The COVID-19 pandemic has extremely affected the scientific community and shifted the paradigm of how research is disseminated. Research related to SARS-CoV-2 has been published in an unprecedented speed and amount. The total number of publications indexed by PubMed is 16,781 on 21th of August, 2020 and with the exception of 8 articles, they were all published in 2020. Although the emergency of the current context justifies the massive publishing, some measures have to be taken to safeguard research ethics and integrity. The pandemic highlighted the importance of scientific research, collaboration work, and fast outputs to help tracking the outbreak. However, different integrity concerns have been raised after issues involving clinical trials protocols and publication process.

On August 20^th, 3058 trials have been registered on ClinicalTrials.gov. A study published in July, that assessed strength of evidence of COVID-19 trials registered on ClinicalTrials.gov, found that only 29,1% of the registered trials have the potential to result in a level 2 evidence, according to OCEBM (Oxford Centre of Evidence-Based Medicine). Trials can influence public opinion and help driving government policies and clinical practice related to the epidemic, so dissemination of low-quality evidence is very concerning and potentially harmful. This alarming scenario is further evidenced by the way the studies have been published and disseminated.

According to the website RetractionWatch, 32 papers and preprints on COVID-19 have been retracted by 20^th of August, 3 other are on a temporary retraction, and one express of concern. The pressure for a rapid publication amid the competitive context has affected the traditional process of scientific publication. Preprints has shown to be one of the mechanisms to speed up the dissemination process. Preprints are an open, effective and fast way to share results, and encourages collaboration and transparency. However, preprints do not comply with the peer review process and many concerns have been raised about the misinformation, and the risks of using them as a reliable source of evidence to drive actions and clinical practice.

The process of scientific publication includes the scrutiny of the manuscript by other scientists, which leads to improvement or even rejection. Although some preprints platforms as bioRxiv and medRxiv have been trying to enhance the screening process after the unexpected surge of coronavirus studies, the problem on the usage of un-reviewed studies in a crisis remains. The media and social media cherry-picking and disseminating preprints results is one of the biggest problems. One example is the most downloaded bioRxiv preprint which suggests that SARS-CoV-2 was lab-created. Although preprints are corrected as quickly as they are spread, the damage caused by misinformation is not so easily corrected. Considering that, speculative studies based on computational models are now barred from bioRxiv and medRxiv.

However, this problem is not exclusive to preprints. The top 5 papers by Altimetric score related to COVID-19 include the peer-reviewed paper “Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis” published by The Lancet. The controversial paper resulted in a letter signed by 120 scientists raising concerns about the quality of data. Unbalanced media attention to studies with poor methodology leads to even more unnecessary or misdirected research, increasing waste and misinformation.

Fortunately, some measures have been created to minimize these problems and strengthen the available evidence. In addition to the mentioned measures taken by bioRxiv and medRxiv, some journals have created alternatives to reduce the time of the review process. MIT press launched in June a new journal called Rapid Reviews: COVID-19 that aims to review the most important preprint studies by using artificial intelligence and volunteer reviewers. Another example is the Outbreak Science Rapid PREreview platform that aims to rapid review preprints related to emerging outbreaks. Other journals such as Nature, The Lancet, and JAMA have already created ways to reduce the time of the peer-review process by presubmission enquires or fast track publications to combine fast decisions with high-quality standards. Through these measures we will be able to find the balance between rapid dissemination of research and minimize potential risks.

One day the tension in research caused by rapid publication vs. quality of SARS-CoV-2 papers will go away and new biomedical needs emerge. Although the focus today is on actions taken by journals and databases, the education of students, the future “research consumers”, can provide a more solid basis for research integrity which underlines the importance of projects such INTEGRITY.