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    Younger Adults Are Missing Early Warning Signs of Colon Cancer

    The LatestColorectal cancer rates are rapidly rising among adults in their 20s, 30s and 40s, and the most common warning sign for the disease is passing blood in the stool, according to a new scientific review.Rectal bleeding is associated with a fivefold increased risk of colorectal cancer, according to the new analysis, which looked at 81 studies that included nearly 25 million adults under 50 from around the world.Abdominal pain, changes in bowel habits and anemia are other common warning signs of the disease and should not be ignored, said the researchers, who published the paper on Thursday in the journal JAMA Network Open.A light micrograph of a colon biopsy from a colonoscopy.Choksawatdikorn/Science SourceWhy It MattersColon and rectal cancer rates have risen among younger adults as rates have declined among older people, who are far more likely to get colonoscopies that can catch cancers and precancerous lesions called polyps.But though millennials born around 1990 are at almost twice the risk of colon cancer compared with people born in the 1950s, and have a risk of rectal cancer that is four times as high, young people without a strong family history of colon cancer aren’t eligible for colonoscopies until the age of 45.Doctors may also miss the warning signs. Anecdotal evidence suggests that because physicians are less likely to suspect malignancies in younger people, they may attribute a symptom like rectal bleeding to a benign condition like hemorrhoids, rather than cancer, said Joshua Demb, a cancer epidemiologist at the University of California, San Diego, and one of the paper’s lead authors.From the time younger adults first go to a caregiver with a complaint about a symptom until they receive a diagnosis can take four to six months on average, the analysis found. Because the diagnosis is often delayed, younger adults tend to have more advanced disease that is harder to treat.“We need to facilitate early detection, and one way is identifying these red flags,” Dr. Demb said.What We Don’t KnowThe causal factors driving the rise in colon and rectal cancers in younger adults were not addressed in the new analysis, and are not well understood.Colorectal cancer has long been associated with obesity, smoking, a sedentary lifestyle, high alcohol intake and diets that are rich in red meat, processed food and sugary drinks.New research exploring the rapid rise in colorectal cancer in younger adults is examining other possible causes, including environmental exposures, changes in gut bacteria and the use of some medications, such as antibiotics. More

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    The Disease Detectives Trying to Keep the World Safe From Bird Flu

    As Dr. Sreyleak Luch drove to work the morning of Feb. 8, through busy sunbaked streets in Cambodia’s Mekong river delta, she played the overnight voice messages from her team. The condition of a 9-year-old boy she had been caring for had deteriorated sharply, and he had been intubated, one doctor reported. What, she wondered, could make the child so sick, so fast?“And then I just thought: H5N1,” she recalled. “It could be bird flu.”When she arrived at the airy yellow children’s ward at the provincial hospital in Kratie, she immediately asked the child’s father if the family had had contact with any sick or dead poultry. He admitted that their rooster had been found dead a few days before and that the family had eaten it.Dr. Luch told her colleagues her theory. Their responses ranged from dubious to incredulous: A human case of avian influenza had never been reported in their part of eastern Cambodia. They warned her that if she set off the bird flu warning system, many senior government officials might get involved. She risked looking foolish, or worse.Anxious but increasingly certain, Dr. Luch phoned the local public health department, located just across the street. Within minutes, a team arrived to collect a sample from the child, Virun Roeurn, for testing in a lab.By then, Virun’s distraught parents had lost faith in the hospital. They demanded that he be sent by ambulance to the capital, Phnom Penh. His flu swab sample traveled with him.Virun died on the journey. At 8 p.m., Cambodia’s National Public Health Laboratory confirmed Dr. Luch’s suspicion: He had died of highly pathogenic avian influenza.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    What to Know About New Covid Variants, ‘FLiRT’: Symptoms, Vaccines and More

