The Sept. 11 email exchange between Alexander and other officials centered on an embargoed CDC bulletin set to publish the following week and which Alexander — an unpaid assistant professor at Canada’s McMaster University who was recruited by longtime Trump operative Michael Caputo — said contained faulty science. For instance, defining teenagers aged 18 and older as “pediatric” patients was “misleading,” Alexander wrote to Charlotte Kent, the editor-in-chief of the CDC’s Morbidity and Mortality Weekly Reports. Alexander also said that the document wrongly conflated the risks of the coronavirus to young children and older adolescents, urging Kent to make multiple changes to the document.

Alexander’s requests — the latest in a series of demands — set off new concerns inside CDC, which was already reeling from Alexander’s efforts to retroactively alter several reports or halt the MMWR process altogether. The reports are sent to researchers, physicians and hospitals to update them on the latest medical guidance and findings. The study in question addressed the death rates of Covid-19 among the pediatric population; CDC has frequently used the term “pediatric” to refer to the population under age 21, in line with how the American Academy of Pediatrics defines the term.

Alexander’s requests also complicated Kent’s own efforts to change the report after she said career civil servants made similar suggestions, according to an email exchange that CDC shared with POLITICO.