COVID 19 Scoping: A Systemic Review and Meta-Analysis.

INTRODUCTION: The world has faced the pandemic of COVID-19 in the march of 2020 and still it continues to effect in 2021. Hence, in the present study we aim to evaluate the gulps in the research so that certain recommendations can be made for the future research. We conducted a scoping review of the COVID meta-analysis.
MATERIALS AND METHODS: Online data was collected from the search engines of EBSCO, PubMed, Google Scholar, and Scopus. The searched terms were COVID-19, CORONA, SARS-CoV-2, clinical features, Wuhan, etc. The study articles were collected that from January 2020 to February 2021. Based on the PRISMA guidelines, the meta-analysis was performed.
RESULTS: In the present study, we finalized 316 articles. On February 2020, the first article was published. We observed a spike in the meta-analysis later on. Most of the meta-analysis were issued in the virology and infection magazines. As expected, the majority studies were from Wuhan. The other countries that published the meta-analysis were the USA, the UK, and Italy. The studies included in each meta-analysis were nearly 25 and the subjects were approximately 16 thousand. However, we noticed a poor quality in majority of these meta-analysis and <10% of all the meta-analysis showed higher confidence.
CONCLUSION: A poor quality of the meta-analysis has predominated the data and very few are of high quality. All the journal editors and the reviewing team should verify and thoroughly organize the protocol so that only high quality meta-analysis are encouraged. Copyright:

INTRODUCTION

The world went into a state of stand still after the declaration of the pandemic COVID-19.[1] There has been no specific therapy and treatment for the COVID-19 disease. Only recently the vaccine has been given in some countries.[2] However, till date, there has been no specific data on the clinical course and the prognosis of the disease.[345678] In all the available studies, there were only reports of the cases observed that were admitted into the hospital, or in the centers of the specific region care centers.[123456789] There has been a surge of the articles about the COVID-19 that are available online and in print.[12345] In the indexed search engines, there have been reports of over 200 articles per day for various types of the journals. Many organizations including the government and the private are issuing grants that encourage the research. Furthermore, the publishers are issuing the open access to the articles on these research and the related topics. All the research institutes and the committee are giving priority to the COVID-19 related topics. The publishing companies are also publishing the COVID-19 topics at the quickly through the quick review process.[56789] The chief motive of all these encouragements was the gain of the knowledge and the COVID-19 proof of the evidence. The meta-analysis is tool that helps to generate good quality evidence based practice. There have been many meta-analysis that are published regarding the COVID-19. There have been questions about the quality and the standard that is being maintained by the recent published meta-analysis.[78910] It is noticed that the quick review process, less time for the peer reviews, demand for the early data release have led to the lower quality of the meta-analysis articles that are being published. Hence, to enumerate the number of the meta-analysis and their quality check being published, the present study was conducted. We performed a scoping review of the meta-analysis that was COVID-19 related and published.

To carry out a scoping review of the meta-analyses published regarding coronavirus disease 2019, evaluating their main characteristics, publication trends, and methodological quality.

MATERIALS AND METHODS

We conducted the search for the data from the online sources like the “EMBASE,” “PubMed,” “Scopus,” and other sources. The study was conducted by two reviewers independently. The PRISMA ScR guidelines were followed.[12] The articles were collected from January 2020 to February 2021. The search words are META ANALYSIS, COVID, COVID-19, SARS, CoV2, PANDEMIC. The disputes between the reviewers were cleared by consent.

The articles were screened for the abstract and the title for the initial screening. Later, the entire text was studied by one reviewer and then was cross checked by the other reviewer. The present study was organized according to the PICOS. The inclusion criteria were COVID-19, meta-analysis of the epidemiological studies, case reports, and other type of the studies such as the systemic reviews that were with the meta-analysis, comparison of the COVID-19 with other respiratory type of diseases.

The following article types were excluded: Incomplete information, meta-analysis done before December 2019, meta-analysis other than corona, research design that did not fit the meta-analysis protocol.

The study design that was considered in the present review was organized according to the title, author, country, date of publishing, the number of the articles in the study, the number of the patients included, the search engine used, the registration of the study, and the protocol followed.

Also the quality of the studies that were included for the present scoping review was analyzed by AMSTAR 2.0.[11] After the trail assessment, to check the quality of the articles in the meta-analysis, the authors performed the data extraction and the stratification of the studies were done.[12]

RESULTS

Out of 1307 meta-analyses, 316 were considered eligible. The flow chart is depicted in Figure 1. On February 26, 2020 the first meta-analysis was published.[13] We observed that nearly two meta-analysis were published in 24 h as showed in Figure 2.