    Experts are closely watching KP.2, now the leading variant.For most of this year, the JN.1 variant of the coronavirus accounted for an overwhelming majority of Covid cases. But now, an offshoot variant called KP.2 is taking off. The variant, which made up just one percent of cases in the United States in mid-March, now makes up over a quarter.KP.2 belongs to a subset of Covid variants that scientists have cheekily nicknamed “FLiRT,” drawn from the letters in the names of their mutations. They are descendants of JN.1, and KP.2 is “very, very close” to JN.1, said Dr. David Ho, a virologist at Columbia University. But Dr. Ho has conducted early lab tests in cells that suggest that slight differences in KP.2’s spike protein might make it better at evading our immune defenses and slightly more infectious than JN.1.While cases currently don’t appear to be on the rise, researchers and physicians are closely watching whether the variant will drive a summer surge.“I don’t think anybody’s expecting things to change abruptly, necessarily,” said Dr. Marc Sala, co-director of the Northwestern Medicine Comprehensive Covid-19 Center in Chicago. But KP.2 will most likely “be our new norm,’” he said. Here’s what to know.The current spread of CovidExperts said it would take several weeks to see whether KP.2 might lead to a rise in Covid cases, and noted that we have only a limited understanding of how the virus is spreading. Since the public health emergency ended, there is less robust data available on cases, and doctors said fewer people were using Covid tests.But what we do know is reassuring: Despite the shift in variants, data from the C.D.C. suggests there are only “minimal” levels of the virus circulating in wastewater nationally, and emergency department visits and hospitalizations fell between early March and late April.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Complications from Alcohol Use Are Rising Among Women

    New research shows that alcohol-related liver disease and other health problems increased even more than expected among women ages 40 to 64 during the pandemic.The LatestA new study adds to a mounting body of evidence showing that rising alcohol consumption among women is leading to higher rates of death and disease. The report, published Friday in the journal JAMA Health Forum, examined insurance claims data from 2017 to 2021 on more than 14 million Americans ages 15 and older. Researchers found that during the first year and a half of the coronavirus pandemic, women ages 40 to 64 were significantly more likely than expected to experience serious complications like alcohol-related cardiovascular and liver disease, as well as severe withdrawal.The BackgroundAlcohol consumption in the United States has generally increased over the last 20 years, said Dr. Timothy Naimi, the director of the Canadian Institute for Substance Use Research at the University of Victoria. Dr. Naimi was a co-author on a recent paper that showed deaths from excessive alcohol use in the United States rose by nearly 30 percent between 2016 and 2021.While men still die more often from drinking-related causes than women, deaths among women are climbing at a faster rate. “The gap is narrowing,” said Dr. Bryant Shuey, an assistant professor of medicine at the University of Pittsburgh and the lead author of the new study.The ResearchThe study looked at serious health issues related to drinking, including alcohol-related liver and heart disease, inflammation of the stomach lining that led to bleeding, pancreatitis, alcohol-related mood disorders and withdrawal. Researchers compared insurance claims data for these complications with the rates they expected to see based on past prevalence of these conditions.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Amid Florida’s Measles Outbreak, Surgeon General Goes Against Medical Guidance

    In a letter, Joseph Ladapo said parents at an elementary school with confirmed measles cases can decide whether their children should attend school.As a cluster of measles cases grew in an elementary school in southern Florida, the state’s surgeon general sent a letter to parents that contradicted widespread medical guidance about how to keep the disease from spreading.Doctors and health officials typically recommend that children who are not vaccinated for measles isolate for 21 days after they have been exposed at school. In the letter, the state surgeon general, Dr. Joseph Ladapo, said it was up to parents and guardians to determine when their children can attend school, even if those children have not been vaccinated against the disease.“Because of the high likelihood of infection, it is normally recommended that children stay home until the end of the infectious period,” the letter read. However, the state Department of Health “is deferring to parents or guardians to make decisions about school attendance,” the letter, sent to parents at Manatee Bay Elementary School in Weston, Fla., continued.Dr. Ladapo added that these recommendations might change in the future and stressed that children with measles symptoms should not go to school. As of Friday, there were six confirmed cases at the school, according to Broward County Public Schools.Measles is one of the world’s most infectious diseases. Cases and deaths have been rising across the globe, in part because health officials have struggled to vaccinate people in the wake of the coronavirus pandemic and growing vaccine hesitancy. In January, the Centers for Disease Control and Prevention warned physicians to “stay alert for measles” as more cases emerged in the United States, largely among unvaccinated children and adolescents.Dr. Ladapo, a former clinical researcher at the University of California, Los Angeles, has played a prominent role in the administration of Gov. Ron DeSantis, a Republican, appearing with the governor at events that mainstream public health experts have repeatedly criticized as spreading dangerous falsehoods.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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    Should No Labels Run a Presidential Candidate?

