Mapping COVID-19 related research from Vietnam: a scoping review.

Introduction: The situation of COVID-19 pandemic is becoming more complex. The research institutes should focus on the most important challenge related to this outbreak at the national level. We aim to realize this scoping review to map publications on COVID-19 in Vietnam in order to guide research priorities and policies in the country.
Methods: This study was conducted at the Thai Binh University of Medicine and Pharmacy, from May to August 2020, according to the guidance for conducting systematic scoping review.
Results: A total of 72 studies met the inclusion criteria. The most frequent publications were original articles (27.8%), followed by letter to editor/correspondence (26.4%). According to the research priorities for COVID-19 set by the WHO, 41.7% studies focused on control and prevention of COVID-19, but none of studies on personal protective equipment or protocol for healthcare workers' safety were conducted. 12.5% studies carried out a thorough investigation into epidemiology of the COVID-19 pandemic in Vietnam. Virology and genomics, natural history of the virus and its transmission in Vietnam were described by 18.1% papers. Only one study was conducted in terms of development for candidate therapeutics.
Conclusion: We call for national investigation on treatment against SARS-CoV-2 and protocol for medical staff protection. The government and academic institutions should work in collaboration with international stakeholders, including the WHO, to combat together the COVID-19. ©2022 Pacini Editore SRL, Pisa, Italy.

Introduction

In December 2020, the first case of an emerging respiratory infectious disease (COVID-19) due to a novel coronavirus, named SARS-CoV-2 was reported in Wuhan, China [1]. This outbreak is highly contagious with the reproduction number R (R0) of SARS-CoV-2 which is estimated up to 3.5 [2-4]. In addition, this can be transmitted directly between humans via droplet, close contact with infected persons and indirect contact with contaminated surfaces or objects [1]. The outbreak has quickly spread out of China and affected the whole world. The World Health Organization (WHO) declared that it was a Public Health Emergency of International Concern on January 30, 2020, and then a pandemic on March 11, 2020 [1]. At the time of writing, the COVID-19 pandemic has affected 213 countries worldwide with 767,346 deaths and 21,564,286 confirmed cases [5].

The situation of pandemic is becoming more complex, and it is increasingly difficult to control diseases in order to reduce both morbidity and mortality rate. The outbreak has overwhelmed most countries in the world, even in high-income countries with modern, advanced medical system. Vietnam is a neighboring country of China with an approximately 1500 km of common border; therefore, the country faces a high risk of a severe COVID-19 pandemic. In addition, Vietnam is middle-income country and has a population density of nearly 100 million people, so this raises more challenges in fighting the outbreak.

The COVID-19 pandemic broke out in Vietnam on January 23, 2020 with the two first cases [6]. As of August 15, 2020, The Ministry of Health (MOH) reported 950 confirmed cases (447 recovered) and 23 deaths [7]. The COVID-19 has caused a complex emergency. The lockdown has seriously affected the domestic economy and the morale as well as quality of life of its citizens. The academic institutions must be primarily responsible for investigating this pandemic from a holistic perspective, including the distribution of asymmetric severity, morbidity, mortality and spread among different geographical areas. Especially in the context of low- and middle-income countries with limited human and economic resources, it is needed to avoid duplication of research topics. However, the research institutes should focus on the most important challenge related to COVID-19 pandemic at the national level. We aim to realize this scoping review to map publications on COVID-19 in Vietnam in order to guide research priorities and policies in the country.

Methods

We realized our scoping review according to the guidance for conducting systematic scoping review proposed by Peters et al. [8]. Development and reporting were followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews [9].

We mapped the literature by 5 key steps: i). we identified the research question, then ii). we identified the literature relevant to COVID-19 in Vietnam and iii). We selected only those studies; iv) the data from the articles, including population type, participation of foreign experts, multinational study, hospital affiliation, studied topics and research priorities for COVID-19 set by the WHO were thereafter collected and summarized; v). Finally, we reported the results. The study was conducted at the Thai Binh University of Medicine and Pharmacy, from May to August 2020.

This scoping review was guided by the following questions: “What type of research on COVID-19 was carried out by Vietnamese institutions? What aspects of this pandemic and its impact were investigated in Vietnam?”

The following databases were investigated in all relevant studies published on: PubMed (http://www.ncbi.nlm.nih.gov/pubmed), Web of Science (http://webofknowledge.com) and Google Scholar (http://scholar.google.com/). The most recent search was conducted on July 31, 2020. The topic search terms used for searching the databases were the following:

#1: “COVID-19” OR “COVID19” OR “SARS-CoV-2” OR “nCoV”

#2: “Vietnam” OR “Viet Nam”

#3: #1 AND #2

No language, type of article or date of publication restrictions were applied. Search criteria were developed to capture articles relevant to research regarding COVID-19 pandemic from Vietnamese institutions. The studies which were not conducted in Vietnam and/or not related to COVID-19 were excluded.

