Covid testing in New York (photo: Michael Appleton/Mayor's Office)
We are now more than halfway through October, it’s been seven months since New York State went on PAUSE and President Trump continues to tout unrealistic ideals of the speed scientists will be able to create a vaccine for COVID-19. In the first presidential debate and since, Trump continues to show a true misunderstanding of scientific research. In order to make good choices to avoid more covid spikes and prolonged suffering, allow students to return to school safely, and more fully resume life before coronavirus, we must understand the speed and process of scientific research -- and let it take its course responsibly.
We have learned a lot in seven months. On March 22, we knew relatively little about how the disease was being transmitted, what we could use to treat it, and what the long-term impacts of the disease were. And yet, politicians had to make choices to protect their constituents, cities, and states. We will need to put what we have learned to the test to avoid a second wave in New York and more infection spikes across the country, and we must allow the scientific process to unfold.
The early response to COVID-19 in New York, unaided by the federal government, has widely been considered a mess. This disaster highlights the complications of making what should be science-based policy before the scientific research is performed or vetted. This pandemic draws attention to the need for transparency, communication of changing information, and public understanding of the speed and nature of scientific research.
Scientific research is built for discovery over time, not rapid speed. The key to understanding why the early guidance on COVID-19 changed repeatedly lies in understanding the method of scientific research and peer review. This applies to figuring out how COVID-19 spreads, the importance of mask-wearing, and the development of a vaccine, among other key pieces of the larger puzzle of a new, deadly virus.
In reality, a published scientific study that can accurately provide findings typically starts many years before it is disseminated. Publication is the end goal for scientists to share the results of their carefully-performed and -vetted research, including rigorous peer-review commentary. Proper design helps to plan out experiments that will reach the estimated goal in a timely manner. Studies must be funded. Biological studies can take many months to years to complete the necessary experiments and statistical analyses.
In the case of COVID-19, many important logistical steps, like funding, may be fast-tracked, but even with widespread desperation for a vaccine, scientific research cannot and must not be rushed. As vaccines proceed through development stages, other research works in parallel understand the complex new virus.
One or more COVID-19 vaccines will eventually go through the federal Food and Drug Administration process. The scientific research involved will also be published in scientific journals at various points including, exploratory research, preclinical models, and clinical trials. Again, this highlights the importance of greater general public understanding of the underpinnings of how so much of the research into COVID-19 and other science typically happens.
Scientific manuscripts -- usually defined as full research articles with novel findings -- must include background, motivation, methods, results, and discussion of how the work fits into the broader scope of the relevant literature. When completed, the manuscript is submitted to a journal where it goes through the process of peer review, described by Elsevier as existing to “validate academic work” and “improve the quality of published research.” Other scientists review the paper in a process that can take from a few weeks to several months, providing feedback on process and conclusions. Based on the peer review, the paper can be rejected or accepted by the journal.
If accepted with revisions, the scientists complete additional experiments, analyses, and writing before resubmission and more review. The article is finally published -- signifying necessary academic quality -- after the final round of revisions is complete. This is usually at least a year after the initial experiments were performed.
During the pandemic, scientists have been working around the clock at speeds not normally observed in biomedical research to attempt faster discoveries of many things including the genetic make-up of the virus, how the virus is transmitted, treatments, and vaccines.
Scientists didn’t initially recommend against masks because they didn’t want to control the virus, or because masks don’t help. Scientists didn’t recommend wearing masks due to some combination of not understanding the mechanism of COVID-19 spread, wanting to avoid N95 mask supply issues, and assumptions of low disease presence. Studies have now found that the virus can be transmitted before symptoms or while asymptomatic, and some studies like one from Alvin Ing show as many as 80% of cases could be asymptomatic. We know more about the virus now, and that helps scientists and policy-makers to make educated choices about masks.
In the last six months, because of scientists, we have learned how vital masks are to decreasing transmission. We have also learned that hydroxychloroquine provides no benefit to COVID-19 patients. Scientists have also developed new testing methods for COVID-19, including a saliva test recently approved by the New York State Department of Health.
When things are moving at pandemic speed, we need to search out the knowledgeable scientific voices that we know guide the public in the right direction, but more importantly we need transparency on changing science. Transparency and communication are key to combating public health crises. COVID-19 will not have a miracle cure. It will have a cure that is developed and tested by hard-working scientists working faster than ever imagined.
Guidelines changing are not a sign of misinformation and false ideas, but rather a symptom of evolving scientific understanding of the virus. It will be a long time, certainly years, before we truly understand the complexities of this novel coronavirus. To avoid another wave while we wait for tireless scientists to develop a safe vaccine, we must listen carefully to those who are on the frontline learning more about the virus every day.
Samantha L. Marshall, PhD, is a postdoctoral research scientist in Orthopedic Surgery at Columbia University Medical Center in New York, NY and a volunteer with Sci4NY.