    More from our inbox:Oppenheimer’s Lessons on Politics and ScienceDisease Outbreaks in Animal IndustriesCans on the Newlyweds’ Car Jacquelyn Martin/Associated PressTo the Editor:Re “With Centrist Platform, No Labels Pushes Cause and Latent Third-Party Bid” (news article, July 16):Although I would love to see our two-party system evolve and I think less acrimony is essential to moving forward, I have two basic problems with the No Labels party idea.First, the U.S. system simply doesn’t support the creation of viable alternate parties. Until the barriers in place are removed, all third parties can do is play spoiler.Second, I firmly believe that our first priority should be defending our democratic foundation. For the first time in U.S. history, we have one party actively and unashamedly undermining the rule of law and democracy itself. We need to defend and shore up our democracy first. Then it will be a great time to change the rules so we don’t have this seemingly black or white constraint for our choice of candidate.Since Harlan Crow, the Texas billionaire who gives generous gifts to Justice Clarence Thomas, is a contributor to No Labels, I am suspicious of the rest of the donors whom we don’t know about.I see this movement as a political effort designed to prey on the public’s good faith, good intentions and frustration with the chaos caused by anti-democracy forces in the U.S.The way forward is to stick together for democracy — not splinter.Deb GarriesCalgary, AlbertaThe writer is an American citizen.To the Editor:The article mentions the possibility of the No Labels movement in the U.S. seeking to be listed on state ballots as a political party. This is no easy job. Of the two largest American minor political parties, Libertarians and Greens, only the Libertarians have been getting their candidates on the ballot in all 50 states.Each state has its own often complex rules and requirements to be listed on its ballots. Any group such as No Labels could also face legal challenges by one or both of the major parties. Such an effort to gain ballot access for a new party typically requires years of work and much money.No Labels could cause problems in battleground states for President Biden’s re-election bid, but No Labels’ major battle would be just trying to get on state ballots.Dan DonovanBrooklynTo the Editor:The third-party scam must have the Trump wing of the G.O.P. chuckling with glee. Currently, only a Republican or Democrat can win the presidency, and that’s not going to change in a year and a half. Donald Trump’s followers will not be moved by persuasion or facts, so he will be a nominee.This week you reported on Mr. Trump’s intent to concentrate power in the executive branch, weakening the courts and Congress. He plans the end of the republic as we know it. Yet his followers will vote for him.The Republicans’ path to power is a continual drumbeat of “President Biden’s too old, we need fresh blood,” etc., shifting attention away from Mr. Biden’s effectiveness. The strategy: Persuade Democratic voters that they are too “sophisticated” (No Labels) to accept the binary choice, and should go for a Manchin, a Kennedy.In 2000, Ralph Nader voters helped elect George W. Bush, who attacked Iraq and ballooned the national debt. Many “Bernie Bros” in 2016 refused to vote for Hillary Clinton, helping clear the way for Mr. Trump.Thanks for nothing.This search for political purity, or just novelty, could ironically result in the beginning of American dictatorship next year. It is unrealistic to think that third-party votes will lead anywhere else.Howard SchmittGreen Tree, Pa.To the Editor:I’d like to propose an alternative way to refer to No Labels. It should be called what it is: Republicans Only Not in Name (RONIN). Not only is that resonant with the term RINO (Republicans in Name Only), which is used by many Republicans to refer to other Republicans they disapprove of. It’s also consistent with the Japanese term “ronin,” a kind of loose cannon in the feudal social structure.Ron GroveFlagstaff, Ariz.Oppenheimer’s Lessons on Politics and