|Ahead of print publication
Coping with the Coronavirus Disease-2019 pandemic: A giant leap towards digital transformation in academic research
Latika Gupta1, Salika Fakirmahmad Gadiwala2
1 Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
2 Division of Clinical and Translational Research, Larkin Health System, South Miami, FL, USA
|Date of Submission||08-Sep-2020|
|Date of Acceptance||09-Oct-2020|
Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, 226014 Uttar Pradesh
Source of Support: None, Conflict of Interest: None
The worldwide coronavirus disease-2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to a remarkable turnaround in the course of human evolution as well as scientific research. Reflections from the history of pandemics such as the Spanish flu in 1918 and older ones such as the smallpox epidemic in the 19th century suggest that widespread changes in public health education, social distancing, and surveillance may contain the spread of infectious diseases. Even 100 years after the first outbreak of the Spanish flu, continued efforts are required each year to raise public awareness and a general understanding of the variants of the condition. It was only in 1933, 15 years after the first outbreak that the discovery of the genome of the influenza virus paved the way for a successful vaccine which is revised based on the seasonality of strains each year.
This pandemic is unique in that social distancing has become the new norm. In the current digital era, the pace of change postpandemic, as well as the adaptability and survival mechanisms, are likely to differ. In this brief, we hope to explore and project the anticipated change in research in the post-COVID-19 era [Figure 1].
|Figure 1: Challenges to academic research during the coronavirus disease-2019 pandemic and suggested solution|
Click here to view
While the early lockdown period in India saw a complete shutdown of all teaching and research activities, researchers and the lay public clamored for information over social media platforms. The first attempts at recovery and inching toward normal life resorted to online classes and virtual forms of research. Amid the ensuing mayhem in the quest to understand the disease better, most countries served revised guidelines for streamlining research. Institutional review board (IRB) clearances are an essential component of ethical research. On similar lines, the Indian Council of Medical Research has released guidelines for the ethics committees to review Biomedical and Health Research and to make the process smooth during this pandemic era. While researchers squander to understand more about COVID-19, IRBs are expected to deal with three categories of research projects, namely, COVID research, pending non-COVID research, and new non-COVID research. Although the urgency of the situation calls for an expedited review of all projects on COVID-19, it is essential to avoid unnecessary delays in non-COVID research. To meet the pressing need for expedited reviews while distancing socially, most IRB meetings have moved online.
Moreover, the pandemic has raised concerns regarding ethics in research. It is essential to be mindful of patient rights and ethical practices in the pandemic period. While survey-based studies may qualify for an exemption from review in some parts of the world, it is essential to introduce the study, the researcher group, and take informed consent about participation as well as publication in a peer-reviewed journal. A cover letter informing participants of these is ideal. Data anonymity is another major consideration, and participants should be preinformed about data anonymity (including internet protocol addresses), indirect identifiers, data storage, and handling. In randomized controlled trials, where well-documented consent is essential for participation, the urgency of the situation in COVID-19 pneumonia may be a major impediment to acquiring a written consent from a sick patient, especially when their kin are not by the side. This condition has resulted in several trials related to COVID-19 accepting voice or video consent by the patient or their kin. While purists may suggest that such an approach is of questionable ethics and telephonic consent is invalid, the urgent need to gather evidence-based on systematic studies in the dire situation calls for a need to reexamine existent consent guidelines., On similar lines, the FDA has provisionally served guidelines for patient recruitment in clinical trials and validating e-signatures. On the other hand, patients visiting hospitals are often asked to sign a declaration stating their understanding of the risks associated with the visit during the pandemic. Walking the line between ethics and required timelines to understand and deal better with COVID-19 has been a struggle for scientists as well as clinicians and caregivers worldwide.
While COVID-19 led to a complete shutdown of libraries and closed spaces worldwide, scholarly reading completely moved online. Most publishers have helped researchers and readers in this unique situation by wavering off article processing charges on papers related to COVID-19. Despite all said and done, surfing this emerging ocean of literature for meaningful data can be an arduous task. The massive load of new data on COVID-19 in such a short time has called for a separate database with curated and verified information on the disease. Thus, various search engines such as LitCOVID are updated daily with newly published articles on SARS-CoV-2. Other open access databases include DisaterLit, ClinicalTrials, COVID Evidence, and iSearch COVID_19 Portfolio (NIH's Expert Curated database of publication and preprints). The absence of COVID-19 in keywords was another impediment to searching these articles in the first few months. However, this has now been incorporated into Medical Subject Heading terms, making article sorting significantly easier.
