August 30, 2022
Dear Friends and Family,
Segment 3 of the Covid Pandemic Critique is devoted to the White House Coronavirus Task Force. All the excerpts are from Silent Invasion by Dr. Deborah Birx, the coordinator of the task force.
The book is 474 pages and some of the character aspects get lost when condensed to 7 pages. I elected to focus on the strategy aspects of the task force and the controversy surrounding it. The strategy implemented by the three public health doctors – Fauci, Birx, and Redfield – was uniform mitigation to all age groups with social distancing, masking, limited group size and wait for a vaccine. This was coupled with lockdowns for most states at the beginning of the virus spread. An overarching assumption underpinning the strategy was that the spread was enhanced by asymptomatic carriers. All of this was challenged repeatedly, hence the controversy. The taskforce never altered the strategy. The Biden administration followed the same strategy augmented with mandatory vaccinations where possible. What does not come out in the excerpts was the devotion and hard work Dr. Birx put into the task force effort – far in excess than that of Drs. Fauci and Redfield.
In hindsight I conclude that President Trump made a mistake in putting the three in charge.
At the end of the attached PDF, you can find the makeup of the task force as well as a short biography of the three doctors (pages 18-21).
Next: In August 2020, five months after the formation of the White House Task Force, Dr. Scott Atlas, a healthcare expert from Stanford University, joined the task force at the request of President Trump. The excerpts from his book A Plaque Upon Our House, provides a counter to the task force strategy.
Happy Learning,
Harley
Dear Friends and Family,
Segment 3 of the Covid Pandemic Critique is devoted to the White House Coronavirus Task Force. All the excerpts are from Silent Invasion by Dr. Deborah Birx, the coordinator of the task force.
The book is 474 pages and some of the character aspects get lost when condensed to 7 pages. I elected to focus on the strategy aspects of the task force and the controversy surrounding it. The strategy implemented by the three public health doctors – Fauci, Birx, and Redfield – was uniform mitigation to all age groups with social distancing, masking, limited group size and wait for a vaccine. This was coupled with lockdowns for most states at the beginning of the virus spread. An overarching assumption underpinning the strategy was that the spread was enhanced by asymptomatic carriers. All of this was challenged repeatedly, hence the controversy. The taskforce never altered the strategy. The Biden administration followed the same strategy augmented with mandatory vaccinations where possible. What does not come out in the excerpts was the devotion and hard work Dr. Birx put into the task force effort – far in excess than that of Drs. Fauci and Redfield.
In hindsight I conclude that President Trump made a mistake in putting the three in charge.
At the end of the attached PDF, you can find the makeup of the task force as well as a short biography of the three doctors (pages 18-21).
Next: In August 2020, five months after the formation of the White House Task Force, Dr. Scott Atlas, a healthcare expert from Stanford University, joined the task force at the request of President Trump. The excerpts from his book A Plaque Upon Our House, provides a counter to the task force strategy.
Happy Learning,
Harley
COVID PANDEMIC CRITIQUE – SEGMENT 3
THE WHITE HOUSE CORONAVIRUS TASK FORCE --EXCERPTS
All Excerpts are from: Silent Invasion by Dr. Deborah Birx (2022)
INTRODUCTION: I wanted to do what was best for my country, but I also had to consider what would happen to me. They could easily blame the civil servants and characterize us as members of the “deep state.” These were realistic possibilities. It was true that Tony Fauci, Bob Redfield, and I had agreed that if one of us was fired the others would resign in protest.
It was clear that the president was constantly soliciting opinions from his senior advisors, but also from his outside influencers and from random people who crossed his path. I was not, and would not be present for many of these interactions, and as such, I needed to ensure that someone in the room was armed not just with the data, but with the correct interpretation of the data.
FLATTENING THE CURVE: On March 10 we had drafts of flatten-the-curve guidance. The “low-cost” interventions would be social distancing and enhanced hygiene vigilance. We made the difficult and significant decision not to include a specific reference to wearing masks. Not without the full support of the CDC on nonmedical-grade masks, given the administration’s ongoing resistance to their use. Four weeks later we were able to put the importance of masking in the opening guidelines. But for that four weeks we put Americans at substantial risk. Silent asymptomatic spread was a significant contributor to the outbreak, and all the advice we’re giving the American public spoke to that point, but without mentioning the concept by name.
We got the green light from President Trump. The White House would post “The President’s Coronavirus Guidelines for America” on its website. Trump would announce the campaign which was eventually given the name “15 days to Slow the Spread.” Following President Trump’s announcement of the guidelines – almost on cue – the recommendations served as the basis for governors to mandate the flattening-the-curve shutdowns. The White House had handed down guidance, and the governors took that ball and ran with it. Based on the weekly governors’ call and my other interactions with them, I could tell they’d been looking for the White House to take the lead in letting the American public know how serious the situation was. The governors now had “permission” to mount a proportionate response and, one by one, other states followed suit.
No sooner had we convince the Trump administration to implement our version of a two-week shutdown than I was trying to figure out how to extend it. Fifteen Days to Slow the Spread was a start, but I knew it would be just that.
