Of note, a recent population-based study conducted in 10 US states that included 21,312 patients (1,272 children) with invasive GAS infections during 2013–2022 documented a decline in pharyngeal strains (such as emm1 and emm12) during the COVID-19 pandemic, alongside an increase in skin-associated emm types (24). Here, PIGG is linked to COVID-19.