RICHMOND — The nation's only physician-governor was in a jam. Before he could announce that he was ordering Virginians to wear face coverings in public buildings against the spread of the novel coronavirus, Ralph Northam had to explain why he was photographed greeting people in Virginia Beach over the weekend without wearing a mask.

“I was not prepared because my mask was in the car,” he confessed in a news briefing. Then Northam (D) had to describe how the new edict would be enforced, and it seemed he wasn’t prepared for that, either.

“This is not a criminal matter,” Northam said. “Law enforcement will not have a role.” Except his executive order specified that violators could be found guilty of a misdemeanor carrying possible jail time. He clarified that he hoped the General Assembly would authorize a civil penalty. His chief of staff took the podium to explain it again.

Northam has plenty of experience communicating difficult issues to patients as a pediatric neurologist, but he has struggled to adapt his quiet bedside manner to the harsh lights of politics. As a result, his performance in what should be a moment tailor-made for his leadership — a doctor in a health crisis — has left him facing mounting criticism.

Instead of rallying Virginia with oratory, he’s taking a doctor’s approach — assessing, charting a middle-of-the-road course, changing his mind when new information arises. It’s not riveting, and it gets tangled up in competing demands. The virus is hitting crowded Northern Virginia much differently than sprawling Hampton Roads, and it’s bypassing some rural areas almost entirely. In trying to accommodate all of that, Northam risks satisfying no one.

Republicans and business leaders say he’s moving too slowly to reopen the state. Democrats and advocates for minority communities say he’s moving too fast. And Virginia has been excoriated in the national media for a testing program that has lagged behind most other states.

“I’m usually more confused after listening to his news conferences every other day than I was before I started listening,” said state Sen. William M. Stanley Jr. (R-Franklin), who called Northam’s coronavirus response “utter mismanagement.”

Other governors have ridden the pandemic to national prominence. Maryland’s Larry Hogan is the Republican willing to stand up to President Trump; New York’s Andrew M. Cuomo (D) is the master communicator. They and others have dominated cable news shows and rocketed in public approval polls.

Northam has resisted calls from major donors and Democratic activists to follow suit. His handlers say privately that he knows he’s not cut out for media stardom — too prone to utter awkward truths or to fall back on rote messaging. Northam has always said he has no political ambitions beyond being governor, and last year’s blackface yearbook scandal made certain of it.

Supporters say those dynamics allow him to focus on the substance of the crisis without worrying about personal image.

“We have a calm, rational, thoughtful governor, and I’ll take that any day of the week,” said Sen. David W. Marsden (D-Fairfax). Stumbles are par for the course in a fast-changing crisis, he said. “There’s nobody throwing a no-hitter here in this country. We are adjusting as we go.”

Northam has acknowledged throughout the shutdown that his actions are disrupting lives but has argued that Virginia — ranked the best state for business in 2019 by CNBC — cannot recover from its economic crisis if it does not first address the health emergency.

“There is no road map for closing or reopening an entire economy, particularly in the absence of federal support, guidelines and constantly evolving science,” said Clark Mercer, Northam’s chief of staff.

If Northam’s approach seems muddled at times, his staff says, it’s because his orders are nuanced. Enforcement of his mask order, for instance, would have been simple to explain if he’d left it to police — but he feared that could lead to inequitable enforcement in minority communities.

“It’s human nature to want clear, hard-and-fast rules that never change and are easy to understand, but that’s simply not possible in a global pandemic that affects literally everyone,” said Grant Neely, Northam’s communications director.

Virginia’s statistics suggest the state is keeping the coronavirus in check. Its hospitals report plenty of bed capacity. No hospital has lacked personal protective gear in several weeks, though a handful of long-term-care facilities have reported shortages.

And with 8.5 million residents, the state has reported fewer confirmed cases, deaths and hospitalizations than neighboring Maryland, population 6 million.

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Northam’s approach seemed to work well for him early on. A Virginia Commonwealth University poll conducted between March 25 and April 8 found 76 percent of Virginians approved of his handling of the crisis, with 40 percent strongly approving.

Even reliable Republican critics were with him. On March 23, the day Northam ordered the state’s schools closed for the year and shuttered dine-in restaurants and many businesses, House Minority Leader Todd Gilbert (R-Shenandoah) acknowledged that Northam faced “no easy task” and said “House Republicans stand ready to assist in any way we can.”

But in a matter of weeks, as the shutdown wore on, Northam was being hit from the left and right. The ACLU pushed him to release more prisoners, while Republicans objected to those let go.

