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3.1 Publications per Day on Average: Chinese Scientists Battle the Outbreak

Originally published in Southern Weekly(南方周末) on Feb. 14th, 2020

(Data as of Feb. 5th is collected by Reporter Zhou Xiaoling and Intern Ye Zi from Southern Weekly)

It takes about 10 minutes to read the full article.

From Jan 15th to Feb 5th, 66 articles on COVID-19 have been published by scientists in China. This is an average of 3.1 articles per day with the participation of 590 researchers.

As for the content, most research with 26 papers focuses on epidemiological analysis and prediction; There are 20 papers on virus analysis, 9 papers on clinical data analysis, and 6 papers on pharmaceutical development. There are also 5 non-research articles of comments from experts and news.

As for SARS-related articles published during the SARS outbreak, from Nov 2002 to July 2003, 2,295 are found on the Web of Science database, 588 of which were contributed by Chinese scientists. The average is 2.17 papers per day. 680 are found on PubMed. 119 of them were published by Chinese scientists, 0.44 papers per day on average.

This article was originally published in Southern Weekly. Do not reproduce without permission.

Reporter | Zhou, Xiaozheng (周小铃); Ye, Zi (叶梓) (Intern)

Editor | Zhang, Yue (张玥)

On Feb 9th, 2020, an article "Clinical characteristics of 2019 novel coronavirus infection in China" written by a team led by Dr. Nan-Shan Zhong, head of a high-level expert team of China's National Health Commission and academician of Chinese Academy of Engineering (CAE), was published on the preprint website medRxiv.

The study reviewed the clinical characteristics of 1,099 diagnosed cases of COVID-19 in China. It showed that only 1.18% of those patients had a direct contact with wildlife, whereas 31.30% had visited Wuhan, and 71.80% had contacts with people from Wuhan. It also found that the median of the incubation period is 3.0 days (ranging from 0 to 24 days). The incubation period could be up to 24 days.

Six days before the article was published, the Standing Committee of the Central Political Bureau of the Communist Party of China stressed that more efforts should be put into scientific research to battle the outbreak. Science and technology are crucial to win this battle. So they encourage researchers from China to participate in scientific projects of epidemic prevention and control, and to share data and information of clinical cases.

According to the findings of Southern Weekly reporters, the first study on COVID-19 in international journal databases was published on Jan 15, 2020. It is a paper from Zhejiang University titled "Recent advances in the detection of respiratory virus infection in humans", was published in the Journal of Medical Virology.

From Jan 15th to Feb 5th, 66 articles on COVID-19 have been published by scientists in China. This is an average of 3.1 articles per day with the participation of 590 researchers. Among these publications, 11 were published in top international journals.

As for SARS-related articles published during the SARS outbreak, from Nov 2002 to July 2003, 2,295 are found on the Web of Science database, 588 of which were contributed by Chinese scientists. The average is 2.17 papers per day. 680 are found on PubMed. 119 of them were published by Chinese scientists, 0.44 papers per day on average.

66 Papers in 21 Days

Since Jan 15, 2020, publications by Chinese scientists at home and abroad on the COVID-19 has been increasing. 11 articles were published on Jan 29 and 9 on Feb 4, which were the highest numbers of publications daily. On Jan 24, 5 articles were published, 4 of which were in top international journals.

The sources of data collected by Southern Weekly reporters are mainly the 'COVID-19 Dynamic Monitoring Platform for Scientific Research' launched by the Wuhan Library of the Chinese Academy of Sciences, as well as journal platforms including China National Knowledge Infrastructure (CNKI), Elsevier and Wiley Online Library.

The 66 papers can be divided into two categories based on their publishing platforms. 32 of these papers were officially published in professional journals. The other 34 papers were published on preprint platforms such as bioRxiv and medRxiv.

bioRxiv preprint platform is a platform for storing and publishing medical academic papers. Papers published on this platform are not peer-reviewed, but undergo basic screening and checked against plagiarism and obvious error, etc. All published papers can be retrieved and cited using their unique digital object identifiers. This won't have impacts on official publishing of papers in the future. medRxiv is another preprint platform for medical research papers.

Among those officially published articles, 11 were published in top international journals and 21 in other journals. Ranking these journals based on the number of these 21 publications, they are Journal of Medical Virology, CNKI, Social Science Research Network (SSRN), Travel Medicine and Infectious Disease, Emerging Microorganisms and Infections, Journal of Virology, Journal of Infection, SCIENCE CHINA Life Sciences, and Radiology.

(Data as of Feb. 5th is collected by Reporter Zhou Xiaoling and Intern Ye Zi from Southern Weekly)

Impact Factors of the Four Top Medical Journals

The New England Journal of Medicine (NEJM), The Lancet, The Journal of the American Medical Association (JAMA) and The British Medical Journal (BMJ) are reputed as the four top medical journals in the world.

Among the 66 papers, 8 are published in these 4 top journals. 3 of them are published in Nature, the world's leading multidisciplinary science journal.