Amid widespread confinement and social distancing, social media is rapidly gaining a foothold as a platform to disseminate and discover the literature while striving for academic growth. Usage of hard copies of journals is in decline in the post-COVID-19 era, with greater use of online media and gray literature for research and reading. Social media is also being increasingly mined for data collection by AI algorithms to identify events and predicting events related to the COVID-19 pandemic. A time-stamped and geocoded analysis of tweets to predict a surge in cases is one such use.
However, several instances of misinformation and the associated infodemic have raised concerns and call for regulation of the flux of information on online portals. Misinformation, including rumors and conspiracy theories during the times of this pandemic, could lead to mass panic and have severe consequences on the community. These should be kept in check by expert panels/communities by fact-checking, verified databases, and public advisory with a clear listing of rumours. Health agencies may track false theories in real time and actively take necessary actions to prevent any harm.
At such a time, social media editors may assume a larger role of delivering credible information to the lay public. Visual communication is a way to attract relevant social media users to keep rendering knowledge. Scientific data could be presented in visual graphics to catch the reader's attention, especially when the information is being shared on social media. Journal editors should make efforts to draw the attention of many scientists and research scholars by assigning a dedicated team for the creation of relevant infographics and visual abstracts, as it will be appealing to the reader from the pool of the information. Time is of the essence in sharing information on a sensitive subject and a morbid disease. Thus, it seems likely that faster metrics such as altmetric may gain greater relevance as a measure of article visibility in the times ahead.
The widespread lockdowns and slowing down of life overall have increased academic time for nonclinicians and doctors when not directly involved in critical care. Consequently, most journals have recorded a massive increase in article submissions. Thus, editors of scholarly journals face another challenge of sifting through a mammoth load of submissions to identify ethical, credible, and useful information in a short time. In a time when most doctors are busy with COVID-19 duties, finding skilled reviewers is all the more essential yet more challenging. Although rigorous peer review is a method to decrease plagiarism and decrease irrelevant articles to get published, there could be chances of mistakes. There are many ways to control piracy and inappropriate paraphrasing, which includes open access software with artificial intelligence (AI) based algorithms. AI-based tools have been using for plagiarism detection and data mining as well. These may be more useful in the pandemic times when there is a dearth of reviewers.
Besides, the felt urgency to understand more about the disease, and to deliver this information timely to scientists, doctors as well as the lay public has led researchers to obviate the delay in publication processing by posting their research on scholarly archival platforms. As a result of this, scientific archival platforms are flooded with preprints. Unfortunately, the absence of a formal peer review can be a serious impediment to maintaining quality control. Recent instances of retraction of articles of immense scientific and political relevance are deeply concerning. This practice needs to be regulated for the well-controlled sharing of information between researchers and the patients.
Due to the need to distance socially, reduced patient visits to the clinics would mean that research patterns would change post-COVID-19. In the past 6 months, widespread lockdowns and public mandate to stay at home have stalled most ongoing research projects. Thus, there has been a clear shift to retrospective data collection for most non-COVID-19 research. Survey-based studies are on the rise. Moreover, virtual platforms have been increasingly used for data collection. Online research became a new norm.
The inability of patients to physically report for a formal visit to the hospital has been another major challenge in delivering care for chronic illness. In these times, virtual clinics have bridged care while distancing socially. While acute medicine still requires a formal presence, a large proportion of telecare can be provided by the diligent use of instant messaging and video services. Audio–video services are the preferred means of consultation for most patients. While the importance of a formal physical exam cannot be overemphasized, the situation has forced clinicians to take recourse in the distant assessment of patient clinical signs and a greater reliance on history and investigations. This could mean a shift to patient-reported outcome measures for the objective assessment of disease in research. The use of smartphone apps and wearable devices may be the solution. However, such tools will require validation before formal use, calling for the need for fresh research, and measures for a successful assessment. Recent suggestions of patient-initiated registries for research (MYPACER) may pave the way for cohort-based research in the post-COVID-19 era. This will also require greater collaboration with computer scientists, engineers, and IT personnel.
COVID-19 has resulted in a global economic meltdown which is projected to have far-reaching consequences including abbreviated funding for research. Recent research suggests that the psychological effects of such a disaster may further impact the way humankind perceives risk and would be a serious impediment to optimism, investment, and economic growth in the future., Understanding the long-lasting effects of this disaster and using that information for better preparedness and delivery of timely interventions during future infectious disease outbreaks is another domain that merits exploration.
Looking at the history of infectious disease pandemics faced by humankind, the natural history of evolution has supported our ability to adapt and change with the times. Fighting a disaster of such proportions requires mental grit together with dedicated research with consistent and committed efforts. Consistent planning, improvising, and structured adaptation to the change may be the key to successful survival.
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