Late last week, the Centers for Disease Control and Prevention signaled it expects to have the updated COVID vaccine available by mid-September, along with a likely recommendation that everyone should get the latest booster shot, according to U.S. health officials.

The announcement comes as COVID hospitalizations increased for the sixth consecutive week, according to CDC data released Monday. For the week ending Aug. 19, hospitalizations rose by 18.8% to 15,067 – similar to levels seen in April. Still, COVID metrics remain at historic lows, public experts have said.

But at least one expert is urging the country to take COVID more seriously – Dr. Deborah Birx, who served as the White House Coronavirus Response Coordinator under former President Donald Trump.

Birx spoke to ABC News’ podcast “START HERE” about why she says the government is living in “a bit of a fantasy world" when it comes to the COVID-19 response. Birx also explains why she believes that the next month's vaccine booster is coming weeks too late and is arguing that seasonal booster shots should be made available more quickly. She also addressed criticism she didn’t combat misinformation from Trump during her time in the White House.

BRAD MIELKE: Dr. Deborah Birx is here, you remember that she served under President Trump as the White House Coronavirus Response Coordination Director in 2020. You probably remember her standing alongside Dr. Anthony Fauci, explaining what Americans should and shouldn’t be doing when we were all so confused.

Dr. Birx, thank you so much for being with us.

DEBORAH BIRX: Happy to be with you.

MIELKE: Hey so, let's get right into it. How serious is this COVID surge that we're seeing right now, in your eyes?

BIRX: Well, I loved your introduction, because you laid it out perfectly. So, what does it mean when someone recommends a fall vaccination? It means that you're ignoring the summer wave. And we've had the summer wave in 2020, 2021, 2022 and now 2023. It is predictable. It's what COVID does. It has been persistent, but we've had these waves, and so we've never gotten to zero. The hospital admissions have never gone to zero.

Now we're living in this, a bit of a fantasy world, where we're pretending that COVID is not relevant. But I can tell you, if you can hear my voice and you know two or three people who have COVID, that means that 5 to 10% of your friends already have COVID. That means that there is a lot of COVID out there, and we're not testing for it and we're not telling people to get tested.

And thank goodness you tested and protected your wife, because that's what it's going to come down to now, we all have to enhance our responsibility to protect those in our family.

MIELKE: As far as the boosters, then? This booster shot. Are these boosters coming too late?

BIRX: Well, the important thing is, this is the booster that would have been appropriate for the summer wave. This booster is most likely not going to work with the winter wave, because we already have a pretty significant escape mutant or escape variant out there that's beginning, just like the current variant, began like eight weeks ago. We are already beginning to see some evidence of a new variant for which the vaccine probably is not well matched. So, the whole point of doing mRNA technology was to be able to switch out –

MIELKE: These are the mRNA vaccines that you can tailor make?

BIRX: Yes. So right now, we should be making the vaccine against this very new variant, the b2.86, so that it is ready in January to really combat what we know will be the winter wave. Now, what's interesting is this summer wave and each summer wave seems to be coming about two weeks later, and that resulted in our winter wave last year being in January rather than primarily December. And so we should expect that late December, early January wave. And so we should be making vaccines right now for that wave.

MIELKE: Why aren't we? ‘Cause I feel like the mRNA vaccines were supposed to be this game changer, where like, yeah, now when something happens we can bust out a new one within weeks. But it still seems like the flu shot, like get your flu shot once a year.

BIRX: Exactly, and what a mistake that is. Because let's remember, the protection against infection is extraordinarily short-lived. And so the protection from either prior infection or the vaccine is short-lived. In some cases, maybe as short as four weeks. In other cases, it may be 3 to 6 months. But we know across the board, natural immunity and vaccine-induced immunity against infection wanes substantially in three to six months.

And so if you are living with immunosuppressed individuals or if you have people in your household over 70, your vaccination and their vaccinations need to be at a different rate than the general population.

And so right now we should be making the b2.86 variant vaccine to be ready in December to immunize people over 70 and those with immunodeficiencies, because this is the only way we're going to ensure that those that are most susceptible – we know precisely who those are, it hasn't changed since 2020 – and to make sure that we have testing in those households so that they can protect their family members, that we tell them when the surges are coming. I mean, we have totally ignored this wave.

