research proposal title about covid 19

A proposal for long-term COVID-19 control

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Universal vaccination, prophylactic drugs, rigorous mitigation, and international cooperation, william a. haseltine william a. haseltine chair and ceo - access health international, trustee - the brookings institution @wmhaseltine.

August 20, 2021

Introduction

Four successive waves of COVID-19 have buffeted the United States for the past year and a half. With each wave, we have bet on different measures to push us through: First, public health measures, then drugs and treatments, and now, with our fifth wave, we hold out hope for vaccine-led recovery. But from the outset, we have underestimated this virus and its ability to maneuver the public health battleground; it is escaping the best defenses we are able to muster and finding new avenues of attack.

In this paper, I propose a multimodal strategy for long-term COVID control, one that sets up multiple barriers of protection so that we are able to not only contain SARS-CoV-2 and eliminate COVID-19 as a major life-threatening disease, but also return to a new social and economic life. The strategy uses the best of what we have on hand today—a rapidly growing arsenal of vaccines and antiviral drugs and public health measures— with an eye towards future improvements and developments.

The most immediate priority should be supporting additional research on the molecular biology of SARS-CoV-2, of which we still know surprisingly little. This is particularly important since there is great likelihood that COVID-19 will become endemic . Unlike the viruses that cause smallpox or polio, SARS-CoV-2 has demonstrated an impressive ability to adapt and thrive in both humans and animals, including our much-loved pet, cats and dogs. Even if we can eliminate the disease from our own communities, it is unlikely we can do the same across the globe and for all our animal populations at the same time.

The best we can hope for is containment of COVID-19 at levels we can tolerate both personally and economically. We have to use all the tools we have at our disposal— being aware of the inequities and disparities from country to country and within countries—that have made this and other diseases so hard to address.

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Research proposals to address COVID-19 challenges sought

Washington University’s  McDonnell International Scholars Academy  and Social Policy Institute (SPI) seek proposals from WashU researchers and their international partners to identify and address the challenges of COVID-19 through artificial intelligence, technology and big data.

This is the second year the Social Policy Institute and McDonnell Academy have partnered to provide seed grants for international research to capitalize on the strengths of both institutions and to further establish Washington University as a leader in global research.

Leaders anticipate providing funding for up to three proposals at $25,000 each in this round, with support from the Mastercard Impact Fund , in collaboration with the Mastercard Center for Inclusive Growth. Proposals are due Feb. 26. For more information, visit the McDonnell International Scholars Academy site . 

Comments and respectful dialogue are encouraged, but content will be moderated. Please, no personal attacks, obscenity or profanity, selling of commercial products, or endorsements of political candidates or positions. We reserve the right to remove any inappropriate comments. We also cannot address individual medical concerns or provide medical advice in this forum.

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• 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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Benjamin Thompson, Noah Baker and Traci Watson discuss some of 2020's most significant coronavirus research papers.

In the final Coronapod of 2020, we dive into the scientific literature to reflect on the COVID-19 pandemic. Researchers have discovered so much about SARS-CoV-2 – information that has been vital for public health responses and the rapid development of effective vaccines. But we also look forward to 2021, and the critical questions that remain to be answered about the pandemic.

Papers discussed

A Novel Coronavirus from Patients with Pneumonia in China, 2019 - New England Journal of Medicine, 24 January

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China - The Lancet , 24 January

A pneumonia outbreak associated with a new coronavirus of probable bat origin - Nature , 3 February

A new coronavirus associated with human respiratory disease in China - Nature , 3 February

Temporal dynamics in viral shedding and transmissibility of COVID-19 - Nature Medicine , 15 April

Spread of SARS-CoV-2 in the Icelandic Population - New England Journal of Medicine , 11 June

High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice — Skagit County, Washington, March 2020 - Morbidity & Mortality Weekly Report , 15 August

Respiratory virus shedding in exhaled breath and efficacy of face masks - Nature Medicine , 3 April

Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 - New England Journal of Medicine , 13 April

Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period - Science , 22 May

Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe - Nature, 8 June

The effect of large-scale anti-contagion policies on the COVID-19 pandemic - Nature , 8 June

Retraction—Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis - The Lancet, 20 June

A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19 - New England Journal of Medicine , 3 June

Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19 - JAMA , 2 September

Immunological memory to SARS-CoV-2 assessed for greater than six months after infection - bioRxiv, 16 November

Coronavirus Disease 2019 (COVID-19) Re-infection by a Phylogenetically Distinct Severe Acute Respiratory Syndrome Coronavirus 2 Strain Confirmed by Whole Genome Sequencing - Clinical Infectious Diseases , 25 August

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Research Article

Competing with a pandemic: Trends in research design in a time of Covid-19

Roles Conceptualization, Data curation, Methodology, Supervision, Validation, Writing – original draft, Writing – review & editing

Affiliation Department of Radiation Oncology, University of Southern California, Los Angeles, California, United States of America

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Visualization, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Affiliation Division of Nephrology and Hypertension, Department of Medicine, University of Southern California, Los Angeles, California, United States of America

• Shelly X. Bian, 

• Published: September 10, 2020
• https://doi.org/10.1371/journal.pone.0238831
• Reader Comments

Introduction

During the Covid-19 pandemic, major journals have published a significant number of Covid-19 related articles in a short period of time. While this is necessary to combat the worldwide pandemic, it may have trade-offs with respect to publishing research from other disciplines.

To assess differences in published research design before and after the Covid-19 pandemic.

We performed a cross-sectional review of all 322 full-length research studies published between October 1, 2019 and April 30, 2020 in three major medical journals. We compared the number of randomized controlled trials (RCTs) and studies with a control group before and after January 31, 2020, when Covid-19 began garnering international attention.

The number of full-length research studies per issue was not statistically different before and after the Covid-19 pandemic (from 3.7 to 3.5 per issue, p = 0.17). Compared to before January 31, 2020, 0.7 fewer non-Covid-19 studies per issue were published versus after January 31, 2020 (p<0.001), a change that was offset by Covid-19 studies. Among non-Covid-19 studies, 0.9 fewer studies with a control group per issue were published after January 31, 2020, with RCTs contributing to nearly all the decline (p<0.001, p = 0.001, respectively). In the same timeframe, non-Covid-19 studies without a control group and non-Covid-19 studies without randomization experienced relatively small changes that did not meet our threshold for statistical significance (increases of 0.1 and 0.1 per issue, p = 0.80, p = 0.88, respectively).

Limitations

Using a simple heuristic for assessing research design and lack of generalizability to the general medical literature.

Conclusions

In summary, the increase in Covid-19 studies coincided with a decrease of mostly non-Covid-19 RCTs.

Citation: Bian SX, Lin E (2020) Competing with a pandemic: Trends in research design in a time of Covid-19. PLoS ONE 15(9): e0238831. https://doi.org/10.1371/journal.pone.0238831

Editor: Daniele Fanelli, London School of Economics and Political Science, UNITED KINGDOM

Received: June 10, 2020; Accepted: August 25, 2020; Published: September 10, 2020

Copyright: © 2020 Bian, Lin. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are available at DOI 10.17605/OSF.IO/A2HQR .

Funding: This work was supported in part by the National Institutes of Health (NIH) through the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): EL receives support from NIDDK K08DK118213. EL also receives support from the University Kidney Research Organization. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Competing interests: The authors have declared that no competing interests exist.

The Covid-19 pandemic has severely disrupted medical research, from shutting down laboratory facilities, to delaying clinical trials, to halting funding [ 1 , 2 ]. Simultaneously, the volume of Covid-19 research has proliferated as experts from all disciplines seek to combat the new threat [ 3 , 4 ]. In the months following the onset of Covid-19, there has been an unprecedented increase in the number of registered clinical trials, preprints, and publications related to Covid-19 [ 5 ].

As of May, 2020, ClinicalTrials.gov listed over 1000 Covid-19 studies. Although some will advance our clinical knowledge, many are small, poorly designed, redundant, and unlikely to prove clinically useful [ 6 ]. Meanwhile the peer review process for Covid-19 studies has accelerated substantially. An analysis of 14 medical journals found a 50% reduction in average turnaround time from submission to publication for Covid-19 related research. This study, however, did not include several of the most influential journals including The Journal of the American Medical Association , The Lancet , and The New England Journal of Medicine [ 7 ]. The proliferation of Covid-19 literature has permeated into non-peer reviewed preprint websites, such as BioRxiv and MedRxiv. As of May 7, MedRxiv and BioRxiv had close to 2800 Covid-19 related articles combined. This has led to several editorials expressing concern over the quality of Covid-19 related research [ 8 , 9 ].

Many people look to most influential medical journals as having the highest standards for publication. The shifting of our research priorities is appropriate and necessary to address the pandemic. However, this diversion may also have unintended consequences on research in other disciplines. To evaluate whether the Covid-19 pandemic had negative effects on published research in other disciplines, we studied characteristics of Covid-19 and non-Covid-19 related research in three of the most cited medical journals: The Journal of the American Medical Association , The Lancet , and The New England Journal of Medicine . Although prior studies have evaluated the proliferation, quality, and design of Covid-19 related publications, none to our knowledge have addressed the pandemic’s effect on the study design of non-Covid-19 medical research. In this cross-sectional study, we investigated whether the design of published non-Covid-19 research changed in three of the highest impact medical journals aimed at a predominantly clinical audience after the onset of the Covid-19 pandemic.

Identifying research studies

We reviewed all full-length research studies published between October 1, 2019 and April 30, 2020 in three of the highest impact medical journals, The New England Journal of Medicine (NEJM) , the Journal of the American Medical Association (JAMA) , and The Lancet . These included “Original Articles” from NEJM (including “Brief Reports” and “Special Reports”), “Original Research” from JAMA (including “Preliminary Communications” and “Special Communications”), and “Research Articles” from The Lancet .

Many Covid-19 studies are case series published as short research studies and letters to the editor. In a sensitivity analysis, we additionally included short research studies published in letter format: “Correspondences” from NEJM and The Lancet and “Research Letters” from JAMA . The Correspondence sections from the NEJM and The Lancet have a broad range and include letters addressing previous articles, primary research, and opinions. From these, we manually identified all letters with a primary data collection effort (including case series and translational research) or secondary analysis of already collected data. We included all of JAMA’s Research Letters. We excluded sections dedicated for case reports (e.g., the “Case Records from the Massachusetts General Hospital in The New England Journal of Medicine ” or “Brief Reports” from JAMA ) but included case reports or case series published as short research studies or letters to the editor. Our publication selection process is outlined in a Prisma flow diagram in Fig 1 .

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

https://doi.org/10.1371/journal.pone.0238831.g001

We assigned each study an organ system (S1 Table in S1 Appendix ) and determined whether it was (i) Covid-19 related, (ii) a study with a control group, and (iii) a randomized controlled trial (RCT). We defined Covid-19-related research as having any Covid-19 related words in the title of the article including “Covid-19”, “novel coronavirus”, “2019-nCoV”, “Coronavirus disease 2019”, or SARS-CoV-2”. We defined a control group as whether the investigators performed a hypothesis-driven analysis, comparing two or more groups. Studies describing trends over time were considered uncontrolled unless the investigators tested a specific hypothesis, such as analyzing the putative effect of a policy intervention. Both authors reviewed all studies, adjudicating conflicts by consensus (see S1 Appendix for additional formal designations).

Statistical analyses

We compared study characteristics before and after the end of January 2020, when Covid-19 began garnering international attention. We defined the pre-Covid-19 era as January 31, 2020 and prior, and the post-Covid-19 era as February 1, 2020 and after. We chose this cutoff because the last week of January, 2020 marked the public announcement of the first cases of Covid-19 outside of China. Simultaneously, the World Health Organization (WHO) began warning other countries of the virus’ global spread and the importance of formulating strategic plans for virus containment around this time. Furthermore, the first Covid-19 publication in the three medical journals of interest was published on February 15, 2020 in The Lancet .

We first plotted the number of published Original Research studies, studies that were Covid-19 related, studies with and without a control group, and studies that were RCTs over time. We performed this descriptive analysis by assigning each issue to a given week, anchoring to the Monday of that week. We computed the average number of studies per week before and after the end of January 2020 to visually demonstrate changes in before and after Covid-19.

Subsequently, we assessed per issue differences in study type before and after the end of January 2020. For each of the three journals examined, issues are published weekly with the rare exception of an omitted week. We used the Mann-Whitney-Wilcoxan test to assess whether the average number of Covid-19 related studies, studies with and without a control group, and studies that were RCTs per issue was different before and after January 31, 2020. We performed analyses using the number of studies per issue instead of the proportion of studies per issue because counts reflect the zero-sum nature of publications and provide meaningful information on the volume of studies published. For instance, a large decrease in the total number of published studies might not change the proportion of published RCTs but would likely decrease the number of published RCTs. Because the total number of published studies per issue did not change substantially over time, this distinction was unlikely material to our results.

Our primary focus was on all full-length research studies and on the non-Covid-19 related subgroup of studies. In a sensitivity analyses, we expanded our sample to all research studies including those in letter format.

To assess changes in publication by organ system, we aggregated the total number of full-length research articles into pre-Covid-19 and post-Covid-19 cohorts. We did this because of the scarcity of some organ systems at an issue level. Because the pre-Covid-19 study period had more months, we plotted the percent of published full-length research studies before and after the onset of Covid-19. For each organ system, we compared the significance of the change in proportion before and after Covid-19 using Fisher’s exact test.

We acknowledge that we did not pre-register our study with a predetermined statistical protocol. Additionally, we performed a large number of statistical tests. Therefore, we performed a conservative Bonferroni correction [ 10 ] to adjust the threshold for rejecting the null hypothesis. Because we performed 21 tests in our primary analysis, we required a p-value of 0.0024 when determining whether a difference was statistically significant.

We identified 322 total full-length research studies, 188 before and 134 after the end of January, 2020. The distribution of full-length research articles by journal for each month is detailed in Table 1 .

https://doi.org/10.1371/journal.pone.0238831.t001

The total number of full-length research studies did not statistically differ before and after Covid-19 (from 3.7 to 3.5 per issue, p = 0.17). After January 2020, non-Covid-19 full-length studies decreased by 0.7 per issue on average (p<0.001), which was offset by Covid-19 full-length studies. The total number of full-length studies with a control group decreased by 0.8 per issue on average (p<0.001) and the number of RCTs decreased by 0.9 per issue (p = 0.001). Fig 2 shows changes in full-length articles by week, which usually includes 1 issue from each journal.

Figure includes all full-length research studies in counts per week. A) Covid-19 versus non-Covid-19 studies, B) controlled versus uncontrolled studies, C) RCTs versus non-RCTs. P-values estimated using a two-sample t-test. The gray vertical lines denote January 31, 2020, the boundary between the pre- and post-Covid-19 eras. Solid horizontal lines denote average values of the solid dots and dashed horizontal lines denote average values of the hollow dots.

https://doi.org/10.1371/journal.pone.0238831.g002

Among non-Covid-19 full-length studies, the number of studies with a control group decreased by 0.9 per issue on average with RCTs contributing to nearly all the decline (p<0.001, p = 0.001, respectively). In the same timeframe, non-Covid-19 full-length studies without a control group and non-Covid-19 full-length studies without randomization did not statistically differ (p = 0.80, 0.88, respectively). Fig 3 shows weekly changes in full-length non-Covid-19 articles.