“Mr. President, we need to take additional action immediately. I’m recommending that we extend the Slow the Spread measures by 30 days.” “What are you basing this on?” I explained to him how the U.S. was tracking as Italy had: we were two weeks behind where they were. I hit hard on Italy’s case fatality rate, the toll it was taking especially on people over 70, people with other health issues – the overweight, the hypertensive, those with known cardiac or other respiratory or systemic issues. I showed him one of the charts we’d created. It literally and figuratively demonstrated the graphic nature of the reality. It showed a steep and inexorable rate of rise of infections, hospitalizations, and deaths. “That fast?” he said. “Yes, Mr. President.” “How many.” “One to two hundred thousand by the end of May. Best-case scenario.” Worst case?” “If we do nothing?” He nodded. “Millions. Somewhere between one-point-five and two-point-five million.” “Are you sure?” “I am, Mr. President.” “Tony, what about you?” He turned to Dr. Fauci. “Do you see it the same?” “Yes, Mr. President. I do.” The president nodded. “Okay, okay.”
“We will never shut down the country again. Never.” President Trump’s tone was emphatic, edged with agitation. It was the first week of April 3, mere days after the president had announce the thirty-day extension of the Slow the Spread campaign, and the ground had shifted suddenly and without warning.
Kevin Hasset, who had once served as the president’s Council of Economic Advisors (CEA) where he had demonstrated a brilliant understanding of economics, had been brought to the White House when the pandemic response began. He and his associate Tyler Goodspeed had put together an independent analysis of the data I’d used for my computational assumptions, using similar case curves they had developed. Their conclusion: in this first surge, 26,000 people would die by Memorial Day. We had predicted between 100,000 and 240,000. Clearly this was an enormous difference. My projections were nearly four to ten times greater. It helped the CEA enormously that their data happened to jibe with a typical seasonal flu season, matching what the president and many in the administration had been saying all along.
OPENING UP: As early as April 7, 2020, at the direction of the White House senior advisors, the task force and many others in the administration were at work on a parallel mission: to develop a plan to reopen the country as soon as possible. My goal was to make the reopening of the states a data-driven exercise; as each state moved toward reopening, it would have to pass through one phase, or gate, before moving on to the next, thus ensuring the greatest degree of public safety.
To move from one phase of reopening to the next, states would have to demonstrate a 14-day continuous decline and test positivity, clearly demonstrating that its community spread was under control. Within my gating criteria was a clear call for weekly testing across a community, even of people who appear well, to serve as an early alert of asymptomatic community spread. This was very important to me, as I fundamentally believed that community spread began silently among the 18-to-35 age group, who were more social and more likely to gather together indoors. I was scrupulous in making sure the benchmarks for proceeding from one gate to the next were as stringent as possible. (Note: As reported in segment 2, testing was problematic; the rapid antigen test was not approved by the FDA for asymptomatic diagnosis until July 2021 and PCR testing was limited for much of the summer and fall of 2020 because of lab analysis constraints. Testing for asymptomatic people was very difficult to achieve in mass).
According to the approved gating criteria, all states had to go through a mandatory two-week period just to prove they could start phase one. I was able to get our strict gating criteria and framework plan approved and posted to the White House website as official policy. Just as important, we’d effectively extended the Slow the Spread Campaign for two addition weeks, to mid-May, as each state demonstrated its control of the virus in their state.
THE GOVERNORS: Up to this point, the vice president had been important for communication with the governors. They still weren’t getting the message about the three-week lag time, that testing of younger cohorts and finding asymptomatic infections was important, that small outbreaks could be mitigated, but that the silent spread was still at work. Calls from Vice President Pence would not be enough. Increasingly, as the doctors on the task force ran into the limits of what could be accomplished from Washington, D.C., I saw a need for more ground-level intervention that could carry our message directly to the decision makers in the states and cities – not over the phone or on Zoom, but in person. Someone from the federal government needed to go out into the field. I believed that was the role of the CDC. I sent an urgent message to Bob Redfield, asking him to send CDC personnel to North Carolina and Arizona, two states at most immediate risk of a surge, to speak with local health authorities and the community. In response to urging, Bob said his hands were tied. He couldn’t force anyone to go to one of the Covid-19 hot spots, or anywhere else for that matter. He had to ask for volunteers.
I had to get out of the White House and to the states. I had to look governors and state and local public health officials in the eye, read their expressions, know when I needed to provide greater clarification, and show them the data and the graphics to give them an evidence base to support the measures I had seen working elsewhere and that had been so effective in other places.
THE UPENN/CHOP MODEL: Dr. David Rubin directs the PolicyLab at Children’s Hospital of Philadelphia (CHOP) had produced a highly interactive Covid-19 forecasting model at the most granular level. They would eventually use it to prepare school reopening guidance and in-person schooling recommendations. We asked him to model the impact of a statewide mask mandate, significant expansion of outdoor dining while reducing indoor dining to 25% and closing standing-room-only bars. We also asked that the model reflect keeping retail spaces open as long as masks were worn in all indoor places. His models demonstrated the impact of these measures on the replication rate of the virus. The UPenn/CHOP model worked in theory. Now we needed to implement it at an actual population level and measure the impact on viral community spread.
