Dr. Deborah Birx Reacts to Vice President Testing Positive for COVID; Criticizes Trump White House Pandemic Communications

Deborah Birx

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Marianne O’Hare : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter . This week we welcome former White House
Coronavirus Response Coordinator under President Trump , Dr.
Deborah Birx , who's written about her tumultuous e xperience in her
new book “Silent Invasion . ”

Dr. Deborah Birx: M ishandling of communications by the Trump White House ca used
significant issues on the ground and caused amazing confusion.

Marianne O’Hare : We hear from F act C heck.org ’s Managing Editor Lori R obertson, and
we end with a bright idea . Now , here are your host s Mark Masselli
and Margaret Flinter .

Mark Masselli: Joining our guest time is White House Coronavirus Response
coordinator. The Press noted that she was careful to never openly
criticize Pres ident Trump or his administration. But now Dr. Deborah
Birx has had time to reflect and share her thoughts in her new book.

Margaret Flinter: Dr. Birx is a highly regarded infectious disease expert. She's the author
of Silent Invasion , the untold story of the Trump administration ,
COVID - 19, and preventing the next pandemic before it's too late.

Mark Masselli: Well, Dr. Birx , thank you for joining us. But before we get to the book,
we start with the news that Vice President Kamala Harris has tested
positive for COVID and the press has noted that this news is in conflict
with the Biden administration trying to present a calm image about
COVID. What are your thoughts about the Vice President ’s situation
and how it relates overall to what the administration is t rying to
communicate?

Dr. Deborah Birx: Well, I think it illustrates our very dilemma right now. She was
vaccinated , boostered and then re - boost ed and I am sure she will do
incredibly well. She has access to all of the really critical therapeutics.
And I t hink that's part of the reason why I wrote the book, I could see
people trying to make it seem as people who lived in rural areas that
they were getting sicker because of how they voted. And I think what
you have realized, in setting up your clinics across Connecticut, it's an
access issue. And our rural health care is very much diminished , And
very much similar to what I encountered in Sub Saharan Africa 20
years ago.

People just do not have access to top line medical care. I applaud
them expanding access to antivirals into more pharmacies. If you had
looked at that site a week ago, you would have seen about 10 sites in
Oklahoma and 10 sites in Nebraska, that is not going to meet the
needs of the people in the rural areas.

Margaret Flinter: Well, Dr. Birx , your book certainly addresses the very tough times that

Deborah Birx

we all went through starting a little over two years ago, and gives you
a chance to set the record straight. But I'd like to, if I can go to a 2020
New York Times report that said , that mid April of t hat year that you
would roam the halls of the White House, sometimes passing out
diagrams to bolster the case that COVID had peaked. Looking back,
what did that report get right or wrong?

Dr. Deborah Birx: Well, the only right part in that report was that I made extensive
graphics every single day. So when I got back to the United States
from Sub Saharan Africa on March 2 nd , there were no , no really
comprehensive data streams coming in to the F ederal G overnment.
We couldn't see any of the laboratories, we c ouldn't see any of the
hospitals. Less than 40% of the hospitals were doing any type of
reporting.

So , we took a while to assemble all of the data. Many of the private
companies helped me , we call ed them to the White House beginning
of March and they set u p testing. Finally, I asked all the commercial
laboratories that I knew well to develop COVID test s for the average
American , and within literally working around the clock. Within three
weeks. They had tests rolling out across this country. Imagine if that
had happened in January , but two of the main company that was
providing tests, Abbott and Roche, they were providing me the nightly
reports coming off of on their instruments.

And I can tell you what it was like to receive those reports and see
Columbia H ospital reporting 42% test positivity at NYU Langone
reporting 52% test positivity. So , it was very clear that we were well
into just dramatic community spread , and so what the graphics
represented was an integration of cases and test positivity, and
hospi talizations. And I wrote it every day. So every single day, every
Cabinet member, the cabinet members, the members of the task
force, senior leaders in the White House got a summary of the
pandemic and graphs .

So , I don't go skipping through the halls of t he White House , but I
distributed those graphs every day. And it , in that particular what
they're referring to is that Apr il 11 , because I asked him what, what
are you referring to and I pulled up of course April 11 th , and it said
that I believed the cases had peaked in the metro area of New York ,
but we're expanding in Boston, Chicago , Detroit, several major
metropolitan areas that had entered exponential growth. So , I guess if
you only looked at the first bullet point, that things were beginning to
stabil ize six weeks in , in New York, you could have ignored the rest of
the report. I don't just emphasize where things are improving. I'm
very critical of my own use of data , and I make sure it's
comprehensive.

