MILWAUKEE – In June 2019, a team of scientists and editors launched an online server where medical researchers could submit articles. The team’s goal was to help the medical community more quickly share research findings and learn from one another.
By the end of the year, the team was receiving about 75 submissions per week.
Then COVID-19 appeared.
Now, nearly that many submissions come in each day.
“I’m thrilled, I’m really thrilled!” said Harlan Krumholz, one of the founders of the server, medRxiv (pronounced “med archive”). “It’s really speeding the ability for scientists to be able to communicate with each other and understand what each other is doing.”
Just as everyday life has been affected by COVID-19, science itself has changed.
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Faced with a brand new, incurable and deadly disease, scientists have had to learn how to produce meaningful information for a world clamoring for speedy results.
Only a month after the first cases of COVID-19 were reported, researchers determined the entire genome of the new virus and openly shared their results online.
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Quick learning, but perhaps more pressure to cut corners
In March, oxygen and ventilators were the only treatment options for patients hospitalized with COVID-19. Now, physicians have added convalescent plasma, remdesivir and dexamethasone to their arsenal.
This speed and openness is not typical of scientific research and has required fundamental changes in how science is done and what work scientists do.
“Science immediately reorganized itself in a purposeful way to address a global threat,” James Bradner, president of the Institutes for BioMedical Research at Novartis, said in a webinar hosted by Chemical & Engineering News.
In most cases, scientists welcome the changes and are proud of what has been accomplished in such a short time.
“You had a biomedical research establishment that was and continues to be hobbled by under-funding” and other issues, said Arturo Casadevall. Yet, in light of the COVID-19 crisis, there has still been “a tremendous generation of knowledge very rapidly.”
Casadevall is a professor at the Johns Hopkins Bloomberg School of Public Health and is one of the research leaders for a nationwide convalescent plasma trial.
At the same time, there is recognition that these efforts must be pursued with caution and thoughtfulness — a challenge when the world is desperate for results.
Pilar Ossorio, a professor of law and bioethics at the University of Wisconsin-Madison, worries there is so much pressure to produce positive results that conditions are ripe for cutting corners. She notes, for example, that in an emergency where people are suffering, there can be resistance to having control groups that don’t get an experimental treatment in a study.
“But it doesn’t work scientifically,” Ossorio said. “It doesn’t produce good enough data that you can actually have any confidence that the test intervention is safe or effective.”
Any failure to maintain scientific rigor can have lasting repercussions, including how the public views science. Earlier in the pandemic, poorly designed clinical trials using hydroxychloroquine as a COVID-19 treatment contributed to controversies over the effectiveness of this medicine, especially when they were pumped up by political leaders.
Maintaining research standards is an ethical mandate, according to Ossorio.
If a poorly designed trial creates more uncertainty, “you’ve imposed burdens and risks on people” without necessarily producing “anything of any social value.”
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Science at ‘warp speed’
Science is largely a methodical and iterative process. That is to say, it’s slow. The process of going from a hypothesis to consensus can take years.
But a pandemic doesn’t wait years for the first treatments to come out.
One solution that has revealed itself: Share information openly and find ways to innovate.
Online preprint servers like medRxiv have emerged as one tool in getting information out fast. Researchers can submit studies directly to online archives, cutting out processes such as peer-review that typically precede publication of studies.
Since December, more than 5,000 manuscripts related to COVID-19 research have been submitted to medRxiv and another preprint server, bioRxiv. Online archives are where the first genetic sequence of SARS-CoV-2, the virus that causes the disease, and data for the dexamethasone clinical trial were first posted.
“I don’t know what we would have done without preprints,” said Casadevall.
But preprints are not without their critics, who emphasize the importance of peer-review in catching bad studies and protecting patients.
Recognizing these criticisms, Krumholz notes that medRxiv editors curate submissions, checking for studies that ought to be peer-reviewed or that could cause medical harm.
Research companies are also sharing more information and resources, normally taboo in a field rife with competition.
To the “surprise and delight” of David Liu, a professor of chemistry at Harvard University, one company agreed to share clinical trial candidates with his lab for testing.
“I hope that choice to cooperate rather than compete becomes part of our legacy,” Liu said in the Chemical & Engineering News webinar.
The pressures of the COVID-19 pandemic have also led some researchers running clinical trials to change traditional protocols. Some of those changes may become standard procedures in the future.
“We have this real brick and mortar view of how clinical research had to happen, and I think COVID has really challenged that,” said Betsy Nugent, the director of clinical trials development for the University of Wisconsin School of Medicine and Public Health and UW Health.
Telemedicine, for example, could help people living in remote areas participate in trials.
“In some ways, I hope this will stay because it gives us an access point to many, many more patients,” Nugent said.
Pivoting work, translating expertise
Some scientists have pivoted their research to join the fight against COVID-19, even if their new work isn’t directly related to finding new medicines and treatments.
Song Gao, an assistant professor of geographic information science at UW-Madison, was among the first to study and map how people’s mobility changed during the COVID-19 pandemic.
Other scientists haven’t just pivoted, they’ve found ways to support COVID-19 research that don’t even match their specific expertise.
Before the pandemic, Michael Joyner, an anesthesiologist who leads the Mayo Clinic’s efforts in the nationwide plasma trial, studied the physiology of marathoners. Casadevall studied fungal diseases.
“I think all of us as scientists, don’t always recognize the expertise that we do have,” said Alison Buttenheim, an associate professor of nursing and health policy at the University of Pennsylvania.
For some scientists, their role in the COVID-19 crisis isn’t in the lab or clinic, but in the world of social media and education.
In March, Buttenheim and Malia Jones, an epidemiologist at UW-Madison, launched “Dear Pandemic,” a social media group that communicates the latest COVID-19 research.
The group is now run by a volunteer team of 10 self-styled “nerdy girls” who are using public health training and scientific literacy to counter the effects of speedy research and what the World Health Organization has called an “infodemic.”
“We work really hard in our tone and in the selection of stories and in our coverage to help make those nuanced and complicated answers intelligible,” Buttenheim said.
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What does the future hold?
Just as COVID-19 will leave deep marks in society, science itself will look different even after the immediate threat of the pandemic has passed.
Tools like preprint servers and conducting trials remotely will almost surely become more common, and science communication and contact tracing may be more highly valued.
Some believe there will be more widespread appreciation — and funding — for science research.
Nugent points out that many UW Health patients “have been asking how they can help, how they can participate,” and that this increased engagement could lead to more participation in medical research going forward.
Others, like Ossorio, are concerned that general trust in science will degrade if opportunities are wasted and misinformation continues.
Underlying all the possibilities scientists see for the future, the prevailing hope is that the scientific community will have learned from this pandemic, and everyone who has looked to science for answers will have learned as well.
“The world is just going to be different,” Jones said, “Getting to the point where there’s hopefully a vaccine that’s effective is going to take enough time that I think science will change.”
Jordan Nutting is a mass media fellow with the American Association for the Advancement of Science writing about science at the Milwaukee Journal Sentinel.
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This article originally appeared on Milwaukee Journal Sentinel: Coronavirus forces scientists to change while searching for vaccine