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      Letter to the Editor: Social Media Is a Double-Edged Sword in the COVID-19 Pandemic

      letter
      Journal of Korean Medical Science
      The Korean Academy of Medical Sciences

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          Abstract

          I read with interest the article on misinformation on coronavirus disease 2019 (COVID-19) by an international team of journal editors.1 The COVID-19 pandemic has been paralleled by an “infodemic” on social media. The index survey included at least a third of participants who have had the experience of working on editorial boards of various medical journals. The majority of them have identified social media as a source of both information and misinformation. While the world is concerned about inequalities based on race, economy and access to health, a more pressing disparity lies in the access to trustworthy and professionally moderated flow of information. Social media platforms have the power to neutralise this inequality. However, geography of social media use is uneven globally, complicating the issue of inequality. Equality ensures that all participants have equal access, but justice determines fair access.2 Thus, a basic principle for justice is access to trustworthy sources. The index survey has delved deep into how misinformation can be minimized on online platforms, including preprint servers. One noteworthy recommendation is to launch a global, open COVID-19 bibliographic database. The other powerful suggestion is to incorporate artificial intelligence checks for facts as well as for plagiarism. The pandemic has started a race to publish. Numerous novice and ambitious authors are eagerly waiting to draft their articles and target top journals even at the expense of unjustified short-cuts and breaches of ethical norms. Unsurprisingly, reports with poorly validated primary data and redundant ideas are on rise and, by a chance, end up in even top medical journals blindly trusted by all. It is believed that plagiarism is also increasing. Not only the absence of appropriate citations but also the lack of or false citations may also constitute plagiarism.3 Authors need to understand the concept of plagiarism in full. Journal editors need to play a more active role in screening for plagiarism, and not just relying on software.4 Complementing the editors, peer reviewers also need to keep their senses heightened. At the beginning of the pandemic, there were some incidences of hastened evaluations at top journals that led to harshly criticized publications and uncovered unpreparedness of the publishing world to operate in the time of crisis. Haste often makes waste. The process of peer review is far from perfect but it is a significant checkpoint for filtering misinformation. It is often a thankless job, but its importance cannot be underscored.5 6 One way to overcome the issue can be the use of open peer review and linking reviewer comments to social media sites.7 This can help provide reviewer recognition as well as accountability. Also, it can help readers on social media sites to have a critical view of studies by reading a third person's viewpoint. Social media can be used for surveys as well as promoting health awareness.8 Maintaining mental health of a population during a pandemic is a difficult task, and social media can help in this regard, too.9 Social media plays an increasingly important role in medical education.10 It can help reduce gender imbalance in medicine.11 Social media platforms can also transform into teleconsultation sites in medium and low income countries.12 Social media editors can share properly validated and cleared of any conflict journal articles via popular online channels.13 14 The eagerness to publish during the pandemic may also transgress ethical boundaries. Most of the preprints that created a ruckus on social media have either not seen the light of publication, or have been rapidly published only to be retracted or put under a notice of concern. An instance is the preprint on ivermectin that changed practice in South America, only to disappear conveniently afterwards.15 A couple of articles in high impact journals were retracted within a month of publication leaving their ghosts behind on social media.16 To sum up, social media is proving to be a double-edged sword. The flow of information is difficult to moderate. Social media accounts should be moderated by skilled professionals capable to distinguish information, tag peer-reviewed reports and unpublished preprints, and filter out misinformation. The pressure on journal editors and peer reviewers is heightened. Authors should also understand their responsibilities. Only with all acting in conjunction, will we be able to utilize the true benefits of social media, without falling prey to misinformation.

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          Information and Misinformation on COVID-19: a Cross-Sectional Survey Study

