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NEJM Working Overtime to Keep Up with the Deluge of Covid-19 Knowledge
September 18, 2020
The New England Journal of Medicine (NEJM) has been busy.
In April, the volume of Covid-19-related articles and correspondence passing over the transom of the New England Journal of Medicine was fast and furious — about 200 a day. As of the beginning of July, NEJM had received nearly 13,000 submissions related to the novel coronavirus, and more than one-third of those were research articles. It was all hands on deck: reviewers and editorial staff who regularly work on content related to other specialties were now pitching in to handle the deluge — remotely, of course. And the process of review and editing has now been telescoped to about 20 days for a Covid-19-related research article to get information out as quickly as possible, according to Editor-in-Chief Eric Rubin, M.D., Ph.D. He is working from his dining room table with his black and white mutt Chester by his side.
“I wish this pandemic had never happened, of course, but it’s been an incredible privilege to be at the center of the research that’s taking place,” said Dr. Rubin, a renowned infectious disease specialist whose career has focused on tuberculosis. “I get to see every major and minor study and people’s thoughts on every aspect of the virus. It’s been an incredible experience.” NEJM has made all its pandemic-related content available free to anyone.
Dr. Rubin pointed to five of the most critical studies NEJM has published that advance our understanding of the novel coronavirus. Specifically:
• February 27: Importation and Human-to-Human Transmission of a Novel Coronavirus in Vietnam: “This was the first report showing how common person-to-person transmission is,” said Dr. Rubin. “Prior to that, Chinese authorities had been saying that most transmissions was occurring from animals to people.”
• March 5: Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany: Viruses are generally believed to be transmitted only by symptomatic people. This letter to the editor detailed the case of an asymptomatic Chinese woman who infected several colleagues during a business trip in Germany.
• May 22: Remdesivir for the Treatment of Covid-19— Preliminary Report: Hospitalized patients who received the antiviral drug recovered 31 percent faster than those who received a placebo — an average of 11 days compared to 15.
• July 14: An mRNA Vaccine against SARS-CoV-2 — Preliminary Report: Moderna Therapeutic’s Covid-19 vaccine provoked an immune response in volunteers during its Phase 1 trial.
• July 17: Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report: The mortality rates of Covid-19 patients on ventilators or requiring oxygen was reduced when treated with the steroid Dexamethasone.
“Our understanding of the virus is pretty good right now, but our understanding of what to do about it is still limited. We still don’t know how to treat the disease optimally and how to prevent people from getting it once exposed,” said Dr. Rubin. “I do want to emphasize we know what public measures work, but we’re just not taking them. We should be wearing masks and social distancing. And we should build into our institutions — our businesses, our schools — all of the components that allow social distancing and masking. That strategy, along with testing, has worked in lots of places.”
NEJM made headlines in May when it retracted a study affirming that certain blood pressure drugs did not increase mortality rates in Covid-19 patients, as some research had suggested. The extensive hospital database used in the NEJM study (and another study ultimately retracted by The Lancet) was called into question, and the database owner refused to make the raw data available to auditors for validation. “The retraction was a big blow for us,” conceded Dr. Rubin. “We had outstanding reviewers for this study, and they didn’t cut any corners. But unfortunately, we’re not very good at spotting deliberate fraud, which it has been alleged that this was.”
“It could take several people, many months to re-do the analysis of raw data, even if it were accessible. NEJM will do a better job of evaluating things like the method of data collection and the reputations of the individuals and companies behind the data”, according to Dr. Rubin. “We’re also taking other actions, including trying to better understand the roles and responsibilities of the authors in the development of their studies. We’re very invested in the quality of what we do and in trying to learn lessons when we have issues.”
In the meantime, the flow of Covid-19 related articles and correspondence has slowed to about 35 to 50 a day, and staff and reviewers are catching up on the backlog of submissions that have nothing to do with a virus that has wreaked havoc on the world. If you’re interested in keeping up with the latest Covid-relevant content from across NEJM Group, be sure to sign up here for the weekly email alert.