Governor Greg Abbott of Texas was our first stop. At the start, the governor seemed skeptical that doing three rather simple things – universal masking, restricting indoor dining occupancy, and allowing only smaller social gatherings. “We’ve done these things,” he told me. “We can’t seem to make any real headway.” “You’ve done two of the three things, Governor,” I told him. “Without the mask mandates, you lessen the positive effects of the other two.” He frowned. “Masks? Nobody seems to agree on that one. It’s a real hard sell.” “It will keep more folks alive,” I said. On July 2 he issued a mask mandate. Cases in Texas peaked around July 15, consistent with the masking mandate being added to Abbott’s decreasing indoor occupancy and his clear public messaging. The UPenn/CHOP model was working! [NOTE: within 13 days]
In late July 2020, I wrote Tony and the rest of the docs on the task force. Masking works and you need to do it anytime you are in public indoor spaces. Schools in areas with fewer than 50 cases per 100,000 should open and schools with greater than 50 cases per 100,000 could open with testing and masking to prevent the present community spread from invading the classrooms.
A DIFFERENT VIEWPOINT: Scott Atlas formally arrived in the White House on August 10, as an unpaid senior advisor to the president. He was already an insidious presence and I suspected he had been so for quite some time. He had made himself comfortable and seemed poised to make me and others very uncomfortable. He had gained notoriety and credibility within the White House and with the president because, for years, he had backed the prevailing views of the Republican Party on health care reform. With his lack of experience in the field, I concluded that as far as his views on the pandemic response were concerned, not much substance was there.
Atlas believed it was possible to fence off the vulnerable Americans with significant medical issues and elderly Americans over seventy and let the virus move undetected and unmitigated among the full population. That was his theory, and if that were possible, it would be a powerful effective tool. The problem was that it wasn’t implementable. It simply wasn’t possible to protect everyone in the community at significant risk and let the virus spread wildly without protective vaccines. He was not an infectious disease expert. He was a respected health care policy wonk on the right. Mistakenly, I at first assumed that, given his lack of direct experience or background in pandemic response, Atlas could be easily dismissed. Clearly, he was a contrarian, and I wondered if, like other of this type, he was more interested in being viewed as a contrarian than in actually advocating for his positions – which, to me, were untenable. Regardless of the name it goes by, this approach, this set of beliefs – that masks are likely ineffective, that children cannot pass on the virus (and thus, by extension, that schools should remain open with students and teachers unmasked), that the role of government is not to squash the virus but to let it spread while protecting only the most vulnerable Americans – was dangerous.
Not only was Atlas dismissive of the data and analysis of the pandemic, and offering dangerous counterfactuals, but he was dismissing me and denying me the opportunity to rebut his claims. I’d been cut out of the loop. I went ballistic. I told Mark Meadows in no uncertain terms that Atlas’s egregious stunt was not something I would tolerate. I didn’t want Atlas around, and I didn’t understand why anyone should have to tolerate his blatant maneuvering and manipulation. Meadow’s response? The equivalent of “That’s interesting.”
On August 2, I came under attack – this time from an unlikely source, Speaker of the House Nancy Pelosi. The media company Politico had reported that, in a meeting with Mark Meadows and Steven Mnuchin, Pelosi had said, “Deborah Birx is the worst. Wow, what horrible hands you’re in.” I had too much respect for Nancy Pelosi to engage in any kind of back-and-forth.
On August 2, I was given the chance, at the last minute, to speak on State of the Union, a Sunday show on CNN, with anchor Dana Bash. I seized on this rare opportunity to address the American people directly, to set the record straight: “I want to be very clear: The virus is extraordinarily widespread. The next morning, August 3, my cell phone range. “Hold for the president.” “Mr. President, this is Debbi,” I said. A moment passed before I heard that familiar, pained tone: “What do you think you’re doing? Don’t you ever do that again. ‘Extraordinarily widespread.’ Do you know how those words scare America.”
SCOTT ATLAS SHRUGS: The Oval Office meeting of August 8. “We are currently at just under 50,000 cases a day,” I said. “We are trending downward from the July peak, but I am very, very concerned about this fall. That could be an incredibly deadly period. The way to prevent that is to mitigate – expand testing, masking, and reduce indoor unmasked gatherings. We’ve got to fight the virus that is here now and coming to new communities in the fall.” The president sat back and folded his arms, nodded. When I pressed on, he waved me off and turned toward Scott Atlas: “Is that how you see it?”
“I couldn’t disagree more strongly,” Scott Atlas said. “No matter what we do, the outcome is going to be the same. You don’t need to mitigate. You don’t need to test. All we need to do, and we’ve already done this, is to protect the most vulnerable.” Though the president might have been doing the opposite of what I was recommending and saying the opposite of what I was saying, his White House supported my actions, and I was never stopped. As a result, I could still go to state and local governments with clear science and data-driven recommendations to mitigate community spread without defying the commander in chief’s orders. If he didn’t specifically lay out what was permissible, then I was free to do what I knew was necessary.
