Just 0.2% of COVID-19 vaccine doses delivered to lower-income countries through COVAX expired before they could be administered, estimated to be a significantly lower quantity than in wealthier countries.

Lower-income countries are letting far fewer COVID-19 vaccine doses expire than wealthier nations

Although people who have recovered from COVID-19 may be less likely to catch it again, there are many reasons to avoid becoming infected in the first place.

Five reasons why it’s a terrible idea to hold a COVID-19 party (even if you’ve been vaccinated)

10.3389/fpos.2021.661257

In order to control the spread of infectious diseases such as COVID-19, it will be important to develop a communication strategy to counteract “vaccine resistance”, that is, the refusal to take the COVID-19 vaccine even when available. This paper reports the results of a survey experiment testing the impacts of several types of message content: the safety and efficacy of the vaccine itself, the likelihood that others will take the vaccine, and the possible role of politics in driving resistance to the vaccine. In an original survey of 1,123 American M-Turk respondents conducted in the summer of 2020, we provided six different information conditions suggesting the safety and efficacy of the vaccine, the lack of safety/efficacy of the vaccine, the suggestion that most others would take the vaccine, the suggestion that most others would not take the vaccine, the suggestion that the vaccine is being promoted by liberals to gain greater control over individual freedom, and the suggestion that its approval is being by President Trump rushed for political motivations. We compared the responses for those in the treatment groups with a control group who received no additional information. In comparison to the control group, those who received information about the safety/efficacy of the vaccine were more likely to report that they would take the vaccine, those who received information that others were reluctant to take the vaccine were more likely to report that they themselves would not take it, and those who received information about political influences on vaccine development expressed resistance to taking it. Communication of effective messages about the vaccine will be essential for public health agencies that seek to promote vaccine uptake.

The Effect of Frames on COVID-19 Vaccine Resistance

10.3389/fimmu.2021.558270

The arrival of the COVID-19 vaccine has been accompanied by increased discussion of vaccine hesitancy. However, it is unclear if there are shared patterns between general vaccine hesitancy and COVID-19 vaccine rejection, or if these are two different concepts. This study characterized rejection of a hypothetical COVID-19 vaccine, and compared patterns of association between general vaccine hesitancy and COVID-19 vaccine rejection. The survey was conducted online March 20-22, 2020. Participants answered questions on vaccine hesitancy and responded if they would accept the vaccine given different safety and effectiveness profiles. We assessed differences in COVID-19 rejection and general vaccine hesitancy through logistic regressions. Among 713 participants, 33.0% were vaccine hesitant, and 18.4% would reject a COVID-19 vaccine. Acceptance varied by effectiveness profile: 10.2% would reject a 95% effective COVID-19 vaccine, but 32.4% would reject a 50% effective vaccine. Those vaccine hesitant were significantly more likely to reject COVID-19 vaccination [odds ratio (OR): 5.56, 95% confidence interval (CI): 3.39, 9.11]. In multivariable logistic regression models, there were similar patterns for vaccine hesitancy and COVID-19 vaccine rejection by gender, race/ethnicity, family income, and political affiliation. But the direction of association flipped by urbanicity (P=0.0146, with rural dwellers less likely to be COVID-19 vaccine rejecters but more likely to be vaccine hesitant in general), and age (P=0.0037, with fewer pronounced differences across age for COVID-19 vaccine rejection, but a gradient of stronger vaccine hesitancy in general among younger ages). During the COVID-19 epidemic’s early phase, patterns of vaccine hesitancy and COVID-19 vaccine rejection were relatively similar. A significant minority would reject a COVID-19 vaccine, especially one with less-than-ideal effectiveness. Preparations for introducing the COVID-19 vaccine should anticipate substantial hesitation and target concerns, especially among younger adults.

Vaccine Hesitancy and Rejection of a Vaccine for the Novel Coronavirus in the United States

The Google-owned video site previously only banned misinformation about coronavirus vaccines. Facebook made the same change months ago.

