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For weeks, Dr. Deborah L. Birx was briefing Americans on a near-daily basis from the White House on the battle against the "invisible enemy."
Now, as President Donald Trump shifts strategy from responding to the pandemic to reopening the country, Birx and other members of the White House coronavirus task force are no longer regulars at televised White House news conferences.
While it's too early to draw conclusions about whether Birx's influence has been diminished, she remains one of the major public faces of the administration's coronavirus response. It is a role that's brought her praise – for her command of public health minutia as well as criticism – for appearing, at times, to fail to run sufficient interference on Trump's mixed, erratic and often incorrect messages about the outbreak.
Birx, 64, who is the White House coronavirus response coordinator, has managed to maintain her composure – and sometimes correct Trump's misinformation – without triggering the wrath of the president or his supporters.
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Trump administration aides said the president has a good working relationship with Birx. Her colleagues, family and longtime acquaintances said that if anyone has the chops to navigate a deadly virus outbreak and an unpredictable White House – to tiptoe around Trump's coronavirus assertions in a way that leaves his ego intact – it's Birx.
"She's trying to speak the truth and preserve the confidence of the president," said Stephen Morrison, a public health expert who served in the Clinton administration and knows Birx from that time and in his role as director of the Global Health Policy Center at the Center for Strategic and International Studies, a Washington, D.C., think tank.
"It's a difficult job. It carries hazards," he said.
'She's doing as well as anyone in her position could ever do'
Trump likes and respects Birx despite some frustrations with her occasional public disagreements with him, according to two White House aides not authorized to speak publicly on the matter. The president's aides said that while Trump doesn't like to be corrected by anybody, he respects Birx's knowledge and takes her advice seriously.
One illustration of the regard Trump has for Birx: Her name has surfaced as a potential replacement for Health and Human Services Secretary Alex Azar. Azar's standing within the White House has been a source of speculation after reports he tried to warn Trump about the dangers of the coronavirus in late January, only to be told he was being alarmist. Trump has dismissed suggestions Azar's job was in peril as "fake news."
Even though Trump has ended regular televised briefings with the task force, Birx has continued to do TV appearances, sitting for an interview on “Fox News Sunday” and participating in a CNN town hall this month.
When Trump said May 5 that he would start winding down the task force, there was speculation that he was sidelining her and other medical experts, including Dr. Anthony Fauci, the administration’s leading infectious disease specialist. Trump reversed himself on the task force only a day later, saying it would continue.
White House press secretary Kayleigh McEnany told reporters Tuesday that Birx remains a key adviser.
"I don't know when in this capacity you will see her, but I talk to Dr. Birx regularly," McEnany said in response to a question about the doctor's whereabouts. She said Birx also had "signed off on" the phased reopening guidelines that Trump approved for states.
Over the past few months, Birx has informed the public about where the U.S. is with testing, about different types of face masks, transmission rates, potential treatments and hospital capacity. She has calmly detailed the myriad painful but necessary disruptions to U.S. daily life from a disease that has killed more Americans than the Vietnam War and Sept. 11, 2001, terrorist attacks combined.
In these appearances, Birx has oscillated between technical remarks about antibody testing and disarmingly personal anecdotes about how, because of social distancing measures, she was not able to treat her 10-month-old granddaughter, who one weekend had been running a high fever. Birx reassures the public one minute, then the next scolds millennials for going to the beach.
When The Associated Press reported that a decision to shelve advice from the Centers for Disease Control and Prevention – the nation's top disease control experts – for reopening communities during the coronavirus pandemic came from the highest levels of the White House, Birx had an explanation: The guidelines were still being edited.
"When I watch the press briefing, Dr. Birx is one I want to hear from," said Katy Talento, a Trump health policy adviser who left the White House last year.
Talento worked with Birx on implementing and then continuing President George W. Bush-era legislation known as PEPFAR (President's Emergency Plan for AIDS Relief). She said Birx has shown an ability to wield scientific expertise while sidestepping Trump's more outlandish coronavirus comments.
"She's doing as well as anyone in her position could ever do," Talento said.
Trump can live with Birx's disagreements, the two White House aides not authorized to speak publicly said, because she has couched them in a respectful manner during meetings and television appearances. Birx has done a good job of managing Trump, the aides said, showing him deference and briefing him in a way that makes him comfortable.
Trump thinks Birx does well on television, an important gauge for him, the aides said.
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'When (he) gets new information, he likes to talk that through out loud'
Birx is one of two Obama administration-appointed health officials working for Trump. The other is Francis Collins, director of the National Institutes of Health – Fauci's boss.
Most Americans have heard of Fauci, the director of the National Institute of Allergy and Infectious Diseases who delivered high-profile testimony to the Senate this week warning of avoidable “suffering and death” if the country reopens too quickly.