Mark Masselli: Well, thanks for that clarification . And there was a lot of fascination

Deborah Birx

about you and your time in the White House. Some saw you as too
deferential to President Trump, when he was in office, and some say,
you may still reflect some of those using your book. And you're right
that Donald Trum p looms large, to be sure, but the scale of what
occurred in 20 20 , was far greater than even him. You even said that
more than 130,000 American lives could have been saved if Trump
and the Republican governors had acted differently. Why won't you
lay th is at Trump's feet in your book?

Dr. Deborah Birx: In the book, I'm very clear about what went terribly wrong , and I’m
just going to roll that back with when you talk about the Republican
Governors . I spent a lot of time across the south in the summer surge
w ith the Republican Governors , and a 100% of them mitigated at the
level that I requested. So and that was the important piece to me
when you were looking at their reality on the ground and
understanding their situations. I didn't have any Republican Govern or
that I went to visit, refused to do the mitigation that we
recommended, and indeed I learned from them. I learned from
people who shared my views , and I learned from people who didn't
share my views.

And that's the problem if we come into everything wit h a perception
that he's Republican, and I can't listen to him, and I can't learn from
him or he's a Democrat, and I can't listen to him and learn from him.
We all have a tremendous problem. And that's why I wanted to make
it clear that one of the most suc cessful programs in the United States
that was funded by the Federal Government , PEPFAR went through
multiple presidents, four presidents now , 10 Congress's .

I was hoping that the book showed clearly what President Trump had
really difficulty with , and I c learly stated these things were wrong. And
they heard the pandemic, particularly related to communication , but
on the other side, I think that White House allowed us to work in a
way with the private sector that had never been done before. And
that resulte d in test therapeutics and vaccines. So , it's a very
complicated piece , and that's why it took 500 pages to explain it ,
because I really wanted people to understand what has to be fixed,
and what we should really learn from .

I'm deferential to every single president of the United States, I've
worked with every single one since Jimmy Carter . I didn't always
agree with what presidents were saying, but the presidents were
elected by the people of the United States. And that required a level
of respect . I find if you work with people coming from respect, you
can get much more done.

Mark Masselli: Yeah.

Margaret Flinter: You know you talked about the experience of presidents, and I think

Deborah Birx

former President Trump, who may be President again, in the
imaginable future , had the experience both of leading the country
through the first pandemic in a 100 years , being right in the heart of
things. And also the experience of being sick, had COVID himself. If he
were to be back in the White House, and you kind of imagine that
future. What do you think he would do differently that would guide
him as a president?

Dr. Deborah Birx: I have never understood or spen t enough time with President Trump
to really answer that question. I hope as a country, we do three
things . I hope we c reate a national transparent database where all
community acquired infections are tabulated and very clear down to
the most granular level , data transparency drives trust. And I think if
every American could really see what was happening in their
community from early community spread in younger age groups,
gradually making it to the vulnerable community members, we have
35 million Americans over 70, only 1.5 million live in nursing homes.
So majority of our individuals most at risk for this disease are in
c ommunities.

If we don't use that data, like we did in PEPFAR, to identify the gaps,
overcome access and barrier issues and use that data to educate
people on their risk and their needs. We're going to continue to have
deadly surges and I think we're at a p lace where we have the tools
that all Americans can survive and thrive in a time of COVID , but we
are not still using the tools effectively. So I'm hoping long before 2024
and a new election that we have the systems and the agencies and
our F ederal institu tions working in a different way and data available
to every American so that they can make a really clear risk assessment
of what they need to do to protect themselves.

I think the illustration of the Vice President is very clear, people get
infected desp ite ful l vaccination and boosting. If she was someone
over 70, with multiple comorbidities, we know that a significant
number of individuals are still hospitalized, that were vaccinated and
boosted and we know that some of them, succumbed to COVID . We
have to change this. We need the F ederal political will to actually
make it happen. We're going to continue to have these surges, we can
not wait till 2024 and hope that President Trump is different , if he was
reelected.

Mark Masselli: Yeah, you've really laid out a clarion call for sort of reform and the
things that really should be focused in on . Talk to us about the
struggle that you're having, because obviously, people are looking at
this through a political lens, right. And I'm wondering if you could just
share a little bit about the struggle you might be having of trying to
get the noise out of the room and have people really focusin g on the
seriousness of this problem, and the actions that need to take place?

