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| For Dr. Deborah Birx, Urging Calm Has Come With Heavy Criticism | For Dr. Deborah Birx, Urging Calm Has Come With Heavy Criticism |
| (3 days later) | |
| WASHINGTON — The White House coronavirus task force has featured two trusted medical voices, diplomatic but authoritative, able to gently push back on President Trump without incurring his wrath: Drs. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, and Deborah L. Birx, the coronavirus response coordinator. | WASHINGTON — The White House coronavirus task force has featured two trusted medical voices, diplomatic but authoritative, able to gently push back on President Trump without incurring his wrath: Drs. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, and Deborah L. Birx, the coronavirus response coordinator. |
| But this week, Dr. Birx’s comments casting doubt on talk of ventilator and hospital-bed shortages, and praising Mr. Trump’s attention to detail in lavish terms, have raised questions about her independence as the number of coronavirus infections in the United States has soared past 100,000. | But this week, Dr. Birx’s comments casting doubt on talk of ventilator and hospital-bed shortages, and praising Mr. Trump’s attention to detail in lavish terms, have raised questions about her independence as the number of coronavirus infections in the United States has soared past 100,000. |
| Practically overnight, Dr. Birx has become a partisan Rorschach test. Conservative commentators have praised her as a truth-teller, pushing back on coronavirus hysteria. Critics of Mr. Trump accused her of squandering the credibility she had developed as a health official in Democratic and Republican administrations. | Practically overnight, Dr. Birx has become a partisan Rorschach test. Conservative commentators have praised her as a truth-teller, pushing back on coronavirus hysteria. Critics of Mr. Trump accused her of squandering the credibility she had developed as a health official in Democratic and Republican administrations. |
| Dr. Birx’s comments, especially those dismissing ventilator shortages, startled some health experts. While most hospitals might have sufficient supplies at the moment, many worry about a crush of patients in the very near future. | Dr. Birx’s comments, especially those dismissing ventilator shortages, startled some health experts. While most hospitals might have sufficient supplies at the moment, many worry about a crush of patients in the very near future. |
| Dr. Howard Bauchner, the editor in chief of The Journal of the American Medical Association, warned Friday of “a potential tsunami coming” on a video call with hundreds of other physicians about rationing ventilators and critical care. | Dr. Howard Bauchner, the editor in chief of The Journal of the American Medical Association, warned Friday of “a potential tsunami coming” on a video call with hundreds of other physicians about rationing ventilators and critical care. |
| Dr. Ryan A. Stanton, a board member at the American College of Emergency Physicians, said Dr. Birx sounded like “the builders of the Titanic saying the ship can’t sink.” | Dr. Ryan A. Stanton, a board member at the American College of Emergency Physicians, said Dr. Birx sounded like “the builders of the Titanic saying the ship can’t sink.” |
| Public health officials have emphasized that regions of the country less urgently in need of more ventilators could donate some of their inventory to health systems in more desperate need, a point that Dr. Birx made Thursday night. | Public health officials have emphasized that regions of the country less urgently in need of more ventilators could donate some of their inventory to health systems in more desperate need, a point that Dr. Birx made Thursday night. |
| Mr. Trump on Friday, appearing to respond to widespread criticism from various cities and states, announced that the federal government would issue contracts to buy thousands of ventilators from a variety of large and small makers. But it appeared doubtful the devices could be produced in time to help the overwhelmed hospitals. | Mr. Trump on Friday, appearing to respond to widespread criticism from various cities and states, announced that the federal government would issue contracts to buy thousands of ventilators from a variety of large and small makers. But it appeared doubtful the devices could be produced in time to help the overwhelmed hospitals. |
| Dr. Birx has had to oscillate between occasionally competing forces on the task force, which features a set of doctors and scientists who have often registered skepticism with the White House’s attitude toward coronavirus policy. In private discussions, she has joined with members of the group whom she has known for decades to push the State Department to issue an advisory against traveling on cruises. | Dr. Birx has had to oscillate between occasionally competing forces on the task force, which features a set of doctors and scientists who have often registered skepticism with the White House’s attitude toward coronavirus policy. In private discussions, she has joined with members of the group whom she has known for decades to push the State Department to issue an advisory against traveling on cruises. |