Fauci, who has been America's top infectious disease expert for decades, was a mentor to Birx earlier in her career.
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Fauci has openly contradicted Trump, tamping down the president's talk of rapidly reopening the U.S. or a quick-fix coronavirus cure.
The White House aides said Trump believes that Fauci is a little too eager to voice his disagreements with the president and that some of his comments are political in nature.
Birx is not like that, in Trump's view, and their relationship is such that Trump can joke with her in public. When he spoke with an Iowa health official about appointing her to the coronavirus task force, he joked: "I'm only going to do it if I have Dr. Birx's permission."
Trump's admiration for Birx is also informed by the fact that one of her biggest champions is Vice President Mike Pence, who brought her into the administration, the aides said.
Fauci's lengthy track record may afford him a certain political insulation from the White House, according to Morrison, the Clinton-era public health official.
While it's not ultimately clear if such protections extend to Birx, she has taken pains to defend Trump, saying in a Fox News interview that aired on April 25 that Trump meant no harm by inquiring in a White House briefing about ultraviolet light and disinfectant as possible coronavirus treatments.
Treatments involving ultraviolet light and disinfectant are unproven and dangerous.
"When (he) gets new information, he likes to talk that through out loud and really have that dialogue," Birx said. "And so that's what dialogue he was having."
Jen Kates, director of global health and HIV/AIDS policy at the Kaiser Family Foundation, a San Francisco-based nonprofit that focuses on U.S. national health issues, said Birx is trying to "stick to the science and data and public health prerogatives while working in a highly politicized environment."
"That's the case more generally when you work with the White House, but in this particular case it's really striking just how difficult that is," she added.
Kates has worked with Birx as part of the latter's job as U.S. Global AIDS coordinator and U.S. Special Representative for Global Health – roles Birx took up in 2014 and has retained since being appointed to the White House coronavirus task force.
The position is run out of the U.S. State Department, where Birx also oversees PEPFAR, the President George W. Bush-era legislation. PEPFAR has provided at least $90 billion in funding for HIV/AIDS treatment, prevention and research around the world since 2003, making it the largest financial commitment by any one nation to address a single disease in the world. PEPFAR is credited with saving millions of lives and effectively helping to alter the overall trajectory of the global HIV/AIDS epidemic.
Before joining the State Department in 2014, Birx directed the Global HIV/AIDS division at the U.S. Centers for Disease Control and Prevention.
"Dr. Birx was a very prominent and well-known figure internationally within global public health circles, but now she is front and center with the American public on a daily basis. Suddenly everybody knows her and she's having to adjust to that," Kates said.
'Do not let them give me blood'
In remarks at her 2014 swearing-in-ceremony as U.S. Global AIDS coordinator and U.S. Special Representative for Global Health – titles that give Birx ranking ambassador-level status within diplomatic circles – then-Secretary of State John Kerry told a story about the birth of Birx's eldest daughter, according to a transcript of his speech.
It's not entirely clear what Kerry's story is intended to illustrate about Birx – grit, determination, medical knowledge, foresight, presence of mind, maybe all of the above.
At the time, Birx was about to embark on her career as a military-trained clinician focusing on the burgeoning field of HIV/AIDS vaccine research.
It was the spring of 1983.
Birx was in labor at the Walter Reed National Military Medical Center in Maryland, a place she would spend the next 25 years helping increase the efficiency of the U.S. military's HIV/AIDS response through collaborations across the Department of Defense.
"She had lost a lot of blood during the delivery, and the obstetrician ordered a transfusion," Kerry said in his remarks in front of Birx's parents, her brother Donald and various members of the diplomatic corps.
"But Debbie had read a report weeks earlier about a new disease no one knew much about, but the risks of a blood transfusion were very, very clear to her. And literally, just before she passed out from pain, Debbie screamed: 'Do not let them give me blood.'"
Her husband at the time refused the transfusion.
Birx probably saved her own life.
"The hospital learned later that that the blood of her blood type – that they would have used – was contaminated with HIV," Kerry said.
'A powerful leader in rooms full of conflicting egos, opinions, org battles'
Birx's brother Donald, 67, describes a Pennsylvania childhood for his sister and another brother – Danny, who died in a plane crash in 2000 – as a semi-rural idyll.
The family grew up outside Philadelphia but moved to Carlisle, about 30 miles outside Harrisburg, the state capital, when Birx was in high school.
"We had to do a lot of things for ourselves because both of our parents worked. We would bike into school each day and we had to go over some really rough roads to get there," he said. "This meant we had a lot of time for exploration, experimentation and just roaming around and looking at things in different ways," he said.
"My sister likes to say: 'We used to run wild.'"
Donald Birx is now president of Plymouth State University in New Hampshire. Their mother, Adele, taught nursing. Their father, also Donald, was an electrical engineer.
