The creation of scientific knowledge is a team project where one person – or a group of people – builds on an existing field of knowledge by experimenting with different theories or hypotheses and presents the results to others for consideration. Those that work in this field of knowledge will evaluate the results and, if validated, the results will be published in a peer-reviewed scientific journal. The coronavirus is changing this process.
The creation of knowledge is the core of the activity of a research scientist or professor. The peer-review publishing process was started during a smallpox outbreak in the 1820s when the powerful Académie de Médecine medical institute in Paris published a weekly account of their discussions as they evaluated a new vaccine. (Tingley) This process of moving from private conversations to public papers was the foundation of peer-reviewed scientific journals.
Getting published in a peer-reviewed journal takes time, this graphic from Voight and Hoogenboom provides the details:
Once published, this new information becomes part of the on-going conversation in this field of study. Eventually, someone will build upon this new information to further expand the understanding of this field of study.
The Crisis of a Novel and Unknown Virus
In an earlier post, we described the situation facing medical staff and first responders:
At the start of this pandemic, medical, public health, and first responders were like a test pilot in an out-of-control experimental airplane. Transmitting a non-stop detailed radio commentary of what the pilot is observing, what the pilot is doing, and what are the results. Often factoids will pop-up out of context or be incompletely reported. 5 Tips When Commanding During A Time of Great Hazard and Uncertainty
The traditional peer-reviewed process would mean that what is being learned on the front lines of the coronavirus fight would not be shared in a peer-review journal for 6 to 12 months.
Kim Tingley, writing for The New York Times Magazine, describes two actions taken by peer-reviewed publishers to make potentially life-or-death research available as quickly as possible:
- Dropping the paywalls of Science, The Lancet, Journal of the American Medical Association (JAMA) and The New England Journal of Medicine to make coronavirus content free online.
- Encouraging researchers to post their submissions on pre-print servers, where anyone can access them before they undergo a peer-review process.
This means that a finding submitted to Science was publically available in days instead of months. Posting initial research findings on pre-print servers allows researchers to quickly share preliminary work and may help the scientific community to collaborate more effectively and efficiently.
This also means that many more people are following scientific journals. That means many factoids, cautions, or concepts are getting significant media attention without noting that this is a preliminary finding that has not been verified.
Awash in Stories
There are heartbreaking and amazing stories of loss and survival. From Dallas, a patient who was on a ventilator for 30 days:
The Texas Health Dallas team had already tried at least a half-dozen therapies. … Then they turned to a treatment from the history books. Convalescent plasma, antibody-rich blood donated by survivors of infectious disease, was developed in the late 1800s to fight diphtheria. It was the subject of the 1901 Nobel Prize in Physiology or Medicine and has been deployed against measles, mumps, and the 1918 Spanish flu.
Texas Health Dallas obtained emergency permission from the federal government to administer convalescent plasma on a compassionate-use basis because Michael remained critically ill. (Kuchment)
That does not mean that every patient who is on a ventilator should immediately receive convalescent plasma. But it does add to the knowledge of COVID-19 treatment outcomes and needs further study.
Getting a Handle On The Work In Progress
There are efforts to keep track of clinical developments. Over 600 clinical trials have been registered at various clinical sites. A global coronavirus COVID-19 clinical trial tracker has been developed. https://www.covid-trials.org/
This remains a bumpy ride over unfamiliar terrain for fire and ems commanders. We are seeing some signs of a framework, not unlike the imposing of order on the chaos of a multiple alarm/multiple hazards incident. The situation remains deadly and fluid.
Stay safe, be smart, mask up.
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Tingley, K. (2020 April 21) Coronavirus Is Forcing Medical Research to Speed Up. The New Your Times Magazine. Accessed April 24, 2020: https://www.nytimes.com/2020/04/21/magazine/coronavirus-scientific-journals-research.html
Voight, M. L., & Hoogenboom, B. J. (2012). Publishing your work in a journal: understanding the peer review process. International journal of sports physical therapy, 7(5), 452–460.
Ward, M. (2020 March 30) 5 Tips When Commanding During A Time of Great Hazard and Uncertainty CompanyCommander.com Reston, VA: Gold Badge Enterprises.
Kuchment, A. (2020 April 25) Dallas medical team rescues coronavirus patient after 30 days on life support: Doctors at Texas Health Dallas relied on their experience with Ebola — and a treatment from the history books — to help a Dallas man recover. Dallas Morning News. Accessed April 26, 2020: https://www.dallasnews.com/news/public-health/2020/04/25/dallas-medical-team-rescues-coronavirus-patient-after-30-days-on-life-support/
Thorlund, K., Dron, L. Park, J., et al (2020 April 24) A real-time dashboard of clinical trials for COVIC-19. The Lancet. DOI: https://doi.org/10.1016/S2589-7500(20)30086-8 Accessed April 26, 2020: https://www.thelancet.com/journals/landig/article/PIIS2589-7500(20)30086-8/fulltext#articleInformation
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