YouTube is banning prominent anti-vaccine activists and blocking all anti-vaccine content

Streaming site cracks down on harmful content about all approved Covid jabs

YouTube to remove misinformation videos about all vaccines

10.3389/fpubh.2021.716333

During the COVID-19 pandemic, information is being rapidly shared by public health experts and researchers through social media platforms. Whilst government policies were disseminated and discussed, fake news and misinformation simultaneously created a corresponding wave of “infodemics.” This study analyzed the discourse on Twitter in several languages, investigating the reactions to government and public health agency social media accounts that share policy decisions and official messages. The study collected messages from 21 official Twitter accounts of governments and public health authorities in the UK, US, Mexico, Canada, Brazil, Spain, and Nigeria, from 15 March to 29 May 2020. Over 2 million tweets in various languages were analyzed using a mixed-methods approach to understand the messages both quantitatively and qualitatively. Using automatic, text-based clustering, five topics were identified for each account and then categorized into 10 emerging themes. Identified themes include political, socio-economic, and population-protection issues, encompassing global, national, and individual levels. A comparison was performed amongst the seven countries analyzed and the United Kingdom (Scotland, Northern Ireland, and England) to find similarities and differences between countries and government agencies. Despite the difference in language, country of origin, epidemiological contexts within the countries, significant similarities emerged. Our results suggest that other than general announcement and reportage messages, the most-discussed topic is evidence-based leadership and policymaking, followed by how to manage socio-economic consequences.

The Response of Governments and Public Health Agencies to COVID-19 Pandemics on Social Media: A Multi-Country Analysis of Twitter Discourse

10.1136/thoraxjnl-2021-217080

Background Conflicting evidence has emerged regarding the relevance of smoking on risk of COVID-19 and its severity.Methods We undertook large-scale observational and Mendelian randomisation (MR) analyses using UK Biobank. Most recent smoking status was determined from primary care records (70.8%) and UK Biobank questionnaire data (29.2%). COVID-19 outcomes were derived from Public Health England SARS-CoV-2 testing data, hospital admissions data, and death certificates (until 18 August 2020). Logistic regression was used to estimate associations between smoking status and confirmed SARS-CoV-2 infection, COVID-19-related hospitalisation, and COVID-19-related death. Inverse variance-weighted MR analyses using established genetic instruments for smoking initiation and smoking heaviness were undertaken (reported per SD increase).Results There were 421 469 eligible participants, 1649 confirmed infections, 968 COVID-19-related hospitalisations and 444 COVID-19-related deaths. Compared with never-smokers, current smokers had higher risks of hospitalisation (OR 1.80, 95% CI 1.26 to 2.29) and mortality (smoking 1–9/day: OR 2.14, 95% CI 0.87 to 5.24; 10–19/day: OR 5.91, 95% CI 3.66 to 9.54; 20+/day: OR 6.11, 95% CI 3.59 to 10.42). In MR analyses of 281 105 White British participants, genetically predicted propensity to initiate smoking was associated with higher risks of infection (OR 1.45, 95% CI 1.10 to 1.91) and hospitalisation (OR 1.60, 95% CI 1.13 to 2.27). Genetically predicted higher number of cigarettes smoked per day was associated with higher risks of all outcomes (infection OR 2.51, 95% CI 1.20 to 5.24; hospitalisation OR 5.08, 95% CI 2.04 to 12.66; and death OR 10.02, 95% CI 2.53 to 39.72).Interpretation Congruent results from two analytical approaches support a causal effect of smoking on risk of severe COVID-19.

Smoking and COVID-19 outcomes: an observational and Mendelian randomisation study using the UK Biobank cohort

Clinical trial on joint flu, Pfizer and AstraZeneca vaccinations reported only mild to moderate side-effects

Flu and Covid jabs safe to be given at same time, study finds

A large study reveals the scale of long Covid, with symptoms affected by sex, age and severity of infection