ScienceJ. Robert Oppenheimer in an undated photo.Associated PressTo the Editor:Re “‘Oppenheimer’ Shows the Danger of Politicizing Science,” by Kai Bird (Opinion guest essay, July 18):Mr. Bird’s excellent essay about J. Robert Oppenheimer illustrates all too well the dangers to our democracy in allowing political rhetoric and policies to alter scientific facts and theories.Such lessons do not belong only to the McCarthy era. The politicization of the Covid vaccine and the far right’s attack on Dr. Anthony Fauci are recent history. And indeed, as we speak, Republican strategists are planning increased executive and presidential political control over scientific and other now independent agencies.Let’s not let the lessons of Oppenheimer be lost. They are as relevant now as they were in the McCarthy era.Ken GoldmanBeverly Hills, Calif.To the Editor:Whether it’s harsh truths about atomic power or the merits of vaccines against Covid-19, influenza and childhood illnesses, it’s science — regularly, honestly and clearly explained — that is sanity’s ultimate home-field advantage.Peter J. PittsNew YorkThe writer, a former F.D.A. associate commissioner, is president of the Center for Medicine in the Public Interest and a visiting professor at the University of Paris School of Medicine.Disease Outbreaks in Animal IndustriesThe United States produces 10 billion animals for food every year, including more pigs and poultry, which can harbor and transmit influenza, than nearly any other country.Gerry Broome/Associated PressTo the Editor:Re “Risk Seen in U.S. Animal Industries” (Science Times, July 11), about the risk of infectious disease outbreaks:This article is illuminating, but one element of the crisis is missing: the degree to which animals suffer in these appalling situations.Consider the complete lack of hygiene to which animals confined in farming operations and live animal markets are subjected without relief until they die, either at the hands of slaughterers or from chronic stress and disease.I doubt that much will be done to control the animal industries identified in the article until more people speak out against what these animals are forced to endure.The cruelty and contamination are linked. We might stretch our imaginations to make this connection and act on it.Karen DavisMachipongo, Va.The writer is the president of United Poultry Concerns, a nonprofit that promotes the respectful treatment of domesticated birds.Cans on the Newlyweds’ CarTo the Editor:Re “Where Those Cans Behind the Car Came From” (Traditions, Sunday Styles, July 16):When my wife, Laurie, and I were married, my brothers affixed a “Just Married” sign and a bouquet of cans to the bumper of my Jeep Cherokee.On our way to the airport that evening, we were pulled over by the Suffield, Conn., police. We weren’t speeding, and there was no one else on the road. Perhaps the officer wanted to congratulate the newlyweds?No; apparently a can had come loose from the vehicle. We were issued a warning — and informed that a ticket would have cost us $82 (more than $200 today) — for “operating with an unsecure load.”Despite that inauspicious start, my wife and I will celebrate our 34th anniversary in November.David CecchiAgawam, Mass. More

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    Your Monday Briefing: North Korea’s Growing Outbreak

    Plus India bans most wheat exports and South Korea amends surgery laws.Good morning. North Korea’s outbreak grows, India bans most wheat exports and South Korea amends its surgery laws.Kim Jong-un, North Korea’s leader, chided health officials for “incompetence” at a Saturday meeting, according to state media.Korean Central News Agency, via Associated PressNorth Korea’s outbreak growsState media reported 21 new deaths and a huge jump in suspected coronavirus cases on Saturday, as North Korea struggled to contain its first reported outbreak.State media said an additional 174,400 people had symptoms, like a fever, that could be caused by Covid-19 — a tenfold jump from the 18,000 such cases reported on Friday. North Korea has reported a total of 524,400 people with Covid-like symptoms since late last month.