Figure includes all non-Covid-19 full-length research studies in counts per week. A) controlled versus uncontrolled studies B) RCTs versus non-RCTs. P-values estimated using a two-sample t-test. The gray vertical lines denote January 31, 2020, the boundary between the pre- and post-Covid-19 eras. Solid horizontal lines denote average values of the solid dots and dashed horizontal lines denote average values of the hollow dots.

https://doi.org/10.1371/journal.pone.0238831.g003

Cardiology and obstetrics/gynecology had the largest declines in full-length published studies, from 23% to 13% (9% decline, p = 0.04) and from 4% to 0% (4% decline, p = 0.02, respectively. Meanwhile infectious diseases had the largest increase, from 9% to 28% (19% increase, p<0.001) ( Fig 4 , Table 2 ).

P-values were estimated using Fisher’s Exact Test. (an asterisk, *, denotes p < 0.0025). January 31, 2020 is the boundary between the pre- and post-Covid-19 eras.

https://doi.org/10.1371/journal.pone.0238831.g004

https://doi.org/10.1371/journal.pone.0238831.t002

In a sensitivity analysis, we included an additional 104 short research studies (57 pre- and 47 post-Covid-19) typically published in Letter format. The sensitivity analysis included a total of 426 research studies, 425 pre- and 181 post-Covid-19 and was not materially different from our primary analysis.

The total number of studies overall did not statistically differ before and after Covid-19 (from 4.9 to 4.8 per issue, p = 0.95). After January 31, 2020, non-Covid-19 studies decreased by 1.2 per issue on average (p<0.001), which was offset by Covid-19 studies. We observed a decrease in number of studies pre- and post-Covid-19 with a control group of 0.9 per issue on average (p = 0.001), which was almost entirely explained by a decrease in RCTs (p = 0.002). Fig 5 shows weekly changes in all articles.

Figure includes full-length research studies as well as research studies in Letter form in counts per week. A) Covid-19 versus non-Covid-19 studies, B) controlled versus uncontrolled studies, C) RCTs versus non-RCTs. P-values estimated using a two-sample t-test. The gray vertical lines denote January 31, 2020, the boundary between the pre- and post-Covid-19 eras. Solid horizontal lines denote average values of the solid dots and dashed horizontal lines denote average values of the hollow dots.

https://doi.org/10.1371/journal.pone.0238831.g005

Among non-Covid-19 studies, the number of studies with a control group decreased by 0.9 per issue on average with RCTs contributing to nearly all the decline (p<0.001, p = 0.002, respectively). In the same timeframe, non-Covid-19 studies without a control group and non-Covid-19 studies without randomization did not statistically differ (p = 0.27, 0.26, respectively). Fig 6 shows weekly changes in all non-Covid-19 articles.

Figure includes all non-Covid-19 full-length research studies as well as research studies in Letter form. A) controlled versus uncontrolled studies B) RCTs versus non-RCTs. P-values estimated using a two-sample t-test.

https://doi.org/10.1371/journal.pone.0238831.g006

In contrast, none of the Covid-19 studies (20 full-length and 21 in letter format) were RCTs, and only one had a control group. Table 3 shows changes in articles per issue in all articles as well as full-length articles before and after January 31, 2020.

https://doi.org/10.1371/journal.pone.0238831.t003

We found that in three of the highest impact medical journals, the increase in Covid-19-related research studies coincided with a concomitant decrease in non-Covid-related RCTs. Unsurprisingly, most Covid-19 studies published in the first three months of the pandemic comprised case reports and case series. No Covid-19 related RCT’s were published from February 1, to April 30, 2020. We observed a decreasing trend in cardiology and obstetrics/gynecology studies post-Covid-19, though the decrease did not meet our threshold for statistical significance.

Prioritizing Covid-19 research is critical to combating the pandemic [ 1 ]. The medical community needs and expects the quick dissemination of Covid-19 research. However, hasty research may result in suboptimal study designs, though some have argued for the need to balance scientific rigor for speed [ 11 ]. Similarly, Kim et. al. recently argued in the Annals of Internal Medicine has stated that “Given the urgency of the situation, some limitations… may be acceptable, including the small sample size, use of an unvalidated surrogate end point, and lack of randomization or blinding” [ 8 ]. Still, researchers and publishers must use caution. In the last month alone, four high-profile Covid-19 articles have been retracted from the Annals of Internal Medicine , The Lancet , and NEJM due to inadequate scientific rigor [ 12 – 15 ]. We similarly observed a large increase in Covid-19 studies that did not have a control group, mostly case reports and series. As Covid-19 researchers have time to apply more rigorous methods to their studies, RCTs and studies with control groups will undoubtedly become more widespread. In the meantime, researchers and journal editors will need to balance the trade-off between accommodating the rapid dissemination of information with Covid-19 research that do not report a control group.

However, we were concerned to observe substitutions occurring at the expense of non-Covid-19 studies with a control group, with substitutions occurring almost entirely at the expense of RCTs. In comparison, we observed minimal changes among non-Covid-19 studies without a control group. If we project these changes over a course of 6 months (a conservative time frame for the Covid-19 pandemic), non-Covid-19 studies with a control group could decrease by 60 and non-Covid-19 RCTs by 70 in these three medical journals combined. Notably, in the field of obstetrics/gynecology, zero studies were published in the post-Covid-19 era despite constituting 4% of full-length publications prior to the outbreak. The decline in non-Covid-19 publications with a control group and especially RCTs likely has multiple reasons. Publication of already accepted studies may be postponed in lieu of emerging Covid-19 research. Journals in the JAMA Network have received 53% more submissions in the first quarter of 2020 than in the first quarter of 2019 [ 16 ]. The flood of submissions and the demand for Covid-19 related work presents publishers and editors with the dilemma of accepting fewer non-Covid-19 publications, quality notwithstanding.

Reviewers and editors might also perceive non-Covid-19 research as overall less relevant given the pandemic. The WHO, national disease organizations, and media have Covid-19 in the forefront of public health. Since January, 2020, COVID-19 papers have been downloaded more than 150 million times, according to the International Association of Scientific, Technical and Medical Publishers [ 17 ]. Major publications have a responsibility to assess the interest of their readership and adjust their publication profile accordingly. Finally, authors might delay submissions until after the pandemic subsides because of unavoidable disruptions in their research or a perception that non-Covid-19 research is viewed less favorably. Many laboratories and non-Covid-19 clinical trials have closed due to social distancing [ 18 ]. Additionally, resources and priorities may have shifted away from non-Covid-19 research to support Covid-19 studies [ 19 ].

Unfortunately, these rejections and delays contribute to a growing backlog of unpublished non-Covid-19 research, hindering future dissemination. The backlog will likely worsen as non-Covid-19 research resumes with long-term negative consequences to published research [ 9 ]. Disruptions in medical research attributable to Covid-19 could thus mirror public health experts’ concerns about delays in non-Covid-19 medical care [ 20 ].

Limitations of our study include using a simple heuristic for assessing study design (e.g., RCT versus not, controlled versus uncontrolled), not accounting for contemporaneous idiosyncratic events (e.g., vaping), and not observing submitted but unpublished work. Additionally, we did not produce a written protocol and preplanned analysis prior to data collection. We also limited our sample to three select high impact journals, and our results do not necessarily generalize to the entire medical literature. We were unable to estimate changes pre- and post-Covid-19 by organ system with precision, likely owing to small sample size. Finally, we used the 3 months preceding the start of Covid-19 to assess the pre-Covid-19 baseline for the three journals of interest. However this surrogate may not be a suitable counterfactual for these journals in the absence of Covid-19. Thus, our findings should be corroborated in a wider sample of journals and time periods.

Substitutions of non-Covid-19 research are inevitable. To alleviate delays in publication, editors could consider establishing dedicated channels for Covid-19 studies that do not compete with non-Covid-19 studies.

Supporting information

S1 appendix. additional details for “competing with a pandemic: research quality in a time of covid-19”..

https://doi.org/10.1371/journal.pone.0238831.s001

Acknowledgments

We would like to thank Gemma Lin for her review of the manuscript.

• View Article
• Google Scholar
• 10. Mittelhammer RC, Judge GG, Miller DJ. Econometric Foundations. Cambridge University Press; 2000. 73–74 p.
• 17. COVID-19 Research Downloaded More Than 150 Million Times, Reports STM [Internet]. International Association of Scientific, Technical and Medical Publishers. [cited 2020 Jul 27]. Available from: https://www.prnewswire.co.uk/news-releases/covid-19-research-downloaded-more-than-150-million-times-reports-stm-824020806.html
• 20. Wong, Laura E, Hawkins, Jessica E, Langness S, Murrell, Karen L, Iris, Patricia, Sammann A. Where Are All the Patients? Addressing Covid-19 Fear to Encourage Sick Patients to Seek Emergency Care. NEJM Catal. 2020;

Frontiers welcomes research proposals about COVID-19

An outbreak of a respiratory disease began in Wuhan, China in December 2019 and the causative agent was discovered in January 2020 to be a novel betacoronovirus of the same subgenus as SARS-CoV and named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Coronavirus disease 2019 (COVID-19) has rapidly disseminated worldwide, with clinical manifestations ranging from mild respiratory symptoms to severe pneumonia and a fatality rate estimated around 2%. Person to person transmission is occurring both in the community and healthcare settings. The World Health Organization (WHO) has recently declared the COVID-19 epidemic a public health emergency of international concern. The ongoing outbreak presents many clinical and public health management challenges due to limited understanding of viral pathogenesis, risk factors for infection, natural history of disease including clinical presentation and outcomes, prognostic factors for severe illness, period of infectivity, modes and extent of virus inter-human transmission, as well as effective preventive measures and public health response and containment interventions. There are no antiviral treatment nor vaccine available but fast track research and development efforts including clinical therapeutic trials are ongoing across the world. Managing this serious epidemic requires the appropriate deployment of limited human resources across all cadres of health care and public health staff, including clinical, laboratory, managerial and epidemiological data analysis and risks assessment experts. Therefore, integrated operational research and intervention, learning from experiences across different fields and settings should contribute towards better understanding and managing COVID-19. This Research Topic aims to highlight interdisciplinary research approaches deployed during the COVID-19 epidemic, addressing knowledge gaps and generating evidence for its improved management and control. It will incorporate critical, theoretically informed and empirically grounded original research contributions using diverse approaches, experimental, observational and intervention studies, conceptual framing, expert opinions and reviews from across the world. The Research Topic proposes a multi-dimensional approach to improving the management of COVID-19 with scientific contributions from all areas of virology, immunology, clinical microbiology, epidemiology, therapeutics, as well as infection prevention and public health risk assessment and management studies. Submissions are welcome for the following article types: original research, review, mini-reviews, systematic reviews, research protocol, opinion and hypothesis. We particularly welcome contributions that include, but are not limited to, the following topics: • SARS-CoV-2 genome structure, encoded proteins, replication properties, viral pathogenesis, comparative phylogenetic and viral receptor binding analysis within the betacoronavirus genus, e.g. SARS-CoV, MERS-CoV; • SARS-CoV-2 antiviral susceptibility and antigen diversity; • Natural history of COVID-19 clinical disease spectrum in different populations and analysis of intrinsic and extrinsic prognostic factors, including sero-epidemiological studies in the general population; • Host factors, including host genetics and immunological variabilities, and their association with disease severity; • Modes and dynamics of SARS-CoV-2 transmission in household, workplace, closed community and healthcare settings, including role of super-spreading events; • Systematic reviews and meta-analysis of COVID-19 epidemiological studies and surveillance data as well as modelling studies and analytical methods for risk assessment studies; • Effectiveness of COVID-19 infection prevention and control procedures including personal protective equipment and airborne/aerosol versus droplet isolation precautions for specific healthcare settings and epidemiological stages of the outbreak; • Effectiveness of novel public health interventions for containment or impact mitigation of the COVID-19 outbreak, including social distancing and quarantine measures; • Clinical accuracy and effectiveness of rapid SARS-CoV-2 diagnostics and serological assays; • Pre-clinical development and clinical trials of therapeutic agents for COVID-19; • Pre-clinical development and clinical trials of COVID-19 candidate vaccines; • Evaluation of methods for COVID-19 epidemiological surveillance, contact tracing studies and public health risk assessment, including digital health solutions and modelling/forecasting studies; • Clinical immunology of COVID-19, including specific antibody and cellular immune responses to SARS-CoV-2 and protective immunity. As this is a multidisciplinary Research Topic, we ask the authors to choose the appropriate Topic Editor for sections upon submission. For any questions please contact the editorial office ( [email protected] ). ***Due to the exceptional nature of the COVID-19 situation, Frontiers is waiving all article publishing charges for COVID-19 related research.***

Keywords : Coronavirus, microbiology, immunology, public health, COVID-19, SARS-CoV-2, infection prevention and control, epidemiology, transmission studies, antiviral therapy

Important Note : All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

The research topic was first published here .

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Review article, challenges during review of covid-19 research proposals: experience of faculty of medicine, ain shams university research ethics committee, egypt.

• 1 Faculty of Medicine, Ain Shams University, Cairo, Egypt
• 2 Misr International University, US Naval Medical Research Unit No.3 (NAMRU-3), Cairo, Egypt
• 3 Faculty of Medicine, October 6 University, Giza, Egypt

The COVID-19 pandemic resulted in an overwhelming increase in research studies submitted to research ethics committees (RECs) presenting many ethical challenges. This article aims to report the challenges encountered during review of COVID-19 research and the experience of the Faculty of Medicine, Ain Shams University Research Ethics Committee (FMASU REC). From April 10, 2020, until October 13, 2020, the FMASU REC reviewed 98 COVID-19 research protocols. This article addressed the question of how to face an overwhelming amount of research submitted to the REC while applying the required ethical principles. Ethical challenges included a new accelerated mode of review, online meetings, balance of risks vs. benefits, measures to mitigate risks, co-enrolment in different studies, protection of a vulnerable COVID-19 population, accelerated decisions, online research, how to handle informed consent during the pandemic, and justification of placebo arm.

Introduction

The majority of the RECs in North African countries are registered with the Office for Human Research Protections and have Federal Wide Assurance (FWA) active numbers ( 1 ). Egypt has a National Ethics Committee, active institutional committees and the Egyptian Medical Research Regulation Law for the regulation of clinical trials and human research ethics issued December 2020; the Egyptian National Ethical Committee collaborates with the United Nations Educational, Scientific and Cultural Organization ( 2 ).