Finally, hospitalizations. Huge mistake to measure hospitalizations as really your sole surveillance, because by the time you see hospitalizations in your area, the virus has been circulating for four to six weeks.

MIELKE: Right, for somebody to have gotten COVID and then for it to progress to the point where they go into the emergency room, by then, the entire community might have it.

BIRX: Correct.

MIELKE: Well then, and I should say, it’s not clear these boosters won’t work against these oncoming variants, you’re just saying [the oncoming variants] weren’t part of these clinical trials, so we don’t know. We also don’t know for a fact that this variant will take over.. But I guess my question still remains – Why? Why aren’t more boosters being cranked out? And if it’s a political concern, where maybe the administration is thinking, “Ugh, no one wants to take more shots, COVID is a political liability for us. Let’s just do it once a year like the flu.” Is that the reason?

BIRX: I think we wanted to make it like flu, because that was easier. But it's never going to be like flu. It stays with us in between the waves. We have a summer wave. We have a winter wave. It makes people much sicker than flu. Many more people die from it than flu. And by the way, flu does not have this level of long COVID and these long side effects that we see with COVID. So let's just all agree it's not flu. It will never be flu. Following it and surveying for it like we do for flu will never be adequate in this country.

I believe, if the federal government said to the private sector, “We need better monoclonal antibodies, we need more antivirals, and we need a vaccine against the new variant that’s coming,” the private sector would do it like they did four years ago. It’s not that they need guarantees from the government that they would pay for it, because now insurance is paying for it.

So what the federal government needs to do is lay out the plan that says, “We’re not done with COVID, COVID’s not done with us. 250,000 Americans died in 2022. We’ve got to do a better job in 2023. And this is part of our better job.”

MIELKE: The CDC says it currently has no plans, there's no talk about bringing back mask mandates of any kind. We've talked about vaccines, antibodies, testing. Is that the right call in your eyes to not make masks part of the conversation going forward?

BIRX: You know, not only should it be part of the conversation, but it should be very clear when there is the need to use it and what families should be alerted to using it. But let's be clear, a lot of our elderly, particularly those in memory care, really can't mask. And that means the people around them need to test and mask.

I'm all for not mandating, but educating. But then you have to give people the tools and the data that they need in order to make their decisions and empower them to make the decisions that's right for their family. And we're just not alerting people to when they need to worry.

MIELKE: So it sounds like, Dr. Birx, like you're saying, like this is something to take seriously. We haven't really taken it seriously enough. There are people living in what you kind of described as like a fantasy world, where we're just acting like COVID doesn't exist because it's just been too long. And then that should stop. But then I got to imagine I'm going to hear a listener screaming into their phone as they listen to this, “Dr. Birx, you stood next to President Trump as he was saying misinformation, outright misinformation about COVID. Why didn't you step in front of him at the microphone right then? Why is this the line coming from you now that you no longer have this official capacity?”

BIRX: Because my line was coming through the whole time. I've known Dr. Fauci for a long time. Dr. Fauci was the outside voice, and I was the inside voice. Someone had to be inside the White House making sure that resources were made appropriately to expand testing, to expand monoclonal and develop vaccines, and that was part of my role. We each had a role to play. If you're referring to the bleach episode

MIELKE: I’m thinking about using disinfectant and bleach in your veins.

[The so-called “bleach episode” refers to when then-President Donald Trump said at a press conference, “And I then I see the disinfectant that knocks it out in a minute. And is there a way we can do something like that by injection inside, or almost a cleaning?”]

BIRX: So I did speak up at the end of that. What never is shown is [Trump’s] back was turned to me, and he was speaking to the DHS scientist. He was not facing me. And if you people asked me, would you have run up to the microphone? I was active-duty military. That is not within my repertoire.

Did I make sure that President Trump, NIH, FDA and CDC were alerted and that the next day President Trump said it wasn't true and that he was joking? Yes, that's what I could get done.

I think getting that 45 days to slow the spread, getting tests out there, getting vaccines out there and getting monoclonal [antibodies] out up there were very important. Were we all perfect? We were not.

I think my biggest regret is not letting Americans know how important they were in preventing that original COVID spread to get beyond the 12 metros that it was in, into the other 25 metros. That was all prevented by Americans really being proactive, and I think because we never called that out, people felt disempowered. And the one thing you want to do in a pandemic is really empower people that they know that their individual actions make a huge difference at the population level.