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• Published: 04 June 2021

Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews

• Israel Júnior Borges do Nascimento 1 , 2 ,
• Dónal P. O’Mathúna 3 , 4 ,
• Thilo Caspar von Groote 5 ,
• Hebatullah Mohamed Abdulazeem 6 ,
• Ishanka Weerasekara 7 , 8 ,
• Ana Marusic 9 ,
• Livia Puljak   ORCID: orcid.org/0000-0002-8467-6061 10 ,
• Vinicius Tassoni Civile 11 ,
• Irena Zakarija-Grkovic 9 ,
• Tina Poklepovic Pericic 9 ,
• Alvaro Nagib Atallah 11 ,
• Santino Filoso 12 ,
• Nicola Luigi Bragazzi 13 &
• Milena Soriano Marcolino 1

On behalf of the International Network of Coronavirus Disease 2019 (InterNetCOVID-19)

BMC Infectious Diseases volume  21 , Article number:  525 ( 2021 ) Cite this article

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Navigating the rapidly growing body of scientific literature on the SARS-CoV-2 pandemic is challenging, and ongoing critical appraisal of this output is essential. We aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic.

Nine databases (Medline, EMBASE, Cochrane Library, CINAHL, Web of Sciences, PDQ-Evidence, WHO’s Global Research, LILACS, and Epistemonikos) were searched from December 1, 2019, to March 24, 2020. Systematic reviews analyzing primary studies of COVID-19 were included. Two authors independently undertook screening, selection, extraction (data on clinical symptoms, prevalence, pharmacological and non-pharmacological interventions, diagnostic test assessment, laboratory, and radiological findings), and quality assessment (AMSTAR 2). A meta-analysis was performed of the prevalence of clinical outcomes.

Eighteen systematic reviews were included; one was empty (did not identify any relevant study). Using AMSTAR 2, confidence in the results of all 18 reviews was rated as “critically low”. Identified symptoms of COVID-19 were (range values of point estimates): fever (82–95%), cough with or without sputum (58–72%), dyspnea (26–59%), myalgia or muscle fatigue (29–51%), sore throat (10–13%), headache (8–12%) and gastrointestinal complaints (5–9%). Severe symptoms were more common in men. Elevated C-reactive protein and lactate dehydrogenase, and slightly elevated aspartate and alanine aminotransferase, were commonly described. Thrombocytopenia and elevated levels of procalcitonin and cardiac troponin I were associated with severe disease. A frequent finding on chest imaging was uni- or bilateral multilobar ground-glass opacity. A single review investigated the impact of medication (chloroquine) but found no verifiable clinical data. All-cause mortality ranged from 0.3 to 13.9%.

Conclusions

In this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all reviews was “critically low”. Thus, systematic reviews that were published early on in the pandemic were of questionable usefulness. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards.

Peer Review reports

The spread of the “Severe Acute Respiratory Coronavirus 2” (SARS-CoV-2), the causal agent of COVID-19, was characterized as a pandemic by the World Health Organization (WHO) in March 2020 and has triggered an international public health emergency [ 1 ]. The numbers of confirmed cases and deaths due to COVID-19 are rapidly escalating, counting in millions [ 2 ], causing massive economic strain, and escalating healthcare and public health expenses [ 3 , 4 ].

The research community has responded by publishing an impressive number of scientific reports related to COVID-19. The world was alerted to the new disease at the beginning of 2020 [ 1 ], and by mid-March 2020, more than 2000 articles had been published on COVID-19 in scholarly journals, with 25% of them containing original data [ 5 ]. The living map of COVID-19 evidence, curated by the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), contained more than 40,000 records by February 2021 [ 6 ]. More than 100,000 records on PubMed were labeled as “SARS-CoV-2 literature, sequence, and clinical content” by February 2021 [ 7 ].

Due to publication speed, the research community has voiced concerns regarding the quality and reproducibility of evidence produced during the COVID-19 pandemic, warning of the potential damaging approach of “publish first, retract later” [ 8 ]. It appears that these concerns are not unfounded, as it has been reported that COVID-19 articles were overrepresented in the pool of retracted articles in 2020 [ 9 ]. These concerns about inadequate evidence are of major importance because they can lead to poor clinical practice and inappropriate policies [ 10 ].

Systematic reviews are a cornerstone of today’s evidence-informed decision-making. By synthesizing all relevant evidence regarding a particular topic, systematic reviews reflect the current scientific knowledge. Systematic reviews are considered to be at the highest level in the hierarchy of evidence and should be used to make informed decisions. However, with high numbers of systematic reviews of different scope and methodological quality being published, overviews of multiple systematic reviews that assess their methodological quality are essential [ 11 , 12 , 13 ]. An overview of systematic reviews helps identify and organize the literature and highlights areas of priority in decision-making.

In this overview of systematic reviews, we aimed to summarize and critically appraise systematic reviews of coronavirus disease (COVID-19) in humans that were available at the beginning of the pandemic.

Methodology

Research question.

This overview’s primary objective was to summarize and critically appraise systematic reviews that assessed any type of primary clinical data from patients infected with SARS-CoV-2. Our research question was purposefully broad because we wanted to analyze as many systematic reviews as possible that were available early following the COVID-19 outbreak.

Study design

We conducted an overview of systematic reviews. The idea for this overview originated in a protocol for a systematic review submitted to PROSPERO (CRD42020170623), which indicated a plan to conduct an overview.

Overviews of systematic reviews use explicit and systematic methods for searching and identifying multiple systematic reviews addressing related research questions in the same field to extract and analyze evidence across important outcomes. Overviews of systematic reviews are in principle similar to systematic reviews of interventions, but the unit of analysis is a systematic review [ 14 , 15 , 16 ].

We used the overview methodology instead of other evidence synthesis methods to allow us to collate and appraise multiple systematic reviews on this topic, and to extract and analyze their results across relevant topics [ 17 ]. The overview and meta-analysis of systematic reviews allowed us to investigate the methodological quality of included studies, summarize results, and identify specific areas of available or limited evidence, thereby strengthening the current understanding of this novel disease and guiding future research [ 13 ].

A reporting guideline for overviews of reviews is currently under development, i.e., Preferred Reporting Items for Overviews of Reviews (PRIOR) [ 18 ]. As the PRIOR checklist is still not published, this study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 statement [ 19 ]. The methodology used in this review was adapted from the Cochrane Handbook for Systematic Reviews of Interventions and also followed established methodological considerations for analyzing existing systematic reviews [ 14 ].

Approval of a research ethics committee was not necessary as the study analyzed only publicly available articles.

Eligibility criteria

Systematic reviews were included if they analyzed primary data from patients infected with SARS-CoV-2 as confirmed by RT-PCR or another pre-specified diagnostic technique. Eligible reviews covered all topics related to COVID-19 including, but not limited to, those that reported clinical symptoms, diagnostic methods, therapeutic interventions, laboratory findings, or radiological results. Both full manuscripts and abbreviated versions, such as letters, were eligible.

No restrictions were imposed on the design of the primary studies included within the systematic reviews, the last search date, whether the review included meta-analyses or language. Reviews related to SARS-CoV-2 and other coronaviruses were eligible, but from those reviews, we analyzed only data related to SARS-CoV-2.

No consensus definition exists for a systematic review [ 20 ], and debates continue about the defining characteristics of a systematic review [ 21 ]. Cochrane’s guidance for overviews of reviews recommends setting pre-established criteria for making decisions around inclusion [ 14 ]. That is supported by a recent scoping review about guidance for overviews of systematic reviews [ 22 ].

Thus, for this study, we defined a systematic review as a research report which searched for primary research studies on a specific topic using an explicit search strategy, had a detailed description of the methods with explicit inclusion criteria provided, and provided a summary of the included studies either in narrative or quantitative format (such as a meta-analysis). Cochrane and non-Cochrane systematic reviews were considered eligible for inclusion, with or without meta-analysis, and regardless of the study design, language restriction and methodology of the included primary studies. To be eligible for inclusion, reviews had to be clearly analyzing data related to SARS-CoV-2 (associated or not with other viruses). We excluded narrative reviews without those characteristics as these are less likely to be replicable and are more prone to bias.

Scoping reviews and rapid reviews were eligible for inclusion in this overview if they met our pre-defined inclusion criteria noted above. We included reviews that addressed SARS-CoV-2 and other coronaviruses if they reported separate data regarding SARS-CoV-2.

Information sources

Nine databases were searched for eligible records published between December 1, 2019, and March 24, 2020: Cochrane Database of Systematic Reviews via Cochrane Library, PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Sciences, LILACS (Latin American and Caribbean Health Sciences Literature), PDQ-Evidence, WHO’s Global Research on Coronavirus Disease (COVID-19), and Epistemonikos.

The comprehensive search strategy for each database is provided in Additional file 1 and was designed and conducted in collaboration with an information specialist. All retrieved records were primarily processed in EndNote, where duplicates were removed, and records were then imported into the Covidence platform [ 23 ]. In addition to database searches, we screened reference lists of reviews included after screening records retrieved via databases.

Study selection

All searches, screening of titles and abstracts, and record selection, were performed independently by two investigators using the Covidence platform [ 23 ]. Articles deemed potentially eligible were retrieved for full-text screening carried out independently by two investigators. Discrepancies at all stages were resolved by consensus. During the screening, records published in languages other than English were translated by a native/fluent speaker.

Data collection process

We custom designed a data extraction table for this study, which was piloted by two authors independently. Data extraction was performed independently by two authors. Conflicts were resolved by consensus or by consulting a third researcher.

We extracted the following data: article identification data (authors’ name and journal of publication), search period, number of databases searched, population or settings considered, main results and outcomes observed, and number of participants. From Web of Science (Clarivate Analytics, Philadelphia, PA, USA), we extracted journal rank (quartile) and Journal Impact Factor (JIF).

We categorized the following as primary outcomes: all-cause mortality, need for and length of mechanical ventilation, length of hospitalization (in days), admission to intensive care unit (yes/no), and length of stay in the intensive care unit.

The following outcomes were categorized as exploratory: diagnostic methods used for detection of the virus, male to female ratio, clinical symptoms, pharmacological and non-pharmacological interventions, laboratory findings (full blood count, liver enzymes, C-reactive protein, d-dimer, albumin, lipid profile, serum electrolytes, blood vitamin levels, glucose levels, and any other important biomarkers), and radiological findings (using radiography, computed tomography, magnetic resonance imaging or ultrasound).

We also collected data on reporting guidelines and requirements for the publication of systematic reviews and meta-analyses from journal websites where included reviews were published.

Quality assessment in individual reviews

Two researchers independently assessed the reviews’ quality using the “A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR 2)”. We acknowledge that the AMSTAR 2 was created as “a critical appraisal tool for systematic reviews that include randomized or non-randomized studies of healthcare interventions, or both” [ 24 ]. However, since AMSTAR 2 was designed for systematic reviews of intervention trials, and we included additional types of systematic reviews, we adjusted some AMSTAR 2 ratings and reported these in Additional file 2 .

Adherence to each item was rated as follows: yes, partial yes, no, or not applicable (such as when a meta-analysis was not conducted). The overall confidence in the results of the review is rated as “critically low”, “low”, “moderate” or “high”, according to the AMSTAR 2 guidance based on seven critical domains, which are items 2, 4, 7, 9, 11, 13, 15 as defined by AMSTAR 2 authors [ 24 ]. We reported our adherence ratings for transparency of our decision with accompanying explanations, for each item, in each included review.

One of the included systematic reviews was conducted by some members of this author team [ 25 ]. This review was initially assessed independently by two authors who were not co-authors of that review to prevent the risk of bias in assessing this study.

Synthesis of results

For data synthesis, we prepared a table summarizing each systematic review. Graphs illustrating the mortality rate and clinical symptoms were created. We then prepared a narrative summary of the methods, findings, study strengths, and limitations.

For analysis of the prevalence of clinical outcomes, we extracted data on the number of events and the total number of patients to perform proportional meta-analysis using RStudio© software, with the “meta” package (version 4.9–6), using the “metaprop” function for reviews that did not perform a meta-analysis, excluding case studies because of the absence of variance. For reviews that did not perform a meta-analysis, we presented pooled results of proportions with their respective confidence intervals (95%) by the inverse variance method with a random-effects model, using the DerSimonian-Laird estimator for τ 2 . We adjusted data using Freeman-Tukey double arcosen transformation. Confidence intervals were calculated using the Clopper-Pearson method for individual studies. We created forest plots using the RStudio© software, with the “metafor” package (version 2.1–0) and “forest” function.

Managing overlapping systematic reviews

Some of the included systematic reviews that address the same or similar research questions may include the same primary studies in overviews. Including such overlapping reviews may introduce bias when outcome data from the same primary study are included in the analyses of an overview multiple times. Thus, in summaries of evidence, multiple-counting of the same outcome data will give data from some primary studies too much influence [ 14 ]. In this overview, we did not exclude overlapping systematic reviews because, according to Cochrane’s guidance, it may be appropriate to include all relevant reviews’ results if the purpose of the overview is to present and describe the current body of evidence on a topic [ 14 ]. To avoid any bias in summary estimates associated with overlapping reviews, we generated forest plots showing data from individual systematic reviews, but the results were not pooled because some primary studies were included in multiple reviews.

Our search retrieved 1063 publications, of which 175 were duplicates. Most publications were excluded after the title and abstract analysis ( n = 860). Among the 28 studies selected for full-text screening, 10 were excluded for the reasons described in Additional file 3 , and 18 were included in the final analysis (Fig. 1 ) [ 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Reference list screening did not retrieve any additional systematic reviews.

PRISMA flow diagram

Characteristics of included reviews

Summary features of 18 systematic reviews are presented in Table 1 . They were published in 14 different journals. Only four of these journals had specific requirements for systematic reviews (with or without meta-analysis): European Journal of Internal Medicine, Journal of Clinical Medicine, Ultrasound in Obstetrics and Gynecology, and Clinical Research in Cardiology . Two journals reported that they published only invited reviews ( Journal of Medical Virology and Clinica Chimica Acta ). Three systematic reviews in our study were published as letters; one was labeled as a scoping review and another as a rapid review (Table 2 ).

All reviews were published in English, in first quartile (Q1) journals, with JIF ranging from 1.692 to 6.062. One review was empty, meaning that its search did not identify any relevant studies; i.e., no primary studies were included [ 36 ]. The remaining 17 reviews included 269 unique studies; the majority ( N = 211; 78%) were included in only a single review included in our study (range: 1 to 12). Primary studies included in the reviews were published between December 2019 and March 18, 2020, and comprised case reports, case series, cohorts, and other observational studies. We found only one review that included randomized clinical trials [ 38 ]. In the included reviews, systematic literature searches were performed from 2019 (entire year) up to March 9, 2020. Ten systematic reviews included meta-analyses. The list of primary studies found in the included systematic reviews is shown in Additional file 4 , as well as the number of reviews in which each primary study was included.

