Transcript: How to Successfully Navigate the COVID-19 Literature Landscape

Garret Duron: Hi, my name is Garret Duron, and I’m an internal medicine resident at Memorial Health University Medical Center in Savannah, Georgia. Today, I’d like to talk to you guys about some of the literature-based challenges that rheumatologists are facing, that we highlighted in our paper published in Current Opinion in Rheumatology back in September of 2020.

The challenges that we highlighted was, number 1, just the sheer volume of research that’s being published on COVID‑19. At the time of our paper, based off of the number of articles that have been published at that time on COVID‑19, which was approximately 22,000 articles, it would have taken about a year of continuous reading, just to catch up with the already published literature at that point in time. Now, we know that since then, the amount of articles have continued to grow, and that this number has exponentially increased. That’s the first challenge that’s facing rheumatologists in terms of staying on top of the literature.

The second problem has been this pandemic of research exceptionalism and misinformation. What I mean by the pandemic of research exceptionalism has been this idea that rigorous science has to be sacrificed in a crisis.

We’ve seen that in terms of the COVID‑19 literature that has been coming out. We’ve seen a number of flawed but expedient research designs that have proliferated. We’ve seen innumerable small observational studies that don’t have clearly defined exposures or endpoints, that have never had a lot of resources.

We’ve seen a lot of underpowered clinical trials that have gone underway and many of them that have similar outcomes, as well. Medical journals have also been susceptible to this pandemic research exceptionalism.

There’s been an expedited review process. We’ve seen articles for COVID‑19 go through a peer review process in about 11 days compared to over 100 days for non‑COVID‑19‑related content.

We’ve seen a lot of errors in the articles that have been published, including error such as duplicative patient data, critical reporting errors, and methodological flaws that have all been published in high-impact journals.

The cost of these errors has seldom been higher, as we’ve also seen this pandemic of misinformation that’s been taking place as well.

What I mean by this is the way that social media, and the susceptible audience, has rapidly amplified any erroneous scientific conclusions that have been found. Some of these conclusions are coming from articles that are even preprint articles that have not been through peer review process. This has been a real challenge for rheumatologists to sort through the literature.

The third thing that we highlighted in our paper was the paucity of literature that there is on rheumatology patient populations specifically.

Thankfully, this has been changing with the efforts of the Global Rheumatology Alliance and the EULAR COVID‑19 database that have been faithfully collecting information on rheumatology patient populations. They’ve been publishing some of their data.

Based off of this, we made several recommendations to practicing rheumatologists. The first was in terms of the primary literature reading peer reviewed publications from high impact journals. A lot of the top journals have COVID‑19‑specific sections on their web pages that they've used to aggregate all their articles on COVID‑19. It’s been a very easy way to access the content.

The New England Journal of Medicine has done this, the journal the American Medical Association has done this, The Lancet, just to name a few. Rheumatology specifically, we know the journals of the American College of Rheumatology, and the "Annals of the Rheumatic Diseases," and "The Journal of Rheumatology" are a few of the journals that have done this as well.

Some of the secondary sources that we recommended in the paper were the American College of Rheumatology clinical practice guidelines and the Infectious Diseases Society of America COVID‑19 Resource Center. British Society for Rheumatology also maintains a phenomenal “Frequently Asked Questions” web page.

While it’s preferable to read the primary literature, select secondary sources have been absolutely invaluable. We also mentioned a number of podcasts specifically for rheumatology. Further information about this can be found in our paper.