The FMASU REC was established in October 2007, to review research conducted at the Faculty of Medicine, Ain Shams University, in Cairo, Egypt. It holds a Federal Wide Assurance Number (FWA 00017585). The committee trained 220 staff members as reviewers working in 32 faculty departments over 23 training events. Since its establishment, the FMASU REC reviewed 414 international and multicentre projects, 5,033 theses, and free research. Since April 10, 2020, the FMASU REC reviewed 98 COVID-19 research studies, Figure 1 .

Figure 1 . FMASU REC Workload from January 1st, 2008 to October 13th, 2020.

During the COVID-19 pandemic in the year 2020, investigators began research to understand the novel virus, its epidemiology and pathogenicity, as well as to find ways for prevention and control, including discovering a treatment and/or vaccine. Worldwide, more than 4,900 studies and trials have been registered on “ Clinicaltrials.gov ” since the start of the pandemic ( 3 ). This rise in the number of emerging COVID-19 research projects has recently resulted in an overwhelming number of research project submissions to RECs.

To ensure ethical research during the COVID-19 pandemic, the World Health Organization (WHO) summarized the key universal ethical standards that should be adhered to by researchers, review bodies, funders, publishers, and manufacturers during a pandemic ( 4 ), identifying the main ethical standards as scientific validity, reasonable risk-benefit ratio, fair and voluntary participation, and independent review ( 5 ).

The European Network of Research Ethics Committees (EUREC) issued a statement that was adopted by the EUREC Board on April 27, 2020, stressing the fact that the administrative processes for reviewing research protocols during the COVID-19 pandemic must be accelerated and simplified if these protocols are related to the treatment, prevention or diagnosis of infections caused by SARS-CoV-2 ( 6 ). However, all research must be guided by the principle that RECs will not compromise the quality of the review process under these extraordinarily stressful circumstances. Furthermore, an accelerated procedure cannot be at the expense of the safety of research participants. The recognized ethical principles must always be respected, and the free and informed consent procedure must remain in accordance with international and national regulations.

In Egypt, there are 115 university hospitals ( 7 ) conducting research on human beings which needs approval from institutional RECs which are either internationally recognized and have an international FWA number and/or are registered with the Ministry of Health and Population (MOHP), or are newly developed and have been submitted for registry with the MOHP. International projects need other final approval from the MOHP REC.

The Clinical Medical Research Regulation Law (the Egyptian law for the conduct of research) was issued on December 23, 2020; its bylaws are currently being written. The Egyptian law is aligned with international guidelines for health research ethics review. The research studies protocols described in this manuscript were submitted during the period April 10 to October 13, 2020, to Ain Shams REC and were reviewed according to the international guidelines.

This article tried to answer the question of how the REC can effectively apply ethical principles when faced with an overwhelming number of research projects submitted.

The aim of this article is to report the challenges encountered and the experience of the FMASU REC during review of COVID-19 research, starting from April 10 to October 13, 2020, and to give an overview about the challenges that the committee faced and how it overcame them.

Modified Standard Operating Procedures

The article tried to illustrate how a governmental university REC in a low-middle income country modified its standard operating procedures (SOPs) to cope with a fast-track review of the overwhelming COVID-19 research and continue reviewing non-COVID-19 research. During the first wave of the pandemic there were no international guidelines for reviewing COVID-19 research. This challenge was increased by a scarcity of information about the disease, governmental lockdown periods, and lack of extra budget allocation.

The FMASU REC was confronted by multiple challenges in reviewing COVID-19 research during the pandemic, necessitating out-of-the box solutions to maintain an effective, accelerated review while at the same time practicing the ethical principles required.

The researchers, as well as the REC members, were encouraged to transform these challenges into opportunities. The SOPs followed by the REC were updated, regarding protocol submission changes to adopt digital submission route, rather than hard-copy paper submissions. Training of the employees on the use of digital technology for submissions and archiving followed. An electronic signature for the head of the committee was introduced. An accelerated, fast-track mode for reviewing protocols was adopted to cope with the pace of the pandemic. While the reviewers had previously been allowed up to 1 month for response for randomized controlled trials (RCTs), they were now expected to respond within one-seven days during the pandemic. The expedited process was meant to help in generating desperately needed knowledge out of the submitted research.

The REC resorted to on-line conferencing to overcome the inability to hold face-to-face meetings due to the Faculty lockdown. The first wave of research was received on April 10, 2020, with seven research projects reviewed in two online meetings over 3 days, including five clinical trials and two observational studies. That new mode of reviewing was dynamic, accelerated, and fast-tracked, in accordance with international guidelines and the REC's updated SOPs.

As the number of submitted research protocols increased rapidly, the REC had to increase the frequency of meetings to every other day, then every week or 2 weeks instead of the previous monthly schedule. Reviewing was done in a shorter time as the institution and investigators were expecting a rapid response. The usual review process that was adhered to by the REC was as follows: all the above minimal-risk protocols were initially reviewed by two reviewers and then discussed in full board meetings. To acquire a faster review track of the COVID-19-related proposals, clinical trials, or repurposed drugs, the number of initial reviewers was increased to three members, then discussed in full board online meetings. The number of members attending the virtual meetings ranged from 9 to 13 members, out of the 15 members comprising the committee.

For this article we reviewed the list of all protocols submitted to FMASU REC for review during the COVID-19 time from April 10, 2020, until October 13, 2020. We listed the titles, principal investigators (PI) names, date of submission and date of response to the investigators. We analyzed the frequencies from these data. We also reviewed the meeting minutes to pin out the most interesting and challenging issues that were discussed during the meetings. Additionally, we reviewed the current procedures and changes that were instituted to the SOPs. Finally, we asked the members to provide their input about their concerns in the review process during the COVID-19 time. Last, we incorporated all the data into the article.

Review Processes

Reviewing research during COVID-19 pandemic lockdown included shortened average duration of review, rapid request for clarifications and reply of investigators and quick provision of decisions. The duration of review was shortened to a minimum of 1 day and a maximum of 7 days. Before the pandemic, for more than minimal risk (low risk studies) and commercially-sponsored studies, the REC adopted a two-reviewer system, followed by discussion by the full Board. During the pandemic, to accomplish a shorter review time, this system was replaced by a three-member review, followed by the online meeting. As for minimal risk studies, the pre-pandemic system was also a two-reviewer, expedited review system, while during the pandemic for COVID-19 protocols, two reviewers were still assigned to review each protocol, but in a shorter reviewing period of 1-7 days.

To overcome the challenges of the short review time, the reviewing process of COVID-19 research stressed the rationale or justification as tackled by many researchers all over the world, the research question, hypothesis, social value, and benefits to the community. The novelty of the research idea was also an important point of discussion during the review process.

“Good science is itself an ethical requirement, as it is meaningless to apply ethical principles to a scientifically flawed product or plan. Bad science can only be bad ethics” ( 8 ). A rigorous revision of the research methodology was conducted, including study design, sample size and type, study procedures, randomization, and blinding. Many studies needed redesigning to specify inclusion and exclusion criteria of subjects, or to rigorously define the diagnosis of mild, moderate, and severe COVID-19 cases according to the National Guidelines reported and updated by the Egyptian MOHP.

Ensuring the well-being of researchers and research participants in the context of a pandemic was a very important objective of the REC. For research participants' well-being, hospital beds and equipment disinfection were under control of the Infection Control Unit, thus conforming to all international guidelines. As for mental health studies (some included healthcare professionals as well as patients), the committee recommended providing medical assistance for those who had high scores (e.g., recommending adding a paragraph in the questionnaire telling participants that if they had high scores for depression, to seek medical consultation). As for researchers, the REC insisted on following international, local governmental, and institutional recommendations. They were supplied with personal protective equipment including surgical, N95 masks, face shields, and goggles.

The REC was rigorous about sample size calculation in the protocol, urging the investigators to have a precise, predefined sample-size calculation, in order to receive REC approval of the study. As a standard procedure, the investigators were required, as a prerequisite before submission to the REC, to refer to the accredited statistics unit at the Department of community medicine in FMASU, to obtain the sample size calculation for any research. While some researchers chose to conduct a pilot study and a convenience sampling because of lack of sufficient data for new or repurposed drugs, the investigators had to provide strong justifications in such instances. The REC required an interim analysis and power calculation, to see if the sample size was large enough, or needed revision to find out if the efficacy of the tested drugs had been reached.

Special Concerns During Review

The balance of risks and benefits is a pivotal element for the protection of human subjects in research. The REC exerted a great effort to mitigate research risks to provide maximum possible protection of research participants. The REC members spent long hours reviewing recent COVID 19-related publications, with special emphasis on adverse events reported involving drugs under trial and drug interactions. Clarifications were required on how to minimize the risks of these side effects, and suggestions were offered to the researchers. For instance, REC recommended additional investigations such as a baseline electrocardiogram, complete blood counts, requested exclusion of high-risk participants, or recommended increased frequency of monitoring visits.

The COVID-19 submitted protocols posted a novel risk-benefit evaluation to the reviewers. For example, in many instances, the REC could not ignore the risk to the researchers who had to interact face-to-face with COVID-19 patients in intensive care units (ICU). The REC had to ensure performance of enrolment and study procedures in unconventional circumstances, such as instances when researchers might not have been allowed in the research setting. The ICU physicians and nurses had to be trained to perform the study procedures. The PI had to keep close contact with the ICU staff and get monitoring reports about the enrolled participants. Whenever possible, the PI could see the patients following the standard safety infection control precautions.

One of the challenges faced by the FMASU REC was the lack of or insufficient animal studies and combining of Phases II and III for testing new drugs. The REC did not encounter Phase I protocols at that time. While the side effects and risks of the proposed therapies were not yet fully studied, Phase II usually includes more patients, and combining Phases II and III usually results in larger sample sizes than Phase II alone.

The REC responded by evaluating the risks and benefits, while maintaining strict requirements for risk minimization. The direct, potential patient benefit was the hope for effectiveness of new drugs, and the indirect benefit was withdrawing drugs from the list of potential drugs if proven non-effective.

The REC faced a big challenge with the large number of protocols, exceeding by far the routine work of the committee. Repurposed drugs, innovative drugs, and vaccines necessitate enormous steps to be approved. During the first 6 months of the pandemic, there was a relatively greater flow of RCTs, Phase III (2/5.85%) and Phase II (15/0.52%), compared to the period before the pandemic. The majority of studies were low risk observational studies (79.86%). Low risk studies are usually reviewed in an expedited manner by two reviewers, but in a shorter reviewing period of 1-7 days. The duration of the initial review was shortened to a minimum of 1 day and a maximum of 7 days compared to a minimum 1-month clinical trial review time, according to the REC SOPs. The total review time in the first rush of protocols during the pandemic was 1 week, but later the total review time was within 1 month, depending on how rapidly the investigators responded to the REC's comments.

The REC members devoted all their time to pandemic work, as most of the submitted protocols, even the non-commercial research, were to find an effective treatment for the emerging COVID-19 disease, either through using a repurposed drug, steroids, or antiviral drugs used earlier in management of Ebola virus, HCV, HIV, or antimalarial drugs. The flow of routine research as multicentre studies between Egyptian research centers, international centers and single center, non-commercial international project submissions, amendments, renewals and theses was slower than before the pandemic, but was reviewed in the same, accelerated manner.

The thesis topics submitted during the early wave of the COVID-19 pandemic were not yet related to the pandemic, but later in 2020 the topics were related to COVID-19.

The refusal rate was minimal; one study was deferred until more information could be obtained, as per the REC reviewers' request. Further details cannot be mentioned in this manuscript for protection of the confidentiality of the research topics.

The most frequent types of research submitted to the REC during the COVID-19 pandemic were observational studies (76.86%) to know the nature of this new emerging disease, followed by Phase III RCTs (5.85%), trying to find the most effective treatment through novel or repurposed drugs, such as drugs previously used in diseases other than COVID-19 such as EBOLA, Hepatitis C Virus, Human Immune Deficiency Virus and malaria Table 1 .

Table 1 . Frequency of clinical trial phases reviewed by FMASU REC from April to October 2020.

The protocols might not have been written as state of the art, as investigators submitted them in an expedited manner. This necessitated more frequent and more rapid than usual communication between the FMASU REC and the investigators. In some instances, the REC required the investigators to provide more information to be able to make informed decisions. The direct communication between the REC members and the investigators was effective in enhancing the quality of the protocols and their scientific validity, in view of the scarce and controversial information concerning COVID-19.

Defining the target population of COVID-19 patients and the vulnerability of this population was another challenge. The investigators had to define their study population with regard to the severity of the disease, the state of consciousness, and addressing what the REC defined as a new vulnerability group; the COVID-19 patients were desperate for treatment and might have agreed to participate in any research project without proper consideration. The protection of moderate and severe cases of COVID-19, as vulnerable groups, was extremely important to the REC. Therefore, the REC insisted that mild and moderate cases give consent for themselves and did not allow a legally-authorized representative to give consent on their behalf.

Allowing enrolment of severe disease cases engendered a wide range of discussion. Although the severe cases were in great need of the benefit of any drug at a time when no proven cure was available, the opposing committee members were hesitant to allow severely ill cases to be enrolled in the studies, if the investigators could not provide enough preliminary evidence of a potential direct benefit. Some investigators requested that in severe cases, the ICU manager might sign the consent on behalf of the subjects, but the REC refused this idea and insisted that the patient be conscious enough to give his or her own consent. Otherwise, the investigators would have to obtain the legal guardian's consent outside the isolation hospital due to rules on who was allowed in an isolation hospital.

Reviewing Telemedicine Studies

The review process had previously been accomplished through hard copies and online communication, as per the preference of the involved REC reviewers. During the pandemic, the shift to electronic communication became mandatory among researchers, the REC administrative office, the REC board, and the reviewers. The institution administration, as well, supported this shift and provided online meeting platforms in support of the digital transformation.

The COVID-19 pandemic resulted in greater use of online surveys and telemedicine. Telemedicine for clinical care started in 2016 at the Faculty of Medicine, Ain Shams University in the Neurology Department to help communication with patients being seen in clinical practice and was later extended to include other departments. To counteract the effects of the lockdown due to COVID-19, FMASU offers different telemedicine services, including consultation and outpatient clinics. Seven departments offer these services: Family Medicine, Clinical Oncology, Internal Medicine, Psychiatry, Paediatrics, Geriatrics and Obstetrics and Gynaecology. Services are offered through a secure link, where data, images and laboratory results can be uploaded and stored in the patient's medical record. The REC received this new type of telemedicine research as another challenge, Table 2 . The use of online surveys to study the behavioral and psychiatric well-being of the community by different age groups, different study populations and in different places, was a new type of research for the REC to review, constituting 13% of the submitted COVID-19 research at that time and the second most frequent type of studies to be reviewed after therapeutic research (18%). The lack of experience in reviewing this type of research was challenging. Breeching of confidentiality and assurance were the major concerns. Additionally, telemedicine services are not common in developing countries like Egypt due to high illiteracy rate, 24.6% in July 2019 as announced by the Central Agency for Public Mobilization and Statistics ( 9 ). While the REC tried to ensure optimization of the research protocol and data collection and follow up, the REC experienced difficulties in interpretation of the PIs or physicians' instructions and data collection by phone. However, the REC also requested that the patient have an educated relative beside him to ensure proper comprehension of the instructions of the PI and for easier communication.