Population and study designs

Most of the reviews analyzed data from patients with COVID-19 who developed pneumonia, acute respiratory distress syndrome (ARDS), or any other correlated complication. One review aimed to evaluate the effectiveness of using surgical masks on preventing transmission of the virus [ 36 ], one review was focused on pediatric patients [ 34 ], and one review investigated COVID-19 in pregnant women [ 37 ]. Most reviews assessed clinical symptoms, laboratory findings, or radiological results.

Systematic review findings

The summary of findings from individual reviews is shown in Table 2 . Overall, all-cause mortality ranged from 0.3 to 13.9% (Fig. 2 ).

A meta-analysis of the prevalence of mortality

Clinical symptoms

Seven reviews described the main clinical manifestations of COVID-19 [ 26 , 28 , 29 , 34 , 35 , 39 , 41 ]. Three of them provided only a narrative discussion of symptoms [ 26 , 34 , 35 ]. In the reviews that performed a statistical analysis of the incidence of different clinical symptoms, symptoms in patients with COVID-19 were (range values of point estimates): fever (82–95%), cough with or without sputum (58–72%), dyspnea (26–59%), myalgia or muscle fatigue (29–51%), sore throat (10–13%), headache (8–12%), gastrointestinal disorders, such as diarrhea, nausea or vomiting (5.0–9.0%), and others (including, in one study only: dizziness 12.1%) (Figs. 3 , 4 , 5 , 6 , 7 , 8 and 9 ). Three reviews assessed cough with and without sputum together; only one review assessed sputum production itself (28.5%).

A meta-analysis of the prevalence of fever

A meta-analysis of the prevalence of cough

A meta-analysis of the prevalence of dyspnea

A meta-analysis of the prevalence of fatigue or myalgia

A meta-analysis of the prevalence of headache

A meta-analysis of the prevalence of gastrointestinal disorders

A meta-analysis of the prevalence of sore throat

Diagnostic aspects

Three reviews described methodologies, protocols, and tools used for establishing the diagnosis of COVID-19 [ 26 , 34 , 38 ]. The use of respiratory swabs (nasal or pharyngeal) or blood specimens to assess the presence of SARS-CoV-2 nucleic acid using RT-PCR assays was the most commonly used diagnostic method mentioned in the included studies. These diagnostic tests have been widely used, but their precise sensitivity and specificity remain unknown. One review included a Chinese study with clinical diagnosis with no confirmation of SARS-CoV-2 infection (patients were diagnosed with COVID-19 if they presented with at least two symptoms suggestive of COVID-19, together with laboratory and chest radiography abnormalities) [ 34 ].

Therapeutic possibilities

Pharmacological and non-pharmacological interventions (supportive therapies) used in treating patients with COVID-19 were reported in five reviews [ 25 , 27 , 34 , 35 , 38 ]. Antivirals used empirically for COVID-19 treatment were reported in seven reviews [ 25 , 27 , 34 , 35 , 37 , 38 , 41 ]; most commonly used were protease inhibitors (lopinavir, ritonavir, darunavir), nucleoside reverse transcriptase inhibitor (tenofovir), nucleotide analogs (remdesivir, galidesivir, ganciclovir), and neuraminidase inhibitors (oseltamivir). Umifenovir, a membrane fusion inhibitor, was investigated in two studies [ 25 , 35 ]. Possible supportive interventions analyzed were different types of oxygen supplementation and breathing support (invasive or non-invasive ventilation) [ 25 ]. The use of antibiotics, both empirically and to treat secondary pneumonia, was reported in six studies [ 25 , 26 , 27 , 34 , 35 , 38 ]. One review specifically assessed evidence on the efficacy and safety of the anti-malaria drug chloroquine [ 27 ]. It identified 23 ongoing trials investigating the potential of chloroquine as a therapeutic option for COVID-19, but no verifiable clinical outcomes data. The use of mesenchymal stem cells, antifungals, and glucocorticoids were described in four reviews [ 25 , 34 , 35 , 38 ].

Laboratory and radiological findings

Of the 18 reviews included in this overview, eight analyzed laboratory parameters in patients with COVID-19 [ 25 , 29 , 30 , 32 , 33 , 34 , 35 , 39 ]; elevated C-reactive protein levels, associated with lymphocytopenia, elevated lactate dehydrogenase, as well as slightly elevated aspartate and alanine aminotransferase (AST, ALT) were commonly described in those eight reviews. Lippi et al. assessed cardiac troponin I (cTnI) [ 25 ], procalcitonin [ 32 ], and platelet count [ 33 ] in COVID-19 patients. Elevated levels of procalcitonin [ 32 ] and cTnI [ 30 ] were more likely to be associated with a severe disease course (requiring intensive care unit admission and intubation). Furthermore, thrombocytopenia was frequently observed in patients with complicated COVID-19 infections [ 33 ].

Chest imaging (chest radiography and/or computed tomography) features were assessed in six reviews, all of which described a frequent pattern of local or bilateral multilobar ground-glass opacity [ 25 , 34 , 35 , 39 , 40 , 41 ]. Those six reviews showed that septal thickening, bronchiectasis, pleural and cardiac effusions, halo signs, and pneumothorax were observed in patients suffering from COVID-19.

Quality of evidence in individual systematic reviews

Table 3 shows the detailed results of the quality assessment of 18 systematic reviews, including the assessment of individual items and summary assessment. A detailed explanation for each decision in each review is available in Additional file 5 .

Using AMSTAR 2 criteria, confidence in the results of all 18 reviews was rated as “critically low” (Table 3 ). Common methodological drawbacks were: omission of prospective protocol submission or publication; use of inappropriate search strategy: lack of independent and dual literature screening and data-extraction (or methodology unclear); absence of an explanation for heterogeneity among the studies included; lack of reasons for study exclusion (or rationale unclear).

Risk of bias assessment, based on a reported methodological tool, and quality of evidence appraisal, in line with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method, were reported only in one review [ 25 ]. Five reviews presented a table summarizing bias, using various risk of bias tools [ 25 , 29 , 39 , 40 , 41 ]. One review analyzed “study quality” [ 37 ]. One review mentioned the risk of bias assessment in the methodology but did not provide any related analysis [ 28 ].

This overview of systematic reviews analyzed the first 18 systematic reviews published after the onset of the COVID-19 pandemic, up to March 24, 2020, with primary studies involving more than 60,000 patients. Using AMSTAR-2, we judged that our confidence in all those reviews was “critically low”. Ten reviews included meta-analyses. The reviews presented data on clinical manifestations, laboratory and radiological findings, and interventions. We found no systematic reviews on the utility of diagnostic tests.

Symptoms were reported in seven reviews; most of the patients had a fever, cough, dyspnea, myalgia or muscle fatigue, and gastrointestinal disorders such as diarrhea, nausea, or vomiting. Olfactory dysfunction (anosmia or dysosmia) has been described in patients infected with COVID-19 [ 43 ]; however, this was not reported in any of the reviews included in this overview. During the SARS outbreak in 2002, there were reports of impairment of the sense of smell associated with the disease [ 44 , 45 ].

The reported mortality rates ranged from 0.3 to 14% in the included reviews. Mortality estimates are influenced by the transmissibility rate (basic reproduction number), availability of diagnostic tools, notification policies, asymptomatic presentations of the disease, resources for disease prevention and control, and treatment facilities; variability in the mortality rate fits the pattern of emerging infectious diseases [ 46 ]. Furthermore, the reported cases did not consider asymptomatic cases, mild cases where individuals have not sought medical treatment, and the fact that many countries had limited access to diagnostic tests or have implemented testing policies later than the others. Considering the lack of reviews assessing diagnostic testing (sensitivity, specificity, and predictive values of RT-PCT or immunoglobulin tests), and the preponderance of studies that assessed only symptomatic individuals, considerable imprecision around the calculated mortality rates existed in the early stage of the COVID-19 pandemic.

Few reviews included treatment data. Those reviews described studies considered to be at a very low level of evidence: usually small, retrospective studies with very heterogeneous populations. Seven reviews analyzed laboratory parameters; those reviews could have been useful for clinicians who attend patients suspected of COVID-19 in emergency services worldwide, such as assessing which patients need to be reassessed more frequently.

All systematic reviews scored poorly on the AMSTAR 2 critical appraisal tool for systematic reviews. Most of the original studies included in the reviews were case series and case reports, impacting the quality of evidence. Such evidence has major implications for clinical practice and the use of these reviews in evidence-based practice and policy. Clinicians, patients, and policymakers can only have the highest confidence in systematic review findings if high-quality systematic review methodologies are employed. The urgent need for information during a pandemic does not justify poor quality reporting.

We acknowledge that there are numerous challenges associated with analyzing COVID-19 data during a pandemic [ 47 ]. High-quality evidence syntheses are needed for decision-making, but each type of evidence syntheses is associated with its inherent challenges.

The creation of classic systematic reviews requires considerable time and effort; with massive research output, they quickly become outdated, and preparing updated versions also requires considerable time. A recent study showed that updates of non-Cochrane systematic reviews are published a median of 5 years after the publication of the previous version [ 48 ].

Authors may register a review and then abandon it [ 49 ], but the existence of a public record that is not updated may lead other authors to believe that the review is still ongoing. A quarter of Cochrane review protocols remains unpublished as completed systematic reviews 8 years after protocol publication [ 50 ].

Rapid reviews can be used to summarize the evidence, but they involve methodological sacrifices and simplifications to produce information promptly, with inconsistent methodological approaches [ 51 ]. However, rapid reviews are justified in times of public health emergencies, and even Cochrane has resorted to publishing rapid reviews in response to the COVID-19 crisis [ 52 ]. Rapid reviews were eligible for inclusion in this overview, but only one of the 18 reviews included in this study was labeled as a rapid review.

Ideally, COVID-19 evidence would be continually summarized in a series of high-quality living systematic reviews, types of evidence synthesis defined as “ a systematic review which is continually updated, incorporating relevant new evidence as it becomes available ” [ 53 ]. However, conducting living systematic reviews requires considerable resources, calling into question the sustainability of such evidence synthesis over long periods [ 54 ].

Research reports about COVID-19 will contribute to research waste if they are poorly designed, poorly reported, or simply not necessary. In principle, systematic reviews should help reduce research waste as they usually provide recommendations for further research that is needed or may advise that sufficient evidence exists on a particular topic [ 55 ]. However, systematic reviews can also contribute to growing research waste when they are not needed, or poorly conducted and reported. Our present study clearly shows that most of the systematic reviews that were published early on in the COVID-19 pandemic could be categorized as research waste, as our confidence in their results is critically low.

Our study has some limitations. One is that for AMSTAR 2 assessment we relied on information available in publications; we did not attempt to contact study authors for clarifications or additional data. In three reviews, the methodological quality appraisal was challenging because they were published as letters, or labeled as rapid communications. As a result, various details about their review process were not included, leading to AMSTAR 2 questions being answered as “not reported”, resulting in low confidence scores. Full manuscripts might have provided additional information that could have led to higher confidence in the results. In other words, low scores could reflect incomplete reporting, not necessarily low-quality review methods. To make their review available more rapidly and more concisely, the authors may have omitted methodological details. A general issue during a crisis is that speed and completeness must be balanced. However, maintaining high standards requires proper resourcing and commitment to ensure that the users of systematic reviews can have high confidence in the results.

Furthermore, we used adjusted AMSTAR 2 scoring, as the tool was designed for critical appraisal of reviews of interventions. Some reviews may have received lower scores than actually warranted in spite of these adjustments.

Another limitation of our study may be the inclusion of multiple overlapping reviews, as some included reviews included the same primary studies. According to the Cochrane Handbook, including overlapping reviews may be appropriate when the review’s aim is “ to present and describe the current body of systematic review evidence on a topic ” [ 12 ], which was our aim. To avoid bias with summarizing evidence from overlapping reviews, we presented the forest plots without summary estimates. The forest plots serve to inform readers about the effect sizes for outcomes that were reported in each review.

Several authors from this study have contributed to one of the reviews identified [ 25 ]. To reduce the risk of any bias, two authors who did not co-author the review in question initially assessed its quality and limitations.

Finally, we note that the systematic reviews included in our overview may have had issues that our analysis did not identify because we did not analyze their primary studies to verify the accuracy of the data and information they presented. We give two examples to substantiate this possibility. Lovato et al. wrote a commentary on the review of Sun et al. [ 41 ], in which they criticized the authors’ conclusion that sore throat is rare in COVID-19 patients [ 56 ]. Lovato et al. highlighted that multiple studies included in Sun et al. did not accurately describe participants’ clinical presentations, warning that only three studies clearly reported data on sore throat [ 56 ].

In another example, Leung [ 57 ] warned about the review of Li, L.Q. et al. [ 29 ]: “ it is possible that this statistic was computed using overlapped samples, therefore some patients were double counted ”. Li et al. responded to Leung that it is uncertain whether the data overlapped, as they used data from published articles and did not have access to the original data; they also reported that they requested original data and that they plan to re-do their analyses once they receive them; they also urged readers to treat the data with caution [ 58 ]. This points to the evolving nature of evidence during a crisis.

Our study’s strength is that this overview adds to the current knowledge by providing a comprehensive summary of all the evidence synthesis about COVID-19 available early after the onset of the pandemic. This overview followed strict methodological criteria, including a comprehensive and sensitive search strategy and a standard tool for methodological appraisal of systematic reviews.

In conclusion, in this overview of systematic reviews, we analyzed evidence from the first 18 systematic reviews that were published after the emergence of COVID-19. However, confidence in the results of all the reviews was “critically low”. Thus, systematic reviews that were published early on in the pandemic could be categorized as research waste. Even during public health emergencies, studies and systematic reviews should adhere to established methodological standards to provide patients, clinicians, and decision-makers trustworthy evidence.

Availability of data and materials

All data collected and analyzed within this study are available from the corresponding author on reasonable request.

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Acknowledgments

We thank Catherine Henderson DPhil from Swanscoe Communications for pro bono medical writing and editing support. We acknowledge support from the Covidence Team, specifically Anneliese Arno. We thank the whole International Network of Coronavirus Disease 2019 (InterNetCOVID-19) for their commitment and involvement. Members of the InterNetCOVID-19 are listed in Additional file 6 . We thank Pavel Cerny and Roger Crosthwaite for guiding the team supervisor (IJBN) on human resources management.

