The Covid-19 pandemic is rapidly changing our lives in previously unimaginable ways and forcing us to view many behaviors in a new light. That is certainly the case for bioscience publishing, which has already undergone significant change in the digital era.

These changes are accelerating in real time in response to the epidemic and the need it created to rapidly disseminate information about the biology of the virus, the clinical features of the infection it causes, and possibilities for prevention and therapy. As is so often the case, necessity accelerates transformative change.

Scientific progress depends on effective transmission of research results to the scientific community, enabling discoveries to be assessed and extended. Once the domain of physical journals collected and stored in libraries, the digital era totally transformed the bioscience publishing ecosystem. Journals of widely varying quality have proliferated, and are increasingly available only online.

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Access only by subscribers is being challenged by open-access platforms. The approach to peer review, the process by which anonymous experts chosen by editors provide analysis and feedback before editorial decisions are made to accept or reject manuscripts, is also evolving.

One important innovation in bioscience publishing is the rise of preprint servers, sites that put manuscripts online without peer review. Long an accepted practice in physics and math through the arXiv (pronounced Archive) web server, this approach to disseminating research has come to the biomedical sciences through bioRxiv and medRxiv.

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bioRxiv was launched and run out of Cold Spring Harbor Labs in 2013, and is supported by a number of non-profit entities. Submissions to it, and the more recently launched medRxiv, are growing exponentially, now exceeding 80,000.

Most conventional biomedical publishers initially viewed preprints as “prior publication” that would preclude subsequent acceptance by peer reviewed journals. This objection has fallen by the wayside in response to widespread support for the value that preprints confer. Preprints unquestionably enable rapid communication of results, in contrast to conventional pre-publication peer review, which delays the time from submission to publication for months — and sometimes for years.

It is now clear that many preprints generate rapid, extensive, and effective reviews after they are posted through readers’ comments on the site, as well as on social media platforms such as Twitter. Fears that preprints would promote many erroneous claims because they lack pre-publication peer review have not proven correct, though much more research on this topic is needed.

How has this played out during the Covid-19 pandemic?

bioRxiv published its first preprint on the novel coronavirus on January 19, 2020, and it has been on a roll ever since, with 33 papers in January, 281 in February, and more than 500 in total as I write this. bioRxiv is currently receiving 25 to 30 scientific papers day on this topic, with the majority now going to medRxiv, the more clinically oriented site.

In a recent discussion I had with Richard Sever, cofounder of both bioRxiv and medRxiv, he told me that about 40% of Covid-19 papers are from China, but that fraction is changing as the infection extends across the world. Given the intense international interest in these papers, the editors established a modified procedure whereby all coronavirus and Covid-19 papers are examined by a group of domain experts — not to provide reviews but to assess whether the work is serious, screening out the very few that might raise questions or be dangerous if they were false. The group asks authors of the rare screened-out manuscripts to submit them elsewhere for peer review.

Many of the papers the preprint servers have published have provided essential data that is relevant to the epidemic. Many or most will subsequently be submitted to peer reviewed journals, as is usual for preprints. Only then will we be able to determine the effect of peer review on these manuscripts.

One bioRxiv paper, published on February 2, erroneously asserted that the virus sequence suggested it might have been man-made. The mistaken conclusion, that would surely have stimulated panic about bioterrorism, was identified as flawed within hours by several scientists, and the paper was withdrawn the next day. This instance reveals the potential risks of posting without reviews, mitigated by the fact that the process of post-publication review worked in this instance. Many papers published in elite journals after peer review are shown to be problematic, so the issue of reproducibility is relevant to all publishing models.

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Even the most elite peer-reviewed journals in the bioscience publishing world are modifying their approach in response to the pandemic. The New England Journal of Medicine, for example, is making all of the material it publishes on Covid-19 open access on the web (everything else is behind a subscription paywall), and putting this content in one place on NEJM’s high-traffic website. Its first original article on the novel coronavirus, now called SARS-CoV-2, was published on January 29, a paper by Chinese scientists on early transmission dynamics of the virus. From then until March 18, the journal published four original articles, six perspective opinion pieces, two editorials, and eight short correspondences. Some of these were landmark papers in the field.

NEJM has even started a podcast, featuring editor-in-chief Eric Rubin and deputy editor Lindsey Baden, both specialists in infectious disease, an outreach that would have been unimaginable for the New England Journal of Medicine I grew up with.

Many other journals are also speeding up the time from manuscript submission to publication. The Lancet has a preprint section for as yet un-reviewed papers (including an important new Covid-19 paper), and other journals are accelerating the review process.

Social media, and in particular what’s sometimes referred to as “medical and scientific Twitter,” is another powerful means to disseminate and debate breaking scientific findings, whether they have been published in standard journals or posted on preprint servers. Subject to the many caveats of Twitter behavior, this platform has sufficient impact that many physicians and scientists with valuable opinions comment on a daily basis, and this certainly applies to Covid-19.

The hunger for information brought on by the pandemic will change many aspects of our society, in both in the short run and the long run. It has heightened the need for faster and better ways to transmit scientific information that simultaneously ensure that as much of it as possible is accurate and well considered. No single approach to scientific communication will ever be perfect, and research will be needed to determine what we did right and what we did wrong during this period.

The enhanced use of preprints, the evolution of “standard” journals, and effective use of social media will all be required for bioscience publishing to adapt to a changing and challenging world.

Jeffrey S. Flier, M.D., is professor of medicine at Harvard Medical School and was dean of the school from 2007 to 2016.

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