Research in COVID times-Innovations, revolutions and contentions.

The year 2020 was plagued by the coronavirus disease (COVID)-19, which swept the world off its feet. Each and every sphere of society was affected and the infliction is still going on. The world of 'Research and Publications' was no exception to this COVID storm. Rather, the research platform is getting more strengthened with each passing day to combat this pandemic with whatever evidence that has come forth over the last few months throughout the globe.

PREPAREDNESS AND GEARING UP OF ORGANISATIONS TO DEVELOP COVID RESEARCH

Every time a new disease invades the world, the scramble for a new drug, vaccine and innovations starts and COVID was no exception to this. A mad search for the right drug, effective vaccine and useful innovations to combat the coronavirus began.

The World Health Organisation (WHO) contributed a lot to the promotion of COVID research. It created the global research database wherein new research findings from multiple nations across the world in different languages are added regularly.[1] It convened the research and development blueprint, which is a broad global coalition of medical and scientific experts who work with a goal to accelerate the development of effective diagnostic tests, vaccines and medicines for the novel coronavirus.[2] The WHO and its collaborating partners launched several international clinical trials to help find an effective drug for COVID-19.

The Indian Council of Medical Research (ICMR), one of the oldest medical research bodies in the world, embraced the growing demands of the changing COVID scenarios and issued regular bulletins, updates and guidelines. The ICMR official website icmr.gov.in became the most accessed and trusted website for COVID-19 information.

THE PROPORTIONALITY OF PANDEMIC AND THE COVID RESEARCH

Researchers found this COVID pandemic an extremely favourable situation to prepare and publish articles on COVID that could enhance their clinical reputation, career and academic promotion opportunities.[3] An analysis showed that COVID-19 papers had authors who had never published before.[4]

The race for research on COVID-19 led to an extraordinary flooding of clinical trial registries and journal editors' desks with research proposals and COVID-19 related manuscripts; nevertheless, the Clinical Trial Registry of India and the International prospective register of systematic reviews (PROSPERO) set up special online facilities to speed up COVID-related research proposals. A search on coronavirus research in the WHO database revealed an astonishing 23,4471 results out of which 8369 were registered as clinical trials. The United States leads both in vaccine and non-vaccine related COVID research with 40 different candidate vaccines being registered and evaluated. China follows with eight different vaccine candidates and other nations trail behind.[5]

In six months (March to August 2020), 12,331 coronavirus articles were tracked on the Web of Science database and 12,602 papers on Scopus. Original research accounted for most of the COVID-19 related articles, while letters, reviews and editorials contributed to the other coronavirus articles. An interesting finding was that the United States, China and Italy led in publishing volume and the British Medical Journal, Journal of Medical Virology and The Lancet led in the number of papers related to the coronavirus. India ranked fifth in the number of unique documents on the two databases.[6] The Indian Journal of Anaesthesia (IJA) saw a record number of 279 COVID-related manuscripts submitted to the journal since March 2020. This included all types of articles; letters to the editor dominated these submissions followed by original articles and others [Figure 1]. Nonetheless, a thundershower of COVID manuscript submissions was seen in May 2020 (the lockdown period) with 47 submissions. The early phases of COVID including COVID lockdown times saw authors busy submitting manuscripts for publication and the editorial team members and peer reviewers coping up with the increased submissions in spite of groping with their own difficulties.[7] This surge of manuscript submissions slowly came down in the following months; however, the soft drizzle of COVID manuscript submissions to the journal still continues [Figure 2]. An analysis of the studies submitted to the IJA revealed that in the early phase of the COVID pandemic (the first 6 months), the proportion of secondary article (reviews, editorials, commentaries, guidelines, letters to editor) submissions was higher than the proportion of studies with original data. This trend is similar to the trend found in a cross-sectional meta-epidemiological study, which found that a large number of non-original articles were published in the early phases of the pandemic. This implies that a valid knowledge base on COVID-19 will take a longer time to develop.[8]

Figure 1

Bar diagram showing distribution of different types of COVID-related studies

Figure 2

COVID article submissions to IJA

There was a mad scramble by various organisations and bodies to various journals to publish their guidelines. However, there was a paucity of high-quality evidence supporting the recommendations in the guidelines. Most of the literature included retrospective studies, case reports/series and expert opinions, which represent weak evidence. The United Kingdom and South African guidelines scored the highest in clarity of guidelines.[9] The Indian Society of Anaesthesiologists was very swift and published two important guidelines in the very early phase of the pandemic.[1011]

JOURNALS AND PUBLISHING INDUSTRY'S TACTICS IN COPING WITH THE COVID MANUSCRIPTS

Several journals waivered all article publishing charges for COVID-19 related research. In fact, it has been said that many journals changed their 'publications rhythms' rapidly to adapt to the new COVID scenario.

