Deborah Birx, MD: a White House coronavirus pandemic response coordinator who doesn’t coordinate

This post is about Dr. Deborah Birx, who was installed as the White House coronavirus pandemic response team’s coordinator. The team is led by Vice President Mike Pence. There are problems with the team, with Dr. Birx, and with the leader, Mr. Pence. The worst problem, though, is the head of government.

This head has failed to provide over-all leadership and has not taken charge of the federal government’s response. He has effectively turned over responsibility for government response to the state governors, but has failed to provide them with funding or direction. The most prominent result has been a free-for-all among states trying to obtain personal protective equipment (PPE) against the virus: masks, face shields, gowns, gloves, respirators, and the like. Individual states have been forced to compete with the federal government for PPE, frequently being outbid or having their shipments hijacked by federal authorities.

The emphasis of this post will be on the personalities of Dr. Birx and Dr. Redfield. There are so many failures in the federal response that it would take an entire book just to give an overview of them all. I focus this post on Dr. Birx because of an article in Science magazine. This article is titled “The inside story of how [redacted] COVID-19 coordinator undermined the world’s top health agency” and it was published October 14, 2020.

I begin with some direct quotes from the article which describe the effect that Dr. Birx’s personality has had on the CDC. The article starts with a meeting held on July 13, in which a top aide to Dr. Birx announced that the CDC would be relieved of its responsibility for data gathering:

Irum Zaidi, a top aide to White House Coronavirus Task Force Coordinator Deborah Birx, chaired the meeting. Zaidi lifted her mask slightly to be heard and delivered a fait accompli: Birx, who was not present, had pulled the plug on the Centers for Disease Control and Prevention’s (CDC’s) system for collecting hospital data and turned much of the responsibility over to a private contractor, Pittsburgh-based TeleTracking Technologies Inc., a hospital data management company. The reason: CDC had not met Birx’s demand that hospitals report 100% of their COVID-19 data every day.

According to two officials in the meeting, one CDC staffer left and immediately began to sob, saying, “I refuse to do this. I cannot work with people like this. It is so toxic.” That person soon resigned from the pandemic data team, sources say.

Other CDC staffers considered the decision arbitrary and destructive. “Anyone who knows the data supply chain in the U.S. knows [getting all the data daily] is impossible” during a pandemic, says one high-level expert at CDC. And they considered Birx’s imperative unnecessary because staffers with decades of experience could confidently estimate missing numbers from partial data.

“Why are they not listening to us?” a CDC official at the meeting recalls thinking. Several CDC staffers predicted the new data system would fail, with ominous implications. “Birx has been on a monthslong rampage against our data,” one texted to a colleague shortly afterward. “Good f—[uck]ing luck getting the hospitals to clean up their data and update daily.”

When Birx, a physician with a background in HIV/AIDS research, was named coordinator of the task force in February, she was widely praised as a tough, indefatigable manager and a voice of data-driven reason. But some of her actions have undermined the effectiveness of the world’s preeminent public health agency, according to a Science investigation. Interviews with nine current CDC employees, several of them senior agency leaders, and 20 former agency leaders and public health experts—as well as a review of more than 100 official emails, memos, and other documents—suggest Birx’s hospital data takeover fits a pattern in which she opposed CDC guidance, sometimes promoting President [redacted] policies or views against scientific consensus.

https://www.sciencemag.org/news/

This behavior typified Dr. Birx’s management style and caused resentment, reduced morale, and resignations among people working on the pandemic response. Dr. Redfield, as head of CDC, was a weak leader. He was unable to stand up to Dr. Birx. No-one provided overall leadership to compensate for these personality clashes.

In some cases, Dr. Birx promoted the president’s views against those of scientific personnel without logical reasons. Most of these cases were based on opinions expressed by the president at random where he noticed and commented on isolated aspects of the program without focussed attention. In most other cases, the president did not notice or direct the rest of the program and allowed Dr. Birx to do what she thought best without interference.

CDC employees with whom Science spoke—who requested anonymity because they fear retaliation—along with other public health leaders, say Birx’s actions, abetted by a chaotic White House command structure and weak leadership from CDC Director Robert Redfield, have contributed to what amounts to an existential crisis for the agency. And her disrespect for CDC has sent morale plummeting, senior officials say. During a May task force meeting, The Washington Post reported, Birx said: “There is nothing from the CDC that I can trust.”

CDC scientists and others say Birx’s record echoes her approach as head of the President’s Emergency Plan for AIDS Relief (PEPFAR) since 2014. Although that program is widely praised, people who worked on it for years say her draconian management and unrealistic data demands damaged morale and disrupted fieldwork and patient services.

…

The interviews and documents obtained by Science show Birx replaced a functional, if imperfect, CDC data system—well understood by hospitals and state health departments—with an error-ridden and unreliable filter on hospital needs that sometimes displays nonsensical data, such as negative numbers of beds. Such problems could hamper effective distribution of federal resources during an anticipated fall and winter spike in COVID-19 and flu cases, CDC officials say.

https://www.sciencemag.org/news/2020/10/

There is only one thing I have to add to the analysis by the Science magazine’s reporters: the issue of religious faith. Both Dr. Birx and Dr. Redfield were selected in part because of their staunch Christian religious faith. This selection is a poor basis for making an appointment to a top management position. Both doctors were highly competent within their fields, but both lacked management abilities needed to hold together teams of people with varied backgrounds.

The leader to whom they looked– Vice President Pence– was also highly religious and authoritarian. He followed the instructions of his leader– our current president– without question because of his own authoritarian personality style. The president’s overall leadership was inconsistent and uninformed.

This would not have mattered as much if there had been a well-organized leader at the top who could keep an eye on the ball. Instead, there was a narcissistic, disorganized, uncaring individual who became president almost by accident. He did not have any experience in leading a team of people towards a common goal that transcended the simple management of a real estate company. Worse, he has no concept of learning from experience, so he makes the same mistakes over and over again. We are all suffering the effects of a president who has no concept of organized leadership.