WASHINGTON -- It's becoming a kind of daily ritual: U.S. President Donald Trump and a phalanx of doctors file into the White House briefing room each evening to discuss the coronavirus, producing a display of rhetorical contortions as the medical officials try to stay true to the science without crossing the president.
The result can be a bewildering scene for Americans trying to understand how best to protect themselves from the virus.
On Tuesday, for example, Dr. Deborah Birx aligned herself with Trump's positive comments about plans to reopen businesses in Georgia and suggested that beauty salons and tattoo parlours there might be able to safely operate by using "creative" forms of social distancing.
But Birx, the White House coronavirus task force co-ordinator, later told Trump privately that Georgia's reopening plan was too hasty. And the next day, Trump publicly denounced Georgia's plans to start to reopen the state as coming "too soon."
On Wednesday, Trump opened his daily briefing by inviting Dr. Robert Redfield, the head of the Centers for Disease Control and Prevention, to "say a couple words just to straighten" out the doctor's earlier comments that the virus's return in the fall could be even more difficult than the current outbreak.
Redfield then tried to "clarify" his remarks by saying the return of the virus during flu season would be a difficult combination -- while allowing that his earlier comments had been accurately reported.
Also Wednesday, a top government doctor said he'd been ousted from his position for opposing politically connected efforts to promote a malaria drug that Trump touted without proof as a remedy for COVID-19.
Dr. Rick Bright "was sidelined for one reason only -- because he resisted efforts to provide unfettered access to potentially dangerous drugs," his lawyers said. Trump said he knew nothing about the matter.
Health experts worry that it hinders the ability of medical professionals to provide frank advice to the president and the public.
"The doctors on the task force and the scientists more generally responding to the pandemic are constantly looking over their shoulders," said Lawrence Gostin, a public health expert at Georgetown University. "There is a tug of war between the politicians and the public health officials. It's a very unhealthy dynamic."
Besides being asked to provide updates on the spread of the virus and best practices for combating it, the doctors find themselves drawn into Trump's efforts to provide a positive take on his handling of the pandemic.
They're keenly aware that the president has a record of bringing respected officials into his fold, talking up their credentials and then ultimately undercutting them or moving them aside. That happened with former Secretary of State Rex Tillerson, former White House chief of staff John Kelly and former Defence Secretary James Mattis.
Even Fauci hasn't escaped the need to massage his message after the fact to soothe a volatile president.
Earlier this month, Fauci set off Trump when he told CNN that more lives could have been saved if the U.S. government had acted more quickly.
"If we had right from the very beginning shut everything down, it may have been a little different," he said. "But there was a lot of pushback about shutting things down back then."
Later that day, Trump retweeted a call to .FireFauci, raising questions about whether Fauci's job was in jeopardy.
The following day, Fauci took the podium at the briefing to say he had used the "wrong choice of words." He added that the "first and only time" that he and Birx had talked to Trump about a national shutdown to mitigate the spread of virus, the president "listened to the recommendation and went to the mitigation."
Trump has largely listened to his team of medical experts. But he also sees them as his subordinates and doesn't want to be crossed. At Thursday's briefing, Birx was the only one of the medical experts advising the president in attendance. She spoke only briefly.
Instead, Trump invited William Bryan, a senior Department of Homeland Security official, to detail ongoing research his agency is conducting on the impact warm temperatures and sunlight might have on killing the virus.
Trump has kept an eye on the doctors' media appearances and has told confidants that he is impressed with Birx's demeanour, according to three White House officials and Republicans close to the White House. The three spoke on condition of anonymity because they were not authorized to speak publicly about private conversations.
Birx has generally tried to avoid splitting with Trump in public, generating some criticism for not speaking out more forcefully. Fauci, for his part, has been more blunt in diverging from the president's message at times.
Trump and some in his inner circle have grown frustrated at Fauci's willingness to break with the president both in interviews and during the briefings. Although Trump has not discussed firing Fauci, despite a clamour from some on the right, he has expressed annoyance at Fauci's positive press coverage -- and word was sent from the White House that the doctor should not participate in any more personal profile stories.
The president also seethed over Redfield's comments about the virus's potential threat this fall, though he later agreed with aides who said the CDC chief's comments had been overblown.
Because of his clashes with Trump, rumours about Fauci's fate take off whenever he misses a briefing because of his other duties. Trump has denied there is any conflict.
Birx, a political appointee from the Obama administration, has encouraged Trump to let the data inform his response to the crisis. At moments, she's also conspicuously heaped praise on the president.
As the Trump administration's original 15-day guidelines promoting social distancing were set to expire at the end of March, she told a Christian TV network popular with Trump's evangelical base that she was confident that the president, like her, was a student of data.
"I think his ability to analyze and integrate data that comes out of his long history in business has really been a real benefit during these discussions about medical issues," Birx told CBN.
Gostin said he's sympathetic of Birx's difficult position. But he said her public sidestepping of questions about how the Georgia governor wants to reopen businesses was problematic.
"It matters because in an ideal world, her only loyalty would be to science and public health," Gostin said.
Michael Weinstein, who heads the AIDS Healthcare Foundation and got to know Birx professionally after she was named the global AIDS co-ordinator in 2014, said Birx is driven by her concerns for patients and public health. She knows that she cannot be an effective advocate for science if she doesn't have the president's ear, Weinstein added.
"I'm glad she's there," Weinstein said. "It's very obvious that she's made a calculation what she must do to remain there, and that's, on balance, beneficial."
Dr. Kavita Patel, an adult medicine physician and health policy expert who served in the Obama White House, said scientists who advise any president have to be thick-skinned. But he said the situation is particularly fraught under Trump, who has sometimes followed his own instincts over the factual information given to him by experts.
"It is clear he is only picking and choosing from that information," Patel said.
"There seems to be a revolving door of people in science and medicine placed in an uncomfortable position," said Patel. "It feels a little bit like you put all the scientists on a Russian roulette board, and depending on where it lands, an individual could be pitted very publicly against the president."
Lemire reported from New York and Madhani reported from Chicago. Associated Press writers Mike Stobbe in New York and Ricardo Alonso-Zaldivar in Washington contributed to this report.
