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Neurology Journals Adapt in the Time of COVID-19

Article In Brief

Neurology journal editors share the risks and opportunities of publishing COVID19 papers amid the outbreak.

As new information emerges about the deadly coronavirus and its implications for neurology practice and patients with neurologic conditions, the role of peer-reviewed neurology journals has never been more important. Neurologists look to the journals for scientific evidence and practical guidance in dealing with a medical challenge that, until a few months ago, did not exist.

In interviews with Neurology Today, editors of major neurology journals said the COVID-19 crisis is, in some cases, prompting them to speed up their work and process a larger volume of submissions than they typically get.

“It's worth it because it's important information,” said José G. Merino, MD, MPhil, FAHA, FAAN, editor-in-chief of Neurology.

Dr. Merino started his 10-year term as Neurology's top editor on April 1, just three weeks after the World Health Organization declared COVID-19 to be a global pandemic. The journal's Call for Papers about the neurologic aspects and patient-management challenges associated with COVID-19 drew 150 submissions by mid-April.

An expedited review process is being used to vet papers quickly and, as soon as a paper is accepted, a PDF of the submitted manuscript is posted online; a PDF of the final copyedited article replaces it a few days later.

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“They will eventually get assigned to an issue, but the important thing is these papers have been peer-reviewed and available online and searchable within a few weeks of submission.”—DR. JOSÉ G. MERINO

“They will eventually get assigned to an issue, but the important thing is these papers have been peer-reviewed and available online and searchable within a few weeks of submission,” said Dr. Merino, professor of neurology at Georgetown University School of Medicine.

In addition to the call for papers, Neurology commissioned a series of invited articles on a range of COVID-19 topics, including how the disease may impact patients with specific neurologic conditions such as stroke or multiple sclerosis. The journal also started a blog to encourage neurologists to share their experiences. As of mid-April, more than 30 commentaries by neurologists in China, South Korea, Jordan, Israel, Italy, Spain, Argentina, the United Kingdom and the United States had been posted.

“Some talk about the professional challenges, including having to deal with a large amount of new patients or how it has changed their practice, and some talk about their personal reaction to the crisis,” Dr. Merino said.

Peer Review Vs Rapid Publication

JAMA Neurology is also receiving a large number of submissions related to COVID-19. Its editor-in-chief, S. Andrew Josephson, MD, FAAN, professor and chair of neurology at the University of California, San Francisco, is particularly proud of the quality of papers received, such as one posted online in mid-April, that revealed 36 percent of patients (n=214) treated for COVID-19 at three sites in Wuhan, China, had neurologic manifestations.

“Our challenge is to continue to provide the rapid turnaround and high-quality review that our readers and our authors expect,” Dr. Josephson said.

While neurologists have an urgent need for information that can help their patients, journal editors know that what they choose to publish will influence how their readers treat their patients.

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“So many researchers have had to shut down their research, and now have time to complete their manuscripts. It is also easier to find reviewers than usual, probably for the same reason.”—DR. CLIFFORD B. SAPER

“The big risk (of working quickly) is that we want to make sure we don't push false narratives,” said Michael R. Sperling, MD, FAAN, editor-in-chief of Epilepsia, the journal of the International League Against Epilepsy. “Hasty work can easily lead to publishing incorrect things.”

When COVID-19 papers first began arriving to Neurology, some reviewers assumed that the journal's usual standards might be temporarily set aside on the idea that some information about the emerging pandemic was better than nothing.

“Some of the reviewers said ‘Well, I understand you may want to lower the bar for this paper because it deals with COVID, and, therefore, it may be suitable,’” Dr. Merino said. “But no, we do not want to change our standards. There is a difference between newsworthiness versus scientific rigor, and it's important to go for the rigor more than the newsworthiness.”

That said, Dr. Merino is enthusiastic about the role of MedRxiv, the preprint server for health sciences; BioRxiv, the preprint service for life sciences; and their pre-publication peers during the COVID-19 crisis. Preprint servers allow authors to submit articles to be archived and distributed online before peer review or editing. The service is free to both authors and readers. MedRxiv was founded by Cold Spring Harbor Laboratory (CSHL), Yale University and BMJ, publisher of the BMJ; BioRxiv is owned by CSHL.

He pointed out that the case series from Wuhan published April 10 by JAMA Neurology after peer review was first posted on MedRxiv on February 25.

“That's the way it's supposed to work,” Dr. Merino said. “This crisis highlights the value of pre-publication servers, which allow rapid sharing of information in a crisis situation. Afterwards, these papers are submitted to and peer-reviewed by medical journals to ensure methodological quality, and they can then be used for medical decision-making.”

