The role of scientific journal editors during the COVID-19 pandemic

The central role of scientific journals is to contribute to the expansion of knowledge, facilitating the dissemination of new findings, collaborating in the generation of new ideas, and giving form to new lines of research. These tasks are legitimate and constitute the foundation of scientific progress, but are not free of the risk of inappropriate conduct or the creation of centres of power, channels of influence, and sometimes an officialism that can be detrimental to the further advance of science. Therefore, scientific editors and article review processes play an essential role, creating models by which to improve the quality of contributions and defending opportunities to disseminate the findings of scientific research.¹

In the last month, the scientific world has witnessed a singular and perhaps an unprecedented event, at least at this scale. Last November saw the initial cases in an epidemic of respiratory tract infections in Wuhan, the largest metropolitan area in the Chinese province of Hubei. The World Health Organization was informed on 31 December 2019, and the disease, denominated COVID-19 and attributed to the SARS-CoV-2 coronavirus, subsequently spread exponentially across the globe. Both scientists and the general public have been eager to receive any new information about this disease, which has affected and caused the deaths of so many people, especially among the most frail population groups.

A majority of editorial platforms have created structures to promote and expedite the publication of articles related to the disease. Publishers have created platforms enabling access to articles and the promotion of these resources; examples include the Elsevier Novel Coronavirus Information Center, the Wiley COVID-19 Resources and News portal, the Springer Nature COVID-19 resources centre, and the Frontiers Coronoravirus Knowledge Hub, among others. The end goal of this initiative is to enable easy access to these publications, aiding readers, authors, and researchers in the response to the pandemic. The commitment of scientific journals in this scenario has led to the development of these new methods, through which some articles have been made available even before undergoing the peer-review process, for example through Cold Spring Harbor Laboratory's bioRxiv.org and medRxiv.org preprint servers, which have specific sections for articles on COVID-19. Through this extraordinary effort, many journals have prioritised the publication of articles on the disease. Networking sites for authors, such as ResearchGate, have also established specific pages including all emerging information, with truly rapid turnaround times for the online publication of articles. We have indisputably seen an unprecedented determination to communicate this information as quickly as possible. The objective of this work is two-fold: maximum accessibility and maximum speed. Many journals have established fast-track publication pathways to ensure early review of articles. Such an approach has been followed by Neurología: within 48 hours, editorial decisions are made and articles are included on PubMed Central, increasing their visibility. There can be no doubt that scientific journals have achieved the desired immediacy of publication, and the literature has become replete with articles in very little time.

The issue to be addressed is whether the results achieved justify the efforts made. Some voices have suggested that prioritising the publication of everything related to COVID-19 has resulted in a decrease in quality, at the expense of work from other areas of research. Essentially, we may note a phenomenon analogous to that observed in the clinical context, in which one of the threats associated with COVID-19 is what some oncologists have referred to as the “distraction effect,”² whereby the preferential treatment of patients with COVID-19 has led to a decrease or absence of care provision to other patients. This distraction effect may have negative repercussions on publishing, which editors must endeavour to prevent. For example, if we analyse hospital case series of Chinese patients, we cannot question the fact that many studies present methodological bias or contribute little to our understanding of the disease; at other moments in time, the same studies would not have been published. In no case do such articles meet the required standard of the publishing journal, and other, higher-quality articles in other areas of knowledge will have been rejected. It is noteworthy that high-impact publications should accept clinical case reports, which is practically unprecedented. A similar situation can be seen within the field of neurology. A Medline search for the terms “COVID-19” and “neurology” returns 144 articles published since February. Of these, 49 (30.5%) are editorial opinions by experts, 29 (20.1%) are isolated case reports; 6 (4.1%) are reviews; 5 (3.4%) are articles on the safety precautions and techniques used during the pandemic; 19 (13.2%) are consensus statements and protocols; 6 (4.1%) address the potential for central nervous system involvement in patients infected with SARS-CoV-2; 20 (13.8%) address the impact on neurological care and the use of telemedicine; 4 (2.7%) address drug treatments; and only 6 (4.1%) are original research articles. If we search for the terms “COVID-19” and “nervous system” and eliminate those articles identified with the previous search, a further 28 articles are identified; of these, 13 (59.0%) are editorial comments by experts; 5 (17.8%) are case reports, with an anatomical pathology study being performed in only one; 4 (14.2%) address the mechanisms by which the virus attacks the central nervous system; one (5.2%) addresses drug treatments; and 5 (17.8%) are reviews. Evidently, given the vast number of people affected, journals should have published fewer opinion articles and more data. Therefore, such an effective response may be considered to have led to poor results. As editors of scientific publications, this should give us pause for reflection.

Editors must consider several issues. Firstly, where should we draw the line for publication speed? Should we immediately publish all articles on COVID-19, or should we select those that are relevant with a view to contributing to knowledge of the disease? On the other hand, articles not published today will probably be of little interest tomorrow, given the constant stream of new information. Our commitment to authors requires that we make these decisions; this is particularly true for Neurología, which must participate in disseminating the work of authors writing in Spanish.³

The importance of rapid publishing must not bring about a reduction in quality. It seems clear that fast-track publishing models such as that used by Neurología, which was deemed appropriate in a recent consensus statement on COVID-19,⁴ should not necessarily imply lowering quality standards. Is it justified that in such a critical situation, expert opinions should generate more than 60 editorial comment articles in high-impact journals? In this novel scenario, experience is relative and these opinions are likely to change over time. Similarly, publications by expert panels and consensus statements may even be considered reckless, as they cannot be supported by scientific evidence, which has always been an indispensable requirement for publication. The majority of publications require that reviews must be systematic, but this criterion cannot be applied in the context of COVID-19. Secondly, we must consider how to achieve this quality, as reviewers are analysing articles that address subject matter with which they are not familiar,⁵ or about which their experience differs⁶; these decisions must be transparent.^7,8 However, the main issue over the last 2 months has been the fact that we have received no submissions of formal research articles addressing epidemiology, clinical practice, or treatment. This seems to highlight a need for editors to promote these types of articles rather than opinions, consensus statements, or impact analyses; while these have been interesting, their publication should be limited in favour of other types of study.

Scientific journal editors are not all the same; while different journals have distinct, heterogeneous functions, the editor will always play a key role in decision-making,⁹ which is influenced by their experience and attitudes.¹⁰ If editors’ responsibility in normal times is to decide what should be published, this role becomes all the more important in the current situation: with the support of editorial committees and reviewers’ opinions,¹¹ editors must provide leadership in the selection of articles and take responsibility for safeguarding the quality of the work published.¹²

After more than 150 publications, we now know that patients with COVID-19 may present headache or olfactory and gustatory alterations, that the disease may be associated with stroke, that some patients present symptoms compatible with Guillain-Barré syndrome or encephalitis, and that the virus can access the central nervous system by several pathways. But many questions remain unanswered. We must challenge ourselves to encourage researchers to publish answers, rather than questions, as quickly as possible: progress cannot be made with questions alone. In the light of this, Neurología will continue to prioritise all new information on COVID-19 that may increase our understanding of the virus’ impact on the nervous system; articles will be published as quickly as possible, with the journal working alongside researchers and the editorial team to ensure the highest possible quality, but also taking into account that many other areas continue to be interesting and relevant to our readers.