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In need of speed

COVID-year medical research wasn’t as sluggish as it seemed, but some changes could have improved its effectiveness


A researcher injects samples into tubes for COVID-19 analysis at El Bosque University virology laboratory in Colombia. Ivan Valencia/Bloomberg via Getty Images

In need of speed

Since the coronavirus pandemic began, much of the national media’s attention has focused on newly released medical research to help the country understand the new virus: What’s the best way to manage patients in the hospital? What are possible treatments for COVID-19? And of course, how can we develop a vaccine to protect people from the virus?

Some aspects of the fight progressed faster than many expected. Operation Warp Speed succeeded in bringing vaccines to market both quickly and safely. Yet other research developments seemed to lag, coming in weeks or even months later than planned. The University of Oxford’s STOIC trial, which discovered that the generic steroid budesonide helps against COVID-19, had planned to enroll its last patient in mid-November of last year—but the study ultimately needed almost two months more. What was the holdup?

To understand that, let’s consider how to design a research study to yield useful information. COVID-19 presents unique challenges to researchers because most patients recover: Its 99 percent survival rate means researchers would expect to need 100 patients to identify one COVID-19 death. Studies focusing on other outcomes—improving severe symptoms, for example—face similar challenges.

Quality research studies vary in their details, but each one builds on this basic framework:

  • It asks a specific question (testing a hypothesis).
  • It includes a group that doesn’t get the proposed treatment (the control group).
  • It follows a large enough group of patients, for a long enough period of time, to detect whether the study group or the control group fares better (it has sufficient power).
  • It assigns patients to the study group or control group randomly, so that the groups will generally be comparable (it ensures a representative sample).
  • It considers whether the proposed intervention helped and whether other factors might interfere with knowing that (it analyzes its results).
  • Other researchers, independent from those who did the study, double-check the work (the peer review process).

As with vaccine development, research studies can be sped up—but only so much before quality suffers. Researchers carefully calculate how many patients they’ll need to enroll in a study in order to achieve accurate results, but they often struggle to find those patients quickly after diagnosis due to legal barriers protecting personal health data.

The Journal of the American Medical Association received 11,000 submissions in the first five months of 2020.

Staff at research journals last year worked hard to minimize delays with peer review and editing: The time between a study’s submission and its publication dropped by almost 50 percent during the pandemic. Yet it still averaged about 60 days at some of the top journals amid the unprecedented rush of journal submissions in 2020. A Lancet article reported in May that the Journal of the American Medical Association received 11,000 submissions in the first five months of 2020, almost three times more than the same period in 2019. This makes the STOIC trial’s path to publication all the more impressive: Its results reached the public less than one month after the last patient enrolled.

The Lancet article also pointed out that in the research world’s well-intentioned haste to do something about the pandemic, it ended up with many small, poorly designed studies, precluding any meaningful attempt at combining their data into larger, stronger studies. Those initial studies did serve as a source of hypotheses for better-quality research, but they also confused the public. For instance, the presence of “research” supporting drugs like hydroxychloroquine that were later shown to be ineffective against COVID-19 stoked online conspiracy theories and social-media debates.

The Lancet authors argued that research teams would have served the public more effectively by coordinating their efforts toward fewer, but higher-quality, studies—and that they would have ultimately saved time, and lives, by doing so.

Still, perhaps the greatest surprise about the pace of research during the COVID-19 pandemic was not how slowly it moved, but rather how quickly, given the year’s chaos. In reflecting on the good and the bad of our response to the pandemic so far, let’s remember the hard work of those who strove to guide it with quality data.


Charles Horton, M.D. Charles is WORLD's medical correspondent. He is a World Journalism Institute graduate and a physician. Charles resides near Pittsburgh with his wife and four children.