Table 2 . Most common COVID-19 research topics reviewed by FMASU REC from April to October 2020.

Ain Shams University includes eight hospitals and several health centers. The total number of beds affiliated with the university is 2,300. Research is allowed in all hospitals and health centers except the specialized hospitals (the Specialized Hospital on within the FMASU campus and the Obour Specialized Hospital in Obour city).

During the first wave of the pandemic from February to October 2020, two main hospitals were transformed into isolation hospitals for moderate and severe adult cases, Obour Specialized Hospital, and the Geriatric Hospital; one new hospital was established, Al Maidany Hospital. Ain Shams student dorms were transformed into hospitals to receive moderate COVID-19 cases. The Internal Medicine and Surgery Departments were allocated for adult COVID-19 cases and the Paediatric Department for pediatric COVID-19 cases. The rest of the hospitals offered the same services as usual, except that every patient being admitted was instructed to do a Polymerase Chain Reaction (PCR) test before admission. If the PCR was positive, the patient would be transferred to Obour Specialized Isolation Hospital.

Ain Shams University designated some of its hospitals and ICUs as “Isolation Hospitals” for the management of COVID-19 patients, which became the target for many, if not all, of the COVID-19 research studies. In view of the overwhelming number of research protocols, more than one research protocol targeted the same population in the same isolation hospital or ICU. In a few instances, the same PI was involved in more than one study. While there are no regulations against this, the REC was concerned about the involvement of the same patient in more than one study. The FMASU REC did not allow enrolment of subjects in more than one ongoing clinical trial. This decision conflicts with Cinnella and Gertner who reported that co-enrolment does not affect the safety of patients, the study outcome, or side effects, provided that the inclusion and exclusion criteria are appropriately set ( 10 , 11 ).

Before COVID-19, the REC stressed on selecting the appropriate control groups for the study, especially regarding how healthy controls were selected. For the COVID-19 protocols the controls were usually sick patients, hence risk mitigation was the major issue. During review of COVID-19 protocols, the REC noticed that several RCTs control groups did not receive interventional medication and had similar characteristics and inclusion criteria, e.g., the severity of the disease. To decrease the number of subjects included in the studies, the REC suggested the use of the same set of controls, whenever applicable and possible, in more than one study. This meant that the subjects were enrolled only once, and their data was shared with other investigators performing their studies at the same time in the same place. The intervention arm, however, included different subjects, receiving different medications according to the trial they were enrolled in. The committee also required the intervention group to control group ratio to be 1:1, and not more, in order to avoid enrolment of more subjects than required in the RCTs.

In many clinical trials placebo control arm is recommended, especially where the effect of the drug is still not well-documented, or as obvious as in cancer research where a drug causes shrinkage of the tumor ( 12 ). For the placebo-controlled trials, the REC decided that all participants must receive the updated standard of care treatment as per the Egyptian MOHP protocol for COVID-19 patients, while the participants receive the new drug under trial as add-on therapy. This way the clinical trial design was an add-on design, where the controls received the standard care MOHP protocol, rather than receiving a sham medication. The REC thought that this could minimize the risk, although the standard protocols at the start of the pandemic had no clear evidence of benefit.

The inclusion of the Egyptian MOHP COVID-19 management protocol was a challenge to the investigators, as the treatment protocol was constantly updated according to new information arising in that arena. The FMASU REC recommended that the standard of care set by the Egyptian MOHP always be updated in the submitted protocols and provided to all COVID-19 study participants.

Regarding the clinical trial endpoints, the FMASU REC had lengthy discussions on the use of measurable achievement vs. patient-related outcomes in the pandemic research. Several protocols used “the time to clinical improvement” as the measure for outcome. Clinical improvement in some studies was defined as the time from randomization to either an improvement of two points on a six or eight-category ordinal scale. Some members of the committee considered the scale as very subjective and required the use of more objective or measurable outcomes. The FMASU REC resorted to the time to clinical improvement scale, in addition to the patient-related outcome scales, the investigators should use more objective outcome measures in their studies, such as persistent positive PCR tests after treatment, or time until the emergence of antibodies against the novel virus. The use of objective tests as outcomes would be a dynamic process as new information is published.

Ensuring the provision of a clear informed consent form was a big challenge for the committee, and certainly for the investigators as well. The motivational force behind the willingness of the patients to enroll in the clinical trials is complex, and therapeutic misconception had to be clearly avoided in the consent language. Due to the scarcity of available information about the virus and the use of novel drugs, the committee ensured that the investigators simplify the information provided to the participants in a manner that the participants could comprehend, as there were so many unknown facts about the virus. The committee understood how challenging it was to describe and explain unknown risks to the potential participants. Still, the FMASU REC required the explanation of risks to be clear and in a language the participants could understand. Furthermore, the prospect of direct benefits was in no way to be promised or overestimated. The FMASU REC members conducted a meticulous review of the wording of the informed consent to ensure the message was clearly communicated to the potential participants and their guardians, regarding the lack of scientific evidence of the efficacy of the used drugs, as well as the unknown side effects, while still providing convincing rationale for the performance of the study.

Additional minor concerns in some of the studies included the completion of a diary for drug doses to be completed by the patients. The FMASU REC was concerned about how a severely ill participant would record his/her daily doses of drugs under trial, especially for the non-educated participants. The FMASU REC requested that this be confined to moderate or highly educated cases only.

The FMASU REC requested the timely reporting of all adverse events as soon as they occurred, not only the serious ones as per the standard procedures which assign a medical monitor in all COVID-19 clinical trials. The medical monitor should be a medical doctor, not involved in the study, but who observes the progress of the study and provides reports to the FMASU REC in case of adverse events. In studies assessing psychological risks to healthcare workers, the FMASU REC requested that participants who tested positive on screening, receive free management and referral to receive psychiatric help if proven to be suffering from anxiety or depression.

Common modifications and clarifications requested by the FMASU REC were the inclusion criteria and the age range of the recruited subjects. Enrolment of subjects not receiving other medicines under trial was a challenge during review. Detailed data of the study procedures were requested in many submitted research studies. More frequent progress reports were requested.

To mitigate risks, more frequent electrocardiograms, complete blood counts, x-rays, and chest Computed Tomographies were requested to safeguard against serious adverse events of the drugs under investigation, such as Hydroxychloroquine and other repurposed drugs. Regarding the control groups in the RCTs, the REC recommended that controls obtain the standard MOHP protocol for COVID-19 management. The REC requested monthly progress reports and swift notification of serious adverse events.

The innovative approaches adopted by the REC in the earlier wave of the COVID-19 pandemic were acceleration of submission of pre-requisite paperwork needed for application, increased frequency of virtual meetings, expansion of meeting agendas, direct contact with the PIs by phone and fast-track review within 1-7 days (compared to the usual 1-month review of clinical trials according to the SOPs.

FMASU REC experience, being active for 13 years since 2007 would be beneficial for other Egyptian RECs, numbering approximately 85 committees in 2021 with variable experience. Seventy Egyptian RECS are linked through a non-governmental body named the Egyptian Network of Research Ethics Committees (also known as ENREC), established in 2008, that enhances REC networking, standardizing the SOPs among RECs all over Egypt, the exchange of knowledge of research review challenges and obstacles, as well as finding solutions through regular annual meetings ( 13 ). Thirty-five RECs are registered with the MOHP.

Data confidentiality is fundamental in both COVID-19 and non-COVID-19 research to protect the life, health, dignity, integrity, right to self-determination, privacy, and confidentiality of personal information of research subjects. It has been practiced since the establishment of the committee according to the Declaration of Helsinki ( 14 ).

During the review of COVID-19 research, the REC was more diligent in reviewing the parts of the protocol where the investigators detailed the precautions for data confidentiality, including databases and computer files, as well as paper copies of questionnaires and informed consents. REC members followed the REC review checklist to review the protocols with confidentiality adequately listed in the checklist. Digital tracking technologies were not allowed, so there were no concerns regarding generated data confidentiality.

Some of the strengths of this analysis at the organizational level were REC resilience and at the research level, the researchers continued conduct of research in spite of the discussed challenges in order to generate knowledge for this new disease and to accomplish investigator career progress. Regarding the research participants: COVID-19 investigation results, including PCR, lab and radiology and all medications given to research participants were provided free of charge. Participants were offered the autonomy to participate in research under strict REC oversight during that period, which was characterized by little and misinformation. Regarding inclusiveness and diversity, participants included healthcare professionals, literate and illiterate patients, and the elderly without discrimination in research enrolment while maintaining equity of healthcare.

Our research prioritization during the COVID-19 pandemic is in line with that of Kheng-Wei Yeoh and Ketan Shah, who provided recommendations for RECs on research prioritization and fast-tracking research, without compromising the participants' safety and well-being. Priority should be given to research that helps find a cure for the patients, while other research should be re-evaluated for public health concerns and precautions incorporated into the studies. As for the design, the authors recommend incorporating the study design into clinical care and look for new information due to the increased demand ( 15 ).

The Pan American Health Organization (PAHO), website on April 15, 2020 published guidance for the development of SOPs for RECs for the review of research during the COVID-19 pandemic. In addition to the revised SOPs, the PAHO recommended that RECs should accelerate reviews and initiate a system for follow up on COVID-19 research ( 16 ).

Due to confidentiality issues, the authors provided minimal details about the studies. We would have liked to expand on the types of research, but many of the studies included new drugs about which we could not provide details. Another limitation is that this article's scope is limited to the performance of the REC and the challenges it faced, rather than a predesigned research study or survey.

During the COVID-19 pandemic the FMASU REC was overwhelmed with a huge number of COVID-19 -related research protocols. The increased amount of research protocols to be reviewed in a short time presented several logistic and ethical challenges. The committee had to adopt different methods of review to ensure adherence to the ethical principles. The ethics training background of the members proved beneficial to balance the risks and benefits to the patients among novel ethical dilemmas.

Author Contributions

All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.

This study was self-funded by the authors, who have not received any monetary or financial support for the writing and publishing.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

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.

Acknowledgments

The authors would like to acknowledge the efforts of all the FMASU REC members and office staff during the first wave of the COVID-19 pandemic and FMASU administration's support.

Abbreviations

RECs, Research ethics committees; EUREC, European Network of Research Ethics Committees; FMASU REC, Faculty of Medicine, Ain Shams University Research Ethics Committee; ICU, Intensive care units; MOHP, Ministry of Health and Population; PAHO, Pan American Health Organization; PCR, Polymerase Chain Reaction; PI, Principal investigator; RCTs, Randomized controlled trials; SOPs, Standard operating procedures; WHO, World Health Organization.

1. Marzouk D, Abd El Aal W, Saleh A, Sleem H, Khyatti M, Mazini L, et al. Overview on health research ethics in Egypt and North Africa. Eur J Public Health . (2014) 24(Suppl. 1):87–91. doi: 10.1093/eurpub/cku110

PubMed Abstract | CrossRef Full Text | Google Scholar

2. Sisi Passes Law Regulating Clinical Medical Research in Egypt. Egypt: Independent Gazette (2020). Available online at: https://egyptindependent.com/sisi-passes-law-regulating-clinical-medical-research-in-egypt/ (accessed February 28, 2021)

Google Scholar

3. Available, online at: https://clinicaltrials.gov/ct2/results?cond=COVID-19 (accessed March 3, 2021)

4. Guidance for Managing Ethical Issues in Infectious Disease Outbreaks . Geneva: World Health Organization (2016). Available online at: https://apps.who.int/iris/bitstream/handle/10665/250580/9789241549837-eng.pdf?sequence=1&isAllowed=y (accessed November 10, 2020)

5. Ethical Standards for Research During Public Health Emergencies: Distilling Existing Guidance to Support COVID-19 R&D. Geneva: World Health Organization (2020). Available online at: https://apps.who.int/iris/bitstream/handle/10665/331507/WHO-RFH-20.1-eng.pdf?sequence=1&isAllowed=y (accessed November 10, 2020)

6. Position of the European Network of Research Ethics Committees (EUREC) on the Responsibility of Research Ethics Committees during the COVID-19 Pandemic (2020). Available online at: https://ancei.es/wp-content/uploads/2020/05/EUREC-Positionpaper_COVID_19.pdf (accessed December, 2020)

7. Ministry of Higher Education and Scientific Research. Available online at: http://portal.mohesr.gov.eg/ar-eg/Pages/Home.aspx (accessed June, 2021)

8. Molyneux M. New ethical considerations in vaccine trials. Hum Vaccines Immunother . (2017) 13:2160–3. doi: 10.1080/21645515.2016.1272744

9. Central Agency for Public Mobilization and Statistics (CAPMAS) (2019). Available online at: https://dailynewsegypt.com/2020/09/08/egypts-illiteracy-rate-decreased-to-24-6-in-july-2019-capmas/ (accessed August 2, 2021)

10. Cinnella G. Enrolling patients into multiple trials: it is time for glasnost. Crit Care Med . (2015) 43:485–6. doi: 10.1097/CCM.0000000000000756

11. Gertner E. COVID-19 trial co-enrolment and subsequent enrolment. Lancet . (2020) 396:461–2. doi: 10.1016/S0140-6736(20)31537-3

12. Schilsky RL. Placebos in Cancer Clinical Trials (2018). Available online at: https://www.cancer.net/research-and-advocacy/clinical-trials/placebos-cancer-clinical-trials (accessed February 28, 2021)

13. Egyptian Network of Research Ethics Committees (2008). Available online at: http://www.enrec.org (accessed July, 2021)

14. WMA Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects (2021). Available online at: https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/ (accessed July, 2021)

15. Kheng-Wei Y, Ketan S. Research ethics during a pandemic (COVID-19). Int Health . (2021) 13:374–5. doi: 10.1093/inthealth/ihaa054

16. Available, online at: https://iris.paho.org/handle/10665.2/52086 (accessed August 1, 2021)

Keywords: research ethics committees, Faculty of Medicine Ain Shams University, COVID-19 research, ethical challenges, accelerated review

Citation: Marzouk D, Sharawy I, Nakhla I, El Hodhod M, Gadallah H, El-Shalakany A, Elwakil R, Moussa MM, Ismail A and Tash FM (2021) Challenges During Review of COVID-19 Research Proposals: Experience of Faculty of Medicine, Ain Shams University Research Ethics Committee, Egypt. Front. Med. 8:715796. doi: 10.3389/fmed.2021.715796

Received: 27 May 2021; Accepted: 29 September 2021; Published: 02 November 2021.

Reviewed by:

Copyright © 2021 Marzouk, Sharawy, Nakhla, El Hodhod, Gadallah, El-Shalakany, Elwakil, Moussa, Ismail and Tash. 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) and the copyright owner(s) 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: Diaa Marzouk, diaamarzouk@med.asu.edu.eg

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The Impact of COVID-19 on Education: A Meta-Narrative Review

Aras bozkurt.