Two articles published in NEJM are both from the Chinese Center for Disease Control and Prevention (China CDC).

Six papers are published in the Lancet. The first authors of 2 papers among them are from Wuhan Jinyintan Hospital. Another 2 are from LKS Faculty of Medicine of the University of Hong Kong. One is from China CDC. The corresponding authors of the last paper, a comment on the COVID-19 outbreak in Wuhan, are Wang Cheng, academician of CAE and Dean of CAS, and Gao Fu, academician of CAE and director of China CDC, and medical experts from the Oxford University and the University of Virginia.

Three articles are published in Nature. First authors of two of them are from Shi Zhengli's group of the Wuhan Institute of Virology, CAS. The first author of the other article is from Zhang Yongzhen's group of the Shanghai Public Health Clinical Center and the School of Public Health of Fudan University. It is worth mentioning here that Prof. Zhang Yongzhen is also a researcher at the National Institute for Communicable Disease Control and Prevention of China CDC.

It means a lot to researchers that they have publications in top journals.

According to the latest SCI impact factors published on June 20th 2019, The New England Journal of Medicine (NEJM) has the highest impact factor of 70.67, followed by The Lancet (59.1), Nature (43.07), The Journal of Infectious Diseases (5.099) and The Journal of Virology (4.324). The Journal of Medical Virology, which has published the most of Chinese researchers articles, has an impact factor of 2.049.

In academia, the impact factor refers to the current average number of citations of literature published in a journal in the past two years. High impact factor indicates high citation rate, which means studies published in a journal are of high quality and have an important influence.

A university researcher in related fields told our reporters that the author would be awarded several ten thousand RMB for a publication in The New England Journal of Medicine because it has a high impact factor of about 70.

A former employee at a top 3A-grade hospital said that papers are published to demonstrate and publicize the results of studies. The number and quality of publications in global journals indicate the scientific achievements.

She explained that basically every medical institution has policies to award authors whose articles are published in journals indexed by SCI.

There are different columns in a top journal. The above-mentioned university researcher pointed out that The Lancet, for example, has columns of research papers and case reports. The Lancet article from China CDC is not a scientific research, but a case report, which means it gathers and publicizes the treatment information of patients. This also counts as a publication.

He observed that research papers were not the mainstream in Science. On the contrary, case reports, review articles, and advertisements make up 60% of its content. The review process of case reports is faster than research papers because they just present first-hand information.

During the outbreak of COVID-19, the National Natural Science Foundation of China set up a special fund on Jan 22 to support studies on COVID-19 and encourage researchers to publish their studies. The fund will support 20 selected projects for a period of 2 years. Each of them will receive a funding of 1.5 million RMB.

The next day, the Ministry of Science and Technology of China launched emergency research projects on COVID-19. 15 experts from the expert team of China's National Health Commission participated. 8 emergency projects have already started and received their fundings. On the same day, a special research group of 13 experts was formed in the lead of the Wuhan Institute of Virology. Members also come from different Chinese universities.

Sharing Data by Publishing Papers

Based on data compiled by our reporters, 590 researchers participated in the studies of the above-mentioned 66 papers. Categorized by their background, they are from universities, research institutions, CDC and hospitals.

45% of the researchers work in 43 Chinese and foreign universities. CDCs are the second largest group, making up 20%, including 17 CDCs at various levels of the nation, provinces, cities, and districts. Hospitals account for 18%, among which Wuhan Jinyintan Hospital has the largest number of participants. Researchers from research institutes account for 17%.

Universities and research institutions with notable achievements are the Chinese Academy of Sciences, Fudan University, the University of Hong Kong and the Capital Medical University. They respectively published 11, 8, 9 and 3 articles.

(Data as of Feb. 5th is collected by Reporter Zhou Xiaoling and Intern Ye Zi from Southern Weekly)

The CDCs stand out in both the number and quality of its publications.

In addition to the China CDC, 14 provincial, municipal and district-level CDCs have also published papers on COVID-19. These provincial CDCs include Hubei, Guangdong, Hunan, Guizhou, and Inner Mongolia CDCs. Municipal CDCs include Wuhan, Jingzhou, Chengdu, Anyang, Panjin, Nanchang, and Xianyang CDCs. District-level ones are Shanghai Jiading CDC and Shanghai Baoshan CDC. The CDC of the Chinese People's Liberation Army also participated.

The China CDC was established in 2002, redesigned from the former Chinese Academy of Preventive Medicine. In an interview with China Health Journal, Li Liming, the former director of China CDC, mentioned that the reason to establish China CDC was to conduct scientific research with the aim of controlling diseases and addressing public health problems.

At present, CDCs at all levels participated in the publication of 11 papers in English. Among these papers, two were published in NEJM, two in Nature, one in The Lancet, one in the SSRN, three in the bioRxiv preprint platform and two in the medRxiv preprint platform. The 6 officially published papers in English by CDCs were all based on their first-hand data of patients.