“North Korea is reporting only ‘people with fever’ because it does not have enough test kits,” an expert said. Covid may not be causing all those fevers, he said, but the number of asymptomatic cases is likely much higher than the official count.Vaccines: North Koreans are unvaccinated, though some elites may have received shots. International health organizations and the South Korean government have said that they were ready to ship vaccines, therapeutics and other aid.In other developments:The Covid-19 death toll in the U.S. is nearing one million. The nation wants to move on, but many of the loved ones left behind are grieving alone.If the U.S. had the same Covid death rate as Australia, about 900,000 lives would have been saved, our Sydney bureau chief writes in an analysis.Prime Minister Jacinda Ardern of New Zealand tested positive and has moderate symptoms.Thanks to its focus on subsidizing its farmers, India has about 10 percent of the world’s grain reserves.Amit Dave/ReutersIndia bans most wheat exportsAdding to concerns of global food insecurity, the world’s second-largest wheat producer has banned most exports of the grain. India’s commerce ministry said that a sudden price spike had threatened the country’s food security.The move, an apparent about-face, could compound a worldwide shortfall and exacerbate a dire forecast for global hunger. In April, Prime Minister Narendra Modi told President Biden that India was ready to supply the world with its reserves.Background: The war has interrupted wheat production in Ukraine and Russia, and blockades in the Black Sea have disrupted transport of the grain. And climate change poses a dire threat. Agricultural experts said that India’s ongoing heat wave could affect the harvest this year. Torrential rains brought on poor harvests in China, while drought in other countries further snarled supplies.Iran: Protests driven by rising food prices spread to at least six provinces on Friday. A hospital near Seoul voluntarily put cameras in its operating rooms in 2020.Chang W. Lee/The New York TimesSouth Korea’s surgery surveillanceSouth Korea has become one of the first countries to require cameras in operating rooms that handle patients under general anesthesia, a measure meant to restore faith in the medical system.For years, hospitals have fielded complaints about doctors turning patients over to unsupervised assistants who perform “ghost surgeries.” About five patients have died from such surgeries in the past eight years, a patient advocate said.According to patient advocates, surgeons deputize nurses to perform operations, thereby packing in more procedures and maximizing profits. They argue that cameras will protect patients and offer medical malpractice victims evidence to use in court.But ethicists and medical officials across the world have cautioned that surveilling surgeons may hurt morale, violate patient privacy and make physicians less likely to take risks to save lives.Background: The surreptitious surgeries began occurring at plastic surgery clinics in the 2010s, after South Korea started promoting medical tourism, according to legal experts. They spread to spinal hospitals, experts said, which mostly perform relatively uncomplicated procedures in high demand among the country’s aging population. THE LATEST NEWSAsia and the PacificMost of the victims were assembly line workers, local officials said.Sajjad Hussain/Agence France-Presse — Getty ImagesAt least 27 people were killed after a fire swept through a commercial building in New Delhi. The city’s chief fire officer said that the city was seeing more fires during India’s heat wave.Most members of the Rajapaksa political dynasty are hiding out at a military base in Sri Lanka as a protest movement grows. Only the president is still clinging to power.Gender transition surgery is a campaign flashpoint in Australia that looks like something from an overseas culture war.The WarHere are live updates.Finland’s government and Sweden’s governing party confirmed