Since the beginning of the COVID-19 pandemic, major worldwide efforts have been made to limit the spread of the disease, adjust healthcare systems, develop treatments, and deploy vaccines. According to the Convention on the Organisation for Economic Co-operation and Development, more than $7 billion was raised in the first 9 months of 2020 to support global collaboration in the development of COVID-19 treatments and vaccines.
As a consequence, non-COVID-19 related issues have been overlooked. For instance, cancer patients have been severely impacted by treatment delays and reduced access to healthcare. In addition, a huge number of surgical procedures have been postponed and major medical events, such as myocardial infarction and strokes, have been treated too late, with disastrous consequences for patients. Moreover, there was an overall steep decrease in funding allocation and scientific publications in non-COVID-19 related areas of research, which may have delayed innovation in these fields.
Assessing the Impact of COVID on Medical Research
In 2020, medical journals publishing international medical research experienced an unprecedented surge in paper submissions, and most of them created COVID-19 resources. We brought together a dedicated consortium of experts, and we took on the challenge of conducting an ambitious review of scientific literature in top medical journals (New England Journal of Medicine, The Lancet, JAMA, Nature Medicine, The BMJ, Annals of Internal Medicine, The Lancet Global Health, The Lancet Public Health, The Lancet Infectious Diseases, and Clinical Infectious Diseases) to assess the impact the COVID-19 pandemic on non-COVID-19 research.
Our multidisciplinary consortium of experts in systematic reviews comprised epidemiologists, physicians, biostatisticians, and methodologists. Together we reviewed all articles published in the top 10 medical journals between 2019 and 2020, including more than 22,000 publications that were categorized and analyzed.
We included all medical publications in 2020 as well as in 2019 because we wanted to address the impact of the pandemic on all the materials produced by the journals. It was necessary to demonstrate that the exponential rise in COVID-19 research has severely impacted editorial boards by overwhelming their workflow and impacting their usual attention for high scientific standards of publication.
What Did We Find?
Decrease in non-COVID-19 studies
The results were striking. COVID-19 studies were first published in February 2020, increasing as the pandemic unfolded, which negatively impacted the production of non-COVID-19 studies — their number decreased during the same time period. Overall, based on the consortium’ analyses, there was a decrease of 18% in the production of non-COVID-19 studies, which may have detrimental effects on non-COVID-19 research and associated health domains.
Changing editorial strategies among major medical journals
Interestingly, the consortium demonstrated that the top medical journals adopted two distinct editorial strategies in the face of the pandemic. Some journals decreased the production of non-COVID-19 studies in order to start publishing COVID-19 studies, which may have helped in maintaining high scientific standards.
Other journals maintained the production of non-COVID-19 studies while integrating COVID-19 studies, which may have induced a lower scientific standard, as editors and reviewers were faced with an increasing number of manuscripts and less time to dedicate to each.
As one can deduce, the balance between the scientific publication and scientific rigor is not easily attainable.
We have learned a lot by unveiling these editorial strategies, as it shows how editorial teams in science might adapt to a pandemic. Today, it seems we are slowly getting back to normal in terms of medical research, but the pandemic left a deep mark in the year 2020.
COVID-19 studies were less detailed and complete
In 2020, researchers changed their publication habits. In COVID-19 research, researchers were more likely to conduct smaller studies (research letters) than researchers working on non-COVID-19 studies, who focused on more complete studies (original articles). This might reflect the willingness to provoke immediate impact and provide novel insights at a time when everyone wants to contribute to the fight against the pandemic.
The consortium also identified a surprising new phenomenon, which we coined as “author multiplicity.” In many COVID-19 studies, we identified a very large number of authors, even in case reports, which are short papers describing an individual patient.
Lessons for the Future: the Promotion of Prudence
This study informs us of our global haste. In medical science, our approach during the pandemic did not always lead to the wisest analyses, nor the most correctly generated data, nor the best study design. Sharing knowledge should remain the cornerstone of medical science, but knowledge must follow strict standards and methodologies. These requirements are the basis of science, and have, ever since its foundation, taken time.
Furthermore, our study underlines how important it is to bear in mind that other large-scale public health issues such as cancer or cardiovascular disease are still ongoing and may be more detrimental globally than the pandemic. As such, they deserve dedicated time and money and should not be neglected.
Alexandre Loupy, MD, PhD, is a professor of nephrology at Necker Hospital and head of an epidemiology and methodology research team in Paris, and is also adjunct professor at Cedars Sinai, University of California Los Angeles. Professor Loupy specializes in the integrative epidemiology of transplantation, diagnosis and prognosis of graft outcomes, and methodological assessment of medical research. Marc Raynaud, PhD, is an epidemiologist working on the team of Professor Loupy. He specializes in prediction and risk stratification in transplantation using artificial intelligence. Because of his mathematical background, he also has an interest for further enhancing methodology and statistics in medical research.