1 Distance Education Department, Anadolu University, Eskişehir, Turkey

2 Department of English Studies, University of South Africa, Pretoria, South Africa

3 Anadolu Üniversitesi, Açıköğretim Fakültesi, Kat:7, Oda:702, 26470, Tepebaşı, Eskişehir, Turkey

Kadir Karakaya

4 Applied Linguistics & Technology Department, Iowa State University, Ames, IA USA

5 Educational Psychology, Learning Sciences, University of Oklahoma, Norman, OK USA

Özlem Karakaya

6 Educational Technology & Human-Computer Interaction, Iowa State University, Ames, IA USA

Daniela Castellanos-Reyes

7 Curriculum and Instruction, Learning Design and Technology, Purdue University, West Lafayette, IN USA

Associated Data

The dataset is available from the authors upon request.

The rapid and unexpected onset of the COVID-19 global pandemic has generated a great degree of uncertainty about the future of education and has required teachers and students alike to adapt to a new normal to survive in the new educational ecology. Through this experience of the new educational ecology, educators have learned many lessons, including how to navigate through uncertainty by recognizing their strengths and vulnerabilities. In this context, the aim of this study is to conduct a bibliometric analysis of the publications covering COVID-19 and education to analyze the impact of the pandemic by applying the data mining and analytics techniques of social network analysis and text-mining. From the abstract, title, and keyword analysis of a total of 1150 publications, seven themes were identified: (1) the great reset, (2) shifting educational landscape and emerging educational roles (3) digital pedagogy, (4) emergency remote education, (5) pedagogy of care, (6) social equity, equality, and injustice, and (7) future of education. Moreover, from the citation analysis, two thematic clusters emerged: (1) educational response, emergency remote education affordances, and continuity of education, and (2) psychological impact of COVID-19. The overlap between themes and thematic clusters revealed researchers’ emphasis on guaranteeing continuity of education and supporting the socio-emotional needs of learners. From the results of the study, it is clear that there is a heightened need to develop effective strategies to ensure the continuity of education in the future, and that it is critical to proactively respond to such crises through resilience and flexibility.

Introduction

The Coronavirus (COVID-19) pandemic has proven to be a massive challenge for the entire world, imposing a radical transformation in many areas of life, including education. It was rapid and unexpected; the world was unprepared and hit hard. The virus is highly contagious, having a pathogenic nature whose effects have not been limited to humans alone, but rather, includes every construct and domain of societies, including education. The education system, which has been affected at all levels, has been required to respond to the crisis, forced to transition into emergency modes, and adapt to the unprecedented impact of the global crisis. Although the beginning of 2021 will mark nearly a year of experience in living through the pandemic, the crisis remains a phenomenon with many unknowns. A deeper and more comprehensive understanding of the changes that have been made in response to the crisis is needed to survive in these hard times. Hence, this study aims to provide a better understanding by examining the scholarly publications on COVID-19 and education. In doing this, we can identify our weaknesses and vulnerabilities, be better prepared for the new normal, and be more fit to survive.

Related Literature

Though the COVID-19 pandemic is not the first major disruption to be experienced in the history of the world, it has been unique due to its scale and the requirements that have been imposed because of it (Guitton, 2020 ). The economies of many countries have greatly suffered from the lockdowns and other restrictive measurements, and people have had to adapt to a new lifestyle, where their primary concern is to survive by keeping themselves safe from contracting the deadly virus. The education system has not been exempt from this series of unfortunate events inflicted by COVID-19. Since brick-and-mortar schools had to be closed due to the pandemic, millions of students, from those in K-12 to those in higher education, were deprived of physical access to their classrooms, peers, and teachers (Bozkurt & Sharma, 2020a , b ). This extraordinary pandemic period has posed arguably the most challenging and complex problems ever for educators, students, schools, educational institutions, parents, governments, and all other educational stakeholders. The closing of brick-and-mortar schools and campuses rendered online teaching and learning the only viable solution to the problem of access-to-education during this emergency period (Hodges et al., 2020 ). Due to the urgency of this move, teachers and instructors were rushed to shift all their face-to-face instruction and instructional materials to online spaces, such as learning management systems or electronic platforms, in order to facilitate teaching virtually at a distance. As a result of this sudden migration to learning and instruction online, the key distinctions between online education and education delivered online during such crisis and emergency circumstances have been obfuscated (Hodges et al., 2020 ).

State of the Current Relevant Literature

Although the scale of the impact of the COVID-19 global pandemic on education overshadows previously experienced nationwide or global crises or disruptions, the phenomenon of schools and higher education institutions having to shift their instruction to online spaces is not totally new to the education community and academia (Johnson et al., 2020 ). Prior literature on this subject indicates that in the past, schools and institutions resorted to online or electronic delivery of instruction in times of serious crises and uncertainties, including but not limited to natural disasters such as floods or earthquakes (e.g., Ayebi-Arthur, 2017 ; Lorenzo, 2008 ; Tull et al., 2017 ), local disruptions such as civil wars and socio-economic events such as political upheavals, social turmoils or economic recessions (e.g., Czerniewicz et al., 2019 ). Nevertheless, the past attempts to move learning and teaching online do not compare to the current efforts that have been implemented during the global COVID-19 pandemic, insofar as the past crisis situations were sporadic events in specific territories, affecting a limited population for relatively short periods of time. In contrast, the COVID-19 pandemic has continued to pose a serious threat to the continuity of education around the globe (Johnson et al., 2020 ).

Considering the scale and severity of the global pandemic, the impacts it has had on education in general and higher education in particular need to be explored and studied empirically so that necessary plans and strategies aimed at reducing its devastating effects can be developed and implemented. Due to the rapid onset and spread of the global pandemic, the current literature on the impact of COVID-19 on education is still limited, including mostly non-academic editorials or non-empirical personal reflections, anecdotes, reports, and stories (e.g., Baker, 2020 ; DePietro, 2020 ). Yet, with that said, empirical research on the impact of the global pandemic on higher education is rapidly growing. For example, Johnson et al. ( 2020 ), in their empirical study, found that faculty members who were struggling with various challenges adopted new instructional methods and strategies and adjusted certain course components to foster emergency remote education (ERE). Unger and Meiran ( 2020 ) observed that the pandemic made students in the US feel anxious about completing online learning tasks. In contrast, Suleri ( 2020 ) reported that a large majority of European higher education students were satisfied with their virtual learning experiences during the pandemic, and that most were willing to continue virtual higher education even after the pandemic (Suleri, 2020 ). The limited empirical research also points to the need for systematically planning and designing online learning experiences in advance in preparation for future outbreaks of such global pandemics and other crises (e.g., Korkmaz & Toraman, 2020 ). Despite the growing literature, the studies provide only fragmentary evidence on the impact of the pandemic on online learning and teaching. For a more thorough understanding of the serious implications the pandemic has for higher education in relation to learning and teaching online, more empirical research is needed.

Unlike previously conducted bibliometric analysis studies on this subject, which have largely involved general analysis of research on health sciences and COVID-19, Aristovnik et al. ( 2020 ) performed an in-depth bibliometric analysis of various science and social science research disciplines by examining a comprehensive database of document and source information. By the final phase of their bibliometric analysis, the authors had analyzed 16,866 documents. They utilized a mix of innovative bibliometric approaches to capture the existing research and assess the state of COVID-19 research across different research landscapes (e.g., health sciences, life sciences, physical sciences, social sciences, and humanities). Their findings showed that most COVID-19 research has been performed in the field of health sciences, followed by life sciences, physical sciences, and social sciences and humanities. Results from the keyword co-occurrence analysis revealed that health sciences research on COVID-19 tended to focus on health consequences, whereas the life sciences research on the subject tended to focus on drug efficiency. Moreover, physical sciences research tended to focus on environmental consequences, and social sciences and humanities research was largely oriented towards socio-economic consequences.

Similarly, Rodrigues et al. ( 2020 ) carried out a bibliometric analysis of COVID-19 related studies from a management perspective in order to elucidate how scientific research and education arrive at solutions to the pandemic crisis and the post-COVID-19 era. In line with Aristovnik et al.’s ( 2020 ) findings, Rodrigues et al. ( 2020 ) reported that most of the published research on this subject has fallen under the field of health sciences, leaving education as an under-researched area of inquiry. The content analysis they performed in their study also found a special emphasis on qualitative research. The descriptive and content analysis yielded two major strands of studies: (1) online education and (2) COVID-19 and education, business, economics, and management. The online education strand focused on the issue of technological anxiety caused by online classes, the feeling of belonging to an academic community, and feedback.

Lastly, Bond ( 2020 ) conducted a rapid review of K-12 research undertaken in the first seven months of the COVID-19 pandemic to identify successes and challenges and to offer recommendations for the future. From a search of K-12 research on the Web of Science, Scopus, EBSCOHost, the Microsoft Academic, and the COVID-19 living systematic map, 90 studies were identified and analyzed. The findings revealed that the reviewed research has focused predominantly on the challenges to shifting to ERE, teacher digital competencies and digital infrastructure, teacher ICT skills, parent engagement in learning, and students’ health and well-being. The review highlighted the need for straightforward communication between schools and families to inform families about learning activities and to promote interactivity between students. Teachers were also encouraged to develop their professional networks to increase motivation and support amongst themselves and to include opportunities for both synchronous and asynchronous interaction for promoting student engagement when using technology. Bond ( 2020 ) reported that the reviewed studies called for providing teachers with opportunities to further develop their digital technical competencies and their distance and online learning pedagogies. In a recent study that examines the impact of COVID-19 at higher education (Bozkurt, 2022 ), three broad themes from the body of research on this subject: (1) educational crisis and higher education in the new normal: resilience, adaptability, and sustainability, (2) psychological pressures, social uncertainty, and mental well-being of learners, and (3) the rise of online distance education and blended-hybrid modes. The findings of this study are similar to Mishra et al. ( 2021 ) who examined the COVID-19 pandemic from the lens of online distance education and noted that technologies for teaching and learning and psychosocial issues were emerging issues.

The aforementioned studies indicate that a great majority of research on COVID-19 has been produced in the field of health sciences, as expected. These studies nonetheless note that there is a noticeable shortage of studies dealing with the effects of the pandemic in the fields of social sciences, humanities, and education. Given the profound impact of the pandemic on learning and teaching, as well as on the related stakeholders in education, now more than ever, a greater amount of research on COVID-19 needs to be conducted in the field of education. The bibliometric studies discussed above have analyzed COVID-19 research across various fields, yielding a comparative snapshot of the research undertaken so far in different research spheres. However, despite being comprehensive, these studies did not appear to have examined a specific discipline or area of research in depth. Therefore, this bibliometric study aims to provide a focused, in-depth analysis of the COVID-19-related research in the field of education. In this regard, the main purpose of this study is to identify research patterns and trends in the field of education by examining COVID-19-related research papers. The study sought to answer the following research questions:

• What are the thematic patterns in the title, abstract, and keywords of the publications on COVID-19 and education?
• What are the citation trends in the references of the sampled publications on COVID-19 and education?

Methodology

This study used data mining and analytic approaches (Fayyad et al., 2002 ) to examine bibliometric patterns and trends. More specifically, social network analysis (SNA) (Hansen et al., 2020 ) was applied to examine the keywords and references, while text-mining was applied (Aggarwal & Zhai, 2012 ) to examine the titles and abstracts of the research corpus. Keywords represent the essence of an article at a micro level and for the analysis of the keywords, SNA was used. SNA “provides powerful ways to summarize networks and identify key people, [entities], or other objects that occupy strategic locations and positions within a matrix of links” (Hansen et al., 2020 , p. 6). In this regard, the keywords were analyzed based on their co-occurrences and visualized on a network graph by identifying the significant keywords which were demonstrated as nodes and their relationships were demonstrated with ties. For text-mining of the titles and abstracts, the researchers performed a lexical analysis that employs “two stages of co-occurrence information extraction—semantic and relational—using a different algorithm for each stage” (Smith & Humphreys, 2006 , p. 262). Thus, text-mining analysis enabled researchers to identify the hidden patterns and visualize them on a thematic concept map. For the analysis of the references, the researchers further used SNA based on the arguments that “citing articles and cited articles are linked to each other through invisible ties, and they collaboratively and collectively build an intellectual community that can be referred to as a living network, structure, or an ecology” (Bozkurt, 2019 , p. 498). The analysis of the references enabled the researchers to identify pivotal scholarly contributions that guided and shaped the intellectual landscape. The use of multiple approaches enables the study to present a broader view, or a meta-narrative.

Sample and Inclusion Criteria

The publications included in this research met the following inclusion criteria: (1) indexed by the Scopus database, (2) written in English, and (3) had the search queries on their title (Table ​ (Table1). 1 ). The search query reflects the focus on the impact of COVID-19 on education by including common words in the field like learn , teach , or student . Truncation was also used in the search to capture all relevant literature. Narrowing down the search allowed us to exclude publications that were not education related. Scopus was selected because it is one of the largest scholarly databases, and only publications in English were selected to facilitate identification of meaningful lexical patterns through text-mining and provide a condensed view of the research. The search yielded a total of 1150 papers (articles = 887, editorials = 66, notes = 58, conference papers = 56, letters = 40, review studies = 30, book chapters = 9, short surveys = 3, books = 1).

Search strings used to create research corpus

Data Analysis and Research Procedures

This study has two phases of analysis. In the first phase, text mining was used to analyze titles and abstracts, and SNA was applied to analyze keywords. By using two different analytical approaches, the authors were able to triangulate the research findings (Thurmond, 2001 ). In this phase, using lexical algorithms, text mining analysis enabled visualizing the textual data on a thematic concept map according to semantic relationships and co-occurrences of the words (Fig.  1 ). Text mining generated a machine-based concept map by analyzing the co-occurrences and lexical relationships of textual data. Then, based on the co-occurrences and centrality metrics, SNA enabled visualizing keywords on a network graphic called sociogram (Fig.  2 ). SNA allowed researchers to visually identify the key terms on a connected network graph where keywords are represented as nodes and their relationships are represented as edges. In the first phase of the study, by synthesizing outputs of the data mining and analytic approaches, meaningful patterns of textual data were presented as seven main research themes.

Thematic concept mapping of COVID-19 and education-related papers

Social networks analysis of the keywords in COVID-19 and education-related papers

In the second phase of the study, through the examination of the references and citation patterns (e.g., citing and being cited) of the articles in the research corpus, the citation patterns were visualized on a network graphic by clusters (See Fig.  3 ) showing also chronical relationships which enabled to identify pivotal COVID-19 studies. In the second phase of the study, two new themes were identified which were in line with the themes that emerged in the first phase of the study.

