ESP32-C3 odd USB problems and no communication

[Fusion]

I have a custom ESP32-C3-WROOM-02 board keeps connecting/disconnecting the USB port. I can see the port come up in Arduino IDE, but 2 seconds later it disappears, then come back and so on
D-/D+ is connected directly to IO18/19. The board of course has 5V to 3V3 for power.
An original dev board from Espressif works fine on the same port/cable. These modules are from Mouser.

I found a github issue with similar problems and some recommended running espefuse summary. Now the USB does not connect/disconnect, it stays connected and I can upload a sketch, but the WifiScan example does not show anything in serial monitor. Something is wrong. I have programmed dozens of ESP32s and this has never happened.
I can see on my USB power monitor that the current went from ~50mA to ~120mA with the WifiScan example, but nothing in serial monitor. I also can't light a simple LED.

I have also tried exporting the sketch to bin and using esptool to flash the bootloader/partition/bin, but the result is the same.

It's as if the program is running, but no GPIOs are doing anything and there's no serial output. Anyone have any idea what could be going on?

[Fusion]

So I got it working by setting USB CDC and Enable Erase Flash in Arduino IDE.

Still preplexed why I had to run espefuse summary to get the USB to stop acting up though.

[Fusion]

Would anyone happen to know why it is required to run espefuse summary to fix the USB?