Deborah Birx

Dr. Deborah Birx: One of the things that has c oncerned me the most watching these last
two years, is as a F ederal civil servant, as someone who spent 29
years in the military , as someone who served every president with
respect , that because I went in the White House for a year to help our
COVID Respon se that I have been interpreted as a political human
being.

I never campaigned, I was never politically appointed by President
Trump, I was retained after being appointed by President Obama. The
fact that I'm having to break through that blue - red divide, t hat's going
to pale how civil servants look at working at a high level with
politicals. I had never made my politics known, which was important
in the military, you couldn't go around saying when there's the hijack.
So I took all of that very seriously. Ab out half of the book is about
what was going on in the White House , b ut half of the book is about
what I learned being in the States, what I learned from governors and
mayors, what I learned from the tribal nations, what I learned from
people who are worki ng in rural areas, and on tribal nation
reservations to really tackle this pandemic.

Those are what American people need to see , and I think the other
really amazing thing was going to over 30 universities, and seeing how
many university presidents and stu dent bodies figured out how to
open safely, hopefully, the book i s a wake up call for people to
actually learn what we need to do. And we need to do differently, I
think, after 9 . 11, and the 9 / 11 Commission changed how we gather
intelligence in this countr y, public health and response to pandemics
don't belong to any one agency , and I think we need that same
approach of really being willing to look at ourselves and see where we
failed and failed the American people , and fix it.

This is bigger than who is in t he Oval Office, certainly who is in the
Oval Office can really impact communications and communications is
critical. So , I don't want to make light of that , the mishandling of
communications by the Trump White House caused significant issues
on the groun d, no matter what state I went into, and caused amazing
confusion among the American people , and so that has to be fixed ,
and there has to be consistency there , but we also have to have a
safety net that says every American ought to be able to see the data
themselves.

That's what we did in Sub Saharan Africa. All the PEPFAR data is public
down to the single site serving small numbers of clients, because we
want to make sure no matter where you live, that you can have the
ability to be virally suppressed and thrive with HIV. So we want the
same in this country with COVID.

Margaret Flinter: So Dr. Birx , I hear such resounding themes around communications ,
around access to services , and you know, I personally think it was a

Deborah Birx

great thing to see everybody being ab le to get a COVID vaccine
regardless of their insurance status when we got to that point, that
was a great moment. But the third theme, in addition to
communication and access to services, is really data, data , data. And
certainly the Center for Disease Co ntrol is working hard to speed up
data reporting and its processes. I think, you know, most of us were
kind of surprised that CDC didn't have the kind of robust, timely , daily
data feeds coming in that I just imagined that they did. And I, what's
your advi ce to CDC about what they need to do to get that input
coming in from all points around the country?

Dr. Deborah Birx: Well, I saw this all the time in tackling pandemics around the globe,
people decide that no one will do it, they don't ask, I went to all 6 , 000
hospitals and said, I need your daily admission data. It's nice to know
how many people are in the hospital. But that doesn't give us any
knowledge about where this pandemic is headed, how bad it's going
to get in you r area? How much human capacity you need, and how
much we're going to need to support you , and how many supplies I'm
going to have to s urge to you including treatment?

So , we were not only collecting very little data, we were collecting the
wrong data, you have to prepare for all types o f pandemic. And I think
for decades, CDC prepared for a pandemic based on symptoms and
tracking people by symptoms. And in this 21st century, every single
disease should be diagnosed laborator il y , we do that for diabetes, we
do that by hypertension, for yo ur cholesterol, we don't have people
come into your clinic and say, I think I have diabetes and you say to
them, Oh, I'm going to give you meds now.

No, you would get their glucose, you would get their hemoglobin A 1c .
And here we are deciding if people hav e flu or RSV, or adenovirus,
based on symptoms, when we have the capacity to do this kind of
sophisticated testing, obviously, because we were able to go from no
tests to a million tests within a matter of months. So we have to, as a
country, the pub lic, t here needs to be a public - private partnership
around this data, that data needs to be transparent.

The hospitals and clinics have the data as well as the laboratories, no
one has to have a separate data submission to the CDC that's just
duplicative and cau ses unbelievable amount of additional work, all of
t his information is available electronically. What we need to ensure is
CMS only pays for definitive diagnosed diseases when it comes to
infectious diseases. And then we would know who had flu and who
had COVID.