Perhaps no area of Northam’s response to the virus has been more criticized than the state’s testing program. According to statistics from Johns Hopkins University, Virginia is near the bottom of all states in testing per capita.

Earlier this month, the Atlantic called Virginia the worst in the nation and accused it of “juking” its results by including unreliable antibody tests to beef up total numbers. The magazine later acknowledged in an editor’s note that three other states and the federal Centers for Disease Control and Prevention also combined the tests. The Associated Press found that, in all, at least nine states have followed that practice, which Northam said he ended when it came to his attention.

Northam appointed former health commissioner Karen Remley to overhaul the testing program. The state now averages more than 8,000 tests per day, climbing toward a daily goal of 10,000. That’s in line with earlier guidance from health experts, although goals have been revising upward as society begins to reopen. If Virginia has moved too fast to loosen restrictions based on inadequate data, there could be a spike in infections in the coming weeks.

One way of judging the true impact of the coronavirus is to look at “excess deaths,” or the number of deaths that occur in a state beyond the number expected for a certain period of time. According to an analysis by the Yale School of Public Health conducted for The Washington Post, there were about 1,800 excess deaths in Virginia between March 1 and May 9.

Only 973 of those deaths were officially attributed to covid-19, the disease the virus causes, or about 53 percent. Nationally, covid-19 deaths account for about 74 percent of excess deaths, raising the possibility that Virginia is undercounting the number of deaths related to the coronavirus.

Maryland is suffering even more deaths but shows a smaller gap between the number of covid-19 fatalities and estimated excess deaths, according to the analysis — with about 2,600 excess deaths and 1,751 of them officially attributed to covid-19, or 66 percent.

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Northam’s response to the crisis has been more aggressive than neighboring governors in some ways, less in others — a pattern his advisers say jibes with Virginia’s position between the hard-hit Northeast and the less affected South.

While Hogan closed nonessential retailers, for instance, Northam let them stay open as long as social distancing could be observed. Northam never banned golfing and boating as Hogan did and was quicker to allow doctors to resume elective surgeries.

Northam declared a state of emergency March 12, a week after Hogan. Northam was the second governor to close schools for the remainder of the academic year, something Hogan and others followed.

It was in deciding to begin reopening the state on May 15 that things got especially complicated. Initially, Northam said he had ruled out a regional approach that would let rural areas open first. Then he reversed course and allowed Northern Virginia to stay shuttered while the rest of the state moved into Phase 1. He said he wouldn’t let individual cities or counties follow suit, then turned around and let Richmond and Accomack County do just that.

A satirical statement that circulated among Northam aides in early May seemed to capture the governor’s struggle to communicate a path forward.

“We have a 6 phase plan to reopen the state,” it said, according to a copy obtained by The Washington Post. “The plan will be a phased plan that we will plan to utilize in phases. The phases will be planned and the planning will be phased. We will move quickly and slowly to open but remain closed. I have created a staff of staffers who will plan the phase and planning while phasing their phases.”

Northam invoked his medical background to explain the decisions — changing diagnosis and treatment based on new factors.

“No one can blame a leader for trying to keep pace with ever-changing facts and making adjustments as the evidence indicates a need to do so,” said Mark Rozell, dean of the Schar School at George Mason University, who wrote a blistering critique of Northam in The Post that was widely circulated by Republicans. “What I have found, though, is a lack of clarity in his leadership approach, a shifting from one decision to another without any clear understanding why.”

A gaffe such as the weekend photos in Virginia Beach further undermines public confidence, Rozell said. “He wants to come out two days later and mandate wearing masks when he doesn’t set the example himself? Republicans unloaded on him for this, and frankly, they have good reason.”

The Republican Party of Virginia called Northam a dictator for the mask decree. And Gilbert dropped his cooperative stance.

“The governor keeps relying on the fact that he’s a physician to give him more moral authority here, but if he wrote orders in a hospital like he’s giving them out as governor, he would be accused of malpractice,” he said. “I think the general public has no idea what to do. They lack consistent information and guidance from the state.”

Gilbert was particularly critical after rural, Republican-heavy southwestern Virginia was rebuffed when it asked to emerge early from restrictions but deep-blue Northern Virginia seemed to get different treatment.

“He was much more wiling to listen to Northern Virginia than he was to Southwest Virginia,” Gilbert said.

And making masks compulsory? In some parts of the state, Gilbert said, that’s going to make people decide not to wear them just to “push back” against government overreach.

Northam’s need to deal with such disparate, competing interests around the state “is a very, very difficult balancing act to perform,” Rozell said. “I would not want to be in his shoes.”

Emma Brown contributed to this report.