| This week, she met with Drs. Fauci, Stephen M. Hahn, the commissioner of the Food and Drug Administration, and Robert R. Redfield, the director of the Centers for Disease Control and Prevention, where the group talked through concerns about the Trump administration’s embrace of malaria drugs as possible treatments for Covid-19, the disease caused by the coronavirus, according to a senior administration official. | This week, she met with Drs. Fauci, Stephen M. Hahn, the commissioner of the Food and Drug Administration, and Robert R. Redfield, the director of the Centers for Disease Control and Prevention, where the group talked through concerns about the Trump administration’s embrace of malaria drugs as possible treatments for Covid-19, the disease caused by the coronavirus, according to a senior administration official. |
| Publicly, Dr. Birx has been a soothing constant next to Mr. Trump and Vice President Mike Pence in coronavirus meetings and briefings, where she has been one of the few regulars in a rotating cast of health officials perched behind the White House lectern. Mr. Pence, who is overseeing the government’s response, introduced her at the time of her appointment as his “right arm.” | Publicly, Dr. Birx has been a soothing constant next to Mr. Trump and Vice President Mike Pence in coronavirus meetings and briefings, where she has been one of the few regulars in a rotating cast of health officials perched behind the White House lectern. Mr. Pence, who is overseeing the government’s response, introduced her at the time of her appointment as his “right arm.” |
| But on Thursday, that delicate balance appeared to tip. After talking to New York officials, Dr. Birx said she had been told that there were still intensive care beds and “over 1,000 or 2,000” ventilators still available. She also dismissed news stories of hospitals drafting blanket do-not-resuscitate orders for critically ill Covid-19 patients. | But on Thursday, that delicate balance appeared to tip. After talking to New York officials, Dr. Birx said she had been told that there were still intensive care beds and “over 1,000 or 2,000” ventilators still available. She also dismissed news stories of hospitals drafting blanket do-not-resuscitate orders for critically ill Covid-19 patients. |
| “To say that to the American people, to make the implication that when they need a hospital bed, it’s not going to be there, or when they need that ventilator, it’s not going to be there — we don’t have evidence of that right now,” she said. | “To say that to the American people, to make the implication that when they need a hospital bed, it’s not going to be there, or when they need that ventilator, it’s not going to be there — we don’t have evidence of that right now,” she said. |
| Just a few feet away stood Dr. Fauci, a longtime friend and mentor of Dr. Birx’s, who had his own message: hunker down. He said that the coronavirus could become cyclical. He cautioned that a vaccine was still many months away. And he said that therapeutic treatments, which Mr. Trump has eagerly pushed as a “game changer,” were still unproven. | Just a few feet away stood Dr. Fauci, a longtime friend and mentor of Dr. Birx’s, who had his own message: hunker down. He said that the coronavirus could become cyclical. He cautioned that a vaccine was still many months away. And he said that therapeutic treatments, which Mr. Trump has eagerly pushed as a “game changer,” were still unproven. |
| “The best way to get the best drug as quickly as possible is to do a randomized controlled trial so that you know is it safe and is it effective,” he said. “If it’s not effective, get it off the board and go to the next thing.” | “The best way to get the best drug as quickly as possible is to do a randomized controlled trial so that you know is it safe and is it effective,” he said. “If it’s not effective, get it off the board and go to the next thing.” |
| The realities on the ground appear to favor the tone of Dr. Fauci’s warnings. Dr. Mahshid Abir, an emergency physician at the University of Michigan and an expert on hospital preparedness, said on Friday that shortages are inevitable. Hospital systems not only in New York but Atlanta, Seattle and New Orleans are already warning that they have or will reach capacity in the coming days. | The realities on the ground appear to favor the tone of Dr. Fauci’s warnings. Dr. Mahshid Abir, an emergency physician at the University of Michigan and an expert on hospital preparedness, said on Friday that shortages are inevitable. Hospital systems not only in New York but Atlanta, Seattle and New Orleans are already warning that they have or will reach capacity in the coming days. |
| “No matter what assumption you use, even on the lower end, the ventilator capacity is just not going to be there,” she said. | “No matter what assumption you use, even on the lower end, the ventilator capacity is just not going to be there,” she said. |
| The United States currently has 160,000 to 200,000 ventilators, but as many as one million patients might need to use one of the machines during the outbreak, according to the Society of Critical Care Medicine. | The United States currently has 160,000 to 200,000 ventilators, but as many as one million patients might need to use one of the machines during the outbreak, according to the Society of Critical Care Medicine. |
| Dr. Birx, who has built a well of bipartisan admiration in her years as a health official, has more recently accommodated herself to the political winds with the kind of presidential flattery that Mr. Trump demands from aides. | Dr. Birx, who has built a well of bipartisan admiration in her years as a health official, has more recently accommodated herself to the political winds with the kind of presidential flattery that Mr. Trump demands from aides. |