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Bob W

In regard to Dr. Horton's sentence:
"For instance, the presence of “research” supporting drugs like hydroxychloroquine that were later shown to be ineffective against COVID-19 stoked online conspiracy theories and social-media debates."
I am surprised at Dr. Horton's dismissive tone because of experts who are not quick to discredit efficacy of these meds. For example, see the Aug. 5th article in the Washington Times (Vaccine inventor questions mandatory shot push, Biden’s Covid-19 strategy), by Dr. Robert Malone (discoverer of in-vitro and in-vivo RNA transfection and the inventor of mRNA vaccines while he was at the Salk Institute in 1988), and Peter Navarro (served in the Trump White House as the Defense Production Act Policy Coordinator). They write:
"For example, there has been much controversy over ivermectin and hydroxychloroquine. Yet, with the emergence of a growing body of scientific evidence, we can be assured these two medicines are safe and effective in prophylaxis and early treatment when administered under a physician’s supervision."

LLAU8530

I would hardly call hydroxychloroquine ineffective, as Dr Horton did. President Trump was given this drug when he came down with COVID- 19. Within several days he was up and running. Nigeria's Dr Stella Emmanuel has successfully treated over 350 patients with this drug. Yet the drug, previously available for decades mysteriously vanished. What about Dr Fauci's connection to the Wuhan lab? I look forward to each issue of WORLD magazine. It would be great to see some investigative reporting dive in to the truth and print what most of the world's media seems afraid to do.

TXfamily

I found this article interesting but perhaps a bit dismissive of research the "establishment" (to use another commenter's word!) doesn't like. This sentence especially concerned me:
"For instance, the presence of “research” supporting drugs like hydroxychloroquine that were later shown to be ineffective against COVID-19 stoked online conspiracy theories and social-media debates."
Shown to be ineffective? Maybe the studies that showed that were some of the rushed, poorly-designed ones the author mentioned. I happened to have recently read an article on new research that suggests hydroxychloroquine is highly effective, so I looked it up to make sure I was remembering correctly. Here it is: https://news.yahoo.com/study-shows-hydroxychloroquine-zinc-treatments-210300816.html
The beginning of the article is referencing a particular study in which the medicine was combined with zinc. Towards the end of the article other studies are also mentioned which show it to be effective. Maybe Dr. Horton hasn't seen this yet? I fear that all conversations about Covid, treatments, and vaccines have become so politicized that it's hard to know who is seeking truth anymore. Would some doctors and scientists distance themselves from a possible treatment just because Trump was excited about it? Maybe so. I'm no fan of Trump, but it's a logical fallacy to assume everything he says is automatically wrong!

John Ronning

I would appreciate reporting that is not simply echoing what the "establishment" (maybe there's a better word) puts out for us. A Christian magazine should be a place where we could find exposes on the lies and manipulation around this issue - eg the coverup of safe, cheap, effective therapeutics for covid (see flccc.net for starters), e.g. how many doctors are saving thousands of patients from hospitalization and death by ignoring the morally insane polices put out by our public agencies (i.e. wait at home until you're very sick, then go to a hospital see e.g. @btysonmd ). I wish it had been World magazine, for example, that published a story like this - of a family's desperate efforts to get Ivermectin to a dying loved one, overcoming hospital intransigence (https://covid19criticalcare.com/wp-content/uploads/2021/05/The-Drug-that-Cracked-Covid-by-Michael-Capuzzo.pdf). I wish it was World that would blow the whistle on drug company corruption (like Merck telling people Ivermectin wasn't safe, after they themselves had distributed many millions of doses to third world countries. I wish it was World that exposed how many people are dying or being disabled from these vaccines (2000 deaths added weekly for the last two reporting periods - https://www.openvaers.com/covid-data/mortality ).

hrh

"COVID-19 presents unique challenges to researchers because most patients recover: Its 99 percent survival rate means ..."

Please read what you type. These words that I've quoted prove that the global reaction to this virus has been blown out of proportion by magnitudes innumerable. Read your words again:

"... most patients recover ..."
"...99 percent survival rate..."

World magazine would do a great service for its readers in prefacing ALL its COVID coverage with these two facts ... and then allotting column inches relative to the danger of this virus, to wit, 1% of the magazine's pages.
Which means this article itself was needless, and if you'd read what you'd typed, you yourself or your editor should have scrapped the article as wasted space, affecting only 1% of your readers.

Stop following the World's lead for your stories, World magazine. Thanks.