Of course, Atlas couldn’t just leave things alone. He wanted and needed to substantiate his claims further, to bring more people within the administration and around the country over to his side. So, on August 13 he announced that he was convening a panel of infectious disease experts for a roundtable discussion. He would invite Dr. Martin Kulldorff, PhD. from Harvard: Dr. Joseph Ladapo from UCLA; Dr. Jay Bhattacharya from Stanford; and Dr. Cody Meissner from Tufts. On August 25, I wrote a sharply worded email to Marc Short, Pence’s chief of staff, informing him that I would not be a part of Atlas’s roundtable, especially with a fringe group who championed herd immunity and who believed that the United States could be like Sweden. Individually, I contacted Marc Short, Mark Meadows and Jared Kushner. I communicated clearly to everyone: “I won’t be in any meetings any longer if Scott Atlas is present at them. If that means in the Oval Office, it doesn’t matter. If it’s at the task force, it doesn’t matter. If it’s at the Covid Huddle, I don’t want him there. Scott Atlas no longer attended task force meetings.
Emboldened, I took things a step further. “I want to be clear: I can’t support what Scott Atlas is saying, and I will need to say exactly the opposite of what the president is saying.” The vice president’s eyes narrowed for a moment. He considered his response for another few seconds. Then, he looked me in the eye, his voice steady, and said, “You need to do what you need to do.”
At about this time, I’d been reading the Biden pandemic plan, which had been made widely available. In short, I was impressed by it, particularly because of its emphasis on the importance of testing aligned with my own beliefs on that crucial mitigation tool.
GOVERNOR REPORTS: Our governor’s reports were a key component of our direct communication of the migration approach being executed across the Sun Belt. The message: masking, closing bars and restricting indoor occupancy, and limiting social gathering indoors – had to be delivered. Still, the kind of pushback Marc Short was receiving and that he was reiterating to me and sharing widely within the administration, continued throughout the summer and intensified in the fall, as the pandemic became far, far worse. The message from some governors was We don’t want to know what you are seeing in our counties, our nursing homes, and our hospitals. Let us go our own way. This resistance always made me wonder. If they’re not willing to listen to us, then whom are they listening to? While I was still on the road, Marc Short had written to me stating, essentially, that these common mitigation points in the governor’s reports had to stop.
I devised a work-around for the governor’s reports I was then writing. Week by week Marc’s office began providing line-by-line edits. After the heavily edited documents were returned to me, I’d reinsert what they had objected to, but place it in those different locations. I shared these strategies with the three members of the data team also writing these reports. Our Saturday and Sunday report-writing routine soon became; write, submit, revise, hide, resubmit. Fortunately, this strategic sleight-of -hand worked.
Eight months into the pandemic, many at both the White House and the CDC still refused to see that silent spread played a prominent role in viral spread and that it started with social gatherings, especially among the younger adults. We had to find a way around them. Bob and I agreed to quietly rewrite the guidance and post it to the CDC website. We would not seek approval. Because we were both quite busy, it might take a week or two, but we were committed to subverting the dangerous message that limiting testing was the right thing to do.
On September 18, Mark Meadow’s name and number flashed across my White House issued smartphone. “What the hell do you think you’re doing? You rewrote and posted the CDC stuff.” You went over my head. You do not make unilateral decisions. It’s that simple. Period. End of sentence. Understood? Don’t ever do this again.” “Understood. I did what I needed to do.” “Don’t do that again without talking with me first.” He never said this, but in this case, his actions spoke louder than words. He allowed the new testing guidance to stand.
The day after Mark Meadows’s angry call, I received a call from the surgeon general of Florida. The news was not good: Scott Atlas had told the governor that the state had achieved the level of infection that met the criteria for herd immunity, that it wouldn’t experience a significant surge again, and that it didn’t need to keep mitigating as it had been. I immediately wrote to Jared Kushner. I informed him that we couldn’t afford to have another state reverse course like Florida had. If Atlas was going to travel to states like I was doing, then we needed to send him someplace like South Dakota, where the outbreak was low and where he could do less real harm. Governor Kristi Noem wasn’t mitigating in any serious way, and Dr. Atlas would find a kindred spirit there. We couldn’t have Atlas telling governors just before winter that testing, masking, and other mitigation were no longer needed.
Governor DeSantis had lifted all restrictions and prevented local counties and cities from adopting their own restrictions based on ground level assessments. His about-face wasn’t a result of a significant decrease in cases; instead, it seemed to be the result of embracing Scott Atlas’s beliefs and positions. Apparently in a single visit to Florida, Atlas had undone months of work.
THE ELECTION: On November 2, the eve of Election Day, the Washington Post reported on an “internal memo” I’d written. The article, headlined “Top Trump Advisor Bluntly Contradicts President on Covid-19 Threat, Urging All-Out Response.” I reported for work the day after the election. I spotted Mark Meadows. “Mark,” I said, “you don’t think that I gave the report to the Post.” He looked up from the documents he was reading. “What I think doesn’t matter. It’s what you made people think that does. You saw the exit polls. You’ve seen what’s going on in the critical races. You think that your words didn’t matter? They did. Big time.” He edged to the side to move past me. “You can’t pin that on me.” “No?” He turned back to face me. “You can believe what you want, but you need to know this: your reputation is toast. What you did or didn’t do isn’t going to change that.”