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Israel Júnior Borges do Nascimento & Milena Soriano Marcolino

Medical College of Wisconsin, Milwaukee, WI, USA

Israel Júnior Borges do Nascimento

Helene Fuld Health Trust National Institute for Evidence-based Practice in Nursing and Healthcare, College of Nursing, The Ohio State University, Columbus, OH, USA

Dónal P. O’Mathúna

School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland

Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany

Thilo Caspar von Groote

Department of Sport and Health Science, Technische Universität München, Munich, Germany

Hebatullah Mohamed Abdulazeem

School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, Australia

Ishanka Weerasekara

Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka

Cochrane Croatia, University of Split, School of Medicine, Split, Croatia

Ana Marusic, Irena Zakarija-Grkovic & Tina Poklepovic Pericic

Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Ilica 242, 10000, Zagreb, Croatia

Livia Puljak

Cochrane Brazil, Evidence-Based Health Program, Universidade Federal de São Paulo, São Paulo, Brazil

Vinicius Tassoni Civile & Alvaro Nagib Atallah

Yorkville University, Fredericton, New Brunswick, Canada

Santino Filoso

Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada

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IJBN conceived the research idea and worked as a project coordinator. DPOM, TCVG, HMA, IW, AM, LP, VTC, IZG, TPP, ANA, SF, NLB and MSM were involved in data curation, formal analysis, investigation, methodology, and initial draft writing. All authors revised the manuscript critically for the content. The author(s) read and approved the final manuscript.

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Supplementary Information

Additional file 1: appendix 1..

Search strategies used in the study.

Additional file 2: Appendix 2.

Adjusted scoring of AMSTAR 2 used in this study for systematic reviews of studies that did not analyze interventions.

Additional file 3: Appendix 3.

List of excluded studies, with reasons.

Additional file 4: Appendix 4.

Table of overlapping studies, containing the list of primary studies included, their visual overlap in individual systematic reviews, and the number in how many reviews each primary study was included.

Additional file 5: Appendix 5.

A detailed explanation of AMSTAR scoring for each item in each review.

Additional file 6: Appendix 6.

List of members and affiliates of International Network of Coronavirus Disease 2019 (InterNetCOVID-19).

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Borges do Nascimento, I.J., O’Mathúna, D.P., von Groote, T.C. et al. Coronavirus disease (COVID-19) pandemic: an overview of systematic reviews. BMC Infect Dis 21 , 525 (2021). https://doi.org/10.1186/s12879-021-06214-4

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317 COVID-19 & Pandemic Essay Topics for Students

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• Pandemic and Its Aftermath Impact The pandemic will be followed by an increase in mortality rates among the vulnerable population such as the poor, the elderly, the chronically ill.
• Impact of the Coronavirus Pandemic on Human Relations In the article, the author analyzes how the coronavirus pandemic has impacted his relationships with family and friends.
• Psychological Effects of Pandemic Control Measures Isolated working conditions combined with the lack of social contacts cause people to experience an increased feeling of stress and anxiety.
• The COVID-19 Pandemic: Human Response The most adequate and effective human response to COVID-19 is launching public information campaigns that contribute to most individuals’ understanding of the situation.
• Government-Funded Assistance Before and After Pandemic Social welfare and national insurance programs are the primary forms of public support aid in the United States. Incentives from social programs are associated with low salaries.
• The Effectiveness of the US in Response COVID-19 Pandemic The paper discusses the effectiveness of the US in response COVID-19 pandemic, the lessons learned from COVID-19, and whether the CDC played its role.
• Police Brutality During COVID-19 Pandemic In the United States, there has been a perceived and observed police injustice towards minority communities, especially Blacks.
• Risk Communication in Pandemic Prevention Effective structuring of risk communication in a way that the citizens get all relevant information about a disease outbreak can prevent a pandemic in the future.
• Economic Systems During the Pandemic Government-mandated national lockdowns restrict COVID-19 propagation and negatively affect the economy. Employees were unable to work during the shutdown.
• How Has the COVID-19 Pandemic Changed the Human Resource Landscape The paper states that the COVID-19 pandemic has changed the human resources landscape, such as staffing, working patterns, and workplaces globally.
• Healthcare Costs Affected by the COVID-19 Pandemic In all over the world, the COVID-19 pandemic led to a dramatic growth of national healthcare spending as the prevention and treatment required the implementation of new measures.
• COVID-19 Pandemic and New Parenthood This paper aims to explain the impact of COVID-19 on the breastfeeding process, the psychological well-being of new mothers, and the type of support necessary.
• The COVID-19 Pandemic: Public Health Policy The COVID-19 pandemic has caused numerous health challenges and made it vital for healthcare professionals and policymakers to introduce new effective measures.
• The COVID-19 Pandemic: Patient Care Problem The essay discusses the COVID-19 pandemic patient care problem and its effect on the hospital’s budget and the role of a nurse leader in mitigating the effects.
• Decision-Making in Nursing: Impact of the COVID-19 Pandemic This paper deals with the impact the COVID-19 pandemic has had on the ability of nurses to make sound decisions as to the wellbeing of patients in clinical settings.
• COVID-19: Considerations for Children and Families During the Pandemic
• Risk and Protective Factors in the COVID-19 Pandemic
• Psychosocial Support for Healthcare Workers During the COVID-19 Pandemic
• Community Strategy For Pandemic Influenza
• Combating the Pandemic COVID-19: Clinical Trials, Therapies, and Perspectives
• Disease and Fertility: Evidence From the 1918 Influenza Pandemic in Sweden
• Pharmaceutical Patents and the HIV/Aids Pandemic
• Gender-based Violence During COVID-19 Pandemic
• Physical Fitness and Exercise During the COVID-19 Pandemic
• Pandemic Perspective: Commonalities Between COVID-19 and Cardio-oncology
• The Successes and Failures of the Initial COVID-19 Pandemic Response in Romania
• Food Safety During and After the Era of COVID-19 Pandemic
• Spanish Flu 1918 Pandemic
• Fighting Strategies Against the Novel Coronavirus Pandemic: Impact on Global Economy
• Diabetes the 132 Billion Dollar Pandemic
• Novel Coronavirus (COVID-19) Pandemic: The Role of Printing Media in Asian Countries
• Spanish Flu Global Pandemic
• Federal Reserve System Vigilant for Flu Pandemic
• Ethics and Preparedness Planning for an Influenza Pandemic
• Cancer Patient Management Challenges During the COVID-19 Pandemic
• Gaussian Doubling Times and Reproduction Factors of the COVID-19 Pandemic Disease
• Revisiting the Global Overfat Pandemic
• The COVID-19 Pandemic and Intelligence Communication in the United States
• Pregnancy During the Global COVID-19 Pandemic
• What Caused the Aids Pandemic?
• Radiation-induced Lymphopenia Beyond the COVID-19 Pandemic
• Exercise Frequency and Subjective Well-Being During COVID-19 Pandemic
• Challenges for Drug Repurposing in the COVID-19 Pandemic Era
• Flexible Teaching and Learning Modalities in Undergraduate Science Amid the COVID-19 Pandemic
• The Great Influenza Pandemic Was the Worse Pandemic That Occurs During the First World War
• The COVID-19 Pandemic: Role of Leisure The COVID-19 pandemic has presented numerous health challenges, and leisure activities have played a significant role in combatting it.
• Managing Incremental Healthcare Costs in a Post Pandemic World India’s burgeoning medical tourism industry offers affordable, high-quality healthcare services and wellness options, attracting global visitors.
• Combating Ebola and Marburg Outbreaks Compared to the COVID-19 Pandemic Treatments for the Zaire Ebola virus and vaccines for COVID-19 have been developed. In combating these epidemics, governments must acquire the required resources.
• Childhood Obesity During the COVID-19 Pandemic While the COVID-19 pandemic elicited one of the worst prevalences of childhood obesity, determining its extent was a problem due to the lockdown.
• Changes in Demand and Supply During the Coronavirus Pandemic The paper explains that government measures to regulate prices, namely the creation of price ceilings, created shortages of essential and personal care products.
• Parenting in a Pandemic: Tips to Keep the Calm at Home The article ​“Parenting in a Pandemic: Tips to Keep the Calm at Home” provides a set of recommendations for parents regarding managing children’s behaviors during the pandemic.
• Leadership Response to COVID-19 Pandemic Outbreak The paper presents a healthcare leadership response plan to the COVID-19 pandemic outbreak. It identifies the issue’s urgency and the importance of effective leadership.
• MD Properties’ Project Evaluation During the COVID-19 Pandemic The purpose of the report was to evaluate the project implemented by MD Properties in 2021 to adapt to help operations during the COVID-19 pandemic.
• Effects Women Have Faced During the COVID-19 Pandemic Globally The essay discusses the challenges women face in maintaining their economic security, juggling caregiving responsibilities, and coping with job losses and business closures.
• The Covid-19 Pandemic Impact on Business The pandemic significantly negatively influenced society and the global economy. The pandemic had a massive influence on economics, enterprises, and labor supply.
• Social Changes Due to the COVID-19 Pandemic The COVID-2019 pandemic has affected all areas of society, and from the experience gained, people should draw the appropriate conclusions in order to avoid this in the future.
• Discussion: Supply Chain Management and Pandemic Although the author was aware of the devastating impact of COVID-19 on the global supply chain, Ellyatt (2021) provides a more in-depth insight into this problem.
• Organizational Culture After the COVID-19 Pandemic The COVID-19 outbreak and its consequences led to the necessity to adjust to new working conditions and make corporate culture more flexible.
• The Role of Digitalization in Supporting SMEs During the COVID-19 Pandemic This article analyzes the impact of the COVID-19 pandemic on SMEs and retailers, focusing on the organizational culture of retail businesses and their responses to the crisis.
• Policy Brief: Access to Education After the Pandemic The After-Hours Academy is a business that aims to provide learners from underserved communities with resources to improve their online education.
• The US Government Pandemic Initiatives In order to address the negative effects of the COVID-19 pandemic, governments worldwide, including in the United States, designed special initiatives to help companies.
• The 1918 Pandemic Representation The 1918 pandemic caused by the flu influenza led to the death of more than 50 million people and was believed to be one of the tremendous diseases in history.
• The COVID-19 Pandemic Impacts on the US This paper discusses some of the social, economic, and psychological impacts of the COVID-19 pandemic on the United States of America.
• Struggles Families Encounter During Pandemic Since late 2019, the coronavirus pandemic has expanded far and quickly, wreaking havoc on countless families worldwide.
• The Impact of the COVID-19 Pandemic on Intimate Partner Violence in the US The safety measures implemented by the U.S. government in order to prevent the spread of coronavirus resulted in increased intimate partner violence in the country.
• The Impact of the COVID-19 Pandemic on Sibling Violence The problem of domestic abuse has been extensively studied by researchers worldwide, and one of the main forms of the phenomenon is sibling violence.
• Stress in Pregnant Women Due to COVID-19 Pandemic Pregnancy is a particularly crucial time for the mental health of a woman. The high levels of stress have been linked to exposure to the pandemic.
• Issues of Working With People During the Pandemic Communication is essential when de-escalating a crisis. It is critical that they feel understood, so they need to pay close attention to them.
• The Rental Housing Market Challenges During the COVID Pandemic The policy of freezing the rental price and setting the bar for a monthly fee, as in a German city, can significantly improve the situation in Istanbul.
• The Malaysian Workforce After the COVID-19 Pandemic This essay discusses the employee health and well-being issue prevalent among the Malaysian workforce after the COVID-19 pandemic in detail.
• How the COVID-19 Pandemic Is Changing the Economy World Health Organization characterized the illness as a pandemic on 11th March 2020, resulting in 3 million cases and the demise of 207,973 people.
• The COVID-19 Pandemic’s Social Impact The authors of the article examine the impact of COVID-19 on the psychological and social conditions of the population.
• Air Canada: History, Profit, Pandemic, and Future Air Canada delivers not only people but also cargo all over the world, but, unfortunately, it took a full two years for the company to adapt to the pandemic.
• Utilitarianism and PR During the Pandemic The principle of utilitarianism in the PR sphere contradicts the modern ethical paradigm because it cannot fully provide the ability to make decisions.
• Vaccination Issue Concerning the COVID-19 Pandemic This paper discusses the current vaccination issue concerning the COVID-19 pandemic. Large numbers of patients worldwide refuse vaccines.
• The COVID-19 Pandemic and the Black Plaque This paper discusses the social, economic, and political factors contributing to COVID-19 in the domestic and international spheres and connects COVID-19 and the Black Plague.
• Modeling the Impact of the COVID-19 Pandemic Coronavirus has taken a substantial toll on people worldwide. Being only a year after the eruption of the virus from Wuhan, its effects have been felt globally.
• Addressing Economic Inequality: The Pandemic Challenge Economic inequality continues to be relevant to modern society, with the full range of human rights being available only to the wealthy minority.
• Pandemic Coverage: Omicron Issues The news media provided trustworthy information surrounding pandemic-related developments that had transpired but proved inefficient in making prognoses.
• Economic Inequality and Pandemic Challenge The most vulnerable populations were affected by the coronavirus pandemic because they often could not access economic and public health resources to meet their needs.
• Influenza (H2N1) vs. COVID-19 Pandemic COVID-19 and H2N1 pandemic has impacted the lives of many people. Both pandemics have some similarities and differences, and each has a particular significance.
• The Issue of the Opioid Pandemic in the USA The efforts at addressing the issue of an opioid pandemic have been quite numerous, yet the results that they have yielded cannot be described as stellar.
• COVID-19 Pandemic: Social Media Response by the American Government Using social media to address the public on COVID-19, President Biden and his vice have developed a seven-point plan to help combat the pandemic.
• Could Avian Flu AH5N1 Become a Pandemic?
• Does the Coronavirus (COVID-19) Pandemic Call for a New Model of Older People Care?
• How Can the COVID-19 Pandemic Lead To Positive Changes in Urology Residency?
• How Should HIV/Aids Pandemic Be Addressed?
• What Is the Potential for Avian Influenza to Cause Another Worldwide Pandemic?
• What Is the Impact of Pandemic COVID-19 on Education in India?
• What Are the Regulatory Challenges for Drug Repurposing During the COVID-19 Pandemic?
• What Were the Successes and Failures of the Initial COVID-19 Pandemic Response in Romania?
• Why Obesity Is the New Global Pandemic of 21st Century?
• What Is the Possible Macroeconomic Impact on the UK of an Influenza Pandemic?
• How Financial Markets Lived Under the Global Pandemic of COVID-19?
• What Are the Measures of Ecology and Economics for Pandemic Prevention?
• Are Women Publishing Less During the Pandemic?
• What Is the Impact of COVID-19’s Pandemic on the Economy of Indonesia?
• Which Interventions Work Best in a Pandemic?
• Why Community Participation Is Crucial in a Pandemic?
• How to Prepare Business for a Post-pandemic World?
• What Are the Strategies for Mitigating an Influenza Pandemic?
• What Are the Origins of HIV and the Aids Pandemic?
• How to Predict and Prevent the Next Pandemic Zoonosis?
• How Did COVID‐19 Pandemic Show Cricial Cybersecurity Issues?
• What Are the Best Practices for Implementing Remote Learning During a Pandemic?
• What Were the Ecological Consequences of a Pandemic?
• How to Manage the Effectiveness of E-Commerce Platforms in a Pandemic?
• What Are the Internal and External Effects of Social Distancing in a Pandemic?
• Pandemic Challenge and Economic Inequality The coronavirus pandemic has presented two significant challenges for American society: public health and economic crises.
• The Impact of the COVID-19 Pandemic on the International Trading The coronavirus pandemic has created new tough barriers to globalization and trade: the shutdown of production and the borders of leading countries and economic groups.
• Production and Growth During the Pandemic: A Case of U.S. Manufacturing By recognizing the factors that shape the production process, U.S. manufacturers have managed to continue delivering solid performance despite the effects of the coronavirus.
• “And the Band Played On” During the AIDS Pandemic The movie “And the Band Played On” touches on different prevalent issues during the AIDS pandemic that affected the world in the 1980s.
• Planning in a Post-Pandemic World With the need for new, stricter health regulations in the workplace for a safer internal environment in the office come limitations on the number of persons of staff present.
• Pandemic in Seurat’s “A Sunday Afternoon on the Island of la Grande Jatte” The current paper includes reflecting on the pandemic through the lens of Seurat’s “A Sunday Afternoon on the Island of La Grande Jatte”.
• Police Killing Black People in a Pandemic Police violence as a network of brutal measures is sponsored by the government that gives the police officers permission to treat black people with disdain.
• Racial Discrimination in the Industry of Face Masks During the COVID-19 Pandemic This research, done in an industry that produces face masks, provides a clear image of racism during the coronavirus pandemic period.
• American Pandemics From Columbus to Coronavirus The decisions made by previous generations of Americans during epidemics led to the development of structural racism and class segregation.
• The COVID-19 Pandemic’s Impact on the Airline Industry The main objective of the paper was to provide evidence-based coverage of the impact of the Covid-19 pandemic on airline operations around the world.
• Pandemic-Related Changes in Consumer Behavior The COVID-19 pandemic has affected consumer behavior around the globe so considerably that new trends have emerged that are mostly based on seeking stability.
• United States Economy’s Outlook After Pandemic The United States has shown signs of a rebound after the Covid-19 pandemic through the rising GDP and the low unemployment rates witnessed in the country.
• Pandemic’s Impact on Mental Health & Substance and Alcohol Abuse While substance use disorder can impose mental health challenges on those who consume drugs, COVID-19 affects the psychology of all humankind.
• The US Stock Market Affected by the COVID-19 Pandemic Despite the terrible effects that the coronavirus has had on the stock market in the United States, it is clear that the country has gained a great deal from the adverse effects.
• COVID-19 Pandemic in Media: Agenda Setting Theory For the analysis, the currently gaining attention theory about the laboratory origin of the virus was chosen, as well as its coverage in authoritative publications.
• The H3N2 Virus Pandemics of 1968 The H3N2 virus contained two genes derived from the six genes from the A(H2N2) virus, associated with the 1957 H2N2 pandemic.
• Tourism Sustainability After COVID-19 Pandemic This essay will discuss how the COVID-19 pandemic has influenced the sustainability sector of the tourism industry.
• The COVID-19 Pandemic and Labor Market Dynamics The labor market dynamics of the COVID-19 recession in the United States are studied using a search-and-matching model incorporating temporary unemployment.
• Recovery the Post Pandemic World The paper briefly explains what sort of recovery the post-pandemic world will likely experience and how Ireland is positioned to cope or change tact.
• Impact of COVID-19 Pandemic on the African American Communities This paper analyzes how the COVID-19 pandemic affected the economic aspect of the African American communities. A female and two males were interviewed.
• The COVID-19 Pandemic and Its Effects Worldwide Covid-19 has remained a threat in many countries in the last two years. Numerous restrictions and precautions have been implemented in various nations.
• COVID-19 and Playing Sports During a Pandemic The review focuses on three significant sports areas under the conditions of a pandemic: health, commercialism, and structural aspects.
• COVID-19 Pandemic and Valuable Cargo The COVID-19 pandemic has played a significant role in changing logistics, with the supply chain playing a more critical role than ever before.
• Telehealth in the Pandemic: Benefits & Limitations Despite the benefits of telehealth during the pandemic period, the older population still has reservations about the suitability and efficacy of such technologies in the long run.
• Review of “For Millions, the Pandemic Is Far From Over” Article The article by Doheny, presented by the reputable healthcare source Medscape, examines the challenges of immunocompromised Americans.
• The COVID-19 Pandemic Impact on Society COVID-19 has disrupted daily life and slowed the global economy. In addition, thousands of people have been affected by this pandemic, and are either sick or dying.
• Older Adults Surviving the COVID-19 Pandemic: The Mental Health Benefits of Physical Activity The aim of this paper is to identify the effect of physical activity on mental health among older adults during the COVID-19 pandemic.
• Virtual Teams’ Adaptation to the Conditions of the COVID-19 Pandemic Virtual teams’ adaptation to the conditions of the COVID-19 pandemic happened through forced utilization of technology to establish effective communication.
• The Dabbawalas and the COVID-19 Pandemic The global COVID-19 pandemic cannot go unnoticed for the dabbawalas, which is a system of lunchbox delivery and return services for India’s employees.
• Impact of the COVID-19 Pandemic on Human Well-Being The COVID-19 pandemic taught people to appreciate their social ties and health more and helped them reconsider the impact of social isolation on human well-being.
• Global Pandemic of COVID-19 From an Epidemiological Perspective The epidemiological perspective of the COVID-19 pandemic requires studying the statistical data for identifying patterns that could be addressed or eliminated.
• Supply Chain Management Challenges Amid the COVID-19 Pandemic The increasing number of suppliers and business continuity risks must be considered to find relevant solutions to the Kuwaiti supply chain management problem.
• The COVID-19 Pandemic’s Impact on Australia This work will focus on discussing some of the considerations necessary for the Australian business to start its operation in a new market environment during COVID-19.
• Long-Term Changes in Information Technology During the Pandemic of COVID-19 The outbreak of the COVID-19 in China is not only destructing the global economy but it can also have a positive effect on the development of the IT industry.
• Covid-19 Pandemic-Related Macroeconomic Issues COVID-19 fueled many macroeconomic issues. The first is high inflation which increased the living costs and pressure on low-income earners.
• Impact of the Coronavirus Pandemic on the Global Economy The paper is aimed to overview the Coronavirus pandemic’s characteristics and analyze the outcomes of the disease outbreak within major economic spheres.
• Texas Judiciary During the COVID-19 Pandemic The current paper indicates that the main issues faced by the Texas justice system and state judges are caused by the COVID-19 pandemic.
• The COVID-19 Pandemic Has Brought Us Too Close Together The resources presented in the articles depict a new reality where violence and riots occur due to a depressed populace who can’t stand any injustice.
• Pre-pandemic and Pandemic Consumer Behavior
• Consumer Behavior: Impact of the COVID-19 Pandemic
• How the Corona Virus-19 Pandemic Affected Society
• Healthcare Policy Influences: COVID-19 Pandemic
• Built Environment and Pandemics
• Hate Crimes Against Asian Americans During the Pandemic
• Hand Sanitizers in COVID-19 Pandemic: Pros and Cons
• The Story of Sam, OCD, and the COVID Pandemic
• Parents and Children’s E-Safety Education During the Pandemic
• Arguments Against Masks During Pandemic and Personal Freedom
• White and Black People in USA During COVID-19 Pandemic
• Psychological Effects COVID-19 Pandemic Leading to Hospital Nursing Shortage
• Poor Staff Management During the Pandemic
• Economic Predictions on Recovery After COVID-19 Pandemic Shock
• Tourism and Sustainable Development During the COVID-19 Pandemic
• Healthcare for Underserved Communities During Covid-19 Pandemic
• Preparing a Child for School During COVID Pandemic
• Restaurant Business During The Pandemic
• US Actions Concerning COVID-19 Pandemic
• The Effect of the COVID-19 Pandemic on Businesses
• Can Coronavirus Pandemic Lead to World War III?
• Poor Management & Care Quality During the COVID-19 Pandemic
• The COVID-19 Pandemic in US and World History
• Comparison of How Communities React to Plagues and COVID-19 Pandemic
• Social Solidarity During the Pandemic
• The COVID-19 Pandemic Organizational Risk Management Strategies
• Global Society: Before and After The Coronavirus Pandemic
• VA Telehealth During the COVID-19 Pandemic: Expansion and Impact
• Mental Health During the Pandemic: Research Design, Steps, and Approach
• Physical Activity Impact on Psychological Health During COVID-19 Pandemic
• Public Policy Meeting: “VA Telehealth During the COVID-19 Pandemic”
• Existence of God in Times of Covid-19 Pandemic
• Children and the COVID-19 Pandemic
• Covid-19 Pandemic and Mental Health of American Population
• Key Takeaways from the Coronavirus Pandemic
• Racial Inequalities in the Context of Pandemic Vaccination
• Healthcare Rationing During a Pandemic
• Pandemics & Biothreats and Governmental Responses

