Imprimir Republish


Previously low-impact studies gained new attention in the pandemic and contributed to the fight against the novel coronavirus

Many of the papers in question relate to the mechanism of action of SARS-CoV-1, which causes Severe Acute Respiratory Syndrome (SARS), and to possible ways of treating the disease

Anna Cunha

A curious phenomenon in scientometrics—the study of scientific production based on certain indicators—has reemerged during the pandemic: “sleeping beauty” articles that suddenly start being cited years or decades after they were first published. More than a dozen papers released between 2003 and 2015 that had previously received little or no attention “woke up” in the midst of the health crisis, having an impact on the fight against the novel coronavirus. The conclusions were reached by a survey carried out by two researchers from the University of New South Wales, Australia.

Based on data from the Web of Science, they analyzed the citation rates of 27,460 articles published in the period on the various variants of the coronavirus family and respiratory infections in general. They found 15 papers with sleeping beauty characteristics, which attracted some attention soon after publication but lost influence over time, going largely unnoticed by the scientific community until they were rediscovered or revisited. On March 9, 2022, when the survey was completed, one of these 15 articles had been cited 3,477 times. The average was 1,090.

Some of the sleeping beauties that started to have an impact in 2020 and beyond relate to the mechanism of action of SARS-CoV-1, which causes Severe Acute Respiratory Syndrome (SARS). They likely had a low impact beforehand because the 2002 outbreak of this disease only lasted a short time. One of them, published in the journal Nature in 2003, investigated how SARS-CoV-1 uses angiotensin-converting enzyme 2 (ACE2) to infect human cells. Between 2010 and 2019, it received an average of 33.6 citations per year. In 2020, it was cited 1,139 times, and it now has a total of just over 3,500 mentions. The results of the study encouraged scientists to assess whether the same mechanism was used by SARS-CoV-2, which was later confirmed, allowing academics to advance in the development of containment strategies for the pathogen.

Two articles described possible treatment methods for SARS. The first, published in the Virology Journal in 2005, focused on the potential of the antimalarial drug chloroquine as an inhibitor of SARS-CoV-1 infection. The second, published in the Journal of Infectious Diseases in 2015, analyzed specialized literature for evidence of the effectiveness of convalescent plasma in people with the disease—both approaches were widely tested on COVID-19 patients, but the results proved ineffective. A 2003 article in The Laryngoscope discussed how to perform a safe tracheostomy in individuals infected with SARS. Another, published in PLOS ONE in 2008, evaluated how masks could reduce the incidence of respiratory infections in the population. According to the Web of Science, the paper received fewer than 10 citations per year until it was cited 95 times in 2020 and 89 times in 2021.

While sleeping beauties are not necessarily rare in science, it is difficult to predict what factors help to awaken them (see Pesquisa FAPESP issue no. 256). In general, the “princes” responsible for breaking the spell and triggering the academic community’s interest in these articles are associated with new scientific discoveries. In some cases, however, they can result from other events, such as the outbreak of a disease. “When that happens, a cascade effect begins, with the newly awakened articles themselves starting to act as princes, helping to catalyze new citations for the papers referenced in their own bibliographies,” says Abel Packer, head of the SciELO Brasil open-access journal library. It is possible that this has happened with the COVID-19 sleeping beauties, according to analyses by researchers at the University of Sfax, Tunisia, based on the results of the Australian survey.

It is difficult to assess whether an article with few citations could potentially have a greater impact

A similar phenomenon was observed in Brazil, albeit on a smaller scale. One stand-out article in this respect was published in the journal Influenza and Other Respiratory Viruses in 2013 by a group led by infectious disease specialist Nancy Bellei of the Department of Medicine at the Federal University of São Paulo (UNIFESP). She worked with Tatiane Karen Cabeça, who was her doctoral student at the time, to analyze the clinical and epidemiological characteristics of several pathogens of the coronavirus family in different groups of patients, confirming that they were capable of causing more than a mild illness of the respiratory tract and that people with comorbidities were at greater risk of becoming infected and developing severe cases of the disease. The paper, funded by FAPESP, received an average of four citations per year between 2014 and 2019. In 2020 and 2021, however, it was cited 28 and 22 times respectively, according to a survey carried out by Packer at the request of the report.

Bellei attributes the study’s impact to its wide-reaching objective: to investigate different variants of the coronavirus and assess their effects in different populations over many years. “We knew that these viruses were capable of jumping from animal species to humans and we saw this happen on two occasions: with SARS in 2002 and with Middle East Respiratory Syndrome (MERS) in 2012,” she highlights. “Cases of MERS were confined to the Middle East, but it was clear that there was potential for these two pathogens to trigger a larger problem.”

The significant increase in the number of times these articles have been cited indicates that studies carried out with the aim of advancing knowledge, even those without an immediate or apparent application, could eventually play a critical role in the prevention and mitigation of new diseases. “Science is built on top of science,” Packer points out. “Whenever scientists are faced with a new problem, they turn to past studies to guide their own investigations, often replicating previous experiments to lay the foundations for new hypotheses. It is like a toolbox that they can turn to when they need to fix something.” But this requires a body of qualified researchers capable of producing and storing knowledge.

A recent example that occurred in Brazil was the Zika Virus Research Network in São Paulo (Rede Zika), a taskforce created in 2015 to find out as much as possible about the pathogen. “This prompt reaction was possible thanks to many years of investment into the creation of virology laboratories in the state of São Paulo and training a qualified scientific workforce,” says Bellei, who did not participate in the network. “Both the research infrastructure created in the past and the continuous funding of basic studies on various pathogens, such as dengue, yellow fever, and Chikungunya, allowed us to accumulate and provide essential information at a time of emergency caused by Zika,” adds Packer. “This reinforces the importance of investing in knowledge and training scientists without worrying about immediate results.”

Scientific articles
TURKI, H. et al. Awakening sleeping beauties during the Covid-19 pandemic influences the citation impact of their references. Scientometrics. vol. 127 pp. 6047–50. aug. 2022.
HAGHANI, M. & VARAMINI, P. Temporal evolution, most influential studies and sleeping beauties of the coronavirus literature. Scientometrics. vol. 126 pp. 7005–50. june 2021.
CABEÇA, T. K. et al. Epidemiological and clinical features of human coronavirus infections among different subsets of patients. Influenza and Other Respiratory Viruses. vol. 7, no. 6, pp. 1040–7. mar. 2013