          Background The coronavirus disease 2019 (COVID-19) pandemic has led to a large volume of publications, a barrage of non-reviewed preprints on various professional repositories and a slew of retractions in a short amount of time. Methods We conducted an e-survey using a cloud-based website to gauge the potential sources of trustworthy information and misinformation and analyzed researchers', clinicians', and academics' attitude toward unpublished items, and pre- and post-publication quality checks in this challenging time. Results Among 128 respondents (mean age, 43.2 years; M:F, 1.1:1), 60 (46.9%) were scholarly journal editors and editorial board members. Social media channels were distinguished as the most important sources of information as well as misinformation (81 [63.3%] and 86 [67.2%]). Nearly two in five (62, 48.4%) respondents blamed reviewers, editors, and misinterpretation by readers as additional contributors alongside authors for misinformation. A higher risk of plagiarism was perceived by the majority (70, 58.6%), especially plagiarism of ideas (64.1%) followed by inappropriate paraphrasing (54.7%). Opinion was divided on the utility of preprints for changing practice and changing retraction rates during the pandemic period, and higher rejections were not supported by most (76.6%) while the importance of peer review was agreed upon by a majority (80, 62.5%). More stringent screening by journal editors (61.7%), and facilitating open access plagiarism software (59.4%), including Artificial Intelligence (AI)-based algorithms (43.8%) were among the suggested solutions. Most (74.2%) supported the need to launch a specialist bibliographic database for COVID-19, with information indexed (62.3%), available as open-access (82.8%), after expanding search terms (52.3%) and following due verification by academics (66.4%), and journal editors (52.3%). Conclusion While identifying social media as a potential source of misinformation on COVID-19, and a perceived high risk of plagiarism, more stringent peer review and skilled post-publication promotion are advisable. Journal editors should play a more active role in streamlining publication and promotion of trustworthy information on COVID-19.
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            Rheumatologists’ perspective on coronavirus disease 19 (COVID-19) and potential therapeutic targets

            The ongoing pandemic coronavirus disease 19 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a matter of global concern. Environmental factors such as air pollution and smoking and comorbid conditions (hypertension, diabetes mellitus and underlying cardio-respiratory illness) likely increase the severity of COVID-19. Rheumatic manifestations such as arthralgias and arthritis may be prevalent in about a seventh of individuals. COVID-19 can result in acute interstitial pneumonia, myocarditis, leucopenia (with lymphopenia) and thrombocytopenia, also seen in rheumatic diseases like lupus and Sjogren’s syndrome. Severe disease in a subset of patients may be driven by cytokine storm, possibly due to secondary hemophagocytic lymphohistiocytosis (HLH), akin to that in systemic onset juvenile idiopathic arthritis or adult-onset Still’s disease. In the absence of high-quality evidence in this emerging disease, understanding of pathogenesis may help postulate potential therapies. Angiotensin converting enzyme 2 (ACE2) appears important for viral entry into pneumocytes; dysbalance in ACE2 as caused by ACE inhibitors or ibuprofen may predispose to severe disease. Preliminary evidence suggests potential benefit with chloroquine or hydroxychloroquine. Antiviral drugs like lopinavir/ritonavir, favipiravir and remdesivir are also being explored. Cytokine storm and secondary HLH might require heightened immunosuppressive regimens. Current international society recommendations suggest that patients with rheumatic diseases on immunosuppressive therapy should not stop glucocorticoids during COVID-19 infection, although minimum possible doses may be used. Disease-modifying drugs should be continued; cessation may be considered during infection episodes as per standard practices. Development of a vaccine may be the only effective long-term protection against this disease. Key Points • Patients with coronavirus disease 19 (COVID-19) may have features mimicking rheumatic diseases, such as arthralgias, acute interstitial pneumonia, myocarditis, leucopenia, lymphopenia, thrombocytopenia and cytokine storm with features akin to secondary hemophagocytic lymphohistiocytosis. • Although preliminary results may be encouraging, high-quality clinical trials are needed to better understand the role of drugs commonly used in rheumatology like hydroxychloroquine and tocilizumab in COVID-19. • Until further evidence emerges, it may be cautiously recommended to continue glucocorticoids and other disease-modifying antirheumatic drugs (DMARDs) in patients receiving these therapies, with discontinuation of DMARDs during infections as per standard practice.
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              High-profile coronavirus retractions raise concerns about data oversight

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                Author and article information

                Journal
                J Korean Med Sci
                J. Korean Med. Sci
                JKMS
                Journal of Korean Medical Science
                The Korean Academy of Medical Sciences
                1011-8934
                1598-6357
                16 July 2020
                27 July 2020
                : 35
                : 29
                : e270
                Affiliations
                Department of Clinical Immunology & Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar, India.
                Author notes
                Address for Correspondence: Sakir Ahmed, MD, DM. Department of Clinical Immunology & Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, KIIT Road, Patia, Bhubaneswar, Odisha 751024, India. sakir005@ 123456gmail.com
                Author information
                https://orcid.org/0000-0003-4631-311X
                Article
                10.3346/jkms.2020.35.e270
                7384897
                32715673
                abaaf1c0-db29-48cc-afc2-b859b7e460ba
                © 2020 The Korean Academy of Medical Sciences.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 July 2020
                : 13 July 2020
                Categories
                Correspondence

                Medicine
                Medicine

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