As the number of cases throughout the nation drops, states are starting to lift mask mandates and COVID-19 restrictions. However, some leaders have cautioned against easing practices that mitigate spread. Meanwhile, recent studies have examined the effects of COVID-19 on pregnant women, the origins of COVID-19 variants and the mental and psychological impact of the pandemic.

Infection Rates Fall, Mandates Being Lifted

As the number of cases throughout the nation drops, states are starting to lift mask mandates and COVID-19 restrictions. In addition to mask mandates being lifted in public spaces, the same is being done for schools. Governors are asking for the federal government to adjust its guidance to reflect the ease in mask usage. However, Centers for Disease Control (CDC) Director Rochelle Walensky has stated that this is not the right time to do so. According to the CDC, the U.S. has an average of more than 230,000 cases per day, a number similar to the peak of last winter, and about 2,300 deaths per day.

Study Demonstrates Importance of Vaccination for Pregnant Women

A study of data from over 14,000 pregnant women and women who had very recently given birth, shows that death or serious medical conditions occur significantly more frequently in those infected with SARS-CoV-2 than those not infected. Medical conditions measured included pregnancy-related hypertensive conditions, postpartum hemorrhaging and infections not related to SARS-CoV-2. The data studied spanned several months in 2020, across several hospitals, prior to vaccine availability. All recorded deaths were in people who were SARS-CoV-2 positive. Other findings included increased need for Caesarean delivery, and infant illness or death among those who tested positive for the virus. The study also found no significant differences in death or non-SARS-CoV-2 illness rates of those who were asymptomatic or had mild symptoms, compared to the uninfected. The overall study findings highlight the importance of vaccination for pregnant women or those of child-bearing age.

New SARS-CoV-2 Lineages Detected in Sewage

A worrying discovery was published in Nature about several new lineages of SARS-CoV-2 with genomic similarities among themselves but significant differences compared to the previously characterized SARS-CoV-2 variants’ genomes. The authors speculate that these mutated viruses may have come from city-dwelling animals such as rats or mice, and/or from human patients whose specific infectious agents had not been sequenced before. Whatever the origin, these new lineages present a potential threat to human health. Even before this publication, scientists had been warning that new variants may possibly arise after the current Omicron wave, and that new variants would continue to cause epidemic spreads. In fact, a recent computational-biology work suggests that the Omicron variant may have evolved in mice before jumping to humans, although a long-term continuous SARS-CoV-2 infection in an immunocompromised person has also been shown to lead to an accumulation of specific mutations, many of which are seen in Omicron. (Note that the human and non-human pathways to new variants are not mutually exclusive, so both could have played a role).

Furthermore, a separate line of warnings — also about the virus jumping from animals to humans — seems to be borne out by the latest genomic data on the current Hong-Kong COVID-19 outbreak, which points to pet hamsters as originators of that cluster. In a very timely and relevant update, the Food and Drug Administration (FDA) this week launched a public webpage with information about detecting SARS-CoV-2 in animals.

Assessing Severity of Viral Variants

An editorial in the New England Journal of Medicine parses out various factors that influence presentation of a disease at the population level and the pitfalls of converting numerical information to facile descriptors such as “less severe/more severe” when comparing virus variants. For example, reports of Omicron being “less severe” might be better explained by the higher percentage of immune individuals in the population during the Omicron compared to earlier waves, rather than by the variant itself being less harmful.

Context Should Be Part of Decision-Making Given SARS-CoV-2 Test Results

All tests carry some probability of false positive and false negative results. To evaluate the practical repercussion of these errors, and to potentially mitigate them, a new study assessed what people do with the results of self-administered tests and what decisions they make. The researchers found that with the current standard instructions, people failed to take into account their pre-test probability of infection. As a result, those who had a high pre-test probability of being infected often failed to quarantine after receiving a negative test result; and those who had a low pre-test probability of infection often unnecessarily quarantined themselves after a positive test result. The researchers also found that a modified set of instructions lowered the proportion of such wrong decisions. A pre-test infection probability could be assessed based on the presence or absence of COVID-like symptoms and/or having been in close contact with a COVID patient. One limitation of the study, however, was that the subjects were asked to read instructions and make decisions hypothetically rather than in real life situations.

Mental and Psychological Burden of COVID-19

Clinicians are seeing more and more cases of Prolonged Grief Disorder (PGD) in people suffering from COVID-19 related losses. Treatment recommendations based on their demonstrated usefulness in clinical practice include interpersonal psychotherapy and cognitive behavioral therapy. The key goals of PGD therapy are learning “to accept the new reality” and to “restore the capacity for well-being, including a sense of autonomy, competence, and relatedness.” An unresolved PGD threatens the affected person’s physical health and shortens their life expectancy. There are further resources for clinicians and social workers who encounter patients with suspected PGD. Children’s mental health has been especially impacted, and in multiple ways, as highlighted by the American Psychological Association (APA). Accordingly, a new article in JAMA Forum advocates for increased attention to the mental health issues in children and youth.

COVID-19 in the History of Infectious Diseases

The Mayo Clinic developed a free online educational resource about the history of infection diseases. The site offers stunning photographs and clearly laid out facts about significant historical and scientific milestones related to infectious outbreaks, vaccinations and research.