🌶️ Hot Pandemic Ideas to Write about

• Labor Market Developments During the Covid-19 Pandemic
• Influenza Pandemic Outbreak Analysis
• Streaming Service for the Elderly During the COVID-19 Pandemic
• Picnics Become Popular Around the Globe During Pandemics
• School Closure During Influenza Pandemic
• Influenza Pandemic Outbreak Overview
• Changing Health Behavior in Current Pandemic Situation
• The Impact of COVID-19 Pandemic on the Community of Charleston, South Carolina
• Mental Health Buring a COVID-19 Pandemic
• Is the Pandemic Beneficial?: Argument with an Opossum
• Job Satisfaction Levels During the COVID-19 Pandemic
• COVID-19 Pandemic: Economic Factors and Consequences
• Florida Administration’s Response to the Coronavirus Pandemic
• City Planning and Pandemics: Efficient Approach
• COVID-19 Pandemic’s Impact on the Environment
• Nature Relatedness and Well-Being during COVID-19 Pandemic
• COVID-19 Pandemic: What We Can Learn From the Past?
• COVID-19 Pandemic and a Globalized Economy
• Psychonomics of Consumers During the covid19 Pandemic
• How the Pandemic Has Worsened Opioid Addition
• The Impact of the Worldwide COVID-19 Pandemic on Essential Social Values
• Project Management in Healthcare During the COVID-19 Pandemic
• The Sports Industry During the Covid-19 Pandemic
• Ethical Perspective on Pandemics
• The Covid-19 Pandemic Analysis
• Mitigating the Impact of the Novel Coronavirus Pandemic
• The Company’s Exit from the Crisis in a Pandemic
• Employees Retention During COVID-19 Pandemic
• Pandemics and Epidemics that Changed the World
• Streaming Service and Elderly During COVID-19 Pandemic
• Hoarding and Opportunistic Behavior during COVID-19 Pandemics
• Racist Assaults Against Asians and Coronavirus Pandemic
• Australian Freight Companies’ Ethics During the COVID-19 Pandemics
• Budgetary Change: Unstable Situation Due to the Pandemic
• City Planning and Pandemic: Efficient Approach
• The Effect of Global Pandemic on the Role of Sports in Our Lives
• Global Pandemic Issues: Prevention of Infection and Transmission of COVID-19
• “Senate HELP Hearing on Coronavirus Responses and Future Pandemic Preparedness”: An Overview
• The Coronavirus Pandemic: Detergents Against the Germs
• AIDS Pandemic: Impact on Human Health
• Negative Impact of the 2020 COVID Pandemic on World Industries
• 2009 H1N1 Flu Pandemic, Vaccination and Rates

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StudyCorgi . "317 COVID-19 & Pandemic Essay Topics for Students." March 1, 2022. https://studycorgi.com/ideas/pandemic-essay-topics/.

StudyCorgi . 2022. "317 COVID-19 & Pandemic Essay Topics for Students." March 1, 2022. https://studycorgi.com/ideas/pandemic-essay-topics/.

These essay examples and topics on Pandemic were carefully selected by the StudyCorgi editorial team. They meet our highest standards in terms of grammar, punctuation, style, and fact accuracy. Please ensure you properly reference the materials if you’re using them to write your assignment.

This essay topic collection was updated on January 22, 2024 .

• Open access
• Published: 08 September 2020

Preparing for a pandemic: highlighting themes for research funding and practice—perspectives from the Global Research Collaboration for Infectious Disease Preparedness (GloPID-R)

• Alice Norton 1 , 2 ,
• Louise Sigfrid 1 ,
• Adeniyi Aderoba 3 , 4 ,
• Naima Nasir 3 , 5 ,
• Peter G. Bannister 6 ,
• Shelui Collinson 7 ,
• James Lee 3 ,
• Geneviève Boily-Larouche 8 ,
• Josephine P. Golding 9 ,
• Evelyn Depoortere 10 ,
• Gail Carson 1 ,
• Barbara Kerstiëns 10 &
• Yazdan Yazdanpanah 11  

BMC Medicine volume  18 , Article number:  273 ( 2020 ) Cite this article

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Funders and researchers around the world are responding to the COVID-19 pandemic at urgent speed, with greater effectiveness and collaboration than ever before. In the past 8 months, the global health research community has collectively generated and shared a huge amount of knowledge in particular into the clinical characterisation, behavioural insights, genetics, epidemiology, viral pathogenesis, clinical management and diagnosis of COVID-19. This is built on substantial prior preparation, with researchers, public health professionals, funders and multilateral bodies in this field having anticipated and prepared for a pandemic for many years. Further knowledge is needed however to control this pandemic and for safe easing of public health measures.

The Global Research Collaboration for Infectious Disease Preparedness (GloPID-R) is an international network of global health funders and stakeholders formed in 2013 to ensure preparedness for a coordinated research response to epidemics and pandemics [ 1 ]. GloPID-R aims to address challenges to effective research in epidemics and pandemics, through both preparedness and response activities.

In December 2019, as part of its preparedness activities, GloPID-R convened a Frontiers meeting with their funded clinical trial networks and cohorts along with key stakeholders involved in emerging epidemic and pandemic preparedness and response globally. The aim was to identify how these groups might collaborate in delivering a coordinated research response in the event of an epidemic or pandemic. Now that we are in the midst of the COVID-19 pandemic, it is important to highlight and reflect on the recommendations identified by these participants, to inform the ongoing research funding and practice during the COVID-19 pandemic as well as preparedness for future outbreaks.

Preparedness themes for research funding and practice

Research cohorts are valuable tools for building pandemic research responses.

Active cohort studies have the potential to play a key role in emerging epidemic and pandemic research. Longitudinal cohorts generate a wealth of data from individual participants about clinical and laboratory outcomes, which allow for a better understanding of effect modifiers such as genetic factors, chronic disease, socio-demographic factors and long-term outcomes than is possible from other study designs. Established cohorts can also function as a broker between emerging disease researchers and the community addressing challenges to the acceptance of research [ 2 ].

There was a call for newly funded cohorts to be designed to be both usable and re-usable in the event of new emerging research questions.