Covid: 37% of people have symptoms six months after infection

10.1136/bmj.n1931

Objective To assess the association between covid-19 vaccines and risk of thrombocytopenia and thromboembolic events in England among adults.Design Self-controlled case series study using national data on covid-19 vaccination and hospital admissions.Setting Patient level data were obtained for approximately 30 million people vaccinated in England between 1 December 2020 and 24 April 2021. Electronic health records were linked with death data from the Office for National Statistics, SARS-CoV-2 positive test data, and hospital admission data from the United Kingdom’s health service (NHS).Participants 29 121 633 people were vaccinated with first doses (19 608 008 with Oxford-AstraZeneca (ChAdOx1 nCoV-19) and 9 513 625 with Pfizer-BioNTech (BNT162b2 mRNA)) and 1 758 095 people had a positive SARS-CoV-2 test. People aged ≥16 years who had first doses of the ChAdOx1 nCoV-19 or BNT162b2 mRNA vaccines and any outcome of interest were included in the study.Main outcome measures The primary outcomes were hospital admission or death associated with thrombocytopenia, venous thromboembolism, and arterial thromboembolism within 28 days of three exposures: first dose of the ChAdOx1 nCoV-19 vaccine; first dose of the BNT162b2 mRNA vaccine; and a SARS-CoV-2 positive test. Secondary outcomes were subsets of the primary outcomes: cerebral venous sinus thrombosis (CVST), ischaemic stroke, myocardial infarction, and other rare arterial thrombotic events.Results The study found increased risk of thrombocytopenia after ChAdOx1 nCoV-19 vaccination (incidence rate ratio 1.33, 95% confidence interval 1.19 to 1.47 at 8-14 days) and after a positive SARS-CoV-2 test (5.27, 4.34 to 6.40 at 8-14 days); increased risk of venous thromboembolism after ChAdOx1 nCoV-19 vaccination (1.10, 1.02 to 1.18 at 8-14 days) and after SARS-CoV-2 infection (13.86, 12.76 to 15.05 at 8-14 days); and increased risk of arterial thromboembolism after BNT162b2 mRNA vaccination (1.06, 1.01 to 1.10 at 15-21 days) and after SARS-CoV-2 infection (2.02, 1.82 to 2.24 at 15-21 days). Secondary analyses found increased risk of CVST after ChAdOx1 nCoV-19 vaccination (4.01, 2.08 to 7.71 at 8-14 days), after BNT162b2 mRNA vaccination (3.58, 1.39 to 9.27 at 15-21 days), and after a positive SARS-CoV-2 test; increased risk of ischaemic stroke after BNT162b2 mRNA vaccination (1.12, 1.04 to 1.20 at 15-21 days) and after a positive SARS-CoV-2 test; and increased risk of other rare arterial thrombotic events after ChAdOx1 nCoV-19 vaccination (1.21, 1.02 to 1.43 at 8-14 days) and after a positive SARS-CoV-2 test.Conclusion Increased risks of haematological and vascular events that led to hospital admission or death were observed for short time intervals after first doses of the ChAdOx1 nCoV-19 and BNT162b2 mRNA vaccines. The risks of most of these events were substantially higher and more prolonged after SARS-CoV-2 infection than after vaccination in the same population.

Risk of thrombocytopenia and thromboembolism after covid-19 vaccination and SARS-CoV-2 positive testing: self-controlled case series study

10.1101/2021.09.17.21263549

Billions of doses of COVID-19 vaccines have been administered around the world, dramatically reducing SARS-CoV-2 incidence in some settings. Many studies suggest vaccines provide a high degree of protection against infection and disease, but precise estimates vary and studies differ in design, outcomes measured, dosing regime, location, and circulating virus strains. Here we conduct a systematic review of COVID-19 vaccines as of August 2021. We included efficacy data from Phase 3 clinical trials for 13 vaccines within the WHO Emergency Use Listing evaluation process and real-world effectiveness for 5 vaccines with observational studies meeting inclusion criteria. Vaccine metrics collected include effects against asymptomatic infection, any infection, symptomatic COVID-19, and severe outcomes including hospitalization and death, for both partial and complete vaccination, and against SARS-CoV-2 variants of concern. In addition, we review the epidemiological principles behind the design and interpretation of vaccine effects and explain important sources of heterogeneity between studies.

A systematic review of COVID-19 vaccine efficacy and effectiveness against SARS-CoV-2 infection and disease

A union representing Massachusetts state troopers sought to make a splash this week in its fight against the state’s coronavirus vaccine mandate. Dozens of troopers had submitted resignation paperwork over the mandate, the State Police Association of Massachusetts announced Monday after an adverse court ruling. It suggested that the mandate-linked resignations would deplete an agency that is “already critically short staffed.”

The evidence is building: Vaccine mandates work — and well

Ohio has the country's second highest total of pediatric COVID hospitalizations.