A NEW ADMINISTRATION: The Biden administration hit the ground running in January 2021, focusing their efforts on consistent messaging and ensuring access to vaccine supplies across the United States. The Biden Covid-19 plan was thoughtful and comprehensive. But, after the inauguration, the Biden administration turned their full attention to effectively rolling out vaccines. Once again, we were slow to act to this global evolving picture. We continued to under-test. We didn’t actively look for those mild and asymptomatic “breakthrough” infections in vaccinees. Once again, our data didn’t keep pace with the virus.
We lost nearly 510,000 Americans in the twelve months from March 1, 2020, to the end of February 2021. What is so dismaying is that despite all our knowledge, our advanced technology, our vaccine rollout and additional therapeutics we lost over another 430,00 Americans in the next twelve months from March 1, 2021, to the end of February 2022. The 2021 summer surge was more deadly that the summer surge of 2020. We will pass 950,000 American lives lost by March 1, 2022. [Note: Death as of August 25, 2022, totaled 1,036,604].
Source: Silent Invasion by Dr. Deborah Birx (2022 est. end of April).
The unabbreviated version of the above can be found in the pdf document below.
THE WHITE HOUSE CORONAVIRUS TASK FORCE --EXCERPTS
All Excerpts are from: Silent Invasion by Dr. Deborah Birx (2022)
INTRODUCTION: I wanted to do what was best for my country, but I also had to consider what would happen to me. They could easily blame the civil servants and characterize us as members of the “deep state.” These were realistic possibilities. It was true that Tony Fauci, Bob Redfield, and I had agreed that if one of us was fired the others would resign in protest.
It was clear that the president was constantly soliciting opinions from his senior advisors, but also from his outside influencers and from random people who crossed his path. I was not, and would not be present for many of these interactions, and as such, I needed to ensure that someone in the room was armed not just with the data, but with the correct interpretation of the data.
FLATTENING THE CURVE: On March 10 we had drafts of flatten-the-curve guidance. The “low-cost” interventions would be social distancing and enhanced hygiene vigilance. We made the difficult and significant decision not to include a specific reference to wearing masks. Not without the full support of the CDC on nonmedical-grade masks, given the administration’s ongoing resistance to their use. Four weeks later we were able to put the importance of masking in the opening guidelines. But for that four weeks we put Americans at substantial risk. Silent asymptomatic spread was a significant contributor to the outbreak, and all the advice we’re giving the American public spoke to that point, but without mentioning the concept by name.
We got the green light from President Trump. The White House would post “The President’s Coronavirus Guidelines for America” on its website. Trump would announce the campaign which was eventually given the name “15 days to Slow the Spread.” Following President Trump’s announcement of the guidelines – almost on cue – the recommendations served as the basis for governors to mandate the flattening-the-curve shutdowns. The White House had handed down guidance, and the governors took that ball and ran with it. Based on the weekly governors’ call and my other interactions with them, I could tell they’d been looking for the White House to take the lead in letting the American public know how serious the situation was. The governors now had “permission” to mount a proportionate response and, one by one, other states followed suit.
No sooner had we convince the Trump administration to implement our version of a two-week shutdown than I was trying to figure out how to extend it. Fifteen Days to Slow the Spread was a start, but I knew it would be just that.
“Mr. President, we need to take additional action immediately. I’m recommending that we extend the Slow the Spread measures by 30 days.” “What are you basing this on?” I explained to him how the U.S. was tracking as Italy had: we were two weeks behind where they were. I hit hard on Italy’s case fatality rate, the toll it was taking especially on people over 70, people with other health issues – the overweight, the hypertensive, those with known cardiac or other respiratory or systemic issues. I showed him one of the charts we’d created. It literally and figuratively demonstrated the graphic nature of the reality. It showed a steep and inexorable rate of rise of infections, hospitalizations, and deaths. “That fast?” he said. “Yes, Mr. President.” “How many.” “One to two hundred thousand by the end of May. Best-case scenario.” Worst case?” “If we do nothing?” He nodded. “Millions. Somewhere between one-point-five and two-point-five million.” “Are you sure?” “I am, Mr. President.” “Tony, what about you?” He turned to Dr. Fauci. “Do you see it the same?” “Yes, Mr. President. I do.” The president nodded. “Okay, okay.”
“We will never shut down the country again. Never.” President Trump’s tone was emphatic, edged with agitation. It was the first week of April 3, mere days after the president had announce the thirty-day extension of the Slow the Spread campaign, and the ground had shifted suddenly and without warning.
