Writing a review of all the scientific medical literature being published on COVID-19... currently running at 300 articles a day – and still counting! – seems more like an unending and hence impossible Sisyphean task than a feasible proposition. Internist and infectious disease specialist Joost Wiersinga managed it, and the July 2020 JAMA article was an immediate resounding success. An update is in the pipeline.
‘But it was fine in the end’, says Wiersinga, putting the task into perspective. ‘Until the beginning of the year I was doing a lot of research into sepsis and pneumonia anyway, and those are two major features of COVID-19. So I was able to gauge the value of a good deal of the available literature fairly quickly with the help of my co-authors. The copycats and unsatisfactory treatment studies without control groups were soon rejected.’
The article that Wiersinga et al. published in the July issue of JAMA can now justifiably be labeled a bestseller. By the end of October the online paper had notched up just under 700,000 readers. ‘But it’s already out of date now: we 'only' looked at 25,000 articles for our review. Meanwhile over 65,000 articles on COVID-19 have been published, so we're working on a update. The general thrust of our review is still rock-solid, for that matter. By July it was already crystal clear that COVID-19 is definitely not just a severe viral pneumonia.’
A number of articles about drugs already emerged from the review. The most striking finding was from the UK, where they had found that the existing drug dexamethasone is effective in patients. ‘It’s the only drug that reduces mortality – and an existing drug that costs hardly anything.’ And the conclusion that the antimalarial chloroquine should not be used to treat coronavirus turns out to be correct. ‘Important data will certainly be added in the coming weeks and months on the various vaccine trials.’
Separating the wheat from the chaff
An important lesson we have learned from Wiersinga’s review is that there’s a good deal of chaff amongst the wheat. ‘In their efforts not to miss anything, some journals have occasionally lowered their standards a bit too far. At the same time I have to say that the peer review of our article was still pretty rigorous and useful. It’s by no means the case that you can get anything published in a time of pandemic. In spite of the occasional blunders and even cases of fraud that have been widely reported in the press, I think this pandemic shows that the self-cleansing power of science is working quite well’, argues Wiersinga.