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Uncovering trends in outbreaks research and how it translates to patient care

on Thu, 04/16/2020 - 07:41

Over 20,000 people from 180 countries to date have watched our Infectious Diseases Outbreaks webinar, which was recorded on Monday 30 March. There were many, many relevant questions which followed from the audience, some of which are answered in this post.

During the webinar, Dr. Bamini Jayabalasingham explained how the research was conducted to uncover trends in outbreaks research, including the various governmental bodies involved and the ways to identify health security research. “I read something on this on Twitter that nicely sums up the findings, said Dr. Jayabalasingham. “It said ‘You can’t catch up to something exponential. It’s like swimming after a speedboat. But scientists can.’”

Dr. Margaret Trexler Hessen provided insight into how the research fits into the clinical context. “Trying to read and absorb the emerging literature is like drinking from the firehose. I was asked to provide context on why does this research matter to clinicians and how it translates to patient care,” said Dr. Hessen.

And Senior Product Manager Chris James showed practical examples of how SciVal and Scopus were used to analyze scholarly output, trending topics and top research organizations working to strengthen our understanding of infectious disease outbreaks.

Unsurprisingly, we were unable to answer all the excellent questions raised, so we’ve asked our speakers to answer a selection.

Missed the webinar? You can watch it via BrightTALK. Also, check out our COVID-19 resources for librarians, campuses and health professionals, including free access to Coronavirus research.

The research for this webinar is also available as an Infographic, which is available download for free.


Webinar questions:

When publications massively increase in the course of a current disease outbreak, how does the peer review process work? Peer review normally takes several weeks to months.

Chris Capot, Director, Communications for Elsevier’s global health solutions:  Much of the research available now on COVID has been fast-tracked by journals. At Elsevier, the peer-review process is one that safeguards and enhances the quality of research that is shared with the global community. All corners of our publishing ecosystem at Elsevier have come together to ensure we fast-track articles with new insights on COVID-19, especially if relevant for potential vaccines, without losing the attention on quality of research. We talk to authors and understand the scope of their paper/study, and we also line up peer-reviewers who are willing to review it in a matter of few days. We ensure they will be available when the paper comes in and also available for any consultation until needed.

While a typical review process can take a few weeks, the amount of time a scientist actually takes to review a paper is usually only a day or two. If we are aware of papers coming in (e.g. having recruited them, or the authors got in touch with us before submitting), we can line up reviewers ahead of time and ask them to commit to clearing their schedules to make time to review the paper immediately. This approach helps ensure as rigorous a review process as possible in a timely way at times of public health crises. Most other major publishers also handle the process in a similar fashion.


As a journalist, how can you make sense between which of these new COVID-19 studies (because there are so many of them coming out quickly) are well-designed and therefore have data which we should pay attention to, versus studies which may have not been well designed and aren't giving us data that we should be reporting on? 

Chris Capot, Director:  There are two main categories of studies coming out now – preprints and journal articles. We at Elsevier encourage authors to share preprints. The Lancet and Cell Press have their own dedicated networks on our preprint platform, SSRN. At the same time, we caution that preprints have not benefited from the pivotal role of peer-review, which validates and improves the quality of final published journal articles. Journalists can reach out and speak with journal editors and authors, just contact the publisher PR people.


How the previous research done in this area is useful to understand and explore new research related to Covid 19?

Dr. Jayabalasingham: The research on COVID-19 relies on past research related to coronaviruses, particularly the previous research on the SARS and MERS outbreaks. Coronavirus related research from 1999-2018 received 40,501 citations in 2019 and 12,875 citations in just January to March of 2020, suggesting that COVID research has been highly citing past coronavirus research.


Regarding the research surges mentioned during outbreaks (i.e. zika, ebola, SARS, and now SARS2), although the flexibility of the scientific community to turn on a dime to focus on the current threats is great to see, is there any research into the efficiency with which the community is studying these topics? Is there a systematic approach to distributing funding for research?

Dr. Jayabalasingham: Both globally and locally, the research portfolio can vary greatly. This can occur as researchers are motivated by nation-specific interests, countries build upon their own inherent research strengths and countries set different social and economic priorities which influence the scientific agenda for the country.

In order to be prepared for emergencies, it is important to have a diverse research workforce. For example, in the case of the outbreak of COVID19, the necessary expertise has come from many sources including those researching health care implementation, epidemiologists, clinicians, health care professionals, disease modelers, statisticians, immunologists, and virologists. Other fields, such as those focused on mental health and income inequality, will also be invaluable as the pandemic’s indirect impact is felt globally. Whilst I am not aware of any studies done on the efficiency with which the community is studying these topics, SciVal facilitates a high-level visualization of the research portfolio.


How much of the surge in papers regarding infectious diseases or outbreak preparedness could be simply the result of more researchers joining academics, not a novel disease?

Dr. Jayabalasingham: Indeed, academic publications overall have increased greatly between 1996 and 2018. There has been a 167% increase in all publications, resulting from a compound annual growth rate (CAGR) of 4.6%. The growth rate is higher in some fields and lower in others. When you look at research related to emerging infectious diseases, the CAGR is 6.7%; and for health security, CAGR is 8.9% during the same period. In comparison, in the broader field of medicine, CAGR has been 3.3% during the same period. Together, this suggests greater investment in outbreak research than would be expected based on current trends in growth in either publications overall or publications in the field of medicine specifically.