Kevin Hasset, who had once served as the president’s Council of Economic Advisors (CEA) where he had demonstrated a brilliant understanding of economics, had been brought to the White House when the pandemic response began. He and his associate Tyler Goodspeed had put together an independent analysis of the data I’d used for my computational assumptions, using similar case curves they had developed. Their conclusion: in this first surge, 26,000 people would die by Memorial Day. We had predicted between 100,000 and 240,000. Clearly this was an enormous difference. My projections were nearly four to ten times greater. It helped the CEA enormously that their data happened to jibe with a typical seasonal flu season, matching what the president and many in the administration had been saying all along.
OPENING UP: As early as April 7, 2020, at the direction of the White House senior advisors, the task force and many others in the administration were at work on a parallel mission: to develop a plan to reopen the country as soon as possible. My goal was to make the reopening of the states a data-driven exercise; as each state moved toward reopening, it would have to pass through one phase, or gate, before moving on to the next, thus ensuring the greatest degree of public safety.
To move from one phase of reopening to the next, states would have to demonstrate a 14-day continuous decline and test positivity, clearly demonstrating that its community spread was under control. Within my gating criteria was a clear call for weekly testing across a community, even of people who appear well, to serve as an early alert of asymptomatic community spread. This was very important to me, as I fundamentally believed that community spread began silently among the 18-to-35 age group, who were more social and more likely to gather together indoors. I was scrupulous in making sure the benchmarks for proceeding from one gate to the next were as stringent as possible. (Note: As reported in segment 2, testing was problematic; the rapid antigen test was not approved by the FDA for asymptomatic diagnosis until July 2021 and PCR testing was limited for much of the summer and fall of 2020 because of lab analysis constraints. Testing for asymptomatic people was very difficult to achieve in mass).
According to the approved gating criteria, all states had to go through a mandatory two-week period just to prove they could start phase one. I was able to get our strict gating criteria and framework plan approved and posted to the White House website as official policy. Just as important, we’d effectively extended the Slow the Spread Campaign for two addition weeks, to mid-May, as each state demonstrated its control of the virus in their state.
THE GOVERNORS: Up to this point, the vice president had been important for communication with the governors. They still weren’t getting the message about the three-week lag time, that testing of younger cohorts and finding asymptomatic infections was important, that small outbreaks could be mitigated, but that the silent spread was still at work. Calls from Vice President Pence would not be enough. Increasingly, as the doctors on the task force ran into the limits of what could be accomplished from Washington, D.C., I saw a need for more ground-level intervention that could carry our message directly to the decision makers in the states and cities – not over the phone or on Zoom, but in person. Someone from the federal government needed to go out into the field. I believed that was the role of the CDC. I sent an urgent message to Bob Redfield, asking him to send CDC personnel to North Carolina and Arizona, two states at most immediate risk of a surge, to speak with local health authorities and the community. In response to urging, Bob said his hands were tied. He couldn’t force anyone to go to one of the Covid-19 hot spots, or anywhere else for that matter. He had to ask for volunteers.
I had to get out of the White House and to the states. I had to look governors and state and local public health officials in the eye, read their expressions, know when I needed to provide greater clarification, and show them the data and the graphics to give them an evidence base to support the measures I had seen working elsewhere and that had been so effective in other places.
THE UPENN/CHOP MODEL: Dr. David Rubin directs the PolicyLab at Children’s Hospital of Philadelphia (CHOP) had produced a highly interactive Covid-19 forecasting model at the most granular level. They would eventually use it to prepare school reopening guidance and in-person schooling recommendations. We asked him to model the impact of a statewide mask mandate, significant expansion of outdoor dining while reducing indoor dining to 25% and closing standing-room-only bars. We also asked that the model reflect keeping retail spaces open as long as masks were worn in all indoor places. His models demonstrated the impact of these measures on the replication rate of the virus. The UPenn/CHOP model worked in theory. Now we needed to implement it at an actual population level and measure the impact on viral community spread.
Governor Greg Abbott of Texas was our first stop. At the start, the governor seemed skeptical that doing three rather simple things – universal masking, restricting indoor dining occupancy, and allowing only smaller social gatherings. “We’ve done these things,” he told me. “We can’t seem to make any real headway.” “You’ve done two of the three things, Governor,” I told him. “Without the mask mandates, you lessen the positive effects of the other two.” He frowned. “Masks? Nobody seems to agree on that one. It’s a real hard sell.” “It will keep more folks alive,” I said. On July 2 he issued a mask mandate. Cases in Texas peaked around July 15, consistent with the masking mandate being added to Abbott’s decreasing indoor occupancy and his clear public messaging. The UPenn/CHOP model was working! [NOTE: within 13 days]
In late July 2020, I wrote Tony and the rest of the docs on the task force. Masking works and you need to do it anytime you are in public indoor spaces. Schools in areas with fewer than 50 cases per 100,000 should open and schools with greater than 50 cases per 100,000 could open with testing and masking to prevent the present community spread from invading the classrooms.
A DIFFERENT VIEWPOINT: Scott Atlas formally arrived in the White House on August 10, as an unpaid senior advisor to the president. He was already an insidious presence and I suspected he had been so for quite some time. He had made himself comfortable and seemed poised to make me and others very uncomfortable. He had gained notoriety and credibility within the White House and with the president because, for years, he had backed the prevailing views of the Republican Party on health care reform. With his lack of experience in the field, I concluded that as far as his views on the pandemic response were concerned, not much substance was there.