that they would seek NATO membership on Sunday, another strategic setback for Russia.Ukrainian forces drove Russian troops farther from Kharkiv, the country’s second-largest city, as thousands of residents return each day. Residents are also returning to Bucha, and Kyiv shortened its curfew.Russian bloggers are criticizing evidence of a military disaster on the Donets River, which is breaking through the Kremlin’s information bubble.Ukraine won the Eurovision Song Contest in a pop culture endorsement of solidarity.World NewsA memorial for the victims of the Buffalo shooting.Joshua Rashaad McFadden for The New York TimesA white gunman killed 10 people and injured three more — almost all Black — at a supermarket in upstate New York, one of the deadliest racist massacres in recent American history. Follow live updates here.Israeli police officers attacked mourners at the funeral procession of Shireen Abu Akleh, a slain Palestinian American journalist.The U.A.E. has a new leader, Sheikh Mohammed bin Zayed Al Nahyan. His half brother Sheikh Khalifa bin Zayed died on Friday, after leading the Persian Gulf country for 18 years.Somalia elected a new president, but the government holds little sway: Al Shabab militants collect taxes, decide court cases and control the streets.Lebanese voters cast ballots for a new Parliament on Sunday, their first chance to pass judgment on lawmakers since the economy fell apart.A Morning ReadKim Do-yoon, an internationally known tattoo artist, at his studio in Seoul. Chang W. Lee/The New York Times Tattooing without a medical license is illegal in South Korea, where decorative body art has long been associated with organized crime. But the law is crashing into rising international demand for what are known as “k-tattoos,” and the country’s tattoo artists argue that it’s time to end the stigma against their business.Lives lived: Katsumoto Saotome compiled six books of survivors’ recollections of the 1945 Tokyo firebombing and founded (without government support) a memorial museum. Saotome died at 90.ARTS AND IDEASThe future of paralysis?Sixteen years ago, Dennis DeGray’s mind was nearly severed from his body. He ran to take out the trash in a rainstorm, slipped, landed hard on his chin, and snapped his neck, paralyzing him from the collarbones down.For several years, he “simply laid there, watching the History Channel,” he said. But then he met Jaimie Henderson, a neurosurgeon at Stanford, who had been developing a brain-computer interface. Henderson asked DeGray if he wanted to fly a drone. DeGray decided to participate.Now, implants in his brain allow DeGray some control, even though he cannot move his hands. Just by imagining a gesture, he can move a computer cursor, operate robotic limbs, buy from Amazon and fly a drone — albeit only in a simulator, for now.There are obvious therapeutic applications. Interest from an increasing number of high-profile start-ups also suggests the possibility of a future in which neural interfaces enhance people’s innate abilities and grant them new ones — in addition to restoring those that have been lost.PLAY, WATCH, EATWhat to CookRyan Liebe for The New York Times. Food Stylist: Hadas Smirnoff.The secret to these chocolate chip cookies? Chill the dough for a day before you bake them.FitnessGetting back into running is easier than you think.What to WatchFour children develop unusual abilities in “The Innocents,” a wonderfully eerie Norwegian horror movie.Now Time to PlayPlay today’s Mini Crossword, and a clue: Clothing (four letters).Here are today’s Wordle and today’s Spelling Bee.You can find all our puzzles here.That’s it for today’s briefing. See you next time. — AmeliaP.S. Elisabeth Goodridge, The Times’s deputy travel editor, will study travel reporting in an era of climate change as a 2023 Nieman fellow at Harvard.The latest episode of “The Daily” is on America’s Covid death toll.You can reach Amelia and the team at briefing@nytimes.com. More

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    California’s Governor Was Tested by the Pandemic. Now a Recall Looms.

