Many librarians make a difference in what could be considered matters of life and death: connecting a patron to health information needed to make treatment decisions, or to social services that provide food and housing, or offering a teen in need the right book at the right time. Some get the opportunity to make such a difference on a larger scale.
In response to the World Health Organization's (WHO) need for timely, accurate, and searchable material about COVID-19, Elaine R. Hicks—research, education, and public health librarian at Tulane University in New Orleans—pulled together an ad hoc organization she named the Librarian Reserve Corps (LRC). Among those who answered her call for volunteers were Stacy Brody, reference and instruction librarian at the George Washington University (GWU) School of Medicine and Health Sciences in Bethesda, MD; and Sara Loree, medical librarian at St. Luke’s Health System, Boise, ID, both of whom soon stepped up to serve as the project's co-leads.
Since then, LRC has vetted, indexed, and helped disseminate tens of thousands of health resources about the SARS-CoV-2 novel coronavirus. Because of their work to organize and streamline information so badly needed by medical and health professionals, humanitarian organizations, researchers, and the public at a critical time in history, Hicks, Brody, and Loree have been named LJ's 2021 Librarians of the Year, sponsored by Baker and Taylor.
Channeling the Flood
In January 2020 Lina Moses, epidemiologist and disease ecologist at the Tulane University School of Public Health and Tropical Medicine (SPHTM), was deployed to WHO headquarters in Geneva to help respond to the pandemic. Her job was to synthesize information for the WHO's Global Outreach Alert and Response Network (GOARN), which aggregates resources from more than 300 technical institutions and networks worldwide to deliver rapid support around infectious disease outbreaks and other public health emergencies. Member organizations include medical and surveillance initiatives, regional technical networks, networks of laboratories, United Nations organizations, the Red Cross and Red Crescent Societies, international humanitarian nongovernmental organizations, and national public health institutions.
GOARN's COVID-19 Knowledge Hub offers a public resource platform for audiences ranging from policy makers to first responders, researchers to educators, and anyone affected by the pandemic. But what Moses encountered was an unevaluated, overwhelming flow of information from journals, databases, preprint servers, government reports and protocols, grey literature, and other sources—a glut of information often termed an infodemic.
"I knew that there would be a lot of questions that needed to be answered, and I knew that there was going to be a lot of knowledge management," says Moses. "We really needed some medical librarian support. That was apparent very early, and almost immediately the need grew exponentially."
So in late February, Moses reached out to Hicks, her liaison from Tulane's Rudolph Matas Library of the Health Sciences. The two had a long history of collaboration, including developing training for the WHO's Hinari Research4Life program for West African research sites and Hicks's discipline-specific information literacy activities at SPHTM. Hicks worked at Illinois' Cook County Department of Public Health from 1996 to 2004 during public health crises such as the nationwide anthrax attacks, SARS, and West Nile virus. She has a long history of public health equity outreach in underserved communities and the University of Illinois Urbana-Champaign iSchool's community informatics, which engages local residents through information skills. “Elaine was all ready," recalls Moses.
"I recognized immediately how large this was going to be," Hicks says. Moses was receiving materials that included a vast number of preprints—publications issued before peer review—as well as narrative commentaries and reviews of articles, rather than structured data analysis. Many were poorly indexed or had unusable metadata. Moses "could not tell from looking at a bibliographic record what it was about, how authoritative it was, and who she should send it to," adds Hicks. Every item required human eyes and a set of decisions to render it usable by GOARN.
Hicks realized that there was too much information flowing in for her to handle alone. "I knew I needed a team," she says—so she created one. She modelled the LRC after the federal government's Medical Reserve Corps community response organization, and pulled it together in a couple of weeks, without a board or budget.
A call for volunteers on the Medical Library Association's MEDLIB-L email discussion list netted a response from about 130 librarians from the United States, Canada, Germany, Australia, and Trinidad. Brody and Loree were among the first volunteers. Working groups were set up, and by March, LRC was up and running.
Boots on the Ground
Right away, the three found themselves on the front lines of a wildly decentralized flow of information. Data about a drug might come in with only a press release accompanying it, or an article preprint could appear in several versions that need to be reconciled, or a publication's life cycle might need tracking to ensure accuracy.
Volunteers sign up to screen and literature by date received—at the beginning, often in two-hour increments, given the sheer volume of material. From April to July, LRC processed an average of 534 articles daily; by the end of June, nearly 20,000 had been processed. Since November, LRC librarians have screened for quality control after artificial intelligence processing is done for the WHO database. Each week, an average of six volunteers screen anywhere from 363 to 1,634 articles, averaging 930 weekly.
At the beginning of the pandemic’s spread, Loree recalls seeing fewer than 10 publications a day about COVID, "and you were digging for any scrap of information you might find." But by the time Hicks answered Moses' request, the flow had ramped up exponentially. Hicks, Brody, and Loree were taken aback at the vast amount of written material LRC had to contend with. The word they use most often is "flood"; by fall 2020 the WHO's database logged more than 100,000 publications.