Journals started publishing COVID-19 papers faster than articles on other topics through fast- track review process.[12] Many journals and publishers tried to make research findings easily accessible by making articles open access, opening up pay walls on COVID-19 articles and encouraging authors to upload their COVID-19 papers on preprint research servers like medRxiv and bioRxiv before publication.[13] It is estimated that around 1300 preprints related to COVID-19 were posted between January and September 2020 on the preprint server bioRxiv.[13]

Internet-based discussions using social media tools like Twitter, YouTube, podcasts and blog posts are now common and they provide critical appraisal and continuous updating of both non- peer-reviewed and peer-reviewed research material related to COVID-19.[14] In May 2020, Twitter opened up its data for researchers to study COVID-19 related Tweets.

Newer tools using artificial intelligence are now being used to analyse huge datasets. For example, the COVID Symptom Study App and BIP4COVID19, which is an open dataset, compiled to provide impact scores for coronavirus-related publications. Variations in statistical techniques like cluster analysis have become very popular to group observations based on observed values of several variables; thus, countries are clustered as per the similarity of the COVID-19 outbreaks in them and the outcomes are analysed.

HAS COVID BROUGHT IN A TRANSGRESSION OF THE RESEARCH SYSTEM?

Most Research Ethics Committees (RECs) speeded up their research protocol assessment process, but in the bargain, research ethics are suffering a severe blow.[15]

The fast-track publication process results in lowering of quality in the peer-review practices. A Danish study found that the average duration of review process was less for COVID category articles (83.8 days for COVID versus 199.7 days for non-COVID) and average length of peer-review reports was also less for COVID category articles (2779.1 words for COVID versus 3015.2 words for non-COVID). Cooperative comments by peer reviewers and suggestions to improve manuscript quality were more common than criticism/open questions for COVID articles.[12]

Poorly designed and executed studies, ethically questionable research studies with data manipulation and data make-up thus successfully passed the fastened peer-review process; furthermore, the conclusions and recommendations of such studies have been followed by the readers and healthcare policy makers too. An apt example of this would be the study entitled 'Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open-label non-randomized clinical trial' published in the July 2020 issue of the International Journal of Antimicrobial Agents. This treatment was also advocated by the President of the United States; however, it was found later that the article had several ethical issues and flaws in the methodology, results and peer-review process because of which it was retracted.[4]

To date, several high-impact studies in well-reputed journals have been retracted, withdrawn or noted with concern following the evidence of research misconduct like duplicate publication or non-availability of underlying data, and unfortunately, Asia is the source of most of these manuscripts.[1215] It is imperative to reiterate here the fact that retractions bring down the academic and scientific integrity of the author, their institution and the concerned journal and also result in a waste of research findings.[15]

CHALLENGES POSED TO RESEARCHERS BY COVID-19

The cancellation of fieldwork and travel to other countries as well as within the nations for research, depression and anxiety in researchers, decrease in funding of early career researchers on contracts are some challenges posed to researchers by COVID-19. Basic science and clinical research was redirected to COVID-19. With the onset of the pandemic, most non-COVID clinical trials worth a lot of money were paused or modified in several countries.[4] To protect ongoing research and the research careers of physician scientists, research institutions implemented strategies to provide guidance on proposal submission, allowances to be paid to grant personnel and relaxation in research timelines.[16] Several universities including those in India relaxed the timelines for the thesis submission of their postgraduate students. The interesting studies published in this issue of the IJA are an example of research done during difficult times—COVID and lockdown times.[1718]

NECESSARY MEASURES TO PROTECT THE QUALITY OF COVID RESEARCH

All research protocols should undergo rigorous and robust scientific and ethical reviews by strong RECs. Rapid peer review should include removing review steps that do not add value; nevertheless, the quality of the reviews should never be lowered. All preprint servers should make it a point to follow ideal publication practices.

All researchers, authors, peer reviewers and editors should guard against data falsification, cooking up of data and issues like plagiarism and duplicate publications. They should keep in mind that the protection and promotion of academic and research integrity is their prime responsibility and that there is no point in encouraging false research.[3] As mentioned in a previous editorial of the IJA, one should remember the ten 'T's (team, timeliness, therapeutic necessity, technology, techniques, tenor, tabulation of data, tests, transparency and teaching and training), which form the basic foundation of good research.[19] Strict quality vigilance exists for the manuscripts submitted to the IJA, and as a result, the COVID manuscripts have been associated with quite a high rejection rate of nearly 84% [Figure 1]; nevertheless, a variety of COVID-19 related manuscripts got published in the previous issues of the IJA.[202122232425262728293031323334353637383940]

To conclude, currently, we live in a COVID-struck world of research wherein new trends have come up. Research in the new normal is beyond normal and it has stretched beyond our wildest imagination to lighten up the dark valleys of COVID.

COVID has undoubtedly taught us the value of research and more important, the value of true and fast research. It has created a revolution of sort in the world of research and publications. But at the same, it is certain that as long as COVID-19 remains with us and even after it goes, research, whether COVID-19 related or unrelated, has to continue. The COVID manuscript submissions to IJA will also continue and so will the journey of our illustrious IJA.