    In California, both Republicans and Democrats say the threat of a recall election has shaped Gov. Gavin Newsom’s recent responses to the coronavirus pandemic.SACRAMENTO — Things have been looking up in California. Vaccines will soon be available to everyone over 16. Los Angeles schools are about to bring hundreds of thousands of students back to classrooms. Disneyland, dark for a year, will throw open its gates in just a few weeks.At the state capital, however, the coronavirus pandemic still clouds Gov. Gavin Newsom’s horizon. Soon, the secretary of state is expected to announce that a campaign to recall him has officially qualified for a special election.Led by Trump stalwarts, amplified by Republican National Committee money and fueled during the pandemic by Mr. Newsom’s own political missteps, the recall initiative is widely regarded as a long shot. Putting it on the ballot requires roughly 1.5 million signatures from disgruntled voters, a drop in the Democrat-dominated bucket of 40 million residents.But even if Mr. Newsom prevails, the pandemic has both tested and tarnished him politically.The tall, telegenic heir to the “fifth-largest economy in the world,” as his predecessor Jerry Brown routinely boasted, Mr. Newsom has lost some of the benefit of California’s doubt. His approval rating has dropped by more than 10 points since May, when 65 percent of Californians trusted his handling of the pandemic. Critics even within his own party have questioned whether his recent decisions have been motivated by public health or the recall attempt.The campaign against Mr. Newsom has highlighted the differences between the powerhouse California that elected him and the virus-battered California he now governs. Longtime political analysts see hidden weaknesses in his polling: The state may not want to recall him, they say, but his popularity has suffered, and his political fortunes are linked more closely than ever to the ebb and flow of the virus in his state.“When you’re evaluating an executive — be it a mayor, a governor, a president, whatever — there are really only a couple of basic questions,” said Mike Madrid, a former political director of the state Republican Party and a co-founder of the anti-Trump group the Lincoln Project.“Are the lights on? Are the trains running on time? And in this case, how have you managed the global pandemic?”At the moment, Mr. Newsom’s report card is mixed.California has record budget reserves, one of the nation’s lowest rates of new virus cases and a vaccine rollout that, after a rocky start, has started to gain steam. But the state also has lagged behind the nation in school reopenings and has the third-highest unemployment rate.A mobile coronavirus vaccination site in the Chinatown neighborhood of Los Angeles. Mr. Newsom’s future is largely tied to California’s ability to control the coronavirus.Philip Cheung for The New York TimesEpidemiologists have warned that the virus may return as the state reopens, but right now, cases are at levels not seen since mid-October. More than 30 percent of the population has received at least one vaccine dose and 30 percent have survived an infection and developed some level of natural immunity.[See how experts graded California’s vaccine rollout.]Barring a fresh surge or a runaway variant, the pandemic could soon be in California’s rearview mirror. A recent poll by the Public Policy Institute of California found that three-quarters of Californians believe that the worst of the crisis is behind them, and 56 percent of likely voters would oppose a recall if an election were held now.“In the face of an unprecedented global health crisis, Governor Newsom has followed the science and moved aggressively to keep California safe,” said Nathan Click, one of the governor’s advisers. “His actions saved countless lives and have earned him the trust of Californians.”Recall attempts are common in California and typically fail. The governor’s defenders say this one would never have met the signature threshold had a judge not granted an extension because of the state’s shutdown, one of many ways the recall and the pandemic are inextricably linked.On Thursday, Mr. Newsom received the Johnson & Johnson vaccine in Los Angeles in a livestreamed event after his administration expanded eligibility to all Californians age 50 and older. Mr. Newsom, 53, showed not one iota of worry about the recall, never mentioning the subject and, after taking off his suit jacket to receive the shot, flexing his muscles in his dark T-shirt.“It has been an extraordinarily challenging year — so much fear, so much anxiety,” Mr. Newsom told reporters. “But now, growing optimism, not only here in Southern California, but throughout our state.”Yet critics and political allies alike said the threat of the recall had indeed loomed large, and had appeared to shape the governor’s pandemic response.In early March, as Los Angeles was just recovering from a brutal winter surge, Mr. Newsom tried to accelerate the reopening of classrooms with sweeping legislation and critical tweaks in the state’s health rules. Then he delivered his annual State of the State address from an empty Dodger Stadium, as if it were a campaign speech.Mr. Newsom gave his State of the State address inside an empty Dodger Stadium.Etienne Laurent/EPA, via ShutterstockHe cited the millions of vaccines the state had administered and the billions of dollars in pandemic aid that he was directing to small businesses. But his language channeled the California labor groups and progressives on whom the state’s Democrats rely to mobilize voters.