| “He has been so attentive to the details and the data, and his ability to analyze and integrate data has been a real benefit during these discussions about medical issues,” she gushed in an interview with the Christian Broadcasting Network on Wednesday. | “He has been so attentive to the details and the data, and his ability to analyze and integrate data has been a real benefit during these discussions about medical issues,” she gushed in an interview with the Christian Broadcasting Network on Wednesday. |
| Updated June 12, 2020 | |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. | Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission. |
| Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. | Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. | Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. |
| The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. | The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| To some extent, public health professionals have expressed sympathy for her position. | To some extent, public health professionals have expressed sympathy for her position. |
| “Harnessing political will to implement recommendations from the country’s top respiratory disease public health experts and organizing the government to manage the response effectively is hard,” said Dr. Thomas R. Frieden, who worked with Dr. Birx when he ran the Centers for Disease Control and Prevention and she oversaw its division on global AIDS. “Many lives depend on getting that balance right.” | “Harnessing political will to implement recommendations from the country’s top respiratory disease public health experts and organizing the government to manage the response effectively is hard,” said Dr. Thomas R. Frieden, who worked with Dr. Birx when he ran the Centers for Disease Control and Prevention and she oversaw its division on global AIDS. “Many lives depend on getting that balance right.” |
| A colonel in the Army, she began her career in the early 1980s as an immunologist at the Walter Reed Army Medical Center, and spent part of her training as a fellow in Dr. Fauci’s lab. In 2014, President Barack Obama put her in charge of addressing the global AIDS epidemic. She also created a program called DREAMS, a public-private partnership to reduce rates of H.I.V. among adolescent girls and young women. | A colonel in the Army, she began her career in the early 1980s as an immunologist at the Walter Reed Army Medical Center, and spent part of her training as a fellow in Dr. Fauci’s lab. In 2014, President Barack Obama put her in charge of addressing the global AIDS epidemic. She also created a program called DREAMS, a public-private partnership to reduce rates of H.I.V. among adolescent girls and young women. |
| In her current role, Dr. Birx’s appeals have extended to some of Mr. Trump’s favorite conservative media personalities. She appeared alongside Mr. Pence in a private White House meeting earlier this month to update figures as divisive and confrontational as Dan Bongino and Eric Bolling. | In her current role, Dr. Birx’s appeals have extended to some of Mr. Trump’s favorite conservative media personalities. She appeared alongside Mr. Pence in a private White House meeting earlier this month to update figures as divisive and confrontational as Dan Bongino and Eric Bolling. |
| And she has introduced herself to new crowds, giving advice on self-quarantining this week on “The Morning Toast,” a talk show on YouTube that is popular with a young audience. | And she has introduced herself to new crowds, giving advice on self-quarantining this week on “The Morning Toast,” a talk show on YouTube that is popular with a young audience. |
| In meetings, Mr. Trump appears to prefer Dr. Birx’s genial approach over Dr. Fauci’s blunt talk. | In meetings, Mr. Trump appears to prefer Dr. Birx’s genial approach over Dr. Fauci’s blunt talk. |
| Mr. Trump and several White House officials view Dr. Fauci with some level of skepticism, believing he tends too much to his own public persona and has gone “rogue” on messaging. Dr. Birx, they think, is more willing to be patient with the president’s interruptions and theorizing about medicine. | Mr. Trump and several White House officials view Dr. Fauci with some level of skepticism, believing he tends too much to his own public persona and has gone “rogue” on messaging. Dr. Birx, they think, is more willing to be patient with the president’s interruptions and theorizing about medicine. |
| Among Mr. Trump’s frustrations with Dr. Fauci has been his unwillingness to embrace the malaria drugs that Mr. Trump has celebrated, chloroquine and hydroxychloroquine. Dr. Fauci has been much more vocal about their risks, and dismissed potential evidence of their success in treating the coronavirus as anecdotal. | Among Mr. Trump’s frustrations with Dr. Fauci has been his unwillingness to embrace the malaria drugs that Mr. Trump has celebrated, chloroquine and hydroxychloroquine. Dr. Fauci has been much more vocal about their risks, and dismissed potential evidence of their success in treating the coronavirus as anecdotal. |
| Noah Weiland reported from Washington, and Maggie Haberman from New York. Sheri Fink contributed reporting from New York. | Noah Weiland reported from Washington, and Maggie Haberman from New York. Sheri Fink contributed reporting from New York. |