A panel of judges ruled that potential jurors do not have to include unvaccinated individuals, researchers have identified protease variants in the coronavirus that could boost its resistance to antiviral treatments, and more in this week's roundup of COVID-19 news.

• In February, the House  voted  to end the COVID-19 national emergency order, with the Senate doing the same a month later. At the time, the White House said that, while President Joe Biden opposed the measure, he would not veto it. On Monday, President Biden signed the bill to end the COVID-19 national emergency. Previously, the White House had intended to  end  both the COVID-19 national emergency and the public health emergency at the same time on May 11. According to The Hill, the end of the national emergency will end several Medicare, Medicaid, and CHIP waivers. Although the White House said earlier this year that ending the COVID-19 emergencies would "create wide-ranging chaos and uncertainty throughout the health care system," many experts have said that they expect it will have a "limited impact" overall. (Samuels, The Hill, 4/10)
• According to a new  study  published in Science Advances, several naturally occurring variants of the main protease of the coronavirus have amino acid mutations that boost their resistance to COVID-19 antivirals, such as nirmatrelvir (the main component of Paxlovid) and ensitrelvir, which was approved in Japan in February. Phylogenetic analysis of these variants suggest that they emerged before the drugs were in widespread use and have appeared independently in several different parts of the world. They are also capable of spreading. The authors of the study said that while it's unclear how much resistance is needed for an antiviral treatment to fail in a clinical setting, these variants could be an "evolutionary stepping stone" to variants with full resistance to treatments, especially as the coronavirus continues to spread and evolve. To prevent this from happening, the authors said pharmaceutical companies could develop new antivirals with different resistance profiles or providers could use a multi-drug approach to treatment. "We are optimistic that ongoing studies will develop additional compounds to avoid cross-resistance and help combat the current COVID-19 pandemic and future coronavirus outbreaks," said Reuben Harris, co-director of the  University of Minnesota's Antiviral Drug Discovery Center and one of the study's authors. (Dall, CIDRAP News, 3/30)
• According to a new case  report  published in  Pediatrics, two infants who were born to mothers who tested positive for COVID-19 developed early-onset seizures, acquired microcephaly, and had significant developmental delay. In one case, the infant was born preterm at 32 weeks to a woman who had been admitted to the ICU with severe COVID-19 in July 2020. After three months, the infant was discharged from the hospital with a seizure disorder and acquired microcephaly. At 13 months, the infant visited the ED for an upper respiratory infection, and three days later, he entered asystolic cardiac arrest and could not be revived. In the second case, an infant was born at 39 weeks to a mother who had asymptomatic COVID-19 late in her second trimester. Soon after birth, the infant developed clinical seizures and had cerebrospinal fluid pleocytosis. Later, the infant would be hospitalized multiple times for breakthrough seizures and respiratory infections. At a one-year follow-up exam, the infant had microcephaly, an abnormal neurologic exam, and significant neurodevelopmental delay and would later enter hospice care. Although neither infant tested positive for the coronavirus, they did have high levels of virus antibodies in their blood. According to the researchers, this suggests the virus could have crossed from mother to infant through the placenta. "This is the first time that we've been able to demonstrate the virus in a fetal organ with transplacental passage," said Michael Paidas, chair of obstetrics and gynecology at the University of Miami  and one of the study's authors. "That's why we think this is so important." According to the researchers, the two cases were extremely rare, but people who had been infected during the pregnancies could inform their children's pediatricians in case of developmental delays. The researchers also encouraged pregnant individuals or those considering pregnancy to get vaccinated against COVID-19. (George, MedPage Today, 4/7; Steenhuysen, Reuters, 4/10)
• The omicron subvariant XBB.1.5 has been the dominant coronavirus variant in the United States since January, and it made up 88.3% of all COVID-19 cases for the week ending April 8. However, several other XBB subvariants, including XBB1.16, may soon overtake XBB.1.5 over the next few weeks. In March, the World Health Organization  labeled  XBB.1.16 as a variant "to watch" after it spread to over 20 countries, including India, Singapore, Australia, the United Kingdom, Canada, and the United States. Due to its mutations, XBB.1.16 has been associated with increased infectivity and a potential increase in pathogenicity. "XBB subvariants are starting to crowd out XBB.1.5 in the US without notable change in clinical outcomes," wrote  Eric Topol, founder and director of the Scripps Research Translational Institute on  Twitter. In particular, Topol said that XBB.1.16 will likely be the one to overtake XBB.1.5 due to its "growth advantage" and "increased fitness." (Carbajal, Becker's Clinical Leadership & Infection Control, 4/10)
• A panel of judges in the U.S. Court of Appeals for the 4th Circuit on Tuesday ruled that potential jurors on a case do not necessarily have to include individuals who are unvaccinated. In September 2021, a husband and wife were found guilty of trafficking heroin and cocaine and soon after challenged their conviction because a federal judge in Virginia had excluded unvaccinated individuals from the jury pool. In the ruling from the panel, the three judges said that Judge David Novak did not exclude potential jurors "based on immutable characteristics like race, gender or ethnic background," but their "perceived inability to serve without creating unnecessary safety risks." According to the court record, the defendants in the case were not vaccinated and instead tested during the days of their trial, leading their attorney to argue that the same could have been done for unvaccinated jurors. However, Novak said he did not have the power to compel jurors to take a COVID-19 test or limit their exposure. He also said he was concerned about increased viral transmission from unvaccinated jurors since the delta variant was circulating at the time. "My job is not just to give them a fair trial, which they are going to get. My job is to — it is my responsibility to make sure everybody is healthy," Novak said before the trial. "People who are conscripted to come to this courthouse to serve their civic duty, I'm not exposing them to COVID for that reason." (Weiner, Washington Post, 4/12)