The large number of CDC's publications owes to its mastery of data.

A doctoral student in the field of public health told us that there are faculty members from her school recruited teams to crawl data from the Internet to write papers. They have ideas but do not have much data. They have to work hard to get data from the Internet. It really depends on who owns the database.

The China CDC must report the outbreak to the WHO (World Health Organization) as soon as possible. The above-mentioned university researcher said that as for research institutions, the way to share data is by publishing papers.

Questions including the Source of the Virus Remain to be Answered

Based on the content of these papers, studies have made breakthroughs in various aspects including epidemiological prediction, pharmaceutical development, virus detection and genetic analysis, and clinical data analysis.

Specifically, there are 26 publications on epidemiological prediction, which is the most popular topic, 20 in viral analysis, 9 in clinical data analysis, and 6 in pharmaceutical research and development. There are 5 non-research articles of expert comments and news.

(Data as of Feb. 5th is collected by Reporter Zhou Xiaoling and Intern Ye Zi from Southern Weekly)

In terms of viral genetic analysis, on Jan 10 2020, Prof. Zhang Yongzhen, from China CDC, Shanghai Public Health Clinical Center and the School of Public Health of Fudan University released the genome sequence of SARS-CoV-2 on GenBank, for researchers to download, use, and analyze. Meanwhile, they declared that publishing study results based on the genome sequence needs to contact him for permission.

On Jan 22, 2020, Professor Gao Shan's group from the School of Life Sciences of Nankai University published their results in the Journal of Bioinformatics, using Professor Zhang's published genome data. Professor Zhang Yongzhen was unhappy and asked him to withdraw his work immediately.

Gao Shan responded to this incident that data from this major public health emergency should be shared, that no one owns the data, and that the China CDC should make it available to the public in the first place. By the time of posting this article, Professor Zhang Yongzhen had not replied to our interview email.

The earliest eye-catching genetic analysis of the virus by Shi Zhengli team from Wuhan Institute of Virology was published on January 23 on the bioRxiv, co-authored by Wuhan Institute of Virology, Wuhan Jinyintan Hospital, and Hubei Province CDC. The origins of the virus genomes in 5 patients were investigated. The results showed that the sequence consistency between coronavirus in patients and the one in bats is as high as 96%.

Recently a researcher from India published a paper on bioRxiv, arguing that there are 4 unique insertion sequences in the spike proteins of SARS-CoV-2, some of which are very similar to sequences of HIV. This paper incited a public suspicion targeted at the Wuhan Institute of Virology.

On February 2, Shi Zhengli replied to our reporters in a text message saying that those who believe the malicious rumor from American media and the suspicion of the Indian scientist do not deserve my explanations. Shi Zhengli also posted a similar comment on her WeChat account and forwarded the news that the Indian scientist withdrew his manuscript on that day.

The next day, the results of Shi Zhengli's group which was previously published on bioRxiv, was officially published in Nature. The results suggested that SARS-CoV-2 uses the same cellular receptors, ACE2, as SARS-CoV does.

According to the latest research results, the current discussions on virus gene analysis has not reached a concrete conclusion. Especially, intermediate hosts in virus transmissions are still unclear.

Moreover, questions such as the source of the virus still remain unanswered.

Kristian Andersen, an evolutionary biologist from the Scripps Research Institute, published in The Lancet and speculated that there is a possibility that infected people could once brought the virus to the Huanan Seafood Market, which means the virus could actually originate elsewhere and then spread to the Huanan Seafood Market, where it then broke out in a large scale. Among the first 41 patients in Wuhan, 14 of them had no history of exposure to the Huanan Seafood Market.

Similarly, a paper published on January 29 by 14 multi-level CDCs in China showed that 55% of the cases before Jan 1st, 2020 were related to the Huanan Seafood Market.

In the field of pharmaceutical research, a recent study by Wuhan Institute of Virology on February 4 found that remdesivir and chloroquine are effective in repressing 2019-nCoV infection in vitro.

It is shown by public information that Wuhan Institute of Virology applied for a Chinese patent for invention (a use patent) for remdesivir, with respect to its function of repressing SARS-CoV-2. It would also gain access to major countries all over the globe, through the PCT (Patent Cooperation Agreement). But it is still uncertain whether the application will be approved.

On the afternoon of February 5, Xinhua News reported that remdesivir had completed the registration and approval for clinical trials, with the support of China National Health Commission and National Medical Products Administration. The first batch of severe patients of COVID-19 will start the trial of this medicine on February 6.

The research on virology is tough. "In biology, nothing is clear, everything is too complicated, everything is a mess, and just when you think you understand something, you peel off a layer and find deeper complications beneath. Nature is anything but simple." as written in The Hot Zone: A Terrifying True Story, a nonfiction thriller about the ebolaviruses.

(Southern Weekend Reporter Gao Yichen also contributed to this article)