The Science you know, the story you don’t

This is the story of the most cited article of my research career so far which provided an elaborate and extensive information regarding the various treatment regimens which were initially approved by the World Health Organization (WHO) for the treatment of SARS-CoV-2 infection. The first lockdown is still vivid in my memory. It was scary to say the least as everyone was stuck at home, going out felt so risky and seeing people getting close to you in a market place felt like you are going to get infected. When the disease is unknown without any known treatment available, it always seems very hard to digest and comprehend in the beginning. I had to go through similar circumstances as well. This is when my colleague and I saw an opportunity to contribute as Scientists towards fighting the enraging pandemic. We discussed what possibly we can do to provide some sort of valuable information in battling the deadly virus and we had the idea of looking up various trials which were under investigation and given emergency usage approval by the WHO. It was funny and quite intriguing how like minds think alike quote became literally a realistic episode for both of us as somehow we thought about similar things at the same time without even discussing with each other beforehand.

Photo by CDC on Unsplash

After having an informal discussion between us, me and my colleague went to our supervisor to discuss further about the possibility of undergoing a study so that we can also contribute to the scientific battle against COVID-19. Our Ma’am is always welcoming new ideas from her research team and she encourages creative discussion at all points. When we went to her, she readily latched on to the idea of a meta-analysis study combining the current treatment methods that are coming up across the globe. Being from a Neurology background, she understood the importance of involving someone from pulmonary medicine as well so that our study gets sufficient authentication. Thus began our journey of getting the work started. Ma’am started an email group where she connected us and another professor from the department of Pulmonary Medicine which initiated the collaboration. Me and my colleague than went to meet our other expert and discuss further the possibility of the idea. He was quite excited to be involved in the project and suggested a lot of interesting ideas which were quite relevant to the study and would later on help significantly in the study design.

Photo by Martin Sanchez on Unsplash

Once all the pieces on the board were placed, we began the work under the aegis of our super-dedicated Supervisor Ma’am. It was a sea of uncertainties at the beginning. We had no idea where to start at first. Ours was an attempt to combine all treatment regimens under one roof and to rank them in order of their performance. To our surprise, nobody was doing it at that time in the entire globe. Individual studies were coming up at breakneck speed almost every other day. It took us almost a month to finally shortlist and identify the search terms that we were going to use to identify and select studies from the global databases. At the beginning, it was quite tedious. Ma’am encouraged us to do the search in a blinded manner, where neither me nor my colleague would know what studies each of us were selecting. This was primarily done to ensure no studies were missed out. More importantly, it ensured that the authenticity of the data we collected was maintained as well. We took another month for collecting and assimilating data, while at the same time we refurbished and finalized our list of variables that we would look at so that it would provide the best possible outcome. At that point, my colleague did the analysis of the various factors, outcomes and objectives for one particular drug Hydroxychloroquine (HCQ) to see how the results really were. Looking back, a year and a half later when HCQ is no longer a treatment of choice and its recommendation has been withdrawn by the WHO, it does seem our study also had some part in facilitating that decision. Our initial analysis found that HCQ was not associated with any form of improvement or reducing death in COVID-19 patients. This was such a significant result that we found, because at that point of time, India along with many other countries were hoarding HCQs and prescribing it as a prophylactic for COVID left, right and centre.

Photo by Towfiqu barbhuiya on Unsplash

Once the initial analysis revealed such awesome results, we delved into the rest of the drugs and treatment regimens that were available. My colleague, the first author man, did most of the analysis while I supported with data verification, quality analysis and figure editing. The entire analysis and overall results were done within the next month or so. Since our first meeting on 16th March of 2020, the work had seen remarkable progress. All the authors of the paper were so enthusiastic about the work that we kept each other going despite facing the lockdown, rise in COVID-19 cases, ups and downs of mental health and so many deaths around, we pursued the work on and on. There were so many moving parts in the paper and required multiple revisions. My colleague prepared the first draft and I helped in devising some parts of it as well. Our Ma’am and our content expert guided us every step of the way, they found time in contributing to it and their suggestions helped us in improving the article leaps and bounds. At last, on 27th May, 2020, we were ready with our complete article and based on our expert’s best suggestion we chose a journal and submitted our article for peer review and publication. We also published a preprint of our work before peer review so that the scientific community could get access to the data and results that we were communicating. This norm was being followed during the pandemic research in order to expedite clinical decisions.

Now, here’s the thing about academia and research life. More often than not, your first choice journal will always reject your article. Although we thought our article had serious merit, it was rejected from the editor’s desk itself. It was disheartening to say the least. This back and forth of rejection and submission went on for another month or two with five more journals in between. The lockdown restrictions were starting to come off and we were getting worried as to the status of our research and whether it will be published or not. Then, finally we submitted to another journal with some serious modifications. The journal took two months for peer-review and sent it back to us with some minor revisions and required the revised version within a fortnight. My colleague and me worked day and night on that to make all the necessary corrections and rebuttals so that the paper could get through. I still remember Ma’am saying “Do this asap, this is one chance to get it through”, and boy, did we get it through. After about a week or so of resubmission, the paper was finally accepted. We breathed a sigh of relief because of the months of work being put in was coming to see the light of the day. The collaboration worked and we did something really good which would go on to create a real impact on COVID-19 research.

The Citation status of our Paper as of now

A year has gone by since we have published the article. It has 14 citations as of now and has been talked about a lot in the scientific community. I understand and appreciate that far better and more significant articles have come from scientific stalwarts across the globe during the ensuing COVID-19 crisis, our little contribution has managed to find its way into the history books as well. The results of our study are still valid to this day and many of the initial conclusions have actually made to the recommendation list of WHO. This is the story of one of our effort towards combating the pandemic. Cheers!!!

Link to the paper is given below:

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Manabesh Nath

A research enthusiast and a neuroscientist by profession, with passion for science communication and frugal innovation.