door meeting where she criticized how the state was responding to the surge in cases.
This evaluate-then-lecture tactic is part of Birx’s new routine, say friends and colleagues. She sees for herself what a region is doing to protect itself, taking stock with her own eyes how behaviors and social functions and retail outfits are – or are not – following guidelines.
“Imagine going to your local Safeway and finding Debbie Birx going up and down the aisles,” says a longtime friend. “Or the bank, or the nail salon, or wherever. That is literally what she’s doing, and it’s the only way she knows to get an accurate perspective on how this virus is spreading, and how people are not doing what they should be doing to stop it.”
Hitting the road
By Tuesday, Birx had rolled her suitcase through yet another airport, arriving in Montana, another day away from her family back in Washington, another non-descript government building to unpack her paraphernalia of charts and research, guidelines and graphs. In Billings, she warned officials in a closed-door meeting they were looking at grim weeks ahead, indicating there would not be any sort of corner-rounding – the virus in states such as Montana was having its way with locals. John Felton, Yellowstone County’s public health officer, recounted Birx’s seriousness to reporters after his meeting with her.
“Her prediction is, if we don’t get better compliance in those areas, we’re looking at a pretty rough rest of the year at this point,” Felton said. “It’s an important message, and we need to pay attention.”
Wednesday found Birx in central Wyoming, on a visit to the Wind River Reservation. Tribal regions are of particular concern to Birx, who worries there is not enough information about the virus, nor testing or resources available. She led a two-hour Zoom call with health officials in the area, again urging the need for masks.
As she travels, says the friend who communicates with her regularly, Birx is trying to “block out the noise.”
It’s hard to do, though. Atlas advocates openly for opening the economy, and downplays the importance of widespread testing and mask-wearing. He has also spread the idea that Covid-19 is mainly bad for older people and does not affect children all that much.
She also has her future to think of.
Birx’s adherence to the administration has led to robust criticism from those who question which loyalty she more aligned: health and science, or Trump. For example, Birx didn’t say anything when the President opined from the podium of the White House briefing room that injecting bleach into one’s body might be an effective method of ridding coronavirus.
“My wife and I both worked for her, and we’ve known her for a long time,” said Kim of that moment Birx visibly squirmed. “When we saw that look on her face, it was a look we’d seen before when people in charge make outrageous statements. She doesn’t say anything, but we know the look on her face, and it was exactly déjà vu. But what do you do when the president talks about injecting bleach?”
He adds that it is her military training that likely prevented her from correcting the person in charge in front of everyone.
“The correct way to do it is behind-the-scenes so they won’t be embarrassed,” he said.
It is unknown whether pushback such as that on the President, or any of her advice, more handily ignored with Atlas’ influence, was part of Birx’s decision to get out on the road. “She easily could work in the private sector and make a ton of money, but her ethos is to work in the public sector and to be a public servant and in the truth business,” says the former colleague.
For now, the friend who communicates with her regularly say Birx is trying to “block out the noise and focus,” which is harder to do as Trump’s rhetoric ramps up, and citizens suffer from virus fatigue.
“Debbie will do what she’s always done,” her friend said, “keep going.”