Research capacity and activity mapping are essential to facilitate collaboration and improve targeting of resources

Improved mapping of both global research capacity and ongoing global research activities was identified as necessary to improve identification of opportunities for collaboration and ‘pivoting’ or ‘supplementing’ of ongoing research efforts in outbreaks and improve coordination as pandemics shift globally.

Research collaboration especially between clinical trial networks and cohorts is essential to improve research outcomes

Coordination, in particular across clinical trials and cohorts, is needed to make the most effective use of scarce resources to ensure that studies are not underpowered due to changes in infection rates in differing geographical areas.

Sustainability of funding and research capacity during inter-epidemic periods is key to ensure quality research can be initiated rapidly for epidemics and pandemics

Setting up completely new studies during epidemics and pandemics takes substantial time from the funding commitment, developing necessary infrastructure, research processes and approvals and most importantly trust within the community and leads to fragmentation. Therefore, it may be more efficient to build on large existing studies with baseline continuous research activities, which allow the recruitment of patients from the outset of an outbreak.

Strengthening local research capacity and working closely with governments, local and regional partners and communities to develop and lead national research plans are necessary to ensure critical activities.

Rapid research and funding systems and rapid data sharing are needed to facilitate knowledge generation to improve practice within epidemics and pandemics

Rapid mobilisation of research funds and resources, early engagement with ethics committees and staged approved ethical protocols, adaptive studies and trial designs were all identified as necessary steps to reduce the significant prior delays in initiating research activities in the epidemic response. Funders acknowledged that for many, current funding structures are often not flexible enough to allow quick pivoting or redirection of resources.

Rapid data sharing is needed to accelerate health benefits and outcomes, to facilitate timely dissemination of data to the public for action, and to prevent misinformation. The GloPID-R Data Sharing Roadmap [ 3 ] highlights the key steps to address to enable global data sharing, and the meeting highlighted the need to share emerging barriers and potential solutions in its implementation.

Ethics and social science need to be core to broader epidemic pandemic and research response activities

Ethics should be at the heart of decision-making and an opportunity for researchers to ensure that the optimal value is being obtained from the research for all stakeholders involved, including communities and individuals. Solutions to improve acceptance and uptake of research by healthcare workers and participants are also crucial along with the need for greater inclusion and translation to the practice of qualitative and social sciences studies in epidemics.

These six preparedness recommendations have already been mirrored and in many cases directly informed practice during the COVID-19 research response (see Table  1 ).

There is potential for further leveraging and global coordination of both existing cohorts and clinical trial networks to improve research quality and outcomes during epidemics and pandemics.

Timely, effective epidemic research to improve health outcomes can only be achieved if multidisciplinary research structures, regulatory functions, funding, partnerships and trust are built and maintained sustainably during inter-epidemic periods. Building sustainable research capacity and capability globally needs to be central to research on the COVID-19 pandemic and for future epidemics and pandemics. Sustainable active studies and multidisciplinary networks, with pre-approved protocols positioned strategically globally, need to build upon this.

Conclusions

Lessons learned from the COVID-19 research response need to be incorporated into a multidisciplinary framework to facilitate rapid, coordinated research funding and support structures for researchers, to provide an even faster and coordinated research response, avoiding redundancy. New funder principles for research in epidemics provide the first step toward this [ 7 ].

Availability of data and materials

Not applicable

Matthiessen L, et al. Coordinating funding in public health emergencies. Lancet. 2016;(2016). https://doi.org/10.1016/S0140-6736(16)30604-3 .

Sigfrid L, et al. Addressing political, economic, administrative, regulatory, logistical, ethical, and social challenges to clinical research responses to emerging epidemics and pandemics: a systematic review. Lancet. 2019;394(2).

Norton A, Pardinaz-Solis R & Carson G. 2019. GloPID-R Roadmap for data sharing in public health emergencies. Available from: https://www.glopid-r.org/wp-content/uploads/2019/06/glopid-r-roadmap-for-data-sharing.pdf .

UKCDR and GloPID-R COVID-19 Research Project Tracker, 2020, https://www.ukcdr.org.uk/funding-landscape/covid-19-research-project-tracker/ .

Principles for data sharing in public health emergencies. GloPID-R data sharing working group. London: Figshare; 2017. Available from: doi: https://doi.org/10.6084/m9.figshare.4733590 [cited 2020 Jul 07].

A Coordinated Global Research Roadmap: 2019 Novel Coronavirus. Available at: https://www.glopid-r.org/wp-content/uploads/2020/03/who-2019-novel-coronavirus-global-research-roadmap.pdf .

Norton A, Mphahlele J, Yazdanpanah Y, Piot P, Bayona MT. Strengthening the global effort on COVID-19 research. The Lancet. 2020;396(10248):375.

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Acknowledgements

Meeting participants:

Adeniyi Aderoba (University of Oxford, Oxford, UK; University of Medical Sciences Teaching Hospital, Ondo State, Nigeria); John Amuasi (ALERRT, Kumasi, Ghana); Amrish Baidjoe (EAN, RECON, London, UK); Peter Bannister (Brighton & Sussex Medical School, Brighton, UK); Genevieve Boily-Larouche (CIHR, Ottawa, Canada); Elaine Boylan (MRC, London, UK); Serge Breysse (GloPID-R, Paris, France); David Carr (Wellcome Trust, London, UK); Gail Carson (GloPID-R, Oxford, UK); Amol Chaudhari (CEPI, London, UK); Guy Cochrane (EMBL-EBI, Hinxton, UK); Shelui Collinson (NHS, London, UK); Chioma Dan-Nwafor (Nigeria Centre for Disease Control (NCDC), Abuja, Nigeria); Xavier De Lamballerie (UVE, Marseille, France); Evelyn Depoortere (European Commission); Lennie Derde (REMAP-CAP, Utrecht, Netherlands); Eric Dortenzio (REACTing, Paris, France); Tamara Giles Vernick (Institut Pasteur, Paris, France); Nina Gobat (PREPARE, ECRAID, Oxford, UK); Josie Golding (Wellcome Trust, London, UK); Herman Goossens (PREPARE, ECRAID, Brussels, Belgium); Jean Marie Habarugira (EDCTP, Hague, Netherlands); Ana Maria Henao Restrepo (WHO, Geneva, Switzerland); David Heymann (LSHTM, London, UK); Elisabeth Higgs (NIH, HHS, USG, Bethesda, USA); Bruno Hoen (Institut Pasteur, Paris, France); William Hsiao (BCCDC PHL, Vancouver, Canada); Thomas Jaenisch (ReCoDID, Heidelberg, Germany); Nina Jamieson (ISARIC, Oxford, UK); Marie Jaspard (ALIMA, Paris, France); Barbara Kerstiëns (European Commission); Trudie Lang (TGHN, Oxford, UK); Joanne Langley (Dalhousie University, Halifax, Canada); James Lee (ISARIC, Oxford, UK); Katherine Littler (WHO, Geneva, Switzerland); Dermot Maher (TDR, Geneva, Switzerland); Denis Malvy (Bordeaux University Hospital, Bordeaux, France); Gustavo Matta (FIOCRUZ, Rio de Janeiro, Brazil); Romans Matulevics (ISARIC, Oxford, UK); Laura Merson (IDDO, Oxford, UK); Shoji Miyagawa (AMED, Tokyo, Japan); Naima Nasir (University of Oxford, Oxford, UK; APIN-Supported HIV Treatment Centre, Jos University Teaching Hospital, Jos, Nigeria); Robert Newton (ALPHA, LSHTM, Entebbe, Uganda); Alice Norton (GloPID-R, Oxford, UK); Piero Olliaro (ISARIC, Oxford, UK); Hitoshi Oshitani (Tohoko University Graduate School of Medicine, Sendai, Japan); Barbara Rath (PEDSIDEA, Vienna Vaccine Safety Initiative, Berlin, Germany); David Robertson (University of Edinburgh, Edinburgh, UK); Cathy Roth (DFID, London, UK); Kathy Rowan (REMAP-CAP, London, UK); Nahoko Shindo (WHO, Geneva, Switzerland); Louise Sigfrid (ERGO, Oxford, UK); Stefanie Sowinski (European Commission); David Vaughn (BMGF, Seattle, USA); Richard Wilder (CEPI, London, UK); Annelies Wilder Smith (LSHTM, London, UK); Jimmy Whitworth (LSHTM, London, UK); Katharine Wright (Nuffield Council on Bioethics, London, UK); Yazdan Yazdanpanah (GloPID-R, Paris, France); and Lay-Myint Yoshida (Nagasaki University, Nagasaki, Japan).

The GloPID-R Secretariat is funded through the European Union’s Horizon 2020 Research and Innovation Programme under grant agreement 643434.

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Norton, A., Sigfrid, L., Aderoba, A. et al. Preparing for a pandemic: highlighting themes for research funding and practice—perspectives from the Global Research Collaboration for Infectious Disease Preparedness (GloPID-R). BMC Med 18 , 273 (2020). https://doi.org/10.1186/s12916-020-01755-y

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Just 20% of the public views the coronavirus as a major threat to the health of the U.S. population and only 10% are very concerned about getting a serious case themselves. In addition, a relatively small share of U.S. adults (28%) say they’ve received an updated COVID-19 vaccine since last fall.

How the Pandemic Has Affected Attendance at U.S. Religious Services

During the pandemic, a stable share of U.S. adults have been participating in religious services in some way – either virtually or in person – but in-person attendance is slightly lower than it was before COVID-19. Among Americans surveyed across several years, the vast majority described their attendance habits in roughly the same way in both 2019 and 2022.

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Here’s a look at what surveys by Pew Research Center and other organizations have found about Americans’ mental health during the pandemic.

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Online Religious Services Appeal to Many Americans, but Going in Person Remains More Popular

About a quarter of U.S. adults regularly watch religious services online or on TV, and most of them are highly satisfied with the experience. About two-in-ten Americans (21%) use apps or websites to help with reading scripture.

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About a third of workers with jobs that can be done remotely are working from home all the time, according to a new Pew Research Center survey.

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Nearly a quarter of countries used force to prevent religious gatherings during the pandemic; other government restrictions and social hostilities related to religion remained fairly stable.

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Research Roundup: How the Pandemic Changed Management

• Mark C. Bolino,
• Jacob M. Whitney,
• Sarah E. Henry

Lessons from 69 articles published in top management and applied psychology journals.

Researchers recently reviewed 69 articles focused on the management implications of the Covid-19 pandemic that were published between March 2020 and July 2023 in top journals in management and applied psychology. The review highlights the numerous ways in which employees, teams, leaders, organizations, and societies were impacted and offers lessons for managing through future pandemics or other events of mass disruption.

The recent pandemic disrupted life as we know it, including for employees and organizations around the world. To understand such changes, we recently reviewed 69 articles focused on the management implications of the Covid-19 pandemic. These papers were published between March 2020 and July 2023 in top journals in management and applied psychology.

• Mark C. Bolino is the David L. Boren Professor and the Michael F. Price Chair in International Business at the University of Oklahoma’s Price College of Business. His research focuses on understanding how an organization can inspire its employees to go the extra mile without compromising their personal well-being.
• JW Jacob M. Whitney is a doctoral candidate in management at the University of Oklahoma’s Price College of Business and an incoming assistant professor at Kennesaw State University. His research interests include leadership, teams, and organizational citizenship behavior.
• SH Sarah E. Henry is a doctoral candidate in management at the University of Oklahoma’s Price College of Business and an incoming assistant professor at the University of South Florida. Her research interests include organizational citizenship behaviors, workplace interpersonal dynamics, and international management.

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What the Data Says About Pandemic School Closures, Four Years Later

The more time students spent in remote instruction, the further they fell behind. And, experts say, extended closures did little to stop the spread of Covid.

By Sarah Mervosh ,  Claire Cain Miller and Francesca Paris

Four years ago this month, schools nationwide began to shut down, igniting one of the most polarizing and partisan debates of the pandemic.

Some schools, often in Republican-led states and rural areas, reopened by fall 2020. Others, typically in large cities and states led by Democrats, would not fully reopen for another year.

A variety of data — about children’s academic outcomes and about the spread of Covid-19 — has accumulated in the time since. Today, there is broad acknowledgment among many public health and education experts that extended school closures did not significantly stop the spread of Covid, while the academic harms for children have been large and long-lasting.

While poverty and other factors also played a role, remote learning was a key driver of academic declines during the pandemic, research shows — a finding that held true across income levels.

Source: Fahle, Kane, Patterson, Reardon, Staiger and Stuart, “ School District and Community Factors Associated With Learning Loss During the COVID-19 Pandemic .” Score changes are measured from 2019 to 2022. In-person means a district offered traditional in-person learning, even if not all students were in-person.

“There’s fairly good consensus that, in general, as a society, we probably kept kids out of school longer than we should have,” said Dr. Sean O’Leary, a pediatric infectious disease specialist who helped write guidance for the American Academy of Pediatrics, which recommended in June 2020 that schools reopen with safety measures in place.

There were no easy decisions at the time. Officials had to weigh the risks of an emerging virus against the academic and mental health consequences of closing schools. And even schools that reopened quickly, by the fall of 2020, have seen lasting effects.

But as experts plan for the next public health emergency, whatever it may be, a growing body of research shows that pandemic school closures came at a steep cost to students.

The longer schools were closed, the more students fell behind.

At the state level, more time spent in remote or hybrid instruction in the 2020-21 school year was associated with larger drops in test scores, according to a New York Times analysis of school closure data and results from the National Assessment of Educational Progress , an authoritative exam administered to a national sample of fourth- and eighth-grade students.

At the school district level, that finding also holds, according to an analysis of test scores from third through eighth grade in thousands of U.S. districts, led by researchers at Stanford and Harvard. In districts where students spent most of the 2020-21 school year learning remotely, they fell more than half a grade behind in math on average, while in districts that spent most of the year in person they lost just over a third of a grade.

( A separate study of nearly 10,000 schools found similar results.)

Such losses can be hard to overcome, without significant interventions. The most recent test scores, from spring 2023, show that students, overall, are not caught up from their pandemic losses , with larger gaps remaining among students that lost the most ground to begin with. Students in districts that were remote or hybrid the longest — at least 90 percent of the 2020-21 school year — still had almost double the ground to make up compared with students in districts that allowed students back for most of the year.

Some time in person was better than no time.

As districts shifted toward in-person learning as the year went on, students that were offered a hybrid schedule (a few hours or days a week in person, with the rest online) did better, on average, than those in places where school was fully remote, but worse than those in places that had school fully in person.

Students in hybrid or remote learning, 2020-21

80% of students

Some schools return online, as Covid-19 cases surge. Vaccinations start for high-priority groups.

Teachers are eligible for the Covid vaccine in more than half of states.

Most districts end the year in-person or hybrid.

Source: Burbio audit of more than 1,200 school districts representing 47 percent of U.S. K-12 enrollment. Note: Learning mode was defined based on the most in-person option available to students.