"In the beginning we saw a lot of the epidemiological models and the forecasting models," recalls Brody. "We continued to see reviews and commentaries—the sheer number of publications that have been written in such a short amount of time."
A large number of those were preprints ingested to meet the urgent need for information; currently more than half of the publications in the preprint server medRxiv are COVID-related. "There wasn't a structure or a framework that was built to handle this," says Brody. "The norms weren't there—the professional understandings of what to deposit as a preprint, how to deposit your preprint, how to version it, can you deposit or post it on multiple servers. People weren't familiar with them. [The influx of preprints] wasn't quite ready for prime time, and now it's center stage."
The National Institutes of Health have been encouraging data sharing among researchers, says Brody, "but now they want to share data rapidly from clinical trials. Is there a good way to do it?" The pandemic has thrust these scholarly communications issues into the spotlight. Researchers are looking for answers—and LRC volunteers are working overtime to provide them.
The volunteers—librarians at all stages of their careers, "from people getting ready to retire, on the top end of their game, down to early career librarians, from all kinds of different organizations," says Hicks—are the most important component of LRC's work, all three affirm. "They are always happy to jump in and help, and eager to participate," Loree says. "We've had some people who have an incredible amount of experience, who have really helped to guide and shape the group."
Public health emergency response is not a neatly defined project, Loree adds. She and Brody have learned to be fluid at the organizational level, "knowing sometimes you're going to have to drop a project because you realize that this is not useful anymore, this is not where volunteers need to put their efforts, this is not where we need to put limited hours."
Ready to Respond
Hicks attributes the speed and efficiency with which she built LRC from the ground up to her work at Cook County, she says—"It was all that emergency preparedness planning, four years worth of training" funded by the federal government.
After 9/11 the country was gearing up for a potential biomedical emergency, a concept new to a regional public health workforce more accustomed to handling hepatitis outbreaks. The biowarfare threat never emerged, and the federal funding eventually dried up. Hicks left the public workforce in 2006 to earn her MS/LIS at the University of Illinois at Urbana-Champaign, but she never forgot those lessons—and when COVID emerged as a global health threat and Moses reached out, she knew she would be able to put that training to good use.
Brody was not set on a career in medical librarianship when she began her MLS studies, but with an undergraduate degree in agriculture and plant sciences, she imagined that she would gravitate to some area of health sciences. As part of an associate fellowship program at the National Library of Medicine Brody worked on a literature research project that helped sharpen her management, leadership, and research skills, as well as offering valuable experience working with national and international partners in a governmental science setting. She continued her work on literature searches for clinicians and researchers at GWU's Himmelfarb Library, where she also maintains the library's Novel Coronavirus COVID-19 Research Guide. When Brody saw LRC’s call for volunteers, she felt that it was an opportunity for her to use her expertise.
Loree also gained experience in a government science agency through an internship—she worked at the Environmental Protection Agency's library while earning her MLS at the University of North Carolina. She also saw the call for volunteers at LRC as a natural extension of her job as a medical librarian. "Everyone I work with at St. Luke's is involved in responding to COVID," says Loree. "It seemed like a role I could play to support people locally and globally by getting more information into the hands of scientists, researchers, and clinicians."
Taking the Lead
Not every early career librarian who volunteers with a nonprofit or NGO will find themselves running it in a few months, of course. But the need for speed, and the ad hoc nature of LRC as it coalesced, accelerated the usual process of moving through the ranks.
Brody and Loree quickly "rose right to the top," says Hicks. "They were the ones who at that time were the most interested and had the best organizational skills."
The two had not envisioned themselves in leadership positions when they signed on as volunteers. Both were driven mainly by the idea of new challenges, and being able to play useful roles during the pandemic—even if they hadn't imagined at the time what those roles would become.
Loree saw the issues her own workplace was having with the flow of resources and felt LRC was an opportunity to help on a larger scale. "Initially, I think I volunteered to help sort some spreadsheets."
Brody, too, was simply looking for ways to contribute to the pandemic response while working from home. "l signed up because I saw it as a way to complement the work I was doing at my own institution," she says. GWU has a reporting system where librarians help monitor and organize key resources for clinicians at the University Hospital, and she thought volunteering with LRC would be a good way to keep on top of pandemic literature.
Since handing the reins to Loree and Brody, Hicks has stepped back from her organizational role at LRC. "I saw it as a great way for Stacy and Sara to build their career around this, knowing the people they would meet and the opportunities that would come along, things that I don’t really need at this point in my career."
Both Brody and Loree agree, however, that Hicks' background in public health has been invaluable in getting LRC off the ground. "It always takes someone to have a vision to do these things," says Brody.
From Sprint to Marathon
Because everyone at LRC started out in what Loree calls "sprint phase," they refined the organizational structure as they went along, learning on the job. Ten months in, "We’re thinking about some of those other aspects that weren’t necessarily top of mind, even though we knew how important they were," she notes. "You just get so caught up in the heat of responding."