Figure 1

Flow chart describing the selection of the articles

Figure 2

Distribution of the meta analysis month wise

Majority of the studies were exclusive for the COVID-19 related only. There were a total of 38 countries participating in the meta-analysis. As expected, the majority studies were from Wuhan. The other countries that published the meta-analysis were the USA, the UK, and Italy. There were few studies that compared the COVID to the other viral respiratory symptoms. An average of 15,200 patients and 22 articles were included in each meta-analysis. Majority of the studies were given in the virology related journals. Almost equal distribution of the meta-analysis was seen among the journals with nearly one meta-analysis per each. For the medical journals the highest number was seen in the clinical and medicine journals, followed by others like gastroenterology [Figure 3].

Figure 3

Distribution of the meta-analysis as per the subject area, journal and the country, (a) subject area, (b) journal (c) country

When we searched for the registration <20% of the meta-analysis were registered in the PROSPERO. There were a variety of the type of the studies such as the randomized controlled trials, research studies, and majority were observational studies. Among the various data search engines, the most frequent were Medline and PubMed that were nearly in 99% of the studies.

In all these meta-analyses, the major area of the focus was clinical features, outcome, epidemiology, and medical managements.

When we analyzed for the quality of the meta-analysis study articles for the quality, a meager 32 articles had a higher confidence levels that constituted <10% of all the meta-analysis. More than half of the articles were with low confidence as shown in Figure 4.

Figure 4

(a) The distribution of the meta-analysis as per the quality (b) assessment of the criteria for the included meta-analysis

DISCUSSION

Evidence-based studies are required for the policymaking. Meta-analysis is highly trusted for the quality of the output they give. Most of the meta-analysis follow several principles based on the PROSPERO guidelines.[14] After the world had to face the pandemic of the COVID-19, the need for the meta-analysis increased that were required to deduce the steps to be taken by the countries to follow. The meta-analysis quality depends on the articles that are included for the analysis along with the number and the methodology followed. Hence, in the present study, we intended to evaluate the quality of the meta-analysis studies done for the COVID-19 by a scoping review.

The prerequisite for any meta-analysis are the studies that are included for the review. The output of the meta-analysis depends on the quality and the number of the articles. If the included studies are of a poor quality then the meta-analysis will also be of bad quality. If a good quality of the meta-analysis is desired, then the a well planned with robust methodology is required.[1516]

There have been some meta-analysis that have been reported as of low quality and had flaws.[678910] These might have been due to the poor quality of the studies that are included for the meta-analysis.

An average of 15,200 patients and 22 articles were included in each meta-analysis. The majority of the studies had such large number of the subjects as most of them were epidemiological that were published in the initial stages of the pandemic. When the quality was assessed, we obtained only 10% to be good quality. Furthermore, we noted that there were zero meta-analysis on the randomized controlled trial (RCT) alone without any other study included. Most of the studies that are published are observational and for the analysis of the risk factors. The RCTs that include the case and the control type of the studies were seldom done in the COVID-19.

The meta-analysis that was studied in the present study was mostly from china. These are followed by the USA, the UK, and Italy. These are also the most effected countries. However, these are also the countries that had been publishing the meta analysis prior to the pandemic.[1718] There is no proof of the correlation.[19] Majority of studies are published in the virology, followed by infectious diseases and clinical researches. They evaluated the epidemiology and the prognosis. PROSPERO is the most common registering platform for the meta-analysis and is also evident in the present system.[2021] There is a high amount of the criticism about the number of the meta-analysis being published about the COVID-19 and also their mass publications.[222324] It is learned from the previous studies that meta-analysis can lead to contradicting output.[2526] The surge in the number of the meta-analysis that are on the COVID-19 have been shown to be of poor quality. This might lead to low applicable findings. This is significant for the policy makers and government agencies for the health program execution. The assumption that meta-analysis give high level of evidence is no more followed.[27282930] This was clearly evident in our quality assessment of the meta-analysis'.

From the present scoping review we can suggest that:

The policy makers should not blindly follow the meta-analysis for the decision making

The authors should maintain a high quality study and refrain from poorly designed studies for the meta-analysis

The meta-analysis should be registered and should follow a strict protocol for the meta-analysis

The publishers should encourage experienced peer review accurately and not compromise on the quality of the meta-analysis.

CONCLUSION

Production of the poor quality of the articles and the meta-analysis has been on rise for the COVID-19 articles. This surge in the meta-analysis is expected to raise. It is suggested that proper evaluation of the meta-analysis be done so that appropriate policies are made from the data given by these meta-analysis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.