Ohio health care workers warn of 'astronomical' COVID-19 pediatric surge

70% of long Covid sufferers develop damage to at least one vital organ like the heart or liver, a new U.K. study found

The number of people with post-Covid syndrome depends on the statistical method used

The difficulties of estimating long Covid

Science communication can be a tough game. There is so much noise — and misinformation — circulating in popular culture that it can be difficult to create a message that resonates.

Mixing science and art to make the truth more interesting than lies

Loud, proud and wrong took center stage on podiums across the NBA, with star players gladly spouting off misinformation and nonsense reminiscent of presidential campaigns of recent vintage.

Stop giving vocal minority of anti-vaxx NBA players the space to be loud and wrong

As the anti-vaccine movement escalates its rhetoric, doctors warn that they're dealing with the fallout: "They’re starting to target people, the messengers — nurses and doctors."

'Vigilante treatments': Anti-vaccine groups push people to leave ICUs

Here's the full story about "vigilante medicine" on ivermectin Facebook. Antivaxxers are starting to wrap doctors and ICUs into their dark conspiracy theories, as they suffer at home with ad-hoc COVID treatments that don't work. I hope you read it.

Ivermectin Facebook is a wildly dark scene, an inverted reality where medical consensus is an elaborate conspiracy to kill you and random people on Facebook have the secret cure. As Dr. Aditi Nerurkar tells me, "They’re starting to target the messengers—nurses and doctors.”

They’ve developed elaborate conspiracy theories about doctors and nurses in the process. They believe ventilators and remdesivir are secretly drowning patients’ lungs, not COVID itself. QAnon boards have begun calling hospitals to harass workers for not prescribing ivermectin.

As they’re home self-medicating, antivaxxers are furious that friends and family won’t be administered ivermectin at the hospital. So they’ve developed directions on how to get loved ones out of ICUs: put them in hospice care, then get them the miracle cures from YouTube.

Obviously, keep taking the ivermectin and hydroxychloroquine, the ivermectin groups say. But also gargle iodine. Buy a nebulizer and inhale food-grade hydrogen peroxide. Anything but the vaccine.

The number of people in these ivermectin groups have exploded. So has the number of people in the groups who have contracted COVID, since the groups are largely filled with unvaccinated people seeking "alternative therapies." So they developed a makeshift “protocol.”

Facebook bans explicit antivaxx groups, but they don't ban groups for quack "cures" that antivaxxers push instead. So in the last couple of months, Ivermectin groups have become the new hubs for antivaxx messaging. But there's a problem: Ivermectin, by itself, isn’t working.

A quick thread: It’s hard to explain just how radicalized ivermectin and antivax Facebook groups have become in the last few weeks. They’re now telling people who get COVID to avoid the ICU and treat themselves, often by nebulizing hydrogen peroxide. So, how did we get here?

We have been asked on WhatsApp whether pregnant women will be prioritised for booster Covid-19 vaccines, and what the current guidance is. 

Do pregnant women get Covid-19 booster vaccines ?

10.31234/osf.io/kdr6u

Could a simple rule of thumb help to find the truth? People struggle with integrating many putative cues to deception into an accurate veracity judgement. Heuristics simplify difficult decisions by ignoring most of the information and relying instead only on a few but highly diagnostic cues (’Use the best, ignore the rest’). We examined whether people would be able to tell lie from truth when instructed to make decisions based on a single, diagnostic cue (verifiability and richness in detail). We show that these simple judgements by lay people allowed to discriminate dishonest from honest statements. These judgements performed at or above state-of-the-art, resource-intensive content analysis by trained coders. For a tech- and training-free approach, heuristics were surprisingly accurate, and hold promise for practice.

Use the best, ignore the rest: How heuristics allow to tell a lie from the truth

10.31234/osf.io/ebw4g

The COVID-19 pandemic has impacted the mental health of many individuals and has caused global increases in psychological distress. Research has shown that social support, psychological flexibility, and coping mechanisms are important protective factors against psychological distress. However, recent evidence suggested that psychological flexibility might not be a coping mechanism but could be the mechanisms to determine the type of coping approach an individual will employ during stressful events. In this study, we test a novel theoretical mediation model to identify if, during stressful events (i.e., COVID-19), individuals perceived level of social support directly increases their psychological flexibility; and if the effect of psychological flexibility on psychological distress is mediated by approach and avoidant coping strategies. To test the model, 360 participants completed the following surveys: COVID-19 concerns scale, the multidimensional scale of perceived social support, the comprehensive assessment of acceptance and commitment therapy, and the brief COPE. Results show that most participants report a high level of psychological distress. One novel finding in our study was the mediating role of coping mechanism between psychological flexibility and psychological distress. Our results partially confirm that psychological flexibility might influence the type of coping an individual will employ during stressful events. Within the context of COVID-19, we have shown that social support, psychological flexibility and the types of coping mechanisms individuals employ have an impact on their levels of psychological distress. However, we argue that the proposed model could be applied to other stressful events.