After high school, Birx majored in chemistry at Houghton College in western New York. She earned her medical degree from Penn State College of Medicine in Hershey.
Birx has two adult daughters, Devynn and Danielle, from a previous marriage.
Last year, she married Paige Reffe, a Clinton administration aide who has worked on various Democratic presidential campaigns, including Kerry's.
Her brother said the woman people see next to the president is "outgoing, protective," supports group dynamics – especially when they advance public health for women – and "deeply cares for and develops the people she works with."
Eric Goosby, her predecessor as U.S. Global AIDS coordinator, said Birx "came of age" as a doctor in the 1980s when "100% of the patients doctors engaged with succumbed" to the disease. He said it was a time when doctors became "overwhelmed" with death and dying. "Debbie was in the middle of all that," he said.
Yet Goosby said that while Birx brings a "deep clinical background" to coronavirus policy discussion in the White House, she is equally "immersed" in how to set up complex health delivery systems for surveilling, storing and acting on key medical information.
One of the HIV achievements Birx is credited with helping to highlight, according to Bruce Richman, founder of Prevention Access Campaign, is that people with undetectable viral loads cannot transmit the virus that causes AIDS.
"She comes into meetings with 100 slides. It's like she has two calculus-computing brains," said Dr. Paul Zeitz, an epidemiologist and former Obama and Trump administration
health official who worked for Birx at the State Department.
"She's always ahead of everybody in understanding where things are going, and has a clear vision of how to get there," added Zeitz, referring to what he described as Birx's "reboot" of a U.S. global HIV/AIDS program that has required sensitive dealings with senior officials, world leaders, activists, administrators and patients all over the world.
"She knows how to deal with intergovernmental squabbling, all the backstabbing that goes on, turf wars. In the White House, I can see her as a powerful leader in rooms full of conflicting egos, opinions, organizational battles. She can transcend all that," he said.
'President Trump has relied on, and consulted with, Dr. Birx'
In a March 25 interview with CBN, a Christian TV network, Birx said she believes Trump, like her, has been attentive to the science and data around coronavirus.
"I think his ability to analyze and integrate data that comes out of his long history in business has really been a real benefit during these discussions about medical issues because in the end, data is data," she said in the interview.
Birx declined to be interviewed for this story.
The Trump administration aides said that there is no doubt Birx is much more cautious than Trump about reopening the country.
But they said Trump routinely solicits views from his advisers, including members of his coronavirus task force, and the resulting disputes are rarely personal.
"None of these people are shy about their positions on these issues," an official said.
"The media’s ridiculous and repeated efforts to create distance and tension between the president and his top health experts, including Dr. Birx, is textbook fake news," said White House spokesman Judd Deere in a statement provided to USA TODAY.
"President Trump has relied on, and consulted with, Dr. Birx and many others as he has confronted this unforeseen, unprecedented crisis," he said.
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In an exchange with reporters on May 8, Trump was asked about how often he meets with Birx, Fauci and the other medical experts on the coronavirus task force.
"I listen to them very, very intently," Trump replied. "A lot."
Many of the White House briefings where Birx and Fauci appeared were two-hour marathon sessions featuring combative exchanges between Trump and reporters – along with slide presentations and discussions of data by the medical experts.
There also were quieter moments of poignancy, such as when Birx told a story about her how grandmother lived with a lifetime of guilt after catching the flu at school in the 1918 influenza epidemic and brought it home to her own mother, who died from it.
"She never forgot that she was the child that was in school that innocently bought that flu home," Birx said of her grandmother, Leah, on March 25.
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'You ought to get your facts right'
Ambassador, doctor, scientist, mom, grandmother, military veteran, public health expert – at home, Birx often goes by the name of "colonel," according to her brother.
This is not intended as a pure reflection of her military rank, but as a term of endearment that speaks to her character: disciplined, professional, direct, measured.
It's also in recognition of the fact that Birx won the title at a time when women rarely achieved high-ranking positions within the military.
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On April 28, as Trump clashed with a reporter who challenged him on whether the U.S. has tested more people for coronavirus per capita than South Korea, another side to the "colonel" was on display. Deferring to Birx, Trump sat quietly as she explained how U.S. testing is focused on concentrated outbreaks across the country. Later in the meeting, she returned to the issue with updated numbers that supported Trump's claims.
"Are you going to apologize, Yahoo?" Trump snapped, referring to the reporter’s outlet.
"You ought to get your facts right."
As Trump continued to upbraid the reporter, Birx softly told the journalist, offering a sympathetic look before removing her glasses: "Just check it again."
Contributing: Courtney Subramanian, Tom Vanden Brook
This article originally appeared on USA TODAY: Deborah Birx praised for managing coronavirus and White House, Trump