Birx, until recently, had largely stayed on the president’s good side, though her rosy depictions of the pandemic fight drew recent skepticism from Democrats and other public health officials. But Trump also shredded Birx privately as well as in his public comments this week for not striking a more optimistic tone about states that are doing well and for saying she had “tremendous respect” for Trump’s rival Pelosi, the officials said.

Throughout the pandemic, some government public health officials have privately expressed worry to West Wing staffers that they are fearful of contradicting the president even as they try to focus on the data and the science behind the administration’s response to the virus, officials said. But publicly, there has been a concerted effort to appear that the team and the Oval Office are speaking with one voice.