What did Dr. Deborah Birx say about the pandemic on CNN on Sunday?

Dr. Birx was interviewed on CNN yesterday by Dana Bash on the program “State of the Union.” It was the type of interview that public figures regret, as she spent most of the time defending herself. While she has been criticized politically over the interview, I am more concerned by the medical and scientific implications of several statements Dr. Birx made during the interview.

She made the statement that the US is in a “new phase” in its fight, saying that the deadly virus is more widespread than when it first took hold in the US earlier this year. “What we are seeing today is different from March and April. It is extraordinarily widespread.” Birx also commented that Americans need to follow health recommendations, including wearing a mask and practicing social distancing.

She seemed particularly focused on “rural” areas. “To everybody who lives in a rural area, you are not immune or protected from this virus,” Birx said. “If you’re in multi-generational households, and there’s an outbreak in your rural area or in your city, you need to really consider wearing a mask at home, assuming that you’re positive, if you have individuals in your households with comorbidities.”

She also said the (US) death toll will largely depend on southern and western states maintaining and accelerate their mitigation efforts. “It’s not super spreading individuals (that should be the focus), it’s super spreading events and we need to stop those. We definitely need to take more precautions.” Birx said each state needs a “dramatically tailored” approach to Covid-19, with a “set of recommendations based on what we are seeing at the community level, what we are seeing relevant to the hospitals.”

To me, none of this constitutes a “New Phase” of anything. This is a highly contagious infectious disease that has no medical control capability, such as a prophylactic drug, and no vaccine. It has progressed throughout the population through cluster outbreaks, mainly arising from large gatherings and in places like bars where high densities of people congregate. CNN’s own website shows there has been a chronic, progressive increase in COVID-19 infections that are doubling every two months (below).

To think this is an “urban” disease simply because the first epicenters were cities, mainly with international airports, is nonsensical. Outbreaks have occurred throughout the US, including early on in rural Georgia. It also seems inappropriate to tell people to “assume they are positive.” If we had a better testing program, people would actually know if they are infected and could act accordingly. 

In a larger perspective, we have failed to “tailor” control of this infection on a local level despite an entire range of initiatives, including contact tracing and local public health mandates. Part of this is due to the dynamics of the COVID-19 infection, but blame also falls on local officials who seem unwilling to rapidly implement control measures.

None of this is news to anyone involved in the COVID response. We all simply need to continue to focus as hard as possible on the important things (masks) to prevent COVID-19 transmission.