Coronavirus Is Forcing Medical Research to Speed Up
As scientists race to understand the coronavirus, the process of designing experiments, collecting data and submitting studies to journals for expert review is being compressed drastically. What typically takes many months is happening in weeks, even as some journals are receiving double their normal number of submissions. Science, one of the world’s most selective research outlets, published the structure of the spiky protein that the virus uses to enter host cells — crucial knowledge for designing a vaccine and antiviral drugs — nine days after receiving it, according to Holden Thorp, the journal’s editor in chief. “It’s the same process going extremely fast,” he says. Is there precedent in Science’s 140-year history? “Not that anybody can remember.”
For both experts and laypeople, being able to access dependable health advice has never felt more important, or challenging. The World Health Organization has described a “massive ‘infodemic’ — an overabundance of information, some accurate and some not — that makes it hard for people to find trustworthy sources and reliable guidance when they need it.” Indeed, in recent weeks, new research has emerged that complicates such basic questions as who should wear face masks and when; what degree of physical separation is safe; and how the virus primarily spreads.
As a practice, science continuously interrogates and refines our understanding. “The answer is never so simple as ‘Masks work or masks don’t.’ It’s going to be ‘Under what conditions do masks have an effect?’ and ‘How much of an effect do they have?’ ” says Brian Nosek, executive director of the Center for Open Science. “The questions that we want answers to are much more complicated than the evidence that we have at any one moment.” The problem is that now we want those answers to be definitive and fast.
That demand for conclusiveness highlights longstanding tensions over the role of a scientific journal. Should it be an arbiter of facts or a generator of new ideas? A keeper of the historical record or a predictor of the future? A private channel for scientists to communicate with one another or a megaphone with which they can reach the public? Or all of the above? “I think this whole pandemic has very much changed our view of ourselves,” says Richard Horton, the editor in chief of the British medical journal The Lancet. “We feel very much that we are publishing research that is literally day by day guiding the national and global response to this virus. And that is both daunting and full of considerable responsibility, because if we make a mistake in judgment about what we publish, that could have a dangerous impact on the course of the pandemic.”
The strength of traditional academic journals, compared with other means of broadcasting scientific knowledge, is that they have the expertise to interrogate the validity of highly specialized experimental methods and the accuracy of the resulting data — and also make the importance of new findings clearer in context. That means getting relevant experts to review papers, which is especially difficult when dealing with a novel pathogen. Many of those who have gained expertise in Covid-19 are also in the thick of trying to stop it. “What we can say with confidence is the best available evidence is what’s coming through the journals,” Nosek says. “But the best available evidence is far, far short of certainty,” he adds — and the decisions that we make about the evidence have “to embrace the uncertainty.”
To make potentially life-or-death research available as quickly as possible, many publishers of elite journals with hefty paywalls, including Science, The Lancet, JAMA and The New England Journal of Medicine, have made coronavirus content free online. Thorp says he and others have also encouraged researchers to post their submissions to so-called preprint servers, where anyone can access them, before review. “Then, we’re not deciding whether the world should or should not have the information,” he says. “What we’re deciding is whether this is an important part of the scientific record that should have the endorsement of our peer-review process.”
By definition, however, it’s difficult to say whether a preprint is “reliable and dependable and true,” says Peter Drotman, the editor in chief of Emerging Infectious Diseases, a journal published by, but editorially independent from, the Centers for Disease Control and Prevention. (It has always been open access.) On the other hand, researchers sharing preliminary work may be helping the scientific community as a whole collaborate more efficiently and effectively — for instance, by enabling researchers to rapidly confirm and build on one another’s findings rather than unnecessarily duplicating experiments.
Scientific journals consider their audience to be other scientists, not the general public. But the scientific journal as we know it was actually born because of popular demand for information during a pandemic.
In the early 1820s, a smallpox outbreak struck Paris and other French cities. A new vaccine was in existence at the time, but reports varied about how effective it was. A powerful medical institution in Paris, the Académie de Médecine, gathered its members to discuss what advice it should issue to the nation. Historically, such meetings were held privately, but the French Revolution had ushered in a new era of government accountability, and journalists were allowed to attend. The scientific debate they relayed upset some members of the Académie, which had hoped to make a clear, unified statement, says Alex Csiszar, an associate professor of the history of science at Harvard University. In response, the Académie sought to regain control of its message by publishing its own weekly accounts of its discussions, which evolved into the academic journals we know today.
Now those same journals tend to be too specialized for general readers to grasp easily, making the concept of “open access,” as far as the public is concerned, “more of an idea than a reality,” Csiszar says. Nevertheless, the current pandemic has certainly increased both the readership of scientific journals and their citations in the press. Before January, the most-read article in Emerging Infectious Diseases, a 2006 study, had 20,000 views. The current most-viewed article, also from 2006, has more than 480,000 views: It gives instructions for making your own “simple respiratory mask” from a T-shirt.
What this sudden growth in scientific engagement will mean over the long term is an open question. Thorp worries about a backlash if people perceive scientists to have overpromised solutions to the pandemic. “It is difficult to share progress with adequate caveats about how long things might take or whether they will work at all,” he wrote in a March editorial. “This is not just fixing a plane while it’s flying — it’s fixing a plane that’s flying while its blueprints are still being drawn.”
Then again, if government officials had heeded available science sooner, we might not be on that plane at all. On Jan. 31, The Lancet published a paper forecasting a global pandemic and asserting that “preparedness plans should be readied for deployment at short notice, including securing supply chains of pharmaceuticals, personal protective equipment, hospital supplies and the necessary human resources to deal with the consequences of a global outbreak of this magnitude.” Britain’s National Health Service “didn’t take any of those actions,” Horton has written. U.S. health agencies and the White House didn’t, either.
None of that, of course, is within our individual control. So in addition to following public-health guidelines, how can nonscientists engage with studies, or news that cites studies, to help them protect their health? Checking sources is important: Heed information that comes from respected journals. But also remember that even the best peer-reviewed advice is likely to change — and change again. That’s how science works, and now it’s working faster than ever. If we put our faith in a single conclusion, it’s easy to feel distressed when it’s amended. If we trust the process, imperfect though it is, we’re better prepared to change with it, which is the most we can hope to do.