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“Moving to a mandate instead of an advisory is stepping things up although at least so far, it just seems to be a change in language rather than a change in de facto enforcement," a health care advocate says.

Therapists are riding a regulatory roller coaster at a time when Americans are struggling with trauma over the pandemic’s rising illnesses, deaths and financial stress. Some critics warn that the United States is on the verge of a mental health crisis.

Trauma, economic inequality, inadequate translation and religious and cultural practices have contributed to the disproportionate spread of the virus among Somali, Congolese and Bhutanese refugees and Pacific Island populations.

"Anytime you find a prevalence of a virus like this at 3.4% of the population, that’s really concerning,” said Dr. Ben Dalziel, assistant professor in the College of Science at OSU and co-director of the project.