Thomas N. Ward, MD, FAHS, FAAN, editor-in-chief of Headache, the American Headache Society's official journal, has a different view. He believes pre-print servers present the same risk of spreading inaccurate information as low-quality medical journals that publish papers of dubious validity.

“I don't like them, frankly, as the information has not been peer-reviewed and naive readers such as some media people may not realize this and spread this information before it has been properly vetted,” said Dr. Ward, emeritus professor of neurology at the Geisel School of Medicine at Dartmouth.

At JAMA Neurology, Dr. Josephson credits the journal's reviewers with hitting the balance between quality standards and speedy publication. “Our reviewers are incredibly busy because of the outbreak,” he said. “But we have had great generosity from them and been able to turn around these manuscripts in a timely fashion.”

Editing During the Pandemic

When an author contacted Epilepsia, Dr. Sperling, professor of neurology and vice chair of research at Thomas Jefferson University, encouraged him to send the manuscript directly to him. Using data from more than 300 COVID-19 patients treated in several hospitals in China, the paper analyzes the risk of seizures. Dr. Sperling reviewed the paper and suggested that the author make several revisions before formally submitting it for consideration.

“I then personally contacted two reviewers and asked them to turn it around in 24 hours,” he said. “I also reviewed it and we did a bit more in the way of revision and were able to accept the paper and get that up online as quickly as possible. We and others have an obligation to get peer-reviewed information out there.”

Annals of Neurology is getting a higher number of manuscript submissions than usual, and Editor-in-Chief Clifford B. Saper, MD, PhD, FAAN, suspects that is a result, in part, of the COVID-19 outbreak.

“So many researchers have had to shut down their research, and now have time to complete their manuscripts,” Dr. Saper, professor of neurology and neuroscience at Harvard Medical School and chairman of neurology at Beth Israel Deaconess Medical Center, said in an email. “It is also easier to find reviewers than usual, probably for the same reason.”

Annals of Neurology has received only a few manuscripts related to COVID-19, and they have been below the usual quality of manuscripts the journal receives. “We are reviewing manuscripts in the usual way, except I am giving the COVID-19 ones priority in case we ever get one that is worth publishing,” he said. “If we ever get a high quality COVID-19 manuscript, we will probably be able to review it very quickly, and it will go up online days after it is accepted.”

The journal Headache has not been inundated with articles about COVID-19, but Dr. Ward was happy with the quality of those the journal has published so far. One of those, based on a survey of health care workers in Singapore during the disease outbreak, reported on headaches associated with wearing personal protective equipment, including masks and goggles.

Instead of speeding up the peer-review process, Headache editors have slowed it down to accommodate reviewers, many of whom are adjusting to telemedicine or other changes in their routine. “We have loosened up the timeline for reviewers and for associate editors to get things done,” Dr. Ward said. “Peer review goes on but this situation makes it a little bit slower.”

What's Needed Now

Dr. Josephson at JAMA Neurology and Dr. Merino at Neurology both said that single-case reports of a COVID-patient were helpful when the disease was brand new, but that has passed. “As we move to this being a more common disease, we are looking for broader views that include multiple patients,” Dr. Josephson said.

He has been pleased with the opinion pieces—called Viewpoint in JAMA Neurology—and personal essays—published in the On the Brain slot—that neurologists have submitted as they grapple with the COVID-19 reality.

“Opinion pieces, whether they be Viewpoints or On the Brain are always very welcome,” he said. “I think the neurology community needs to hear from each other as how they are dealing with different aspects of this illness, either professionally or personally.”

Link Up for More Information

• Mao L, Jin H, Wang M, Hu Y, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China https://jamanetwork.com/journals/jamaneurology/fullarticle/2764549. JAMA Neurol 2020; Epub 2020 Apr 10.
    • Lu L, Ziong W, Liu D, et al. New-onset acute symptomatic seizure and risk factors in coronavirus disease 2019: A retrospective multicenter study https://onlinelibrary.wiley.com/doi/full/10.1111/epi.16524. Epilepsia 2020; Epub 2020 Apr 18.
      • Ong JJY, Bharatendu C, Goh Y, Tang JZY, et al. Headaches associated with personal protective equipment – A cross-sectional study among frontline healthcare workers during COVID-19 https://headachejournal.onlinelibrary.wiley.com/doi/full/10.1111/head.13811; Headache 2020; Epub 2020 Mar 30.