Publishing during a pandemic

Are Brean About the author
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‘We are placing our journal at your disposal,’ the editors of the Journal of the Norwegian Medical Association stated during the Spanish flu in 1919. We are now doing the same in 2020. The major difference is one of momentum.

Photo: Einar Nilsen

During the worst pandemic the world has seen until now – the Spanish flu in 1918–20 – it took some time before the epidemic was recognised. There is not even any agreement about when it started, or whether it started in Asia, the United States or England (1). Not until a luminary such as the Spanish king Alfonso XIII (1886–1941) fell ill, did the disease come under the media spotlight – and was given a name (1). There was also a time lag in Norway. In August 1918, the Journal of the Norwegian Medical Association published observations made by the medical student Thorleif Tybring Speilberg (1894–1968) in June the same year about a possible link between ‘the Spanish disease’ and a massive outbreak of illness on board two Norwegian coastal defence ships (2). The Directorate of Health issued a circular to the nation’s doctors with a request for ‘records of possible deaths from the disease’ (3). After this, only a handful of messages were sent to the doctors nationwide in the autumn of 1918. When the epidemic picked up again in January 1919, the Journal of the Norwegian Medical Association felt compelled to request that reports to the Directorate of Health ‘without delay be brought to the attention of doctors through the medical journals. We are placing our journal at your disposal’ (4).

This contrasts starkly with the amount and speed of information seen during the current pandemic. On 7 January 2020, the Chinese authorities reported that a novel corona virus was the causal factor in a cluster of patients with an unusual form of pneumonia in Wuhan (5). On 24 January, the sequenced genome of the virus and clinical descriptions of the first patients were published in the New England Journal of Medicine (6). Moreover, as early as 29 January, no more than three weeks after the Chinese authorities first reported on the cause of the disease, Preben Aavitsland wrote in an editorial in the Journal of the Norwegian Medical Association that ‘the corona virus epidemic will reach Norway’ (5).

However, even in the time of the pandemic there are other diseases, and there are needs other than for a constant stream of information about COVID-19

During the Spanish flu, as during the COVID-19 pandemic, medical journals the world over played and continue to play a key role in bringing information to both doctors and the public at large. The difference is the speed at which it happens. There are many reasons for this. The fact that healthcare services and reporting procedures in most countries are far better now than they were then is an obvious precondition. However, the transition from print to digital publishing is at least as important. Now, large volumes of studies and data are made available very quickly, and they can be read all over the world simultaneously. A recent article in JAMA, which presented results from 138 Chinese COVID-19 patients, was accepted on the same day that the last patient was included, and published four days later (7). Norway’s first case history of COVID-19 was accepted for publication here in the Journal of the Norwegian Medical Association on 18 March 2020, only three days after its first submission (8). An English translation was immediately available in PubMed. Compared to the normal editorial processes for journals, this is lightning speed. It comes at a price. One aspect of this situation is that the editorial office and peer reviewers literally have to work day and night to assure the quality and final preparation of the content. Another, more worrying aspect is that speed may sometimes come at the cost of quality assurance (9).

Like other journals, we in the Journal of the Norwegian Medical Association have established separate editorial procedures to ensure rapid publication of manuscripts related to the epidemic (10, 11). In this way, we hope to provide clinicians with useful information in the best and fastest way possible. Just as we did in 1919, we wish to ‘place our journal at your disposal’ (4).

However, even in the time of the pandemic there are other diseases, and there are needs other than for a constant stream of information about COVID-19. As a result, the printed issue of the Journal of the Norwegian Medical Association remains relevant and useful, despite its long lead time. The printed issue to which this editorial belongs went to press when the COVID-19 pandemic was still in its infancy, and it bears the mark of this. We nevertheless hope that it will provide useful information also about other aspects of medicine, as well as quiet contemplation of material well suited for hopefully restful Easter days. You readers have certainly earned that in these testing times for the healthcare services. We promise to provide you with swift and relevant updates online. In the printed issue, it is permitted to draw a deep breath and see that our diverse profession also has other facets. Happy reading and Happy Easter!

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