Is Psychological Flexibility a Coping Mechanism?

10.31234/osf.io/8jver

Depersonalisation is a common dissociative experience characterised by distressing feelings of being detached or ‘estranged’ from one’s self and body and/or the world. The COVID-19 pandemic forced millions of people to socially distance from others and to change life habits. We have conducted an online study on 622 participants worldwide to investigate the relationship between digital media-based activities and distal social interactions in influencing peoples’ sense of self during the lockdown as opposed to before the pandemic. We found that increased use of digital media-based activities and online social e-meetings correlated with higher feelings of depersonalisation. We also found that people reporting higher experiences of depersonalisation also reported enhanced vividness of negative emotions (as opposed to positive emotions). Our study also reveals a weak negative correlation between the frequency of physical exercise during the lockdown and the occurrence of depersonalisation experiences. Finally, participants who reported that lockdown influenced their life to greater extent had higher occurrences of depersonalisation experiences. Our findings may help address key questions regarding well-being during a lockdown, in the general population. Our study points to potential risks related to an overly sedentary and hyper-digitalized life habits that may induce feelings of living in one’s ‘head’ (mind), disconnected from one’s body, self and the world.

Zoomed out? Depersonalization is Related to Increased Digital Media Use During the COVID-19 Pandemic Lockdown

10.31234/osf.io/cpxry

During the COVID-19 pandemic, government-mandated protection measures such as contact restrictions and mask wearing significantly affected social interactions. In the current preregistered study we hypothesized that such measures could influence self-reported mood and the ability to recognize emotional expressions from the eye region of faces. We found that mood was positively related to face-to-face but not to virtual interactions. This suggests that contact restrictions leading to a decrease in face-to-face compared to virtual interactions may be related to negative mood. We also found slight improvements in emotion recognition from the eyes in a student sample tested during the pandemic relative to a comparable sample tested prior to the pandemic although these differences were restricted to female participants.

The Emotional Lockdown: How Social Distancing and Mask Wearing influence Mood and Emotion Recognition

CNN's John Avlon discusses how members of the Republican Party have handpicked doctors who align with their own personal Covid-19 beliefs.

GOP members go 'doctor shopping' for Covid-19 deniers

Elimination still the strategy but PM is relying on luck and people doing the right thing in easing measures while there are still new cases, say experts

‘Calculated risk’: Ardern gambles as New Zealand Covid restrictions eased

10.1136/bmj.n2306

What do the data on hospital admissions show?An analysis of UK data from the National Immunisation Management Service (NIMS) and the Coronavirus Clinical Information Network (CO-CIN),1 endorsed by the UK Scientific and Advisory Group for Emergencies (SAGE),2 shows that of 40 000 patients with covid-19 who were admitted to hospital between December 2020 and July 2021 a total of 33 496 (84%) had not been vaccinated. It found that 5198 (13%) of these patients had received their first vaccine and 1274 (3%) their second. A total of 611 patients with previous covid-19 (reinfection) were not included in the analysis.Is the picture similar for deaths?The important figure here is the number of “breakthrough” deaths, those involving covid-19 that occurred in someone who had received both vaccine doses and had a first positive PCR test result at least 14 days after the second vaccination dose. Data from the Office of National Statistics show that 256 (0.5%) of the 51 281 covid related deaths that occurred in England between 2 January and 2 July 2021 were breakthrough deaths.3 Nearly two thirds (61.1%) of the breakthrough deaths were in men, whereas 52.2% of other covid-19 deaths were in men. And 13.1% of breakthrough deaths were people who were identified from hospital episode data or causes of death as likely to have been immunocompromised, compared with 5.4% for other covid-19 deaths. SAGE noted this trend in its latest minutes, stating, “Vaccination generally reduced the odds of in-hospital mortality, although immunocompromised patients in the study had persistently high risk of mortality after both first and second dose vaccines.”4

Covid-19: How is vaccination affecting hospital admissions and deaths?