Income and family background also made a big difference.

A second factor associated with academic declines during the pandemic was a community’s poverty level. Comparing districts with similar remote learning policies, poorer districts had steeper losses.

But in-person learning still mattered: Looking at districts with similar poverty levels, remote learning was associated with greater declines.

A community’s poverty rate and the length of school closures had a “roughly equal” effect on student outcomes, said Sean F. Reardon, a professor of poverty and inequality in education at Stanford, who led a district-level analysis with Thomas J. Kane, an economist at Harvard.

Score changes are measured from 2019 to 2022. Poorest and richest are the top and bottom 20% of districts by percent of students on free/reduced lunch. Mostly in-person and mostly remote are districts that offered traditional in-person learning for more than 90 percent or less than 10 percent of the 2020-21 year.

But the combination — poverty and remote learning — was particularly harmful. For each week spent remote, students in poor districts experienced steeper losses in math than peers in richer districts.

That is notable, because poor districts were also more likely to stay remote for longer .

Some of the country’s largest poor districts are in Democratic-leaning cities that took a more cautious approach to the virus. Poor areas, and Black and Hispanic communities , also suffered higher Covid death rates, making many families and teachers in those districts hesitant to return.

“We wanted to survive,” said Sarah Carpenter, the executive director of Memphis Lift, a parent advocacy group in Memphis, where schools were closed until spring 2021 .

“But I also think, man, looking back, I wish our kids could have gone back to school much quicker,” she added, citing the academic effects.

Other things were also associated with worse student outcomes, including increased anxiety and depression among adults in children’s lives, and the overall restriction of social activity in a community, according to the Stanford and Harvard research .

Even short closures had long-term consequences for children.

While being in school was on average better for academic outcomes, it wasn’t a guarantee. Some districts that opened early, like those in Cherokee County, Ga., a suburb of Atlanta, and Hanover County, Va., lost significant learning and remain behind.

At the same time, many schools are seeing more anxiety and behavioral outbursts among students. And chronic absenteeism from school has surged across demographic groups .

These are signs, experts say, that even short-term closures, and the pandemic more broadly, had lasting effects on the culture of education.

“There was almost, in the Covid era, a sense of, ‘We give up, we’re just trying to keep body and soul together,’ and I think that was corrosive to the higher expectations of schools,” said Margaret Spellings, an education secretary under President George W. Bush who is now chief executive of the Bipartisan Policy Center.

Closing schools did not appear to significantly slow Covid’s spread.

Perhaps the biggest question that hung over school reopenings: Was it safe?

That was largely unknown in the spring of 2020, when schools first shut down. But several experts said that had changed by the fall of 2020, when there were initial signs that children were less likely to become seriously ill, and growing evidence from Europe and parts of the United States that opening schools, with safety measures, did not lead to significantly more transmission.

“Infectious disease leaders have generally agreed that school closures were not an important strategy in stemming the spread of Covid,” said Dr. Jeanne Noble, who directed the Covid response at the University of California, San Francisco health system.

Politically, though, there remains some disagreement about when, exactly, it was safe to reopen school.

Republican governors who pushed to open schools sooner have claimed credit for their approach, while Democrats and teachers’ unions have emphasized their commitment to safety and their investment in helping students recover.

“I do believe it was the right decision,” said Jerry T. Jordan, president of the Philadelphia Federation of Teachers, which resisted returning to school in person over concerns about the availability of vaccines and poor ventilation in school buildings. Philadelphia schools waited to partially reopen until the spring of 2021 , a decision Mr. Jordan believes saved lives.

“It doesn’t matter what is going on in the building and how much people are learning if people are getting the virus and running the potential of dying,” he said.

Pandemic school closures offer lessons for the future.

Though the next health crisis may have different particulars, with different risk calculations, the consequences of closing schools are now well established, experts say.

In the future, infectious disease experts said, they hoped decisions would be guided more by epidemiological data as it emerged, taking into account the trade-offs.

“Could we have used data to better guide our decision making? Yes,” said Dr. Uzma N. Hasan, division chief of pediatric infectious diseases at RWJBarnabas Health in Livingston, N.J. “Fear should not guide our decision making.”

Source: Fahle, Kane, Patterson, Reardon, Staiger and Stuart, “ School District and Community Factors Associated With Learning Loss During the Covid-19 Pandemic. ”

The study used estimates of learning loss from the Stanford Education Data Archive . For closure lengths, the study averaged district-level estimates of time spent in remote and hybrid learning compiled by the Covid-19 School Data Hub (C.S.D.H.) and American Enterprise Institute (A.E.I.) . The A.E.I. data defines remote status by whether there was an in-person or hybrid option, even if some students chose to remain virtual. In the C.S.D.H. data set, districts are defined as remote if “all or most” students were virtual.

Sarah Mervosh covers education for The Times, focusing on K-12 schools. More about Sarah Mervosh

Claire Cain Miller writes about gender, families and the future of work for The Upshot. She joined The Times in 2008 and was part of a team that won a Pulitzer Prize in 2018 for public service for reporting on workplace sexual harassment issues. More about Claire Cain Miller

Francesca Paris is a Times reporter working with data and graphics for The Upshot. More about Francesca Paris

Study tracks shifts in student mental health during college

Dartmouth study followed 200 students all four years, including through the pandemic.

A four-year study by Dartmouth researchers captures the most in-depth data yet on how college students' self-esteem and mental health fluctuates during their four years in academia, identifying key populations and stressors that the researchers say administrators could target to improve student well-being.

The study also provides among the first real-time accounts of how the coronavirus pandemic affected students' behavior and mental health. The stress and uncertainty of COVID-19 resulted in long-lasting behavioral changes that persisted as a "new normal" even as the pandemic diminished, including feeling more stressed, less socially engaged, and sleeping more.

The researchers tracked more than 200 Dartmouth undergraduates in the classes of 2021 and 2022 for all four years of college. Students volunteered to let a specially developed app called StudentLife tap into the sensors that are built into smartphones. The app cataloged their daily physical and social activity, how long they slept, their location and travel, the time they spent on their phone, and how often they listened to music or videos. Students also filled out weekly behavioral surveys, and selected students gave post-study interviews.

The study -- which is the longest mobile-sensing study ever conducted -- is published in the Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies . The researchers will present it at the Association of Computing Machinery's UbiComp/ISWC 2024 conference in Melbourne, Australia, in October. The team made their anonymized data set publicly available -- including self-reports, surveys, and phone-sensing and brain-imaging data -- to help advance research into the mental health of students during their college years.

Andrew Campbell, the paper's senior author and Dartmouth's Albert Bradley 1915 Third Century Professor of Computer Science, said that the study's extensive data reinforces the importance of college and university administrators across the country being more attuned to how and when students' mental well-being changes during the school year.

"For the first time, we've produced granular data about the ebb and flow of student mental health. It's incredibly dynamic -- there's nothing that's steady state through the term, let alone through the year," he said. "These sorts of tools will have a tremendous impact on projecting forward and developing much more data-driven ways to intervene and respond exactly when students need it most."

First-year and female students are especially at risk for high anxiety and low self-esteem, the study finds. Among first-year students, self-esteem dropped to its lowest point in the first weeks of their transition from high school to college but rose steadily every semester until it was about 10% higher by graduation.

"We can see that students came out of high school with a certain level of self-esteem that dropped off to the lowest point of the four years. Some said they started to experience 'imposter syndrome' from being around other high-performing students," Campbell said. "As the years progress, though, we can draw a straight line from low to high as their self-esteem improves. I think we would see a similar trend class over class. To me, that's a very positive thing."

Female students -- who made up 60% of study participants -- experienced on average 5% greater stress levels and 10% lower self-esteem than male students. More significantly, the data show that female students tended to be less active, with male students walking 37% more often.

Sophomores were 40% more socially active compared to their first year, the researchers report. But these students also reported feeling 13% more stressed than during their first year as their workload increased, they felt pressure to socialize, or as first-year social groups dispersed.

One student in a sorority recalled that having pre-arranged activities "kind of adds stress as I feel like I should be having fun because everyone tells me that it is fun." Another student noted that after the first year," students have more access to the whole campus and that is when you start feeling excluded from things."

In a novel finding, the researchers identify an "anticipatory stress spike" of 17% experienced in the last two weeks of summer break. While still lower than mid-academic year stress, the spike was consistent across different summers.

In post-study interviews, some students pointed to returning to campus early for team sports. Others specified reconnecting with family and high school friends during their first summer home, saying they felt "a sense of leaving behind the comfort and familiarity of these long-standing friendships" as the break ended, the researchers report.

"This is a foundational study," said Subigya Nepal, first author of the study and a PhD candidate in Campbell's research group. "It has more real-time granular data than anything we or anyone else has provided before. We don't know yet how it will translate to campuses nationwide, but it can be a template for getting the conversation going."

The depth and accuracy of the study data suggest that mobile-sensing software could eventually give universities the ability to create proactive mental-health policies specific to certain student populations and times of year, Campbell said.

For example, a paper Campbell's research group published in 2022 based on StudentLife data showed that first-generation students experienced lower self-esteem and higher levels of depression than other students throughout their four years of college.

"We will be able to look at campus in much more nuanced ways than waiting for the results of an annual mental health study and then developing policy," Campbell said. "We know that Dartmouth is a small and very tight-knit campus community. But if we applied these same methods to a college with similar attributes, I believe we would find very similar trends."

Weathering the pandemic

When students returned home at the start of the coronavirus pandemic, the researchers found that self-esteem actually increased during the pandemic by 5% overall and by another 6% afterward when life returned closer to what it was before. One student suggested in their interview that getting older came with more confidence. Others indicated that being home led to them spending more time with friends talking on the phone, on social media, or streaming movies together.

The data show that phone usage -- measured by the duration a phone was unlocked -- indeed increased by nearly 33 minutes, or 19%, during the pandemic, while time spent in physical activity dropped by 52 minutes, or 27%. By 2022, phone usage fell from its pandemic peak to just above pre-pandemic levels, while engagement in physical activity had recovered to exceed the pre-pandemic period by three minutes.

Despite reporting higher self-esteem, students' feelings of stress increased by more than 10% during the pandemic. Since the pandemic, stress fell by less than 2% of its pandemic peak, indicating that the experience had a lasting impact on student well-being, the researchers report.

In early 2021, as students returned to campus, the reunion with friends and community was tempered by an overwhelming concern of the still-rampant coronavirus. "There was the first outbreak in winter 2021 and that was terrifying," one student recalls. Another student adds: "You could be put into isolation for a long time even if you did not have COVID. Everyone was afraid to contact-trace anyone else in case they got mad at each other."

Female students were especially concerned about the coronavirus, on average 13% more than male students. "Even though the girls might have been hanging out with each other more, they are more aware of the impact," one female student reported. "I actually had COVID and exposed some friends of mine. All the girls that I told tested as they were worried. They were continually checking up to make sure that they did not have it and take it home to their family."

Students still learning remotely had social levels 16% higher than students on campus, who engaged in activity an average of 10% less often than when they were learning from home. However, on-campus students used their phones 47% more often. When interviewed after the study, these students reported spending extended periods of time video-calling or streaming movies with friends and family.

Social activity and engagement had not yet returned to pre-pandemic levels by the end of the study in June 2022, recovering by a little less than 3% after a nearly 10% drop during the pandemic. Similarly, the pandemic seems to have made students stick closer to home, with their distance traveled cut by nearly half during the pandemic and holding at that level in the time since.

Campbell and several of his fellow researchers are now developing a smartphone app known as MoodCapture that uses artificial intelligence paired with facial-image processing software to reliably detect the onset of depression before the user even knows something is wrong.

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Story Source:

Materials provided by Dartmouth College . Original written by Morgan Kelly. Note: Content may be edited for style and length.

Journal Reference :

• Subigya Nepal, Wenjun Liu, Arvind Pillai, Weichen Wang, Vlado Vojdanovski, Jeremy F. Huckins, Courtney Rogers, Meghan L. Meyer, Andrew T. Campbell. Capturing the College Experience . Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies , 2024; 8 (1): 1 DOI: 10.1145/3643501

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Top 50 cited articles on Covid-19 after the first year of the pandemic: A bibliometric analysis

Srinivas b.s. kambhampati.

a Sri Dhaatri Orthopaedic, Maternity & Gynaecology Center, 23, Lane 2, SKDGOC, Vijayawada, Andhra Pradesh, 520008, India

Nagashree Vasudeva

Raju vaishya.

b Indraprastha Apollo Hospitals, New Delhi, India

Mohit Kumar Patralekh

c Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi, 110029, India

Background & aims

It has been just over a year since the Covid-19 pandemic started. The top 50 cited articles on this subject would help identify trends and focus on the research efforts.

We utilised e-utilities in PubMed to find publications on Covid-19 until the date of search on 7/2/21. The iCite website was used to find the top 50 citations of the output from the search strategy. We looked into their full text for the editorial dates, type of study, level of evidence, focus of the article and country of origin. We also counted the errata and comments on each of them.

The total number of citations of all 50 articles was 123,960, the highest being 10, 754 for a single article. Huang C was the most cited first author. They were published from week 4–17, with February being the month with most citations. Lancet was the most cited journal, having published 9 of the 50 articles. Majority belonged to level 3 of the evidence ladder and were retrospective studies. Thirty percent of them had an errata published and an average of 7 comments per article.

The top 50 most cited articles identify the most impactful studies on Covid-19, providing a resource to educators while identifying trends to guide research and publishing efforts. There has been an explosion of publications and an unprecedented rate and number of citations within the first year for any single condition in the literature.

1. Introduction

Covid-19 has affected humanity in a major way. An extremely dangerous virus, hitherto unknown to humanity, had to be studied and contained in order to overcome the pandemic. Research on Covid-19 had surged in the early days with an unprecedented surge in the publications on that specific topic. With vaccination drives in majorly affected countries, and the emergence of second and third waves, the interest on this topic in the scientific community has been sustained. Pubmed is the most commonly used and freely available database and most of the articles published on the Covid-19 topic in major journals were fast-tracked and made freely available for rapid dissemination of information and findings. Top 50 cited articles have been published in many areas of medicine. In fact there have been publications related to Covid-19 from an earlier period. The differences have been discussed in the discussion section of this manuscript. Due to the sheer volume of publications on this topic, there would be different outcome if two studies were done six months apart. We looked into the top 50 cited publications on this topic in the literature in the PubMed to analyse the trends and focus of research among the most cited articles.

A search was done on 7/2/21 with a search strategy of (COVID-19 OR SARS-CoV-2 OR “New Corona Virus” OR “coronavirus 2″ OR “new coronavirus”) AND ((“2020/01/01"[Date - Create]: “2021/01/01"[Date - Create]))

For all publications in 2020 which gave an output of 88337.

