As COVID-19 cases skyrocketed before the Thanksgiving holiday weekend, Dr. Deborah Birx, coordinator of the White House coronavirus response, warned Americans to "be vigilant" and limit celebrations to "your immediate household."
For many Americans that guidance has been difficult to abide, including for Birx herself.
The day after Thanksgiving, she traveled to one of her vacation properties on Fenwick Island in Delaware. She was accompanied by three generations of her family from two households. Birx, her husband Paige Reffe, a daughter, son-in-law and two young grandchildren were present.
The Centers for Disease Control and Prevention has asked Americans not to travel over the holidays and discourages indoor activity involving members of different households. "People who do not currently live in your housing unit, such as college students who are returning home from school for the holidays, should be considered part of different households," the CDC said.
Even in Birx's everyday life, there are challenges meeting that standard. She and her husband have a home in Washington. She also owns a home in nearby Potomac, Maryland, where her elderly parents, and her daughter and family live, and where Birx visits intermittently. In addition, the children's other grandmother, who is 77, also regularly travels to the Potomac house and returns to her 92-year-old husband near Baltimore.
Birx's own experiences underline the complexity and difficulty of trying to navigate the perils of the pandemic while balancing a job, family and health, especially among essential workers like her.
Yet some of Birx's peers in public health say she should be held to a higher standard given her prominent role in the government's response to the pandemic and the current surge in COVID-19 deaths across the country.
Birx has expressed a desire to maintain a significant role on the White House coronavirus task force when President-elect Joe Biden is inaugurated next month, according to a person familiar with the Biden team's personnel deliberations and a Trump administration coronavirus task force official. Neither was authorized to publicly discuss internal deliberations and both spoke on condition of anonymity.
"To me this disqualifies her from any future government health position," said Dr. Angela Rasmussen, a virologist at the Georgetown Center for Global Health Science and Security. "It's a terrible message for someone in public health to be sending to the American people."
After The Associated Press raised questions about her Thanksgiving weekend travels, Birx acknowledged in a statement that she went to her Delaware property. She declined to be interviewed.
She insisted the purpose of the roughly 50-hour visit was to deal with the winterization of the property before a potential sale — something she says she previously hadn't had time to do because of her busy schedule.
"I did not go to Delaware for the purpose of celebrating Thanksgiving," Birx said in her statement, adding that her family shared a meal together while in Delaware.
Birx said that everyone on her Delaware trip belongs to her "immediate household," even as she acknowledged they live in two different homes. She initially called the Potomac home a "3 generation household (formerly 4 generations)." White House officials later said it continues to be a four-generation household, a distinction that would include Birx as part of the home.
Birx's job makes her an "essential worker" by federal guidelines, in a position that requires extensive travel to consult with state and local officials on the pandemic response. She has traveled to 43 states, driving 25,000 miles, (40,000 kilometers), she said, often to coronavirus hot spots. Birx also has an office in the White House, where numerous COVID-19 infections have been revealed.
Through it all, she said she has kept herself and her family safe through isolating, wearing a mask and regular testing.
Birx has not said how long she isolates for before visiting family. Medical experts say people who only recently became infected often do not test positive. They say wearing a mask has limited efficacy in an environment such as the White House, where few others use them.
Margaret Flynn, the children's other grandmother, comes to the Potomac home to provide child care, then returns to her husband, who has health complications. Birx said that she hasn't seen the other grandmother since the beginning of the pandemic and does not know how frequently she visits the Potomac house.
Flynn confirmed that she hasn't spoken to Birx in months. Flynn declined to say how frequently she visits the home to look after the grandchildren.
From the podium at the White House, Birx has spoken about how she comes from a multigenerational family with her parents and her daughter's family, including grandchildren, all living under one roof. Many saw that as a relatable family dilemma.
In early April, she said she understood the sacrifices many were making and explained that she couldn't visit her Potomac home when one of her grandchildren had a high fever.
"I did not go there," she said, while standing next to President Donald Trump. "You can't take that kind of risk."
She has resumed her visits to the house since then.
Numerous elected officials, including prominent Democrats, have been forced to acknowledge that they have not heeded their own stern warnings to the public about the dangers of spreading the virus.
But Birx occupies a position of far greater authority when it comes to the pandemic. Many Americans rely on the advice that she and the government's top infectious disease expert, Dr. Anthony Fauci, have given.
Kathleen Flynn, whose brother is married to Birx's daughter who lives in the Potomac house, said she brought forward information about Birx's situation out of concern for her own parents, and acknowledged family friction over the matter.
"She cavalierly violated her own guidance," Flynn said of Birx.
Richard Flynn, her father, confirmed details of Birx's Thanksgiving holiday gathering and visits to the Potomac house, but said he trusted the doctor and believes she's doing what's right. He said Birx's visits to the house have occurred only every few weeks of late.
"Dr. Birx is very conscientious and a very good doctor and scientist from everything I can see," Richard Flynn said during a recent interview.
Medical experts say public health officials such as Birx need to lead by example, including personal conduct that's beyond reproach.
"We need leadership to be setting an example, especially in terms of things they are asking average Americans to do who are far less privileged than they are," said Dr. Abraar Karan, a global health specialist at Brigham and Women's Hospital and Harvard Medical School, about the high-profile lapses in judgment.
Birx came to the White House coronavirus task force with a sterling reputation. A public servant since the Reagan administration, Birx has served as a U.S. Army physician and a globally recognized AIDS researcher. She was pulled away from her ambassadorial post as the U.S. global AIDS coordinator to assist the task force in late February.
Birx, however, has faced criticism from public health experts and Democratic lawmakers for not speaking out forcefully against Trump when he contradicted advice from medical advisers and scientists about how to fight the virus.
While she stayed in Trump's good graces far longer than Fauci, who frequently contradicted Trump, the president by late summer had sidelined Birx, too.
Kathleen Flynn said she urged her brother and sister-in-law not to allow her mother to babysit, arguing it put her mother at risk by spending so much time in a household other than her own, while also posing a danger to Birx's elderly parents. Flynn, who said she has long had a strained relationship with her brother, is currently not on speaking terms with him and has never met Birx.
Flynn said her mother waited about a week after Birx's Thanksgiving trip before returning to the Potomac home to provide child care help.
Lawrence Gostin, a public health expert at Georgetown University's law school who has known Birx professionally for years, said that he's confident that Birx took all necessary precautions to minimize risks in her Thanksgiving travel. Still, he said it undercuts her larger goal to get Americans to cooperate with government officials' efforts to minimize the death and suffering caused by the virus.
"It's extraordinarily important for the leaders of the coronavirus response to model the behavior that they recommend to the public," Gostin said. "We lose faith in our public health officials if they are saying these are the rules but they don't apply to me."