Competing with a pandemic: Trends in research design in a time of Covid-19

INTRODUCTION

During the Covid-19 pandemic, major journals have published a significant number of Covid-19 related articles in a short period of time. While this is necessary to combat the worldwide pandemic, it may have trade-offs with respect to publishing research from other disciplines.

OBJECTIVES

To assess differences in published research design before and after the Covid-19 pandemic.

METHODS

We performed a cross-sectional review of all 322 full-length research studies published between October 1, 2019 and April 30, 2020 in three major medical journals. We compared the number of randomized controlled trials (RCTs) and studies with a control group before and after January 31, 2020, when Covid-19 began garnering international attention.

RESULTS

The number of full-length research studies per issue was not statistically different before and after the Covid-19 pandemic (from 3.7 to 3.5 per issue, p = 0.17). Compared to before January 31, 2020, 0.7 fewer non-Covid-19 studies per issue were published versus after January 31, 2020 (p<0.001), a change that was offset by Covid-19 studies. Among non-Covid-19 studies, 0.9 fewer studies with a control group per issue were published after January 31, 2020, with RCTs contributing to nearly all the decline (p<0.001, p = 0.001, respectively). In the same timeframe, non-Covid-19 studies without a control group and non-Covid-19 studies without randomization experienced relatively small changes that did not meet our threshold for statistical significance (increases of 0.1 and 0.1 per issue, p = 0.80, p = 0.88, respectively).

LIMITATIONS

Using a simple heuristic for assessing research design and lack of generalizability to the general medical literature.

CONCLUSIONS

In summary, the increase in Covid-19 studies coincided with a decrease of mostly non-Covid-19 RCTs.

Ethics of clinical science in a public health emergency: drug discovery at the bedside

Clinical research under the usual regulatory constraints may be difficult or even impossible in a public health emergency. Regulators must seek to strike a good balance in granting as wide therapeutic access to new drugs as possible at the same time as gathering sound evidence of safety and effectiveness. To inform current policy, I reexamine the philosophical rationale for restricting new medicines to clinical trials, at any stage and for any population of patients (which resides in the precautionary principle), to show that its objective to protect public health, now or in the future, could soon be defeated in a pandemic. Providing wider therapeutic access and coordinating observations and natural experiments, including service delivery by cluster (wedged cluster trials), may provide such a balance. However, there are important questions of fairness to resolve before any such research can proceed.