I think I've been getting similar issues for a little while that I've been able to work around until now. If I git checkout 3.10 and then hit the "Local Windows Debugger" button, I get this:

Build started...
1>------ Build started: Project: pythoncore, Configuration: Debug x64 ------
1>Killing any running python_d.exe instances...
1>Regenerate opcode.h opcode_targets.h
1>C:\Users\sween\Source\Repos\temp\cpython\PCbuild\regen.targets(62,5): error MSB3073: The command " Tools\scripts\generate_opcode_h.py Lib\opcode.py Include\opcode.h" exited with code 103.
1>Done building project "pythoncore.vcxproj" -- FAILED.
2>------ Build started: Project: _ctypes, Configuration: Debug x64 ------
3>------ Build started: Project: python, Configuration: Debug x64 ------
========== Build: 0 succeeded, 3 failed, 0 up-to-date, 0 skipped ==========

However, if I then run .\PCbuild\build.bat, and then hit the "Local Windows Debugger" button, the build succeeds.

Is there some difference in which python executable is chosen to run .py files between build.bat versus what Visual Studio does?