Social networks analysis of the references in COVID-19 and education-related papers 2019–2020 (Only the first authors were labeled – See Appendix Fig. ​ Fig.4 4 for SNA of references covering pre-COVID-19 period)

Strengths and Limitations

This study is one of the first attempts to use bibliometric approaches benefiting from data mining and analysis techniques to better understand COVID-19 and its consequences on published educational research. By applying such an approach, a large volume of data is able to be visualized and reported. However, besides these strengths, the study also has certain limitations. First, the study uses the Scopus database, which, though being one of the largest databases, does not include all types of publications. Therefore, the publications selected for this study offer only a partial view, as there are many significant publications in gray literature (e.g., reports, briefs, blogs). Second, the study includes only publications written in English, however, with COVID-19 being a global crisis, publications in different languages would provide a complementary view and be helpful in understanding local reflections in the field of education.

Findings and Discussion

Sna and text-mining: thematic patterns in the title, abstract, and keywords of the publications.

This section reports the findings based on a thematic concept map and network graphic that were developed through text mining (Fig.  1 —Textual data composed of 186.234 words visualized according to lexical relationships and co-occurrences) and sociograms created using SNA (Fig.  2 —The top 200 keywords with highest betweenness centrality and 1577 connections among them mapped on a network graph) to visualize the data. Accordingly, seven major themes were identified by analyzing the data through text-mining and SNA: (1) the great reset, (2) digital pedagogy, (3) shifting educational landscape and emerging educational roles, (4) emergency remote education, (5) pedagogy of care, (6) social equity, equality, and injustice, and (7) future of education.

• Theme 1: The Great Reset (See path Fig.  1 : lockdown  +  emergency  +  community  +  challenges  +  during  >  pandemic and impact  >  outbreak  >  coronavirus  >  pandemic and global  >  crisis  >  pandemic  >  world; See nodes on Fig.  2 : Covid19, pandemic, Coronavirus, lockdown, crisis ). The first theme in the thematic concept map and network graphic is the Great Reset. It has been relatively a short time since the World Health Organization (WHO) declared the COVID-19 a pandemic. Although vaccination had already started, the pandemic continued to have an adverse impact on the world. Ever since the start of the pandemic, people were discussing when there would be a return to normal (Bozkurt & Sharma, 2020a , b ; Xiao, 2021 ); however, as time goes by, this hope has faded, and returning to normal appears to be far into the future (Schwab & Malleret, 2020 ). The pandemic is seen as a major milestone, in the sense that a macro reset in economic, social, geopolitical, environmental, and technological fields will produce multi-faceted changes affecting almost all aspects of life (Schwab & Malleret, 2020 ). The cover of an issue of the international edition of Time Magazine reflected this idea of a great reset and presented the COVID-19 pandemic as an opportunity to transform the way we live and work (Time, 2020 ). It has been argued that the pandemic will generate the emergence of a new era, and that we will have to adapt to the changes it produces (Bozkurt & Sharma, 2020 ). For example, the industrial sector quickly embraced remote work despite its challenges, and it is possible that most industrial companies will not return to the on-site working model even after the pandemic ends (Hern, 2020 ). We can expect a high rate of similar responses in other fields, including education, where COVID-19 has already reshaped our educational systems, the way we deliver education, and pedagogical approaches.
• Theme 2: Digital pedagogy (See path on Fig.  1 : distance learning  >  research  >  teacher  >  development  >  need  >  training  +  technology  +  virtual  >  digital  >  communication  >  support  >  process  >  teaching  >  online  >  learning  >  online learning  +  course  >  faculty  >  students  >  experience ; See nodes on Fig.  2 : online learning, distance learning, computer-based learning, elearning, online education, distance education, online teaching, multimedia-based learning, technology, blended learning, online, digital transformation, ICT, online classes, flexible learning, technology-enhanced learning, digitalization ). Owing to the rapid transition to online education as a result of COVID-19, digital pedagogy and teachers’ competencies in information and communication technology (ICT) integration have gained greater prominence with the unprecedented challenges teachers have faced to adapt to remote teaching and learning. The COVID-19 pandemic has unquestionably manifested the need to prepare teachers to teach online, as most of them have been forced to assume ERE roles with inadequate preparation. Studies involving the use of SNA indicate a correspondence between adapting to a digital pedagogy and the need to equip teachers with greater competency in technology and online teaching (e.g., Blume, 2020 ; König et al., 2020 ). König et al. ( 2020 ) conducted a survey-based study investigating how early career teachers have adapted to online teaching during COVID-19 school closures. Their study found that while all the teachers maintained communication with students and their parents, introduced new learning content, and provided feedback, they lacked the ability to respond to challenges requiring ICT integration, such as those related to providing quality online teaching and to conducting assessments. Likewise, Blume ( 2020 ) noted that most teachers need to acquire digital skills to implement digitally-mediated pedagogy and communication more effectively. Both study findings point to the need for building ICT-related teaching and learning competencies in initial teacher education and teacher professional development. The findings from the SNA conducted in the present study are in line with the aforementioned findings in terms of keyword analysis and overlapping themes and nodes.
• Theme 3: Shifting educational landscape and emerging educational roles (See path on Fig.  1 : future > education > role > Covid19; See nodes on Fig.  2 : higher education, education, student, curriculum, university, teachers, learning, professional development, teacher education, knowledge, readiness ). The role of technology in education and human learning has been essential during the COVID-19 pandemic. Technology has become a prerequisite for learning and teaching during the pandemic and will likely continue to be so after it. In the rapid shift to an unprecedented mode of learning and teaching, stakeholders have had to assume different roles in the educational landscape of the new normal. For example, in a comprehensive study involving the participation of over 30 K higher education students from 62 countries conducted by Aristovnik et al. ( 2020 ), it was found that students with certain socio-demographic characteristics (male, lower living standard, from Africa or Asia) were significantly less satisfied with the changes to work/life balance created by the COVID-19 pandemic, and that female students who were facing financial problems were generally more affected by COVID-19 in their emotional life and personal circumstances. Despite the challenges posed by the pandemic, there is likely to be carry over in the post-pandemic era of some of the educational changes made during the COVID-19 times. For example, traditional lecture-based teacher-centered classes may be replaced by more student-centered online collaborative classes (Zhu & Liu, 2020 ). This may require the development and proliferation of open educational platforms that allow access to high-quality educational materials (Bozkurt et al., 2020 ) and the adoption of new roles to survive in the learning ecologies informed by digital learning pedagogies. In common with the present study, the aforementioned studies (e.g., Aristovnik et al., 2020 ; König et al., 2020 ) call for more deliberate actions to improve teacher education programs by offering training on various teaching approaches, such as blended, hybrid, flexible, and online learning, to better prepare educators for emerging roles in the post-pandemic era.
• Theme 4: Emergency remote education (see path Fig.  1 : higher education  >  university  >  student  >  experience  >  remote; See nodes on Fig.  2 : Covid19, pandemic, Coronavirus, higher education, education, school closure, emergency remote teaching, emergency remote learning ). Educational institutions have undergone a rapid shift to ERE in the wake of COVID-19 (Bozkurt & Sharma, 2020a ; Bozkurt et al., 2020 ; Hodges et al., 2020 ). Although ERE is viewed as similar to distance education, they are essentially different. That is, ERE is a prompt response measure to an emergency situation or unusual circumstances, such as a global pandemic or a civil war, for a temporary period of time, whereas distance education is a planned and systematic approach to instructional design and development grounded in educational theory and practice (Bozkurt & Sharma, 2020b ). Due to the urgent nature of situations requiring ERE, it may fall short in embracing the solid pedagogical learning and teaching principles represented by distance education (Hodges et al., 2020 ). The early implementations of ERE primarily involved synchronous video-conferencing sessions that sought to imitate in-person classroom instruction. It is worth noting that educators may have heavily relied on synchronous communication to overcome certain challenges, such as the lack of available materials and planned activities for asynchronous communication. Lockdowns and school closures, which turned homes into compulsory learning environments, have posed major challenges for families and students, including scheduling, device sharing, and learner engagement in a socially distanced home learning environment (Bond, 2020 ). For example, Shim and Lee ( 2020 ) conducted a qualitative study exploring university students’ ERE experiences and reported that students complained about network instability, unilateral interactions, and reduced levels of concentration. The SNA findings clearly highlight that there has been a focus on ERE due to the school closures during the COVID-19 pandemic. It is key to adopt the best practices of ERE and to utilize them regularly in distance education (Bozkurt, 2022 ). Moreover, it is important to note that unless clear distinctions are drawn between these two different forms of distance education or virtual instruction, a series of unfortunate events in education during these COVID-19 times is very likely to take place and lead to fatal errors in instructional practices and to poor student learning outcomes.
• Theme 5: Pedagogy of care (See path Fig.  1 : r ole  >  education  >  Covid19  >  care ; See nodes on Fig.  2 : Stress, anxiety, student wellbeing, coping, care, crisis management, depression ). The thematic concept map and network graphic show the psychological and emotional impact of the COVID-19 pandemic on various stakeholders, revealing that they have experienced anxiety, expressed the need for care, and sought coping strategies. A study by Baloran ( 2020 ), conducted in the southern part of the Philippines to examine college students’ knowledge, attitudes, anxiety, and personal coping strategies during the COVID-19 pandemic, found that the majority of the students experienced anxiety during the lockdown and worried about food security, financial resources, social contact, and large gatherings. It was reported that the students coped with this anxiety by following protective measures, chatting with family members and friends, and motivating themselves to have a positive attitude. In a similar study, Islam et al. ( 2020 ) conducted an investigation to determine whether Bangladeshi college students experienced anxiety and depression and the factors responsible for these emotional responses. Their cross-sectional survey-based study found that a large percentage of the participants had suffered from anxiety and depression during the pandemic. Academic and professional uncertainty, as well as financial insecurity, have been documented as factors contributing to the anxiety and depression among college students. Both studies point to the need for support mechanisms to be established by higher education institutions in order to ensure student wellbeing, provide them with care, and help them to cope with stress, anxiety, and depression. Talidong and Toquero ( 2020 ) reported that, in addition to students’ well-being and care, teachers’ perceptions and experiences of stress and anxiety during the quarantine period need to be taken into account. The authors found that teachers were worried about the safety of their loved ones and were susceptible to anxiety but tended to follow the preventive policies. A pedagogy of care has been presented as an approach that would effectively allow educators to plan more supportive teaching practices during the pandemic by fostering clear and prompt communication with students and their families and taking into consideration learner needs in lesson planning (e.g., Karakaya, 2021 ; Robinson et al., 2020 ). Here it is important to stress that a pedagogy of care is a multifaceted concept, one that involves the concepts of social equity, equality, and injustice.
• Theme 6: Social equity, equality, and injustice (See path on Fig.  1 : Impact  >  outbreak  >  coronavirus  >  pandemic  >  social ; See nodes on Fig.  2 : Support, equity, social justice, digital divide, inequality, social support ). One of the more significant impacts of COVID-19 has been the deepening of the existing social injustices around the world (Oldekop et al., 2020 ; Williamson et al., 2020 ). Long-term school closures have deteriorated social bonds and adversely affected health issues, poverty, economy, food insecurity, and digital divide (Van Lancker & Parolin, 2020 ). Regarding the digital divide, there has been a major disparity in access to devices and data connectivity between high-income and low-income populations increasing the digital divide, social injustice, and inequality in the world (Bozkurt et al., 2020 ). In line with the SNA findings, the digital divide, manifesting itself most visibly in the inadequacy and insufficiency of digital devices and lack of high-speed Internet, can easily result in widespread inequalities. As such, the disparities between low and high socio-economic status families and school districts in terms of digital pedagogy inequality may deepen as teachers in affluent schools are more likely to offer a wide range of online learning activities and thereby secure better student engagement, participation, and interaction (Greenhow et al., 2020 ). These findings demonstrate that social inequities have been sharpened by the unfortunate disparities imposed by the COVID-19, thus requiring us to reimagine a future that mitigates such concerns.
• Theme 7: Future of education (See word path on Fig.  1 : Future  >  education  >  Covid19  >  pandemic  >  changes and pandemic  >  coronavirus, outbreak, impact  >  world ; See nodes on Fig.  2 : Sustainability, resilience, uncertainty, sdg4). Most significantly, COVID-19 the pandemic has shown the entire world that teachers and schools are invaluable resources and execute critical roles in society. Beyond that, with the compulsory changes resulting from the pandemic, it is evident that teaching and learning environments are not exclusive to brick-and-mortar classrooms. Digital technologies, being at the center of teaching and learning during the pandemic period, have been viewed as a pivotal agent in leveraging how learning takes place beyond the classroom walls (Quilter-Pinner & Ambrose, 2020 ). COVID-19 has made some concerns more visible. For example, the well-being of students, teachers, and society at large has gained more importance in these times of crisis. Furthermore, the need for educational technology and digital devices has compounded and amplified social inequities (Pelletier et al., 2021 ; West & Allen, 2020 ). Despite its global challenges, the need for technology and digital devices has highlighted some advantages that are likely to shape the future of education, particularly those related to the benefits of educational technology. For example, online learning could provide a more flexible, informal, self-paced learning environment for students (Adedoyin & Soykan, 2020 ). However, it also bears the risk of minimizing social interaction, as working in shared office environments has shifted to working alone in home-office settings. In this respect, the transformation of online education must involve a particular emphasis on sustaining interactivity through technology (Dwivedi et al., 2020 ). In view of the findings of the aforementioned studies, our text-mining and SNA findings suggest that the COVID-19 impositions may strongly shape the future of education and how learning takes place.

In summary, these themes extracted from the text-mining and SNA point to a significant milestone in the history of humanity, a multi-faceted reset that will affect many fields of life, from education and economics to sociology and lifestyle. The resulting themes have revealed that our natural response to an emerging worldwide situation shifted the educational landscape. The early response of the educational system was emergency-based and emphasized the continuance of in-person instruction via synchronous learning technologies. The subsequent response foregrounded the significance of digitally mediated learning pedagogy, related teacher competencies, and professional development. As various stakeholders (e.g., students, teachers, parents) have experienced a heightened level of anxiety and stress, an emerging strand of research has highlighted the need for care-based and trauma-informed pedagogies as a response to the side effects of the pandemic. In addition, as the global pandemic has made systemic impairments, such as social injustice and inequity, more visible, an important line of research has emerged on how social justice can be ensured given the challenges caused by the pandemic. Lastly, a sizable amount of research indicates that although the COVID-19 pandemic has imposed unprecedented challenges to our personal, educational, and social lives, it has also taught us how to respond to future crises in a timely, technologically-ready, pedagogically appropriate, and inclusive manner.

SNA: Citation Trends in the References of the Sampled Publications

The trends identified through SNA in citation patterns indicate two lines of thematic clusters (see Fig.  3 -A network graph depicting the citing and being cited patterns in the research corpus. Node sizes were defined by their citation count and betweenness centrality.). These clusters align with the results of the analysis of the titles, abstracts, and keywords of the sampled publications and forge the earlier themes (Theme 4: Emergency remote education and Theme 5: Pedagogy of care).

