A year ago, when I wrote the editorial for the first issue of Cardiovascular Revascularization Medicine (CRM) for 2020, there was not a clue as to what the year was going to look like. Yes, there were reports on the deadly virus from Wuhan, China, but we were in full plans and preparation to execute the largest Cardiovascular Research Technologies (CRT) meeting ever in February. At that time, no one could imagine that the virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) would impact so many lives around the globe, with over 40 million people infected, million deaths, and a global economic meltdown.
As the year ends and a new one starts, we often pay attention to the main impactful events in the year past and make resolutions and projections for the new year. The pandemic was another example of how fooled we can be when we try to predict the future. As we end 2020 and start 2021, these rules do not apply to the virus, which does not recognize calendar-year rules. Perhaps the most frustrating is that after dealing with the virus for nearly a year, all we can say is that the virus's behavior and response for prevention and therapy are unpredictable. Thus, as we begin 2021, the unknown still supersedes any prediction made by experts and laymen. Nevertheless, in 2020, we learned primarily from observations that the virus is highly infectious and does not discriminate between poor people and world leaders, that the mortality rate can range from under 1% to over 10%, and that there is not a definitive therapy to combat the virus or its collateral damage in the form of cytokine storm.
Over the past year, I have been watching the impact of the virus primarily from the perspective of a physician taking care of COVID-19 patients and non-COVID-19 patients during the pandemic; from the scientific aspect trying to understand the science of the virus, along with the suggested therapeutics and clinical trials that mixed with politics in an election year in the United States; and, finally, as the Editor-in-Chief of this journal. What is frustrating is that a year into the pandemic, the scientific community still lacks consensus on the spread of the virus, the efficacy of the therapeutics, and the safety and efficacy of the upcoming vaccines that, by the time this editorial will be in print, may be available for some of us, but the questions on their efficacy and safety will remain open. As a clinical trialist, I was disappointed with the lack of sufficient randomized clinical trials in the field of therapeutics to battle SARS-CoV-2, the conflicting results and lack of definitive studies, leaving the science to opinion and interpretation by the media and their surrogates.
Finally, as the Editor-in-Chief of CRM, it was appalling to watch and read the level of studies that made it into the top-ranked journals. The studies that made it to these journals were poorly designed, not randomized, underpowered, and many of them had poor quality and bias. Yet the rush to publish, with subsequent retractions, calls into question the credibility of these top-ranked journals. In addition, with the bombardment of COVID-19-related papers at journals' editorial offices, there was a pushback of non-COVID-19 manuscripts that could not be handled because of lack of capacity. The lockdown and the decision to cease elective cases during the early months of the pandemic resulted in more free time for the academic community to submit manuscripts and to expedite the review process. Indeed, in 2020, CRM had a record number of submitted manuscripts beyond COVID-19. I suspect that our readers had more free time to read manuscripts and to comment on them with letters to the editor and on social media.
Despite the many challenges that 2020 posed, it was a good year for the journal. We have seen growth in the quantity and the quality of the manuscripts submitted to CRM, we substantially increased the editorial commentaries, and we cannot wait to read “The Last Word” from Spencer B. King, III, the journal's Editor-at-Large. I would like to take this opportunity to express my gratitude to the authors; the reviewers; the Editorial Board; our managing editor, Jason Wermers; and our publisher, Elsevier, for their contribution to the journal during this difficult time.
Making predictions is a risky proposition. In a previous editorial, I speculated that CRT 2020, held in February, would be the last in-person meeting of the year. Unfortunately, because of the pandemic, in-person meetings have ceased since then, and we do not know how soon we will be able to resume them. As an adaptation to the situation, we have seen the proliferation of virtual meetings, with a change of culture in dissemination of medical education. But these virtual meetings, although feasible with technology, are not an adequate substitute for in-person meetings and social networking. Dissemination of medical education via the web is not good enough, as we miss the social interaction. Further, for a virtual meeting that lasts 3 or 4 days, we usually do not set aside the time to be online for the duration of the meeting, and our ability to watch these meetings is, therefore, limited to only few hours a day. With that in mind, we decided to hold CRT 2021 as a virtual meeting taking place over 10 Saturdays, from February 13 through April 24. Whenever we are able to hold an in-person CRT meeting, we will take all the safety precautions, including social distancing and face masks.
So what will 2021 look like? It all depends on how we are able to live with the coronavirus. This will depend on two things: how strong an immunity people build against the virus after being exposed and the arrival of a vaccine against the virus. Eventually, the pandemic will be over, but it is hard to predict when this will happen. Past pandemics have lasted for 3 or 4 years and included deadly surges. If the therapeutics work, then 2021 will be much better than 2020. While many of the therapeutics are in the pipeline, there is no substitute for a rigorous clinical trial to make a definitive conclusion rather than practice anecdotal medicine that works on a few events if they happen to world leaders.
The pandemic taught us a lesson that we must take to heart if we want to survive and win this battle. I project that 2021 will be the year of adaptation to a new reality of living with the virus but with new rules of adhering to the science and the truth. Few things will change in our life for the foreseeable future. If 9/11 left us with Transportation Security Administration screening for life in airports, I suspect that COVID-19 will leave us with masks for many years to come. So, as I am reluctant to predict events in 2021, it is much easier to forecast how CRM will be in 2021. We expect to have higher-quality manuscripts, more exposure on social media, and a higher impact factor. As we launch this first issue for 2021, I would like to wish to all of our readers, authors, and supporters a healthy new year, and I hope to see all of you at our CRT 2021 Virtual meeting.
Funding
None.
Declaration of competing interest
RW – Advisory Board: Amgen, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, Pi-Cardia Ltd.; Consultant: Amgen, Biotronik, Boston Scientific, Cardioset, Cardiovascular Systems Inc., Medtronic, Philips, Pi-Cardia Ltd.; Grant Support: AstraZeneca, Biotronik, Boston Scientific, Chiesi; Speakers Bureau: AstraZeneca, Chiesi; Investor: MedAlliance.