So there are some simple fixes. Obviously, that's what the nine pages
at the back of the book are , that really ask Congress to look at this.
CDC has to get out of that mindset that there's public health, and then
there's health. There's just health , and we need to use health data to

Deborah Birx

tackle the pandemics that we have of obesity, opioids, TB , around the
globe, and also hypertension, and diabetes, and use data in real time
to improve each of those pieces . People told us that we would not be
able to cha nge the pandemic around the world in HIV, and we did.
And now you do it through data, you actually document what's
happening and who is at risk. And that's where you find what you've
done. You saw the need, you saw the access issue , but you don't stop
with one clinic, you look where they're still in need, I use data to find
the patients who need to be served.

So , it is possible to change pandemics, and we have the luxury of
having a vaccine and effective therapeutics. So we have the tools, but
we have to ut ilize them in a data driven way .

Mark Masselli: Well , coupled with good communication , and in that context, let's
discuss a current challenge we're seeing in our community health
center, and less than 40% of patients who've received the COVID
vaccine have returned to get a booster and I'm wondering what your
thoughts of , that we can do better or differently?

Dr. Deborah Birx: Well, first and foremost, we have to be honest. And I think there was
a lack of honesty about what these vaccines can do and can't do . They
were never measured to prevent infection. We did not test people
weekly in that phase three trial to see who got mild and
asymptomatic disease to site vaccination. We didn't do that. We were
only tracking in those trials, symptomatic disease and the comparison
for efficacy was severe disease and death , and so number one, when
we put these vaccines out there is tell the American people we don't
know how well this will prevent infection.

We think it's going to be very effective against severe disease. Don't
assume because you got the vaccine that you are now invincible and
Superman. And I think if you had put the data up day after day and
collected the information on breakthroughs, which were very evident
in June of 2021 in the southern surge, the wanin g protection against
infection, the waning protection against hospitalization , and the
wa ning protection against death, and you made that available and
understandable in real time, people would have seen the reason to
get a booster. We went out there and s aid, this is a miracle -- it was,
but it had limitations. It's fractured trust, because we're not being
crystal clear to the American people.

I mean, the fact that we're coming out with data now, that says 50%
of the people hospitalized in January, were fu lly vaccinated, that
would have changed people's strategies , but now we're telling them
the end of April when one of the most deadly surges has already
passed through the country. These surges are predictable. This late
spring surge happened last year, hig hly predictable, just like this late
spring surge, we should be preparing right now, for a summer surge

Deborah Birx

and putting the data out daily to the American people, and how
you're going to address those gaps. Every hospitalization and death at
this point is a fa ilure.

Margaret Flinter: Dr. Birx , I noted you mentioned the tribal nations , and your book h as
an important chapter about the tribal nations that really
demonstrated the powerful role of community in curbing spread,
despite the fact that they don't have th e strongest health ca re system.

Dr. Deborah Birx: The tribal nations communicated continuously and presented the
data about test positivity and where this virus is and why they're at
the highest risk. People talk about black and brown Hispanic, and they
al ways leave out the tribal nations, the tribal nations have the highest
case fatality rate in any population. And they knew that , because they
were collecting their own data, they were given inadequate testing,
they are often far removed from health centers , and so what they had
was a sense of community. And they utilize that sense of community
to protect one another.

And I think the same thing happened at many of the universities and
schools, the student body came together to really help other students
focu sed on mental health and really ensured that students could
survive. We have solutions in this country that really show how to
communicate. And I think the other piece of that we haven't done is
the behavioral research to understand vaccine hesitancy. It's very
frustrating to me that we collect data on things and then we don't do
anything to change the number. So we got to collect data and fix
things.

Mark Masselli: Well , thank you, Dr. Birx , and COVID is an evolving story. Your book is
an important part of the history. And thank you for your decades of
service , not only in the PEPFAR HIV AIDS world, but also with COVID.
And thanks to our audience for joining us, you can learn more about
Conversations on Health Care , and sign up for our email at
chcradio.com .

Dr. Deborah Birx: Thank you, and I appreciate so . I looked into everything that you were
doing, starting with one becoming 200 . You don't do that unless
you're data driven and you saw the need and you found a sol ution.
This is what we need all the way across the country.

Margaret Flinter: Thank you. Dr. Birx , thank you for joining us.

Mark Masselli: Congratulation and thank you so much.