The strategy of (COVID-19 OR SARS-CoV-2 OR “New Corona Virus” OR “coronavirus 2″ OR “new coronavirus”) AND ((“2021/01/01"[Date - Create]: “3000"[Date - Create])) was used for all publications from 2021 which gave an output of 11855.

When this search strategy was fed through eUtilities, we got a total of 11853 + 87793 articles. The PMIDs of all these articles were fed into the iCite website for citations and related data, from which we got 95806 articles. Some articles were left out by the iCite website and were not processed.

The output from the iCite website was fed into Excel and analysed for citation numbers and other basic outcomes. The data from the iCite website includes information on Field Citation Ratio (FCR), expected citations, number of citations, PMIDs of all articles citing every article, total number of references and DOI (Digital Object Identifier) address for each of the article obtained from the search. We analysed this preceding data and present the results. We calculated citations per week, week number the article was published in the year and percentages where appropriate.

FCR is calculated by the number of citations received by a publication divided by the average number of citations received by publications within that field in the same year. PubMed page of each of the 50 articles was scanned to see the number of comments and errata published against each of them and noted.

The top 50 cited articles were selected from this output and full texts collected and analysed for the purpose of this paper. We looked into the following information from the full text of each manuscript: create date in PubMed, type of study, level of evidence, focus of the paper, month published, country it was published from, week of the year it was published.

We also looked into the following times (in days) of each article as given in their full text where applicable; (i) time from submission to accepting to publish, (ii) from acceptance to publication and (iii) from submission to publication. Any errata or comments on the articles on PubMed were also noted down. We collected the data and analysed it in an Excel database.

The total number of citations of the top 50 papers was 123,960. The top 50 cited publications were published between the weeks 4–17 of last year. Week five saw the most number of publications (8 in number) and most citations for publications, but publications from week four (6 publications) had the most citations per publication ( Table 1 ). February was the month with most publications of the top 50 cited and had the maximum total citations as well as citations per week among the four months these articles were published ( Table 2 ). Most publications were done in the month of February (19 in number) with a sum of citations of 53,204 for that month. However, the citations per publication was maximum for the month of January at 3862 per citation.

Table 1

Publications in Week number with Total Citations and citations/publication.

Cell highlighted with green and light orange indicates the highest value and lowest value in the corresponding column in all the tables where applicable.

Table 2

Publications according to the month of the year.

Most studies published were of level 3 evidence in the evidence pyramid with 27 (40%) in number. Studies of level 3 had the most citations per publication at 2930.35. Twelve of the thirteen retrospective analyses belonged to this category with a citation sum of 38,418. Since citations are a function of duration since publication, we looked at the sum of citations per publication per week (CPW). A level 2 study [ 1 ] had the highest at 200.223 followed by a level 3 study [ 2 ] with 151.02 CPW.

Cohort study was the commonest type of study with a citation sum of 51,574. Of them, 12 were of evidence level 3, and four of these belonged to evidence level 4. Nine of the articles were correspondence to the editor, making it the second commonest type of study.

Lancet was the most cited journal publishing on this topic ( Chart 1 .) Table 3 gives the numbers published by each journal with their impact factors.

Journals publishing with number of publications on the right and total citations on the left. Citations/publication of each journal were given in brackets.

Table 3

Journals publishing top 50 cited articles on Covid-19.

Totals ∗ Averages # ^Journal names are given using standard abbreviations.

A total of 24 journals published the 50 most cited articles on Covid-19. Half of these journals (12 in number) had an impact factor of >20 Table 3 . There were a total of 15 papers (30%) which published errata on PubMed. Of these, 12 articles were published in journals with an impact factor of 20 or higher.

China was the country with the most publications (31) and citations (92276) Chart 2 .

Most cited Countries Publishing on Covid-19. Numbers in brackets indicate number of publications and citations per week for that country.

Table 4 shows the Level of evidence with names of journals in each level of evidence that published on this topic. It is evident that the higher level of evidence studies were from the highest impact factor journals. The number of citations was also higher for these journals and they top each category of evidence. Standard abbreviations for the journals were used in the table. Level 3 had the highest number of citations and but citations per publication was highest for level 2 studies at 3709 followed by level 3 studies at 2930. Level 5 studies included opinions and Letters to the editors. Some level 5 articles received more number of citations than some level 1 and 2 articles. Huang C was the most cited first author at 10,754 citations followed by Guan WJ Table 5 .

Table 4

Level of Evidence with journals in each level along with the numbers and citations of publications.

Table 5

Top 10 authors on Covid-19.

Table 6 shows the speciality-wise distribution of publications, citations and citations per week. Not surprisingly, Pulmonology was the speciality that topped the list. In fact, the first four entries in the table are expected to be high as major work on this topic was done in those fields. These were followed by molecular sciences and internal medicine.

Table 6

Publications and citations according to speciality.

The studies were analysed and categorised according to the focus of the study to give a comprehensive idea about the research trends, as shown in Table 7 . Majority of the papers describe the clinical data, which included the timeline of the disease, demographics of the patients, risk factor analysis, clinical features, blood and radiological investigations, treatment protocols used, prognostic factors, predictors of mortality, psychological impact and the outcomes.

Table 7

Publications according to the focus of the study.

One article was a consensus of the Coronaviridae Study Group (CSG) of the International Committee on Taxonomy of Viruses to name the virus as 2019-nCoV and individual isolates as SARS-CoV-2. 4 studies detailed the diagnostic aspect of the disease. These included proving a diagnostic workflow of the disease, identification of the nCov-19 in body fluids and assessment of viral loads, analysing sensitivity and specificity of the RT-PCR and CT scans in the diagnosis. Twelve studies described the epidemiological characteristics of COVID-19. These studies described the aetiology and source of origin, modes of transmission, incubation period, timeline of the outbreak, epidemiologic curve and doubling time, stability of nCov19 in aerosols and other surfaces, tracking of the disease and geographical distribution of the outbreak. Some of the epidemiological studies focussed on the clinical data as well. The epidemiological data is very beneficial for the authorities to draft public health policies such as quarantine guidelines. Three studies focussed on providing various aspects of pathological findings. Two of them were post-mortem analyses detailing the histopathology of various organs, whereas the other study described the immune pathways and their dysregulation. Six studies carried out a detailed structural analysis of the virus. They provide insights into full-length genome sequencing, cell receptors, pathogenic mechanisms at the cellular level, phylogenetic origin and, antibody testing. This information identifies potential targets for developing diagnostic tests, vaccines, and anti-viral drugs, accelerating the countermeasure development. The remaining seven studies concentrated on therapeutic interventions. Various anti-viral agents were tested and compared to determine their applicability and efficacy. Three of them focussed on the coagulation profile abnormalities and stressed the importance of using anticoagulants in the treatment as the thrombotic phenomenon is associated with a worse prognosis.

Table 8 groups publications into clinical studies involving patients (clinical trials, case Series, Case Reports, RCTs), non-clinical publications (e.g. Correspondence letters, Reviews) and Basic Science studies (Lab studies, Non-human experimental research). Each of these categories have been classified according to the level of evidence in the table. Majority (60%) were clinical studies and the highest citations per article was seen for a clinical study at 2925.

Table 8

Publications grouped as clinical/non clinical and Basic sciences, each category classified according to the level of evidence.

4. Discussion

As of Feb 9, 2021, the top 50 cited papers were cited 123,960 times on PubMed. There was a study looking into the top 50 cited papers on this subject [ 3 ]. But this was done in May 2020 which was very early during the pandemic. We feel now that sufficient time has passed since onset of the pandemic, (just over a year since the pandemic started), it is an appropriate time for a relook into this topic, especially with reference to citation numbers. ElHawary et al. [ 3 ] reported 63,849 citations for the top 50 cited articles which is about half of what we found about nine months after they studied. They searched Web of science (WOS), Google Scholar and Scopus for their top 50 citations. Pubmed search was not done in their study. They reported that over half of the publications were done in just three journals. Retrospective case series and correspondence/viewpoints formed the bulk of publications at 42% and 26% respectively.

In another study by Yuetian Yu [ 4 ], done in May 2020, scanning WOS database, 3626 publications were identified on this topic. Martinez-Perez et al. [ 5 ] found 14,335 publications between January and July 2020 with 42,374 citations from WOS. Senel et al. [ 6 ] reviewed literature on publications on coronavirus from 1980 to 2019 and found only 13,833 publications with a peak publication year of 2016 having 837 publications. This study may be considered as the baseline level of interest on coronavirus before the current pandemic. We found a total of 99,646 articles before we filtered the top 50 cited articles. Our study looked into some publication metrics of the articles which the previous publications did not include. These included, apart from general bibliometric data, like citations, journal and author data, clinically relevant data like focus of the paper, type of study, level of evidence of the study, speciality, month and week of publication, and country from which it was published. Most studies looked into WOS since citations are readily given in that database whereas for PubMed, it requires to use a different portal to get citation numbers which is not common knowledge.

Since most of the top cited studies we found were from the early stages of the Pandemic, one could expect that retrospective analysis is the type of study that would be the most commonly done as information was still needed to define various aspects of the disease. It could also be expected that lower level evidence studies in the evidence ladder would be done at this stage as higher level studies need greater understanding about the disease before they can be planned. Citations for studies done later take time to increase and catch up.

In a previous publication [ 7 ], we found 6831 total publications in the first 3 months of the pandemic and 1638 in the last week of the study alone from PubMed. This outbreak of Coronavirus has triggered an interest in publications and research that has never been seen on this subject. The publication numbers on Covid-19 have dwarfed those from any other subject during the pandemic. Irmak et al. [ 8 ] did the only study looking into the top 50 cited articles on PubMed in May 2020. They studied citations and co-citations and mapped them using R statistical software and Gephi softwares. Our study is different from theirs. We wanted to look into the top cited papers and analyse metric data as stated above.

Since the Pandemic originated in China, preliminary studies from china were the most cited studies and hence this country topped the citation numbers among countries at 92,276 which is 74.4% of the total number of citations of all the 50 publications 4 . Thirty one of the fifty publications originated from China. The maximum number of these top-cited articles belong to the speciality of Pulmonology. It is not surprising, as the COVID-19 disease is primarily a respiratory disease.

It has been reported in a study that more than 50% of the publications looked into had cited two high profile articles published in high impact factor journals even after the articles were retracted from publication [ 9 ]. A mechanism may need to be put in place to identify and prevent retracted articles from being cited in future studies. This may perhaps be included in the reference manager as a feature and/or included in scanning of manuscripts while submitting in the editorial manager of a journal.

We looked at the PubMed page of each article for the number of comments and errata Table 3 . Fifteen publications (30%) had at least one erratum published and of these, two articles had two errata on them. We are not aware of the average number errata published on PubMed, but 30% in the top 50 cited quality articles appears high. One study reported 19% studies containing errata among 127 studied [ 10 ]. They classified them into trivial, minor and major. Since errata are usually published after a time lag, for a fast evolving pandemic like the Covid-19, studies with major errata which could potentially change the conclusion of the study should be minimized so that further studies do not use any wrong conclusions. Their occurrence could be due to fast tracking of the articles on Covid-19 by most journals which reduces the reviewing times and also the deluge of submissions for publication [ 7 , 11 , 12 ].

We looked at the times related to publishing these articles ( Table 3 ). Not all journals give this data. From the data that was available, most journals appear to have fast tracked the publication process with an average time for submission to accepting at 10.9 days, acceptance to publication at 6.2 days and from submission to publication at just over two weeks (16.3 days).

The total number of comments published were 303 in all 50 publications with an average of 7.97 for each. Thirty eight of the top 50 cited had at least one comment published in PubMed. It indicates the level of interest the pandemic has evoked in the academic circles. It could also be due to free full text availability which encourages more researchers to be involved in the discussions.

All the articles in this study were published as open access and were freely available. Covid-19 publications in most major journals have been fast tracked and published open access for faster dissemination of knowledge and control of the pandemic. This could be one reason why the citation numbers have been so high. Shekhani et al. found open access provided a low magnitude but a significant correlation to high citation rate for manuscripts [ 13 ]. The most cited publication in the top 50, with a citation count of 10,754 in our study was by Huang C et al. [ 1 ].

5. Limitations

Limitations of our study include the fact that this study looked into a single database, namely PubMed. This has not been done in any of the previous studies. Most studies on citations looked into WOS. Although the citation number may be different from database to database, we believe the overall trends may be similar. But we do not have data to support this point. We could not compare with other studies to prove this because they were done at a different point of time.

6. Conclusions

There has been an explosion of publications on this topic and an unprecedented rate of citations within the first year for any condition in the literature. Chinese authors published on COVID-19 maximally, and Pulmonology was the medical speciality on which the articles were written and maximally by the Chinese authors. Majority of the publications focussed on the clinical data of the condition. The high-impact journals published these top-cited articles. The results identify impactful articles on Covid-19, providing a resource to educators while identifying trends that may be used to guide research and publishing efforts.

Declaration of competing interest

There is no conflict of interest to disclose for any of the authors.

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COVID-19 pandemic could have led to 20,000 prostate cancer diagnosis being missed

by University of Surrey

Prostate cancer diagnoses in 20,000 men could have been missed due to the COVID-19 pandemic, finds a new study published in BJU International from the University of Surrey and the University of Oxford.

Increased waiting times and changes in people's behavior in seeking medical attention during the pandemic could be responsible for missed diagnoses.

During this study, scientists sought to investigate the effect of the COVID-19 pandemic on diagnoses and mortality rates for prostate cancer in England. Using data from OpenSAFELY, comprising 24 million electronic health care records of people registered with primary care providers , scientists analyzed prostate cancer incidence between January 2015 and July 2023.

Lead author Dr. Agnieszka Lemanska, senior lecturer in health data science at the University of Surrey, said, "Understandably, during the COVID-19 pandemic, resources and attention in health care systems shifted towards preventing and managing the virus. This was to the detriment of other areas of the health service including cancer care .

"Early cancer diagnosis is key to improving cancer-related outcomes and long-term survival. It is important that we learn the lessons from the pandemic however, to do this we need to fully understand the scale of how services and diagnosis rates were impacted during this time."

To assess the effect of COVID-19, scientists used pre-pandemic data and statistical models to predict the expected rates of prostate cancer from March 2020, as if the pandemic had not happened.

Analyzing the data from 285,160 participants, scientists found that in 2020, 15,550 new diagnoses were in the dataset, compared to the predicted 20,322, a drop in diagnosis rates of 4,772 (31%). In 2021, there were 17,950 recorded instances of prostate cancer, compared to the estimated 21,098, a decline of 3,148 (18%). By 2022, the incidence of diagnoses returned to the levels that would have been expected.

Scientists then modeled these findings from the OpenSAFELY dataset, which represents 40% of the English population and estimated that the drop in incidence represented approximately 20,000 missed cases in England.

In addition, two peaks in mortality from prostate cancer were also identified by scientists, one in April 2020 and another in January 2021, when prostate cancer-related mortality increased from approximately 5.5 to 8.5 and 7.5 deaths per 100,000, respectively. Scientists note that these two peaks coincided with the two national lockdowns in the U.K. These mortality changes were transient and, therefore, not explored with statistical models.