“When this pandemic ends — and it will end soon — we’re not going back to normal. Normal was never good enough,” the governor said. “Normal accepts inequity.”Days later, after the recall proponents publicly estimated they would exceed 2 million signatures from voters favoring his ouster, he announced that California would be changing its notoriously complex, color-coded system of health restrictions. When the system was devised, life without the threat of Covid-19 seemed so remote that the state’s least-strict designation was caution-tape yellow. But now, the governor said, he was adding a hopeful new “green tier,” a sudden move his critics tied to the recall effort.“Before the threat of a recall the governor told us there was no green because we could never be normal again,” tweeted Jon Fleischman, a former executive director of the California Republican Party. “It’s funny how his science turned out to be political science.”Similar accusations have arisen from some would-be allies.Dr. Jeffrey V. Smith, the Santa Clara County executive, took issue with the governor’s plan to dedicate 40 percent of first vaccine doses to vulnerable, poorer communities as determined by a state index.Mr. Newsom presented the plan last month as proof of his determination to ensure that rich Californians did not crowd the poor out of access to scarce vaccinations. But the policy change also helped Mr. Newsom politically.A new tweak in the system for determining health restrictions let a county move into a lower tier once a critical mass of vaccinations had been administered in disadvantaged ZIP codes. Many of those targeted ZIP codes were in Los Angeles, where teachers’ unions were refusing to return to classrooms until the county was out of the strictest level of health rules. Parent groups, meanwhile, were demanding in-person instruction.Dr. Smith — whose Bay Area county has plenty of poor people but virtually none of the targeted ZIP codes — said the vaccine targets were part of a “fake equity plan,” based less on fairness than on Mr. Newsom’s desire to open up Los Angeles.“What’s really going on has nothing to do with distribution,” said Dr. Smith, who serves in a nonpartisan position but said he identifies as a Democrat. “It has to do with the governor’s desire to buy himself out of the recall election by reopening Southern California as fast as he can.”It is unclear how much voters will care about Mr. Newsom’s mix of motivations. Californians, who overwhelmingly opposed former President Donald J. Trump in the last election, are unlikely to replace a Democratic governor if their main alternatives are limited to the current challengers, who are Republican supporters of Mr. Trump.Conservative activists in Pasadena gathered some of the roughly 1.5 million signatures needed to trigger the recall election.David Mcnew/Agence France-Presse — Getty ImagesIf a recall is placed on the ballot in a special election that most likely would be held in the fall, voters will be asked two questions: Whether Mr. Newsom should be recalled, and if so, who should finish the 14 months or so remaining in his term. So far, no Democrats have stepped up as an alternative, and party leaders from progressives such as Senator Bernie Sanders of Vermont to centrists such as President Biden have sought to maintain that united front.The politicking to come is expected to be expensive, national and corrosive. Recall proponents and their allies say they have raised about $4.1 million, including large contributions from major Republican donors, the state Republican Party and potential candidates such as John Cox, a San Diego businessman who lost to Mr. Newsom in 2018.The governor’s team has reported about $3 million in contributions, including about $400,000 from the state Democratic Party, $250,000 from a union representing state government engineers, $125,000 each from the agricultural magnates Stewart and Lynda Resnick and more than $500,000 in small-dollar online donations in the 48 hours after the governor started a website called Stop the Republican Recall.Supporters of Mr. Newsom portray the initiative as the work of Republican extremists. The leader, the governor has said, believes that the government should “microchip migrants.”Orrin Heatlie, the retired Northern California sheriff’s sergeant who is the recall’s lead proponent, wrote a 2019 Facebook post that read: “Microchip all illegal immigrants. It works! Just ask Animal control.”Mr. Heatlie acknowledged in an interview that he wrote the post, but he said that it was not meant to be taken literally and that he intended it as a “conversation starter.”He said Mr. Newsom brought the recall on himself by imposing too many restrictions early in the pandemic and dining at an elite wine country restaurant while asking Californians to quarantine last fall.Darry Sragow, a longtime Democratic strategist, predicts that Mr. Newsom will survive the recall. But he added that the governor’s numbers indicate that his troubles with voters are not over.Last month, pollsters at Emerson College and Nexstar Media Group asked Californians about the 2022 election. If they could, would they vote again for Mr. Newsom?More than 58 percent of registered voters said they preferred someone new.Shawn Hubler More