Atlas believed it was possible to fence off the vulnerable Americans with significant medical issues and elderly Americans over seventy and let the virus move undetected and unmitigated among the full population. That was his theory, and if that were possible, it would be a powerful effective tool. The problem was that it wasn’t implementable. It simply wasn’t possible to protect everyone in the community at significant risk and let the virus spread wildly without protective vaccines. He was not an infectious disease expert. He was a respected health care policy wonk on the right. Mistakenly, I at first assumed that, given his lack of direct experience or background in pandemic response, Atlas could be easily dismissed. Clearly, he was a contrarian, and I wondered if, like other of this type, he was more interested in being viewed as a contrarian than in actually advocating for his positions – which, to me, were untenable. Regardless of the name it goes by, this approach, this set of beliefs – that masks are likely ineffective, that children cannot pass on the virus (and thus, by extension, that schools should remain open with students and teachers unmasked), that the role of government is not to squash the virus but to let it spread while protecting only the most vulnerable Americans – was dangerous.
Not only was Atlas dismissive of the data and analysis of the pandemic, and offering dangerous counterfactuals, but he was dismissing me and denying me the opportunity to rebut his claims. I’d been cut out of the loop. I went ballistic. I told Mark Meadows in no uncertain terms that Atlas’s egregious stunt was not something I would tolerate. I didn’t want Atlas around, and I didn’t understand why anyone should have to tolerate his blatant maneuvering and manipulation. Meadow’s response? The equivalent of “That’s interesting.”
On August 2, I came under attack – this time from an unlikely source, Speaker of the House Nancy Pelosi. The media company Politico had reported that, in a meeting with Mark Meadows and Steven Mnuchin, Pelosi had said, “Deborah Birx is the worst. Wow, what horrible hands you’re in.” I had too much respect for Nancy Pelosi to engage in any kind of back-and-forth.
On August 2, I was given the chance, at the last minute, to speak on State of the Union, a Sunday show on CNN, with anchor Dana Bash. I seized on this rare opportunity to address the American people directly, to set the record straight: “I want to be very clear: The virus is extraordinarily widespread. The next morning, August 3, my cell phone range. “Hold for the president.” “Mr. President, this is Debbi,” I said. A moment passed before I heard that familiar, pained tone: “What do you think you’re doing? Don’t you ever do that again. ‘Extraordinarily widespread.’ Do you know how those words scare America.”
SCOTT ATLAS SHRUGS: The Oval Office meeting of August 8. “We are currently at just under 50,000 cases a day,” I said. “We are trending downward from the July peak, but I am very, very concerned about this fall. That could be an incredibly deadly period. The way to prevent that is to mitigate – expand testing, masking, and reduce indoor unmasked gatherings. We’ve got to fight the virus that is here now and coming to new communities in the fall.” The president sat back and folded his arms, nodded. When I pressed on, he waved me off and turned toward Scott Atlas: “Is that how you see it?”
“I couldn’t disagree more strongly,” Scott Atlas said. “No matter what we do, the outcome is going to be the same. You don’t need to mitigate. You don’t need to test. All we need to do, and we’ve already done this, is to protect the most vulnerable.” Though the president might have been doing the opposite of what I was recommending and saying the opposite of what I was saying, his White House supported my actions, and I was never stopped. As a result, I could still go to state and local governments with clear science and data-driven recommendations to mitigate community spread without defying the commander in chief’s orders. If he didn’t specifically lay out what was permissible, then I was free to do what I knew was necessary.
Of course, Atlas couldn’t just leave things alone. He wanted and needed to substantiate his claims further, to bring more people within the administration and around the country over to his side. So, on August 13 he announced that he was convening a panel of infectious disease experts for a roundtable discussion. He would invite Dr. Martin Kulldorff, PhD. from Harvard: Dr. Joseph Ladapo from UCLA; Dr. Jay Bhattacharya from Stanford; and Dr. Cody Meissner from Tufts. On August 25, I wrote a sharply worded email to Marc Short, Pence’s chief of staff, informing him that I would not be a part of Atlas’s roundtable, especially with a fringe group who championed herd immunity and who believed that the United States could be like Sweden. Individually, I contacted Marc Short, Mark Meadows and Jared Kushner. I communicated clearly to everyone: “I won’t be in any meetings any longer if Scott Atlas is present at them. If that means in the Oval Office, it doesn’t matter. If it’s at the task force, it doesn’t matter. If it’s at the Covid Huddle, I don’t want him there. Scott Atlas no longer attended task force meetings.
Emboldened, I took things a step further. “I want to be clear: I can’t support what Scott Atlas is saying, and I will need to say exactly the opposite of what the president is saying.” The vice president’s eyes narrowed for a moment. He considered his response for another few seconds. Then, he looked me in the eye, his voice steady, and said, “You need to do what you need to do.”
At about this time, I’d been reading the Biden pandemic plan, which had been made widely available. In short, I was impressed by it, particularly because of its emphasis on the importance of testing aligned with my own beliefs on that crucial mitigation tool.