As it transitions into "more of a marathon approach," says Loree, the organization is moving from solely dealing with the flow of information to a project-based model that can address discrete tasks. As LRC shifts from a reactive to a proactive approach, “it's a little easier to take on specific projects and define those, have a project lead, and then volunteers can be apply to be a part of that project," she notes. In addition to broadening LRC’s scope, "it also helps us know who in our volunteer corps might be the right people or be interested in a certain project, because we can advertise it to our group—say, 'We're doing a validation study, are you interested in participating?' so people can plug in and out a little bit more, rather than ask them to sustain a certain level of hours per week." LRC now has dedicated volunteer management and communications teams.
Several outside partners interested in aiding the cause have partnered with LRC. Library vendor Springshare has donated licenses for several of its products, including LibGuides CMS, which LRC uses as a website and a way to build instructional guides for volunteers, and LibAnswers, which allows LRC to receive and respond to requests for information from WHO and GOARN partner organizations and post search strategies and results centrally—additions that have been "transformative for the organization," says Loree. LRC has also moved from using Zotero to manage bibliographic data to DistillerSR systematic review software, which is also used by the WHO.
Keeping the Momentum
The next step for the Corps' leaders is investigating how to ensure its sustainability. In LRC's early days, explains Brody, "it was more of that immediate response: What can we do to index, what can we do to search. As this has evolved it's grown more into questions around how you structure an organization."
While Hicks is not currently actively involved in LRC's day-to-day work, she is still thinking about its future—specifically, how other nonprofits with similar beginnings evolved over time. LRC "is unusual because it developed organically, without any bureaucracy, without any money, just people wanting to solve problems," she notes. "Now the organization is at a point where they need to figure out how to maintain the level of involvement while things change."
Some of the big-picture issues include building out best practice statements and standards for information response, developing recommendations around searching COVID-related subjects, and facilitating partnerships and collaborations between different—often international—database creators in partnership with WHO Librarian Thomas Allen.
LRC has recently undertaken a validation study, in partnership with the Canadian Agency for Drugs and Technologies in Health (CADTG), of several specialized COVID-19 databases that have been developed in response to the pandemic. The study will evaluate their completeness and currency; preliminary results are expected in late January.
One item not on LRC's agenda yet is funding—at least partly because its organizers simply haven’t had time, but also because the information landscape has continued to shift so dramatically that it’s hard to predict what assets they will need down the line. That will likely change once LRC cmopletes some planned impact assessment in 2021. “We’ve talked about doing some sort of lessons-learned document with our partners to understand the information and librarian response more broadly,” says Loree. "But I don't know that we've outlined specifics yet, mostly just because we're moving so fast, and everybody's doing this in their side time"—Loree and Brody put in 15 to 20 hours a week with LRC on top of their regular jobs throughout most of 2020. "We just have to pace ourselves."
"In the public health world you've got preparedness, response, and recovery," explains Hicks. "We hit the ground running in a response mode. But I think that when things settle down would be a good time to think about preparedness."
Loree and Brody find ongoing value in their work at LRC. The opportunities it offers, from inside knowledge of COVID-19 resources to experience administering an information nonprofit to networking, keep paying off, both say.
"I continue to volunteer because I really enjoy the opportunities it presents to think about some of the big-picture issues in evidence dissemination, research cycles, and publication cycles," says Loree—"talking about those issues with other people who are excited about this topic and are thinking about ways that the information response might evolve, or might help contribute to, on-the-ground responses in the future." Her involvement in LRC also gives her a deeper understanding of the information ecosystem as a whole, and helps her better support the COVID teams at St. Luke's.
For Brody, a relatively new librarian, work with LRC has expanded her professional network and given her a close-up look at how experts respond to public health emergencies. The experience also supplies her with real-time practical information as she instructs medical students on scholarly publications and research dissemination as part of her job.
All three of LJ's 2021 Librarians of the Year agree that the pandemic response has shone a spotlight on the need for sophisticated treatment of information—which isn't going to disappear with the development of an effective vaccine. The emerging WHO field of infodemiology—the study of user-contributed health-related electronic content, with a focus on improving public health—will likely offer new opportunities for information professionals in public libraries as well as those in the academic or health science spheres.
During the pandemic, "what librarians always struggle with, how to answer health questions authoritatively and ethically, became extremely exaggerated," says Hicks. "There is the issue of midinformation [informational ambiguity based on scant or conflicting evidence, often about emerging scientific knowledge], misinformation, and how librarians can deal with this at the reference desk." The WHO convened the first Infodemiology Conference in July; Hicks considers the field a "whole new frontier."
"Information and public health have the spotlight on them now, which is a real shot in the arm for people in both of these occupations," says Hicks. "Even though it's in the context of a major problem, look at how fast people are learning, responding, changing, and being open to new ways of doing things. In this case it’s a pandemic, but it could have been anything that so shocked all of our systems and our societies—and in this case created opportunity.” LRC is still taking volunteers; anyone interested can sign up on the organization's website.
Moses sees Hicks, Brody, and Loree's work advancing the field of public health at a time when resources—and best practices to ensure their accuracy and access—are needed more than ever. "LRC has stepped up and moved evidence-based outbreak response forward in a way that I'm confident we're doing it better," she says, "and that translates into lives saved."