Publishing research in a pandemic
Pandemic publishing compresses the time available to prepare, review and release research while increasing its immediate influence on clinical and public decisions. Rapid access must be weighed against inadequate scrutiny, with medical writers helping preserve independent assessment and clear interpretation under pressure.
Speed, scrutiny and public consequences
Manuscript preparation and peer review take time, and peer review acts as a gatekeeper for new scientific and medical information; the benefit of rapid pandemic publication must be weighed against the harm of inadequate internal or external vetting. The ethical question is whether accelerating speculative treatments justifies lowering scientific-integrity thresholds. A 2020 bioethics viewpoint rejected a forum for bad science but favoured communicating good science despite possible distortion, retaining inconvenient data when refining treatments and choosing transparency over censorship to earn public trust.
Without adequate prepublication scrutiny, misinformation can circulate, be cited and remain believed even after debunking or retraction. In the first months of 2020, Retraction Watch listed 15 COVID-19 articles retracted, two temporarily retracted and one expression of concern. Publications can influence clinical practice, government policy and individual choices about masks, distancing and resuming normal activities, making flawed, fraudulent or politically influenced information particularly consequential.
Small, worrying studies prompted differing advice: a vaccine-education specialist argued that findings likely to frighten people required far more data, while a vaccinologist and journal editor favoured publishing even inconclusive work that could stimulate definitive studies, with careful explanation to prevent misinterpretation. Disclaimers cannot prevent selective use of data to support a cause. In spring 2020, experiment design, data collection and journal review were being compressed from months into weeks while some journals received twice their normal submissions.
Less controlled releases also raised concerns: a 2020 bioethics critique judged a Gilead teleconference sharing and discussing single-site data among investigators irresponsible and unethical, undermining good clinical practice protections, and criticised unfounded claims promoted by heads of state. By 2021, research-integrity discussions treated COVID-19 as an amplification of longstanding pressure to publish too quickly, with cultural change across stakeholders needed to keep publication at the pace science warrants.
Early changes in journal publishing
By the end of February 2020, nearly 300 COVID-19 papers had appeared on bioRxiv and medRxiv compared with 261 in journals; many scientists welcomed the faster communication, but unreviewed preprints required cautious interpretation.
A medical publishing editor's spring 2020 assessment identified the following changes and concerns.
- Capacity to write and review. Clinical demands left clinicians little time to write results, while homebound researchers had time to analyse old data and prepare papers; editors and reviewers were not always available for their usual tasks.
- Competition. Nature and Science competed for research papers, while The Lancet, The BMJ, the New England Journal of Medicine and JAMA competed for medical research, especially hot topics, raising the question of whether standards were lowered to accept them.
- Free access and services. Prestigious journals and publishers created COVID-19 sites; nearly 100 journals, societies, institutes and companies agreed to make COVID-19 research and data freely available at least during the outbreak; some journals waived processing charges and some editing companies offered free editing.
- Volume and speed. More than 16,000 COVID-19 articles appeared in peer-reviewed journals between January and May 2020, most using fast-track review, and journals published calls for reviewers.
- Selectivity and duplicate patients. The New England Journal of Medicine reported 40 COVID-19 submissions daily and 2% acceptance; a JAMA editorial identified patients reported in multiple submissions, sometimes with overlapping authorship, and case reports of the same patients appeared in different journals.
- Quality. Many published papers were judged poor and at least half of little scientific interest; high-impact journals published observational studies with fewer than 10 cases, poor case reports and open, noncomparative, nonrandomised trials with fewer than 50 patients, while specialty journals received rejected papers.
- Authorship. Chinese authors were numerous and their papers, unlike during earlier coronavirus outbreaks, were signed only by Chinese authors; this change needed evaluation after the pandemic.
- Evidence tracking. New databases and websites compiled the literature. On 1 April 2020 the UK's Evidence for Policy and Practice Information and Coordinating Centre listed 2,340 papers, excluding 1,404 without primary data and 169 concerning other viruses; remaining categories were case reports (189), transmission/risk/prevalence (159), health impacts (143), diagnosis (95), genetics/biology (80), case study/organisation (72), treatment drugs (41), mental-health impacts (10), social/economic impacts (8), vaccine development (5) and intervention/outcome studies (5).
- Preprints. Support grew among previously resistant authors and writers. At least 2,000 COVID-19 preprints were deposited during January–March 2020, though totals were hard to estimate across archives; on 6 April medRxiv held 924 and bioRxiv 279. A pre-pandemic bioRxiv analysis found 30% remained unpublished, with most posted close to or after journal submission; whether this would apply to medRxiv COVID-19 preprints was unknown.
- Editorial conflicts and expedited scrutiny. The International Journal of Antimicrobial Agents published papers by Didier Raoult's team on chloroquine for coronavirus infection, including encouraging results in 19 patients despite numerous biases; the editor and another board member were co-authors, most papers were accepted after 12–24 hours of review, and the journal's owner, the International Society of Antimicrobial Chemotherapy, judged the article below its expected standard, particularly its explanation of inclusion criteria and patient-safety triage. The papers attracted a US presidential tweet, and the assessment suspected media attention was their principal objective; Raoult and editor-in-chief Jean-Marc Rolain co-authored seven COVID-19 papers in the journal in March 2020 alone.
The enduring effects were uncertain in spring 2020: whether journals would restore charges and paywalls, clinicians and researchers would accept preprints, fast-track and open review would become permanent, or journals would all adopt open access required continued observation.
Rapid review and the writer's advice
A proposed 2020 rapid-response process would recruit virology, immunology, epidemiology and other relevant experts to volunteer immediate, at least cursory prepublication review of COVID-19 manuscripts, potentially within 24 hours. The proposal applied both to COVID-19 and future emergencies.
Postpublication-review platforms offered another route, but a 2020 critique judged F1000's possible 14-day route too slow for many authors or institutions facing the emergency and insufficiently prestigious for their preferences; prior-publication policies could also prevent later journal publication.
Emergency use of publication before peer review should not normalise relaxed vetting where the circumstances do not warrant it. Professional medical writers can advise colleagues to follow established processes, usually including independent critical review, to protect publication quality and integrity. Source checking should give appropriate weight to respected journals while recognising that even strong peer-reviewed advice may change repeatedly when a virus remains poorly understood. Communicators should caution against immediate acceptance without undermining sound findings published rapidly.
Later assessment of the ethical costs
A 2022 infectious-disease journal editor's assessment described publishers struggling with the surge of COVID-19 therapeutic research in 2020, with dramatic increases in preprints and in retractions. His journal received more plagiarised content, although deliberate copying was difficult to distinguish from overenthusiastic cutting and pasting. Pressure to publish cutting-edge COVID-19 research, inadequate publishing staff and lowered standards together created an ethical dilemma needing attention in subsequent years.