Duplicate citations were initially removed in Zotero. All studies related to COVID-19 which were realized in the Vietnamese institutions, and authored by a Vietnamese researcher or a non-Vietnamese researcher were eligible for inclusion. Published and accepted articles in press that were already published online, or preprints were also included.

Two researchers (TLD and VTH) independently performed the screening of the articles. Any discordant result was resolved by agreement. In case of dispute, a third reviewer (MMT or TDN) was consulted for the decision. Reference lists of selected articles were screened to identify studies that might have been missing from the research. After the abstracts had been screened, the full texts of the articles were assessed for eligibility by the same two researchers and selected or rejected for inclusion in the systematic review.

Included publications were abstracted and summarized in Microsoft Excel 2016 using the following items: title, authors, name of the Vietnamese institutions involved in the study, time of publication (month and year), type of study (Original article, review, short communication, letter to editor/correspondence, perspective, commentary, editorial, preprint), studied topics, national or collaborative international, name of the countries in case of multinational studies and funding.

Results

STUDY RESEARCH

The initial search provided 256 papers. Of which 161 duplicate were deleted. After being screened by authors, 23 records were excluded because they did not meet the eligibility following criteria: research not conducted in Vietnam (19) and research not related to COVID-19 but mentioned COVID-19 in their abstract or in the text (4). Finally, 72 studies met the inclusion criteria [6, 10-80]. Figure 1 shows the research strategy according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.

Fig. 1.

Study flow diagram

CHARACTERISTICS OF INCLUDED STUDIES

Table I shows the characteristics of the included papers. The most frequent publications were original articles (20/72, 27.8%), followed by letter to editor/correspondence (19/72, 26.4%), preprints (12/72, 16.7%) and short communication (6/72, 8.3%). Two studies were published early February 2020 on the first cases of COVID-19 in Vietnam. Six, 18, 20, 22 and 4 papers were published from March to August 2020, respectively. The majority of the studies (43/72, 59.7%) were conducted in collaboration with scientists from other countries but only 4 (5.6%) were multinational research. A total of 13/72 (18.1%) studies were affiliated by the authors of hospitals.

Tab. I.

General characteristics of 72 included papers.

Characteristics	Number of papers	Percentage
Publication type
Original article	20	27.8
Letter to editor/correspondence	19	26.4
Short communication	6	8.3
Review	5	6.9
Perspective	3	4.2
Case report	1	1.4
Commentary	1	1.4
Editorial	1	1.4
Viewpoints	2	2.8
Preprints	12	16.7
Other	2	2.8
Participation of foreign experts	43	59.7
Multinational study	4	5.6
Hospital affiliation	13	18.1
Studied topics
Clinicopathologic	8	11.1
Control and prevention	30	41.7
Economic impact	7	9.7
Epidemiology	9	12.5
Health impact	3	4.2
Medical management	5	6.9
Social impact	3	4.2
Treatment	2	2.8
Virology and genome	11	15.3

The funding was declared in 39 studies (54.2%) with 19 research (26.4%) were funded. Regarding the funding of selected studies, 11 studies were funded by non-government organizations and 8 received a governmental funding.

RESEARCH PRIORITIES

According to the research priorities for COVID-19 set by the WHO [81], a total of 30/72 (41.7%) studies focused on control and prevention of COVID-19 but no study on personal protective equipment or protocol for healthcare worker safe was conducted. Nine (12.5%) studies carried out a thorough investigation into epidemiology of the COVID-19 pandemic in Vietnam. Thirteen (18.1%) studied the virology and genomics, natural history of the virus and its transmission in Vietnam. The clinicopathological features of COVID-19 were described by 8 papers (11.1%). Two studies (one original article and one review) concentrated on the treatment of SARS-CoV-2 (Tab. II).

Tab. II.

Research priorities for COVID-19 in Vietnam.