• Thematic Cluster 1: The first cluster centers on the abilities of educational response, emergency remote education affordances, and continuity of education (Bozkurt & Sharma, 2020a ; Crawford et al., 2020 ; Hodges et al., 2020 ) to mitigate the impact of COVID-19 on education, especially for more vulnerable and disadvantaged groups (UNESCO, 2020 ; Viner et al., 2020 ). The thematic cluster one agrees with the theme four emergency remote education . The first trend line (See red line in Fig.  3 ) shows that the education system is vulnerable to external threats. Considering that interruption of education is not exclusive to pandemics – for example, political crises have also caused disruptions (Rapp et al., 2016 ) – it is clear that coping mechanisms are needed to ensure the continuity of education under all conditions. In this case, we need to reimagine and recalibrate education to make it resilient, flexible, and adaptive, not only to ensure the continuity of education, but also to ensure social justice, equity, and equality. Given that online education has its own limitations (e.g., it is restricted to online tools and infrastructures), we need to identify alternative entry points for those who do not have digital devices or lack access to the internet.

“What we teach in these times can have secondary importance. We have to keep in mind that students will remember not the educational content delivered, but how they felt during these hard times. With an empathetic approach, the story will not center on how to successfully deliver educational content, but it will be on how learners narrate these times” (p. iv).

Conclusion and Suggestions

The results from this study indicate that quick adaptability and flexibility have been key to surviving the substantial challenges generated by COVID-19. However, extreme demands on flexibility have taken a toll on human well-being and have exacerbated systemic issues like inequity and inequality. Using data mining that involved network analysis and text mining as analytical tools, this research provides a panoramic picture of the COVID-19-related themes educational researchers have addressed in their work. A sample of 1150 references yielded seven themes, which served to provide a comprehensive meta-narrative about COVID-19 and its impact on education.

A portion of the sampled publications focused on what we refer to as the great reset , highlighting the challenges that the emergency lockdown brought to the world. A publication pattern centered around digital pedagogy posited distance and online learning as key components and identified the need for teacher training. Given the need for adaptability, a third theme revealed the demand for professional development in higher education and a future shift in educational roles. It can be recommended that future research investigate institutional policy changes and the adaptation to these changes in renewed educational roles. The ERE theme centered on the lack of preparation in instituting the forced changes brought about by the COVID-19 pandemic. The publications related to this theme revealed that the COVID-19 pandemic uncovered silent threads in educational environments, like depression, inequality, and injustice. A pedagogy of care has been developed with the aim of reducing anxiety and providing support through coping strategies. These research patterns indicate that the future of education demands sustainability and resilience in the face of uncertainty.

Results of the thematic analysis of citation patterns (Fig.  3 ) overlapped with two of the themes found in our thematic concept map (Fig.  1 ) and network graphic (Fig.  2 ). It was shown that researchers have emphasized the continuity of education and the psychological effects of the COVID-19 crisis on learners. Creating coping strategies to deal with global crises (e.g., pandemics, political upheavals, natural disasters) has been shown to be a priority for educational researchers. The pedagogy of resilience (Purdue University Innovative learning, n.d. ) provides governments, institutions, and instructors with an alternative tool to applying to their contexts in the face of hardship. Furthermore, prioritizing the psychological long-term effects of the crisis in learners could alleviate achievement gaps. We recommend that researchers support grieving learners through care (Noddings, 1984 ) and trauma-informed pedagogy (Imad, 2020 ). Our resilience and empathy will reflect our preparedness for impending crises. The thematic analysis of citation patterns (1: educational response, emergency remote education affordances, and continuity of education; 2: psychological impact of COVID-19) further indicates suggestions for future instructional/learning designers. Freire ( 1985 ) argues that to transform the world we need to humanize it. Supporting that argument, the need for human-centered pedagogical approaches (Robinson et al., 2020 ) by considering learning a multifaceted process (Hodges et al., 2021 ) for well-designed learning experiences (Moore et al., 2021 ) is a requirement and instructional/learning designers have an important responsibility not only to design courses but an entire learning ecosystem where diversity, sensitivity, and inclusivity are prioritized.

ERE is not a representative feature in the field of online education or distance education but rather, a forced reaction to extraordinary circumstances in education. The increasing confusion between the practice of ERE and online learning could have catastrophic consequences in learners' outcomes, teachers' instructional practices, and institutional policies. Researchers, educators, and policymakers must work cooperatively and be guided by sound work in the field of distance learning to design nourishing educational environments that serve students’ best interests.

In this study, text mining and social network analysis were demonstrated to be powerful tools for exploring and visualizing patterns in COVID-19-related educational research. However, a more in-depth examination is still needed to synthesize effective strategies that can be used to support us in future crises. Systematic reviews that use classical manual coding techniques may take more time but increase our understanding of a phenomenon and help us to develop specific action plans. Future systematic reviews can use the seven themes identified in this study to analyze primary studies and find strategies that counteract the survival of the fittest mindset to ensure that no student is left behind.

Acknowledgements

This paper is dedicated to all educators and instructional/learning designers who ensured the continuity of education during the tough times of the COVID-19 pandemic.

This article is produced as a part of the 2020 AECT Mentoring Program.

SNA of references covering pre-COVID-19 period (Only the first authors were labeled)

Authors’ Contributions

AB: Conceptualization, Methodology, Software, Formal analysis, Investigation, Resources, Data Curation, Writing—Original Draft, Writing—Review & Editing, Visualization, Funding acquisition.; KK: Conceptualization, Investigation, Writing—Original Draft, Writing—Review & Editing.; MT: Conceptualization, Investigation, Writing—Original Draft, Writing—Review & Editing.; ÖK: Conceptualization, Investigation, Writing—Original Draft, Writing—Review & Editing.; DCR: Conceptualization, Investigation, Writing—Original Draft, Writing—Review & Editing.

This paper is supported by Anadolu University, Scientific Research Commission with grant no: 2106E084.

Data Availability

Declarations.

This is a systematic review study and exempt from ethical approval.

The authors declare no competing interests.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Aras Bozkurt, Email: moc.liamg@trukzobsara .

Kadir Karakaya, Email: ude.etatsai@ayakarak .

Murat Turk, Email: [email protected] .

Özlem Karakaya, Email: ude.etatsai@melzo .

Daniela Castellanos-Reyes, Email: ude.eudrup@dletsac .

• Adedoyin OB, Soykan E. Covid-19 pandemic and online learning: The challenges and opportunities. Interactive Learning Environments. 2020 doi: 10.1080/10494820.2020.1813180. [ CrossRef ] [ Google Scholar ]
• Aggarwal, C. C., & Zhai, C. (Eds.). (2012). Mining text data. Springer Science & Business Media. 10.1007/978-1-4614-3223-4
• Aristovnik A, Keržič D, Ravšelj D, Tomaževič N, Umek L. Impacts of the COVID-19 pandemic on life of higher education students: A global perspective. Sustainability. 2020; 12 (20):8438. doi: 10.3390/su12208438. [ CrossRef ] [ Google Scholar ]
• Ayebi-Arthur K. E-learning, resilience and change in higher education: Helping a university cope after a natural disaster. E-Learning and Digital Media. 2017; 14 (5):259–274. doi: 10.1177/2042753017751712. [ CrossRef ] [ Google Scholar ]
• Baker, V. L. (2020, March 25). How colleges can better help faculty during the pandemic . Inside Higher Ed.  https://www.insidehighered.com/views/2020/03/25/recommendations-how-colleges-can-better-support-their-faculty-during-covid-19 . Accessed 15 Apr 2022
• Baloran ET. Knowledge, attitudes, anxiety, and coping strategies of students during COVID-19 pandemic. Journal of Loss and Trauma. 2020; 25 (8):635–642. doi: 10.1080/15325024.2020.1769300. [ CrossRef ] [ Google Scholar ]
• Beaunoyer E, Dupéré S, Guitton MJ. COVID-19 and digital inequalities: Reciprocal impacts and mitigation strategies. Computers in Human Behavior. 2020; 111 :106424. doi: 10.1016/j.chb.2020.106424. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Blume C. German Teachers’ Digital Habitus and Their Pandemic Pedagogy. Postdigital Science and Education. 2020; 2 (3):879–905. doi: 10.1007/s42438-020-00174-9. [ CrossRef ] [ Google Scholar ]
• Bond M. Schools and emergency remote education during the COVID-19 pandemic: A living rapid systematic review. Asian Journal of Distance Education. 2020; 15 (2):191–247. doi: 10.5281/zenodo.4425683. [ CrossRef ] [ Google Scholar ]
• Bozkurt A. Intellectual roots of distance education: A progressive knowledge domain analysis. Distance Education. 2019; 40 (4):497–514. doi: 10.1080/01587919.2019.1681894. [ CrossRef ] [ Google Scholar ]
• Bozkurt A. Resilience, adaptability, and sustainability of higher education: A systematic mapping study on the impact of the coronavirus (COVID-19) pandemic and the transition to the new normal. Journal of Learning for Development (JL4D) 2022; 9 (1):1–16. doi: 10.5281/zenodo.6370948. [ CrossRef ] [ Google Scholar ]
• Bozkurt A, Sharma RC. Emergency remote teaching in a time of global crisis due to CoronaVirus pandemic. Asian Journal of Distance Education. 2020; 15 (1):i–vi. doi: 10.5281/zenodo.3778083. [ CrossRef ] [ Google Scholar ]
• Bozkurt A, Sharma RC. Education in normal, new normal, and next normal: Observations from the past, insights from the present and projections for the future. Asian Journal of Distance Education. 2020; 15 (2):i–x. doi: 10.5281/zenodo.4362664. [ CrossRef ] [ Google Scholar ]
• Bozkurt A, Sharma RC. On the verge of a new renaissance: Care and empathy oriented, human-centered pandemic pedagogy. Asian Journal of Distance Education. 2021; 16 (1):i–vii. doi: 10.5281/zenodo.5070496. [ CrossRef ] [ Google Scholar ]
• Bozkurt A, Jung I, Xiao J, Vladimirschi V, Schuwer R, Egorov G, Lambert SR, Al-Freih M, Pete J, Olcott D, Jr, Rodes V, Aranciaga I, Bali M, Alvarez AV, Jr, Roberts J, Pazurek A, Raffaghelli JE, Panagiotou N, de Coëtlogon P, Shahadu S, Brown M, Asino TI, Tumwesige J, Ramírez Reyes T, Barrios Ipenza E, Ossiannilsson E, Bond M, Belhamel K, Irvine V, Sharma RC, Adam T, Janssen B, Sklyarova T, Olcott N, Ambrosino A, Lazou C, Mocquet B, Mano M, Paskevicius M. A global outlook to the interruption of education due to COVID-19 pandemic: Navigating in a time of uncertainty and crisis. Asian Journal of Distance Education. 2020; 15 (1):1–126. doi: 10.5281/zenodo.3878572. [ CrossRef ] [ Google Scholar ]
• Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. The Lancet. 2020; 395 (10227):912–920. doi: 10.1016/S0140-6736(20)30460-8. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, Zheng J. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Research. 2020; 287 :112934. doi: 10.1016/j.psychres.2020.112934. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Crawford, J., Butler-Henderson, K., Rudolph, J., Malkawi, B., Glowatz, M., Burton, R., ... & Lam, S. (2020). COVID-19: 20 countries' higher education intra-period digital pedagogy responses. Journal of Applied Learning & Teaching, 3 (1), 1–20. 10.37074/jalt.2020.3.1.7
• Czerniewicz L, Trotter H, Haupt G. Online teaching in response to student protests and campus shutdowns: Academics’ perspectives. International Journal of Educational Technology in Higher Education. 2019; 16 (1):43. doi: 10.1186/s41239-019-0170-1. [ CrossRef ] [ Google Scholar ]
• DePietro, A. (2020). Here’s a look at the impact of coronavirus (COVID-19) on colleges and universities in the U.S. Forbes.  https://www.forbes.com/sites/andrewdepietro/2020/04/30/impact-coronavirus-covid-19-colleges-universities/?sh=20a7121461a6 . Accessed 15 Apr 2022
• Dwivedi YK, Hughes DL, Coombs C, Constantiou I, Duan Y, Edwards JS, Gupta B, Lal B, Misra S, Prashant P, Raman R, Rana NP, Sharma SK, Upadhyay N. Impact of COVID-19 pandemic on information management research and practice: Transforming education, work and life. International Journal of Information Management. 2020; 55 :102211. doi: 10.1016/j.ijinfomgt.2020.102211. [ CrossRef ] [ Google Scholar ]
• Fayyad U, Grinstein GG, Wierse A, editors. Information visualization in data mining and knowledge discovery. Morgan Kaufmann; 2002. [ Google Scholar ]
• Freire P. The politics of education: Culture, power and liberation. Bergin & Garvey; 1985. [ Google Scholar ]
• Greenhow C, Lewin C, Staud Willet KB. The educational response to Covid-19 across two countries: A critical examination of initial digital pedagogy adoption. Technology, Pedagogy and Education. 2020 doi: 10.1080/1475939X.2020.1866654. [ CrossRef ] [ Google Scholar ]
• Guitton MJ. Cyberpsychology research and COVID-19. Computers in Human Behavior. 2020; 111 :106357. doi: 10.1016/j.chb.2020.106357. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hansen DL, Shneiderman B, Smith MA, Himelboim I. Analyzing social media networks with NodeXL: Insights from a connected world. 2. Morgan Kaufmann; 2020. [ Google Scholar ]
• Hern, A. (2020). Covid19 could cause permanent shift towards home working. The Guardian.  http://www.miamidadetpo.org/library/2020-03-13-uk-covid19-could-cause-permanent-shift-towards-home-working.pdf . Accessed 15 Apr 2022
• Hodges, C., Moore, S., Lockee, B., Trust, T., & Bond, A. (2020). The difference between emergency remote teaching and online learning . EDUCAUSE Review.  https://er.educause.edu/articles/2020/3/the-difference-between-emergency-remote-teaching-and-online-learning . Accessed 15 Apr 2022
• Hodges, C. B., Moore, S. L., Lockee, B. B., Aaron Bond, M., Jewett, A. (2021). An Instructional Design Process for Emergency Remote Teaching. In Burgos, D., Tlili, A., Tabacco, A. (Eds), Radical Solutions for Education in a Crisis Context. Lecture Notes in Educational Technology (pp. 37–51). Singapore: Springer. 10.1007/978-981-15-7869-4_3
• Imad, M. (2020). Leveraging the neuroscience of now. Inside Higher Ed .  https://www.insidehighered.com/advice/2020/06/03/seven-recommendations-helping-students-thrive-times-trauma . Accessed 15 Apr 2022
• Islam MA, Barna SD, Raihan H, Khan MNA, Hossain MT. Depression and anxiety among university students during the COVID-19 pandemic in Bangladesh: A web-based cross-sectional survey. PLoS ONE. 2020; 15 (8):e0238162. doi: 10.1371/journal.pone.0238162. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Johnson N, Veletsianos G, Seaman J. U.S. faculty and administrators’ experiences and approaches in the early weeks of the COVID-19 pandemic. Online Learning. 2020; 24 (2):6–21. doi: 10.24059/olj.v24i2.2285. [ CrossRef ] [ Google Scholar ]
• Karakaya K. Design considerations in emergency remote teaching during the COVID-19 pandemic: A human-centered approach. Education Technology Research and Development. 2021; 69 :295–299. doi: 10.1007/s11423-020-09884-0. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• König J, Jäger-Biela DJ, Glutsch N. Adapting to online teaching during COVID-19 school closure: Teacher education and teacher competence effects among early career teachers in Germany. European Journal of Teacher Education. 2020; 43 (4):608–622. doi: 10.1080/02619768.2020.1809650. [ CrossRef ] [ Google Scholar ]
• Korkmaz G, Toraman Ç. Are we ready for the post-COVID-19 educational practice? An investigation into what educators think as to online learning. International Journal of Technology in Education and Science. 2020; 4 (4):293–309. doi: 10.46328/ijtes.v4i4.110. [ CrossRef ] [ Google Scholar ]
• Lorenzo G. The Sloan Semester. Journal of Asynchronous Learning Networks. 2008; 12 (2):5–40. doi: 10.24059/olj.v12i2.1693. [ CrossRef ] [ Google Scholar ]
• Mishra S, Sahoo S, Pandey S. Research trends in online distance learning during the COVID-19 pandemic. Distance Education. 2021; 42 (4):494–519. doi: 10.1080/01587919.2021.1986373. [ CrossRef ] [ Google Scholar ]
• Moore, S., Trust, T., Lockee, B. B., Bond, A., & Hodges, C. (2021). One year later... and counting: Reflections on emergency remote teaching and online learning. EDUCAUSE Review.  https://er.educause.edu/articles/2021/11/one-year-later-and-counting-reflections-on-emergency-remote-teaching-and-online-learning . Accessed 15 Apr 2022
• Nicola, M., Alsafi, Z., Sohrabi, C., Kerwan, A., Al-Jabir, A., Iosifidis, C., ... & Agha, R. (2020). The socio-economic implications of the coronavirus and COVID-19 pandemic: A review. International Journal of Surgery, 78 , 185-193. 10.1016/j.ijsu.2020.04.018 [ PMC free article ] [ PubMed ]
• Noddings N. Caring: A feminine approach to ethics. Moral Education; 1984. [ Google Scholar ]
• Oldekop, J. A., Horner, R., Hulme, D., Adhikari, R., Agarwal, B., ... Zheng, Y. (2020). Covid-19 and the case for global development. World Development, 134 , 105044. [ PMC free article ] [ PubMed ]
• Pelletier, K., Brown, M., Brooks, D. C., McCormack, M., Reeves, J., Arbino, N., Bozkurt, A., Crawford, S., Czerniewicz, L., Gibson, R., Linder, K., Mason, J., & Mondelli, V. (2021). 2021 EDUCAUSE Horizon Report Teaching and Learning Edition . EDUCAUSE.  https://www.learntechlib.org/p/219489/ . Accessed 15 Apr 2022
• Purdue University Innovative Learning. (n.d.). Hy-flex and resilient pedagogy resources.  https://www.purdue.edu/innovativelearning/teaching-remotely/pedagogy.aspx . Accessed 15 Apr 2022 
• Quilter-Pinner H, Ambrose A. The new normal: The future of education after Covid-19. The Institute for Public Policy Research; 2020. [ Google Scholar ]
• Rapp C, Gülbahar Y, Adnan M. e-Tutor: A multilingual open educational resource for faculty development to teach online. International Review of Research in Open and Distributed Learning. 2016; 17 (5):284–289. doi: 10.19173/irrodl.v17i5.2783. [ CrossRef ] [ Google Scholar ]
• Robinson H, Al-Freih M, Kilgore W. Designing with care: Towards a care-centered model for online learning design. The International Journal of Information and Learning Technology. 2020; 37 (3):99–108. doi: 10.1108/IJILT-10-2019-0098. [ CrossRef ] [ Google Scholar ]
• Rodrigues M, Franco M, Silva R. COVID-19 and Disruption in Management and Education Academics: Bibliometric Mapping and Analysis. Sustainability. 2020; 12 (18):7362. doi: 10.3390/su12187362. [ CrossRef ] [ Google Scholar ]
• Rose S. Medical student education in the time of COVID-19. JAMA. 2020; 323 (21):2131–2132. doi: 10.1001/jama.2020.5227. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Sahu, P. (2020). Closure of universities due to coronavirus disease 2019 (COVID-19): impact on education and mental health of students and academic staff. Cureus, 12 (4). 10.7759/cureus.7541 [ PMC free article ] [ PubMed ]
• Schwab M, Malleret T. Covid-19: The great reset. World Economic Forum; 2020. [ Google Scholar ]
• Shim TE, Lee SY. College students’ experience of emergency remote teaching due to COVID-19. Children and Youth Services Review. 2020; 119 :105578. doi: 10.1016/j.childyouth.2020.105578. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Smith AE, Humphreys MS. Evaluation of unsupervised semantic mapping of natural language with Leximancer concept mapping. Behavior Research Methods. 2006; 38 (2):262–279. doi: 10.3758/bf03192778. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Suleri J. Learners’ experience and expectations during and post COVID-19 in higher education. Research in Hospitality Management. 2020; 10 (2):91–96. doi: 10.1080/22243534.2020.1869463. [ CrossRef ] [ Google Scholar ]
• Talidong KJB, Toquero CMD. Philippine teachers’ practices to deal with anxiety amid COVID-19. Journal of Loss and Trauma. 2020; 25 (6–7):573–579. doi: 10.1080/15325024.2020.1759225. [ CrossRef ] [ Google Scholar ]
• Thurmond VA. The point of triangulation. Journal of Nursing Scholarship. 2001; 33 (3):253–258. doi: 10.1111/j.1547-5069.2001.00253.x. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Time (2020). The great reset: cover image.  https://time.com/collection/great-reset/ . Accessed 15 Apr 2022
• Tull, S., Dabner, N., & Ayebi-Arthur, K. (2017). Social media and e-learning in response to seismic events: Resilient practices. Journal of Open, Flexible & Distance Learning , 21 (1), 63–76.  http://www.jofdl.nz/index.php/JOFDL/article/view/405 . Accessed 15 Apr 2022
• UNESCO. (2020). COVID-19 education response.  https://en.unesco.org/covid19/educationresponse/ . Accessed 15 Apr 2022
• Unger S, Meiran WR. Student attitudes towards online education during the COVID-19 viral outbreak of 2020: Distance learning in a time of social distance. International Journal of Technology in Education and Science. 2020; 4 (4):256–266. doi: 10.46328/ijtes.v4i4.107. [ CrossRef ] [ Google Scholar ]
• Van Lancker, W., & Parolin, Z. (2020). COVID-19, school closures, and child poverty: A social crisis in the making [published online ahead of print, 2020 Apr 7]. T he Lancet Public Health, 5 (5), e243–e244. 10.1016/S2468-2667(20)30084-0 [ PMC free article ] [ PubMed ]
• Viner, R. M., Russell, S. J., Croker, H., Packer, J., Ward, J., Stansfield, C., ... & Booy, R. (2020). School closure and management practices during coronavirus outbreaks including COVID-19: A rapid systematic review. The Lancet Child & Adolescent Health, 4 (5), 397-404. 10.1016/S2352-4642(20)30095-X [ PMC free article ] [ PubMed ]
• West, D., & Allen, J. (2020). How to address inequality exposed by the COVID-19 pandemic. Tech Crunch .  https://techcrunch.com/2020/10/27/how-to-address-inequality-exposed-by-the-covid-19-pandemic/ . Accessed 15 Apr 2022
• Williamson B, Eynon R, Potter J. Pandemic politics, pedagogies and practices: Digital technologies and distance education during the coronavirus emergency. Learning, Media and Technology. 2020; 45 (2):107–114. doi: 10.1080/17439884.2020.1761641. [ CrossRef ] [ Google Scholar ]
• Xiao, J. (2021). From equality to equity to justice: Should online education be the new normal in education?. In Bozkurt, A. (Eds.), Handbook of research on emerging pedagogies for the future of education: Trauma-informed, care, and pandemic pedagogy (pp. 1–15). IGI Global. 10.4018/978-1-7998-7275-7.ch001
• Zhu X, Liu J. Education in and after Covid-19: Immediate responses and long-term visions. Postdigital Science and Education. 2020; 2 :695–699. doi: 10.1007/s42438-020-00126-3. [ CrossRef ] [ Google Scholar ]