GOVERNOR REPORTS: Our governor’s reports were a key component of our direct communication of the migration approach being executed across the Sun Belt. The message: masking, closing bars and restricting indoor occupancy, and limiting social gathering indoors – had to be delivered. Still, the kind of pushback Marc Short was receiving and that he was reiterating to me and sharing widely within the administration, continued throughout the summer and intensified in the fall, as the pandemic became far, far worse. The message from some governors was We don’t want to know what you are seeing in our counties, our nursing homes, and our hospitals. Let us go our own way. This resistance always made me wonder. If they’re not willing to listen to us, then whom are they listening to? While I was still on the road, Marc Short had written to me stating, essentially, that these common mitigation points in the governor’s reports had to stop.
I devised a work-around for the governor’s reports I was then writing. Week by week Marc’s office began providing line-by-line edits. After the heavily edited documents were returned to me, I’d reinsert what they had objected to, but place it in those different locations. I shared these strategies with the three members of the data team also writing these reports. Our Saturday and Sunday report-writing routine soon became; write, submit, revise, hide, resubmit. Fortunately, this strategic sleight-of -hand worked.
Eight months into the pandemic, many at both the White House and the CDC still refused to see that silent spread played a prominent role in viral spread and that it started with social gatherings, especially among the younger adults. We had to find a way around them. Bob and I agreed to quietly rewrite the guidance and post it to the CDC website. We would not seek approval. Because we were both quite busy, it might take a week or two, but we were committed to subverting the dangerous message that limiting testing was the right thing to do.
On September 18, Mark Meadow’s name and number flashed across my White House issued smartphone. “What the hell do you think you’re doing? You rewrote and posted the CDC stuff.” You went over my head. You do not make unilateral decisions. It’s that simple. Period. End of sentence. Understood? Don’t ever do this again.” “Understood. I did what I needed to do.” “Don’t do that again without talking with me first.” He never said this, but in this case, his actions spoke louder than words. He allowed the new testing guidance to stand.
The day after Mark Meadows’s angry call, I received a call from the surgeon general of Florida. The news was not good: Scott Atlas had told the governor that the state had achieved the level of infection that met the criteria for herd immunity, that it wouldn’t experience a significant surge again, and that it didn’t need to keep mitigating as it had been. I immediately wrote to Jared Kushner. I informed him that we couldn’t afford to have another state reverse course like Florida had. If Atlas was going to travel to states like I was doing, then we needed to send him someplace like South Dakota, where the outbreak was low and where he could do less real harm. Governor Kristi Noem wasn’t mitigating in any serious way, and Dr. Atlas would find a kindred spirit there. We couldn’t have Atlas telling governors just before winter that testing, masking, and other mitigation were no longer needed.
Governor DeSantis had lifted all restrictions and prevented local counties and cities from adopting their own restrictions based on ground level assessments. His about-face wasn’t a result of a significant decrease in cases; instead, it seemed to be the result of embracing Scott Atlas’s beliefs and positions. Apparently in a single visit to Florida, Atlas had undone months of work.
THE ELECTION: On November 2, the eve of Election Day, the Washington Post reported on an “internal memo” I’d written. The article, headlined “Top Trump Advisor Bluntly Contradicts President on Covid-19 Threat, Urging All-Out Response.” I reported for work the day after the election. I spotted Mark Meadows. “Mark,” I said, “you don’t think that I gave the report to the Post.” He looked up from the documents he was reading. “What I think doesn’t matter. It’s what you made people think that does. You saw the exit polls. You’ve seen what’s going on in the critical races. You think that your words didn’t matter? They did. Big time.” He edged to the side to move past me. “You can’t pin that on me.” “No?” He turned back to face me. “You can believe what you want, but you need to know this: your reputation is toast. What you did or didn’t do isn’t going to change that.”
A NEW ADMINISTRATION: The Biden administration hit the ground running in January 2021, focusing their efforts on consistent messaging and ensuring access to vaccine supplies across the United States. The Biden Covid-19 plan was thoughtful and comprehensive. But, after the inauguration, the Biden administration turned their full attention to effectively rolling out vaccines. Once again, we were slow to act to this global evolving picture. We continued to under-test. We didn’t actively look for those mild and asymptomatic “breakthrough” infections in vaccinees. Once again, our data didn’t keep pace with the virus.
We lost nearly 510,000 Americans in the twelve months from March 1, 2020, to the end of February 2021. What is so dismaying is that despite all our knowledge, our advanced technology, our vaccine rollout and additional therapeutics we lost over another 430,00 Americans in the next twelve months from March 1, 2021, to the end of February 2022. The 2021 summer surge was more deadly that the summer surge of 2020. We will pass 950,000 American lives lost by March 1, 2022. [Note: Death as of August 25, 2022, totaled 1,036,604].
Source: Silent Invasion by Dr. Deborah Birx (2022 est. end of April).
The unabbreviated version of the above can be found in the pdf document below.
| covid_3l_w.h._task_force_--_segment_3.pdf |