Interestingly, scientists also identified a shift in characteristics of men diagnosed with prostate cancer during the pandemic. Men diagnosed during the pandemic were more likely to be older, as the data revealed in 2020, the average age at diagnosis was 71.6, which was higher than the average age in 2019 of 71.3. The average age in 2021 again increased to 71.8 years old. By 2022, the age at diagnosis dropped to 71.4 and dropped again in 2023 to 71.0 years, which meant it returned to the pre-pandemic values.

Dr. Agnieszka Lemanska added, "Although incidences of the cancer have returned to pre-pandemic levels by the end of 2022, there has not been an increase in diagnoses to account for the missed cases. The prevalence of prostate cancer at the end of our study was still lower than it would have been if the pandemic had not occurred. The ramifications of the pandemic are still being felt and we need to do more to investigate the consequences of this on patients and health care systems."

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Biden signs executive order on advancing study…

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Biden signs executive order on advancing study of women’s health while chiding ‘backward’ gop ideas.

President Joe Biden speaks during a St. Patrick’s Day reception in the East Room of the White House, Sunday, March 17, 2024. (AP Photo/Stephanie Scarbrough)

First Lady Jill Biden waves to attendees during an event with military families at Fort Buchanan in San Juan, Puerto Rico, Sunday, March. 17, 2024. (AP Photo/Alejandro Granadillo)

By COLLEEN LONG (Associated Press)

WASHINGTON (AP) — President Joe Biden signed an executive order Monday aimed at advancing the study of women’s health by strengthening data collection and providing better funding opportunities for biomedical research while chiding Republicans for having “no clue about the power of women” but saying they’re “about to find out” come November’s election.

Women’s health has long been underfunded and understudied. It wasn’t until the 1990s that the federal government mandated women be included in federally funded medical research; for most of medical history, though, scientific study was based almost entirely on men.

“We still know too little about how to effectively prevent, diagnose and treat a wide array of health conditions in women,” said Dr. Carolyn Mazure, the head of the White House initiative on women’s health.

Today, research often fails to properly track differences between women and men, and does not represent women equally particularly for illnesses more common to them — which Biden suggested his order would help change.

“To state the obvious, women are half the population and underrepresented across the board. But not in my administration,” the president said, drawing raucous applause at a White House reception marking Women’s History Month.

Biden said he’s long been a believer in the “power of research” to help save lives and get high-quality health care to the people who need it. But the executive order also checks off a political box during an election year when women will be crucial to his reelection efforts. First lady Jill Biden is leading both the effort to organize and mobilize female voters and the White House Initiative on Women’s Health Research.

The announcement comes as the ripple effects spread from the Supreme Court’s decision that overturned federal abortion rights, touching on medical issues for women who never intended to end their pregnancies. In Alabama, for example, the future of IVF was thrown into question statewide after a judge’s ruling.

In his comments at the reception, Biden didn’t mention by name former President Donald Trump, who is now running to reclaim the White House. Instead, he referred to “my predecessor” who had been “bragging about overturning” the Roe v. Wade decision that had guaranteed the constitutional right to abortion.

The president suggested that would hurt Trump and the GOP during this fall’s election, saying, “You can’t lead America with old ideas and take us backward.”

Further leaning into politics, Biden said his administration has “turned around the economy because we focused on women,” noting that female unemployment had fallen and the number of women-owned small businesses had increased.

He said his administration has ensured that “women can access jobs in sectors where they’ve been historically underrepresented” and said he’d told leaders from some of the nation’s top labor unions that he wants to see more women and minorities in their ranks.

Women were a critical part of the coalition that elected Biden in 2020, giving him 55% of their vote, according to AP VoteCast. Black women and suburban women were pillars of Biden’s coalition while Trump had a modest advantage among white women and a much wider share of white women without college degrees, according to the AP survey of more than 110,000 voters in that year’s election.

Vice President Kamala Harris, women’s health advocate Maria Shriver and the first lady also addressed the reception.

“Finally women will get the health care we deserve,” Jill Biden said, saying the order signed Monday was “without precedent.”

Harris drew strong applause for noting that she “stood before you as the first woman vice president of the United States” and talked about visiting an abortion clinic in Minnesota last week.

“There are those who are intent on dragging us backward,” the vice president said of Republican states that have limited access to abortion.

“We all face a question: What kind of country do we want to live in?” Harris said. “A country of liberty, freedom and rule of law? Or a country of disorder, fear and hate?”

Shriver joked that this is probably the first time a president has signed an executive order that mentions menopause and said the action could only be taken “by a president who respects women.”

The National Institutes of Health is also launching a new effort around menopause and the treatment of menopausal symptoms that will identify research gaps and work to close them, said White House adviser Jennifer Klein. NIH funds a huge amount of biomedical research, imperative for the understanding of how medications affect the human body and for deciding eventually how to dose medicine.

Some conditions have different symptoms for women and men, such as heart disease. Others are more common in women, like Alzheimer’s disease, and some are unique to women — such as endometriosis, uterine cancers and fibroids found in the uterus. It’s all ripe for study, Mazure said.

And uneven research can have profound effects; a 2020 study by researchers at the University of Chicago and University of California, Berkeley, found that women were being overmedicated and suffering side effects from common medications, because most of the dosage trials were done only on men.

The first lady announced $100 million in funding last month for women’s health.

___ Associated Press writer Gary Fields contributed to this report.

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2021: research and medical trends in a post-pandemic world

• Mike May 1  

Nature Medicine volume  26 ,  pages 1808–1809 ( 2020 ) Cite this article

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Goodbye 2020, a year of arguably too many challenges for the world. As tempting as it is to leave this year behind, the biomedical community is forever changed by the pandemic, while business as usual needs to carry on. Looking forward to a new year, experts share six trends for the biomedical community in 2021.

Summing up 2020, Sharon Peacock, director of the COVID-19 Genomics UK Consortium, says “we’ve seen some excellent examples of people working together from academia, industry, and healthcare sectors...I’m hopeful that will stay with us going into 2021.” Nonetheless, we have lost ground and momentum in non-COVID research, she says. “This could have a profound effect on our ability to research other areas in the future.”

The coronavirus SARS-CoV-2 has already revealed weaknesses in medical research and clinical capabilities, as well as opportunities. Although it is too soon to know when countries around the world will control the COVID-19 pandemic, there is already much to be learned.

To explore trends for 2021, we talked to experts from around the world who specialize in medical research. Here is what we learned.

1. The new normal

Marion Koopman, head of the Erasmus MC Department of Viroscience, predicts that emerging-disease experts will overwhelmingly remain focused on SARS-CoV-2, at least for the coming year.

“I really hope we will not go back to life as we used to know it, because that would mean that the risk of emerging diseases and the need for an ambitious preparedness research agenda would go to the back burner,” Koopman says. “That cannot happen.”

Scientists must stay prepared, because the virus keeps changing. Already, Koopman says, “We have seen spillback [of SARS-CoV-2] into mink in our country, and ongoing circulation with accumulation of mutations in the spike and other parts of the genome.”

Juleen R. Zierath, an expert in the physiological mechanisms of metabolic diseases at the Karolinska Institute and the University of Copenhagen, points out that the pandemic “has raised attention to deleterious health consequences of metabolic diseases, including obesity and type 2 diabetes,” because people with these disorders have been “disproportionally affected by COVID-19.” She notes that the coupling of the immune system to metabolism at large probably deserves more attention.

2. Trial by fire for open repositories

The speed of SARS-CoV-2’s spread transformed how scientists disseminate information. “There is an increased use of open repositories such as bioRxiv and medRxiv, enabling faster dissemination of study and trial results,” says Alan Karthikesalingam, Research Lead at Google Health UK. “When paired with the complementary — though necessarily slower — approach of peer review that safeguards rigor and quality, this can result in faster innovation.”

“I suspect that the way in which we communicate ongoing scientific developments from our laboratories will change going forward,” Zierath says. That is already happening, with many meetings going to virtual formats.

Deborah Johnson, president and CEO of the Keystone Symposia on Molecular and Cellular Biology, notes that while virtual events cannot fully replace the networking opportunities that are created with in-person meetings, “virtual events have democratized access to biomedical research conferences, enabling greater participation from young investigators and those from low-and-middle-income countries.” Even when in-person conferences return, she says, “it will be important to continue to offer virtual components that engage these broader audiences.”

3. Leaps and bounds for immunology

Basic research on the immune system, catapulted to the frontlines of the COVID-19 response, has received a boost in attention this year, and more research in that field could pay off big going forward.

Immunobiologist Akiko Iwasaki at the Yale School of Medicine hopes that the pandemic will drive a transformation in immunology. “It has become quite clear over decades of research that mucosal immunity against respiratory, gastrointestinal, and sexually transmitted infections is much more effective in thwarting off invading pathogens than systemic immunity,” she says. “Yet, the vast majority of vaccine efforts are put into parenteral vaccines.”

“It is time for the immunology field to do a deep dive in understanding fundamental mechanisms of protection at the mucosal surfaces, as well as to developing strategies that allow the immune response to be targeted to the mucosal surfaces,” she explains.

“We are discovering that the roles of immune cells extend far beyond what was previously thought, to play underlying roles in health and disease across all human systems, from cancer to mental health,” says Johnson.

She sees this knowledge leading to more engineered immune cells to treat diseases. “Cancer immunotherapies will likely serve as the proving ground for immune-mediated therapies against many other diseases that we are only starting to see through the lens of the immune system.”

4. Rewind time for neurodegeneration

Oskar Hansson, research team manager of Lund University’s Clinical Memory Research, expects the trend of attempting to intervene against neurodegenerative disease before widespread neurodegeneration, and even before symptom onset, to continue next year.

This approach has already shown potential. “Several promising disease-modifying therapies against Alzheimer’s disease are now planned to be evaluated in this early pre-symptomatic disease phase,” he says, “and I think we will have similar developments in other areas like Parkinson’s disease and [amyotrophic lateral sclerosis].”

Delving deeper into such treatments depends on better understanding of how neurodegeneration develops. As Hansson notes, the continued development of cohort studies from around the world will help scientists “study how different factors — genetics, development, lifestyle, etcetera — affect the initiation and evolution of even the pre-symptomatic stages of the disease, which most probably will result in a much deeper understanding of the disease as well as discovery of new drug targets.”

5. Digital still front and center

“As [artificial intelligence] algorithms around the world begin to be released more commonly in regulated medical device software, I think there will be an increasing trend toward prospective research examining algorithmic robustness, safety, credibility and fairness in real-world medical settings,” says Karthikesalingam. “The opportunity for clinical and machine-learning research to improve patient outcomes in this setting is substantial.”

However, more trials are needed to prove which artificial intelligence works in medicine and which does not. Eric Topol, a cardiologist who combines genomic and digital medicine in his work at Scripps Research, says “there are not many big, annotated sets of data on, for example, scans, and you need big datasets to train new algorithms.” Otherwise, only unsupervised learning algorithms can be used, and “that’s trickier,” he says.

Despite today’s bottlenecks in advancing digital health, Topol remains very optimistic. “Over time, we’ll see tremendous progress across all modalities — imaging data, speech data, and text data — to gather important information through patient tests, research articles or reviewing patient chats,” he says.

He envisions that speech-recognition software could, for instance, capture physician–patient talks and turn them into notes. “Doctors will love this,” he says, “and patients will be able to look a doctor in the eye, which enhances the relationship.”

6. ‘Be better prepared’ — a new medical mantra

One trend that every expert interviewed has emphasized is the need for preparation. As Gabriel Leung, a specialist in public-health medicine at the University of Hong Kong, put it, “We need a readiness — not just in technology platforms but also business cases — to have a sustained pipeline of vaccines and therapies, so that we would not be scrambling for some of the solutions in the middle of a pandemic.”

Building social resilience ahead of a crisis is also important. “[SARS-CoV-2] and the resulting pandemic make up the single most important watershed in healthcare,” Leung explains. “The justice issue around infection risk, access to testing and treatment — thus outcomes — already make up the single gravest health inequity in the last century.”

One change that Peacock hopes for in the near future is the sequencing of pathogens on location, instead of more centrally. “For pathogen sequencing, you need to be able to apply it where the problem under investigation is happening,” she explains. “In the UK, COVID-19 has been the catalyst for us to develop a highly collaborative, distributed network of sequencing capabilities.”

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May, M. 2021: research and medical trends in a post-pandemic world. Nat Med 26 , 1808–1809 (2020). https://doi.org/10.1038/s41591-020-01146-z

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Published : 07 December 2020

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ORIGINAL RESEARCH article

The impact of covid-19 pandemic on the world's major economies: based on a multi-country and multi-sector cge model.

• 1 Huaqiao University, Quanzhou, Fujian, China
• 2 Weifang Engineering Vocational College, Weifang, Shandong, China
• 3 Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
• 4 Weifang University of Science and Technology, Weifang, Shandong, China
• 5 Dongbei University of Finance and Economics, Dalian, Liaoning Province, China

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Objective: To quantitatively assess the impact of COVID-19 pandemic on public health, as well as its economic and social consequences in major economies, which is an international public health concern. The objective is to provide a scientific basis for policy interventions.This study utilizes a multi-country, multi-sector CGE-COVID-19 model to analyze the repercussions of the pandemic in 2022. The re-search focuses on quantifying the effects of COVID-19 on the macroeconomy and various industry sectors within six economies: the US, China, the EU, the UK, Japan, and South Korea.The COVID-19 pandemic shock had the most significant impact on China and the EU, followed by notable effects observed in the US and the UK. In contrast, South Korea and Japan experienced relatively minimal effects. The reduction in output caused by the pandemic has affected major economies in multiple sectors, including real industries such as forestry and fisheries, and the services such as hotels and restaurants. Conclusion: The overall negative macroeconomic impact of the epidemic on major economies has been significant. Strategic interventions encompassing initiatives like augmenting capital supply, diminishing corporate taxes and fees, offering individual subsidies, and nurturing international cooperation held the potential to mitigate the detrimental economic consequences and enhance the global-economic amid the pan-demic. Consequently, this study contributes to the advancement of global anti-epidemic policies targeting economic recovery. Moreover, using the CGE-COVID-19 model has enriched the exploration of general equilibrium models in PHEIC events.Research on the economic impact of PHEIC, particularly epidemic diseases, has focused on healthcare costs, focusing on both direct expenses (such as public health resourcing and treatment costs) and

Keywords: COVID-19 pandemic, Public Health, economic impact, CGE model, Multi-country analysis, policy interventions

Received: 15 Nov 2023; Accepted: 29 Feb 2024.

Copyright: © 2024 Sun, Yan, Zhang and Cao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Tingting Cao, Weifang University of Science and Technology, Weifang, 262700, Shandong, China

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.