COVID-19 Research Articles Downloadable Database

March 19, 2020

Updated January 12, 2024

COVID-19 Research Guide Home

• Research Articles Downloadable Database
• COVID-19 Science Updates
• Databases and Journals
• Secondary Data and Statistics

Important announcement:  

The CDC Database of COVID-19 Research Articles became a collaboration with the WHO to create the  WHO COVID-19 database  during the pandemic to make it easier for results to be searched, downloaded, and used by researchers worldwide.

The last version of the CDC COVID-19 database was archived and remain available on this website.  Please note that it has stopped updating as of October 9, 2020 and all new articles were integrated into the  WHO COVID-19 database .  The WHO Covid-19 Research Database was a resource created in response to the Public Health Emergency of International Concern (PHEIC). Its content remains searchable and spans the time period March 2020 to June 2023. Since June 2023, manual updates to the database have been discontinued.

If you have any questions, concerns, or problems accessing the WHO COVID-19 Database please email the CDC Library for assistance.

Materials listed in these guides are selected to provide awareness of quality public health literature and resources. A material’s inclusion does not necessarily represent the views of the U.S. Department of Health and Human Services (HHS), the Public Health Service (PHS), or the Centers for Disease Control and Prevention (CDC), nor does it imply endorsement of the material’s methods or findings.

Below are options to download the archive of COVID-19 research articles.  You can search the database of citations by author, keyword (in title, author, abstract, subject headings fields), journal, or abstract when available.  DOI, PMID, and URL links are included when available.

This database was last updated on October 9, 2020 .

• The CDC Database of COVID-19 Research Articles is now a part of the WHO COVID-19 database .  Our new  search results are now being sent to the WHO COVID-19 Database to make it easier for them to be searched, downloaded, and used by researchers worldwide. The WHO Covid-19 Research Database was a resource created in response to the Public Health Emergency of International Concern (PHEIC). Its content remains searchable and spans the time period March 2020 to June 2023. Since June 2023, manual updates to the database have been discontinued.
• To help inform CDC’s COVID-19 Response, as well as to help CDC staff stay up to date on the latest COVID-19 research, the Response’s Office of the Chief Medical Officer has collaborated with the CDC Office of Library Science to create a series called COVID-19 Science Update . This series, the first of its kind for a CDC emergency response, provides brief summaries of new COVID-19-related studies on many topics, including epidemiology, clinical treatment and management, laboratory science, and modeling. As of December 18, 2021, CDC has stopped production of the weekly COVID-19 Science Update.

Excel download:

• Articles from August until October 9 2020 [XLS – 29 MB]
• Articles from December 2019 through July 2020 [XLS – 45 MB]
• The CDC Database of COVID-19 Research Articles is now a part of the WHO COVID-19 database .  Our new search results are now being sent to the WHO COVID-19 Database to make it easier for them to be searched, downloaded, and used by researchers worldwide.
• October 8 in Excel [XLS – 1 MB]
• October 7 in Excel [XLS – 1 MB]
• October 6 in Excel [XLS – 1 MB]
• Note the main Excel file can also be sorted by date added.

Citation Management Software (EndNote, Mendeley, Zotero, Refman, etc.)  download:

• Part 1 [ZIP – 38 MB]
• Part 2 [ZIP – 43 MB]
• October 8 in citation management software format [RIS – 2 MB]
• October 7 in citation management software format [RIS – 2 MB]
• October 6 in citation management software format [RIS – 2 MB]
• Note the main RIS file can also be sorted by date added.

The COVID-19 pandemic is a rapidly changing situation.  Some of the research included above is preliminary.  Materials listed in this database are selected to provide awareness of quality public health literature and resources. A material’s inclusion does not necessarily represent the views of the U.S. Department of Health and Human Services (HHS), the Public Health Service (PHS), or the Centers for Disease Control and Prevention (CDC), nor does it imply endorsement of the material’s methods or findings.

To access the full text, click on the DOI, PMID, or URL links.  While most publishers are making their COVID-19 content Open Access, some articles are accessible only to those with a CDC user id and password. Find a library near you that may be able to help you get access to articles by clicking the following links: https://www.worldcat.org/libraries OR https://www.usa.gov/libraries .

CDC users can use EndNote’s Find Full Text feature to attach the full text PDFs within their EndNote Library.  CDC users, please email Martha Knuth for an EndNote file of all citations.  Once you have your EndNote file downloaded, to get the full-text of journal articles listed in the search results you can do the following steps:

• First, try using EndNote’s “Find Full-Text” feature to attach full-text articles to your EndNote Library.
• Next, check for full-text availability, via the E-Journals list, at: http://sfxhosted.exlibrisgroup.com/cdc/az   .
• If you can’t find full-text online, you can request articles via DocExpress, at: https://docexpress.cdc.gov/illiad/

The following databases were searched from Dec. 2019-Oct. 9 2020 for articles related to COVID-19: Medline (Ovid and PubMed), PubMed Central, Embase, CAB Abstracts, Global Health, PsycInfo, Cochrane Library, Scopus, Academic Search Complete, Africa Wide Information, CINAHL, ProQuest Central, SciFinder, the Virtual Health Library, and LitCovid.  Selected grey literature sources were searched as well, including the WHO COVID-19 website, CDC COVID-19 website, Eurosurveillance, China CDC Weekly, Homeland Security Digital Library, ClinicalTrials.gov, bioRxiv (preprints), medRxiv (preprints), chemRxiv (preprints), and SSRN (preprints).

Detailed search strings with synonyms used for COVID-19 are below.

Detailed search strategy for gathering COVID-19 articles, updated October 9, 2020 [PDF – 135 KB]

Note on preprints:   Preprints have not been peer-reviewed. They should not be regarded as conclusive, guide clinical practice/health-related behavior, or be reported in news media as established information.

Materials listed in these guides are selected to provide awareness of quality public health literature and resources. A material’s inclusion does not necessarily represent the views of the U.S. Department of Health and Human Services (HHS), the Public Health Service (PHS), or the Centers for Disease Control and Prevention (CDC), nor does it imply endorsement of the material’s methods or findings. HHS, PHS, and CDC assume no responsibility for the factual accuracy of the items presented. The selection, omission, or content of items does not imply any endorsement or other position taken by HHS, PHS, and CDC. Opinion, findings, and conclusions expressed by the original authors of items included in these materials, or persons quoted therein, are strictly their own and are in no way meant to represent the opinion or views of HHS, PHS, or CDC. References to publications, news sources, and non-CDC Websites are provided solely for informational purposes and do not imply endorsement by HHS, PHS, or CDC.

To receive the COVID-19 Science Update, please enter your email address to subscribe today.

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