Research priorities for COVID-19 set by the WHO	Number of included studies	Percentage
Natural history of the virus, its transmission and diagnosis	13	18.1
Animal and environmental research on the origin of the virus, including management measures at the human-animal interface	0	0
Epidemiological studies	9	12.5
Clinical characterization and management of disease caused by the virus	8	11.1
Infection prevention and control, including best ways to protect health care workers	30	41.7
Research and development for candidate therapeutics and vaccines	1	1.4
Ethical considerations for research	0	0
Integration of social sciences into the outbreak response	15	20.8

Discussion

Until now, Vietnam has reported three waves of COVID-19 outbreaks. After each wave, the pandemic is increasingly completed, and the new cases are on the increase [7]. Particularly, in the third outbreak which started on July 26, 2020, the rate of spread of this disease is higher than before. A total of 476 autochthonous cases within 3 weeks were recorded (50.1% of all cumulative cases in the country from nearly 7 months), including medical staff. Furthermore, 23 deaths were recorded in this time [7]. Especially, the source of infection in the community has not been determined. Studies on epidemiology, transmission, preventive measures, and treatment strategies are essential to reduce morbidity and mortality of COVID-19. Especially in poor countries, with limited financial capacity, it is necessary to identify priority studies according to each period of pandemic in the national level.

Our review is useful in the actual context of COVID-19 in Vietnam for fund allocation from the government to support health care and related research. We identified 72 articles, including 12 preprints conducting on the COVID-19 pandemic in the country. Unfortunately, the current published research on COVID-19 in Vietnam seems to be discordant from the epidemic research priorities set by the WHO. This is possible that some of projects are still ongoing and have not been captured in this review, but the current publications do not provide a strong preparation for the country to neither adequately tackle the pandemic nor to accumulate experience for prevention of other outbreaks in the future. The research gap related to COVID-19 identified by the WHO are: i) natural history of SARS-CoV-2, its transmission and diagnosis; ii) animal and environmental research on the origin of the virus; iii) epidemiological studies; iv) clinical characterization and management of COVID-19; v) infection prevention and control, including health care workers protection; vi) research and development for candidate vaccines and treatment; vii) ethical considerations for research; and viii) integration of social sciences into the outbreak response [81]. These points should be utilized for focusing the topic and planning future research steps in Vietnam.

Most of the included studies in this scoping review were letter to editor and focused on control and prevention aspect. It is important because multiple effective measures have been applied to fight the COVID-19 pandemic in Vietnam such as: early lockdown, a strong political commitment and prompt actions with a multi-sectoral response plan, blanket media coverage of COVID-19 prevention, intensive surveillance, case management and large-scale health quarantine not only for patients, but also for persons in close contact with cases [10-24]. But these articles were narrative and described on experiences and reported views and experimental studies remain limited. Moreover, since the SARS-CoV-2 virus is highly contagious [2-4], safety for all healthcare workers must be ensured to protect themselves and to prevent nosocomial transmission. In fact, several medical staff in Vietnamese health facilities such as Bach Mai and Da Nang hospitals were infected by SARS-CoV-2 [7]. Isolation of infected health workers and colleagues who have contact with them aggravates the overload of medical human resources. Therefore, research on personal protective equipment, protocol for its safety and the implementation of designated hospital units for COVID-19 patients are essential [82]. But in Vietnam, research on this field is scarce.

Thirteen included studies in this review investigated the COVID-19 epidemiology in Vietnam, but epidemiological studies focused on viral transmission or health resources utilization remained lacking. We also find that there is a lack of experimental studies and large multicentral, clinical trials inspecting treatment modalities of COVID-19. Only one original article focused on new treatment options. This can be explained by the poor participation of hospitals, especially central and provincial hospitals, in research.

The funding was declared in 39 studies. Of which, only 8 were Vietnamese government founders, while the remaining funding was raised by non-government organizations. Furthermore, despite the participation of foreign experts in 43 research, only 4 multinational studies were conducted. The government and academic institutions should work in collaboration with international stakeholders, including the WHO, to combat together the COVID-19.

This review has some limitations. We have screened the published papers only on PubMed, Web of Science and Google scholar. Ongoing research projects have not been captured. Finally, we have so far focused on only COVID-19-related studies in Vietnam. But this work shows the gap in research on COVID-19 of the country. It is the first step toward contributing to the development of a national research agenda. It helps government make decisions about prioritizing and allocating resources. We call for national investigation that takes emerging epidemics along with other public health priorities into consideration. In addition, we recommend establishing national capacity and encourage the investment in national companies for laboratory research materials. Furthermore, we strongly encourage hospitals and health facilities to get involved in therapeutic research strategies of SARS-CoV-2. Moreover, leading national universities must conduct projects to come up with solutions in the public health crisis, and provide guidance for the government based on the most scientific evidence. A COVID-19 national research framework with specific research projects should be thoroughly discussed to address critical gaps identified through this scoping review. This can be achieved through a partnership between the government, the Ministry of Health, and researchers in collaboration with WHO and international partners.

Acknowledgements

We thank to medical staff of Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam for their support in data collection.