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Mark Masselli: At Conversations on Health Care we want our audience to be truly in
the know when it comes to the facts about healthcare reform and policy. Lori Robertson is an award winning journalist and Managing

Deborah Birx

Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of d eception in U.S. Politics.
Lori, what have you got for us this week?

Lori Robertson: The percentage of Americans without health insurance went down
from 2020 to 2021. That's the latest information from the National
Health Interview Survey. The estimates wh ich are early released
figures subject to some final editing and waiting are the 8.9% of the
US population did not have health insurance at the time they were
interviewed in the third quarter of 2021. It's a decrease of 1.4
percentage points from the last quarter of Donald Trump's presidency
to the third quarter of Joe Biden's presidency.

The latest report from the National Health Interview Survey its report
for the first six months of 2021 had estimated the number of the
uninsured dropped by about 500,000 people in the first six months of
2021 compared to the 2020 . Data for the NH I S are collected by the
Census Bureau, which separately issues annual reports on the number
lacking health insurance for the entire year. In 2021 11 . 3 million
people were enrolled in Affordable Care Act exchange plans through
healthcare.gov and state run marketplaces.

In this year's Open Enrollment Period , 14 . 5 million people were
enrolled in plans for 2022 with 3 million of them being new
consumers. About 79 million Americans were enrolled in Medicaid
according to the latest figures from last fall. Employer based
insurance remains the primary source of insurance for Americans with
nearly half of the population on work based health coverage as of
2019.

And t hat's my fact check for this week. I'm Lori Robertson, Managing
Editor of FactCheck.org.

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Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy
Center at the University o f Pennsylvania. If you have a fact that you'd
like checked, e - mail us at www.chcradio.com , we'll have
FactCheck.org's Lori Robertson check it out for you here on Conversations on Health Care.

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Margaret Flint er: Each week Conversations highlights a bright idea about how to make wellness a part of our communities and everyday lives.

For several decades, the CDC has been screening new mothers for issues that could signal a threat to the child's ability to thrive . The
surveillance tool, the P regnancy R isk A ssessment M onitoring S ystem,

Deborah Birx

or PRAMS , as its known, is a population based surveillance tool
designed to identify groups of women and infants at higher risk for
future health problems. Dr. Craig Garfield, founde r of The Family and
Child Health Innovations program at Lurie Children's Hospital in
Chicago thought they were leaving out an important part of the
equation, the dads .

Dr. Craig Garfield : CDC actually approached us , is because they have had for 35 years a
survey of mothers in the perinatal period that gives us really good
data on public health as they transition into motherhood. And they
started to get back comments saying why is the only question that
you asked me about my partner is whether he hit , kick , beat or
slapped me during pregnancy. There's so many things that he did that
helped me get through this pregnancy and you don't ask about any of
those.

Margaret Flinter: Dr. Garfield partnered with the CDC and the Georgia Department of
Health to pilot the deployment of a new surveillance tool. PRAMS for
dads.

Dr. Craig Garfield : We ask questions about the dad ’ s physical health, mental health
access to health care dad 's involve ment with the baby , ideas around
breastfeeding , because we know that the chances o f moms
successfully breastfeeding have a lot to do with if Dad is supportive of
that as well. And then what other risky behaviors that dads might be
involved in that we need to know from a public health perspective,
smoking, drinking, having a gun , those s orts of questions.

Margaret Flinter: Dr. Garfield says identifying issues such as obesity or smoking in a
father at the time of birth is an excellent time to empower the new
father to address those issues impacting not only his health, but the
health of mo ther and baby as well.

Dr. Craig Garfield : As a pediatrician I work with a lot of fathers and the fathers I work
with all are looking at the time of birth to really be the best kind of
father they can be. And a lot of that has to do with being able to
main tain their own h ealth so that they are there when their child gets
older. They want to be there and be involved in different ways that
maybe their father or their grandfather was .

Margaret Flinter: Since launching the pilot PRAMS for dads -- Dr. Garfield's team and
the CDC have expanded the program partnering with several other
states, including Ohio and Massachusetts, and inexpensive easily
deployed surveillance tool, screening new dads for health concerns
that could impact not only their newborn ’ s future health, but their
own health as well. And providing a reliable public health data set for
in dividuals, families, clinicians, and population health as well. Now
that's a bright idea.

Deborah Birx
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Mark Masselli: You've been listening to Conversations on Health Ca re. I'm Mark
Masselli.
Margaret Flinter: And I'm Margaret Flinter.
Mark Masselli: Peace and Health .
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