Quite something for UK to take such a stance against so many countries vaccine rollouts…especially those countries administering the *exact same* vaccines as UK (Pfizer/AZ/Moderna/etc) As we’ve come to expect, UK’s latest travel policy is as unnecessarily complicated as ever

Understanding, MULTIPLE countries are not happy with UK government tonight One foreign minister tells me: “In our first meeting with Liz Truss, UK new Foreign Secretary, we expect her to explain why our Pfizer jabs are supposedly different to Pfizer jabs in UK or Europe”

UK government confirm tonight that if a person has been vaccinated in Africa, or South America, or countries including UAE, India, Turkey, Jordan, Thailand, Russia… …you are considered “unvaccinated” and must follow “unvaccinated” rules = 10 day home quarantine & tests

Demand for MIQ spaces is vastly outstripping supply, with spots snapped up in just two hours

Frustration for New Zealand returnees as Covid quarantine waiting list hits 30,000

UK and airlines welcome news that US will lift Covid-19 travel restrictions from early November

US to lift Covid travel ban for vaccinated passengers from UK and most of EU

These are risk levels that you pose to other people. They're compared with you as - a nonsmoker - a sober driver - a vaccinated person. Unvaccinated? 5x as likely to get sick, for 3x as long. Total risk to others? 15x a vaccinated person Details:https://election.princeton.edu/2021/09/15/your-failure-to-vaccinate-is-worse-for-other-people-than-drunk-driving/

The Covid-19 pandemic has caused unprecedented upheaval for universities and their delivery of education and training. Many institutions have adapted to lockdown and social distancing requirements by moving teaching and research online.This resulted in a huge change in the teaching and learning dynamic between staff and students, with the suspension of face-to-face teaching (including lectures, seminars and one-to-one sessions) as well as placements and other programme specific activities that required direct contact with others. Many students were restricted to halls or other university accommodation, others (UK and overseas) returned home to continue their studies online. Although research has been conducted on the impacts of Covid-19; particularly around the experiences, behaviour and wellbeing of university students, very little focused specifically on academic staff during the pandemic and none on those just in psychology

The impact of Covid-19 on students, staff and Departments of Psychology in UK Universities

10.31234/osf.io/z6kxm

Despite the widespread availability of COVID-19 vaccines, the United States has a depressed rate of vaccination as of September 2021. Understanding the psychology of collective vaccine refusal, particularly the sources of variation across U.S. sub-populations, can aid in designing effective intervention strategies to increase vaccination across different regions. Here, we demonstrate that county-level moral values (i.e., Care, Fairness, Loyalty, Authority, and Purity) are associated with COVID-19 vaccination rates across 3,106 counties in the contiguous United States. Specifically, in line with our hypothesis, we find that fewer people are vaccinated in counties whose residents prioritize moral concerns about bodily and spiritual purity. Further, we find that stronger endorsements of concerns about fairness and loyalty to the group predict higher vaccination rates. These associations are robust after adjusting for structural barriers to vaccination, the demographic make-up of the counties, and their residents' political voting behavior. Our findings have implications for health communication, intervention strategies based on targeted messaging, and our fundamental understanding of the moral psychology of vaccination hesitancy and behavior.

Moral Values Predict County-Level COVID-19 Vaccination Rates in the United States

If Covid deaths continue to rise we could be in trouble by November

Are we heading for another winter lockdown?

An estimated 1.5 million children worldwide have lost a parent, custodial grandparent, or other relative who cared for them, due to COVID-19.

Global study estimates 1.5 million children have lost a caregiver from COVID-19

A majority of Americans — including suburban voters — support vaccine mandates for federal workers as well as private companies, according to the latest installment of the Axios/Ipsos Coronavirus Index.

Axios-Ipsos poll: 60% of voters back Biden vaccine mandates

10.1136/bmj.n2251

The risk of 12-15 year old healthy boys experiencing cardiac adverse events such as myocarditis after their second dose of the Pfizer and BioNTech vaccine is around four times adolescents’ risk of being admitted to hospital as a result of infection with SARS-CoV-2, a preprint study has found.1

Covid-19: Boys are more at risk of myocarditis after vaccination than of hospital admission for covid