How do you think researchers from developing countries can contribute to research during infectious disease outbreaks to be able to support clinicians?

Dr. Jayabalasingham: In the five years before the Ebola outbreak (2008-2013), sub-Saharan Africa contributed to approximately 3-4% of all Ebola research publications. During and after the outbreak, this value increased to 7-11%, exemplifying the essential role that local researchers play in disseminating knowledge about outbreaks globally.


How do you see herd immunity in the picture? Are we able to predict percentage of success of upcoming herd immunity by age cohorts yet? What variables would need to be taken into account for this modelling?

Dr. Hessen: As you point out, herd immunity does not exist at the onset of a new disease. Development of herd immunity depends on 2 things: the disease must generate protective immunity AND a significant portion of the population must become infected (symptomatically or asymptomatically) and therefore immune.

We don’t yet know whether SARS-CoV-2 generates protective immunity. Assuming that it does, we’ll need 60% to 70% of the population* to be immune in order for herd immunity to operate. This could occur through vaccination or naturally acquired immunity or a combination. The process could take months to years, and could be most accurately measured by widespread serologic testing.

Flattening the curve by use of social distancing and other mitigation techniques actually works in the opposite direction, aiming to reduce the number (and therefore the percentage of the population) infected. However, this strategy can be very helpful and may be the most ethically appropriate in a disease with a significant case fatality rate. It can reduce the number of infections and the rate of spread. Occasionally, this allows eradication of the outbreak through a gradual attrition of cases (as in the SARS outbreak in the early part of this century).

In the current pandemic, I think that is unlikely, but flattening the curve helps us to reduce the chance that the healthcare system will become overwhelmed (resulting in loss of lives that might have been saved otherwise), allows a bit of a head start for research on therapies and vaccines, and may ultimately result in fewer infections and less loss of life.

*Using a basic reproductive number (R0) of 2.5 to 3 (as widely estimated), the percentage of the population required for herd immunity to operate can be calculated:

H=(R0-1)/R0, or (2.5-1)/2.5=.6, or (3-1)/3=.66.


THE CDC MMWR case reports were invaluable in providing evidence for researchers. I was a residence in Internal Medicine when these 5 invaluable case reports were published. What do you view the role of case reports in providing early signals that can guide research?

Dr. Hessen: Early in the course of an emerging disease, case reports are invaluable in describing the clinical features, the demographics of those affected and other information that helps to define the new disease. Conditions characterized by a long course and/or a wide spectrum of manifestations, such as HIV, require a very large number of case reports or case series to understand the full range of disease. Such case reports and case series are, as you point out, the earliest clues for researchers; in the case of HIV, of course, the occurrence of pneumocystis pneumonia in the absence of a known cause prompted researchers to look for immune dysfunction.


Do we have any data about the effect of COVID19 on HIV patients? Are there any known cases of co-infection already?

Dr. Hessen: I have found only a single case report of COVID-19 in a person with HIV infection:

The US Department of Health and Human Services AIDSinfo website ( says this:

The limited data currently available do not indicate that the disease course of COVID-19 in persons with HIV differs from that in persons without HIV. Before the advent of effective combination antiretroviral therapy (ART), advanced HIV infection (i.e., CD4 cell count <200/mm3) was a risk factor for complications of other respiratory infections. Whether this is also true for COVID-19 is yet unknown.


How can I find international collaborations so that I can help in the fight for Coronavirus?

Chris James: It is easier to strengthen existing collaborations or use existing networks to be introduced to potential collaborators than it is to start a new relationship from scratch. With that in mind you can use SciVal to identify the researchers working in the specific area of the Coronavirus that is of interest to you that are based in your institution. You can potentially use them to get an introduction to an international researcher working on the Coronavirus.


How can I access this information in SciVal? Is there a place where this data is freely available? Are there resource for researchers in places like Africa where we have less access? How accessible is Scival?

Chris James: Currently, there is no free access to SciVal. Elsevier is a founding partner of Research4Life. Research4Life has four main programs – HINARI, AGORA, OARE, ARDI – that provide research for free or at low cost to institutions in the developing world. Our goal is to foster a strong and independent research culture in the developing world – one that is fully integrated into the international research community with sustainable economic development and enhanced quality of life.

Elsevier contributes over a quarter of the nearly 68,000 peer-reviewed resources in Research4Life, encompassing ScienceDirect and Scopus, including over 3,100 Elsevier journals and 13,000 books. In 2015, there were over 5 million Research4Life article downloads from Elsevier’s ScienceDirect. We also provide technical and communications expertise to advance Research4Life, and have committed to the program through 2020.


How can I reproduce the data on the map for my region/field?

Chris James: Yes, you can create a version of the map in SciVal. You can import all of the publication from the Coronavirus search query from Scopus into SciVal. In the Trends module you can use the country and region filters to limit the map showing institutions working in this field for your country or region of interest.


Does SciVal checks for all the articles published through Elsevier alone or also include articles published by other publishers like Springer, Oxford university press, etc.

Chris James: SciVal is based on Scopus data and covers articles over 50 million articles from over 5,000 publishers from 1996 – current date, including Springer Nature, Wiley Blackwell, Tailor and Francis, Oxford University Press etc


Does Scopus utilize (take advantage of) information provided by state-funded databases (e.g., PubMed/US National of Library of Medicine) to support their own (database)?

Chris James: Yes, the majority of the data from databases like PubMed can also be found in Scopus