key: cord-0049432-9aagb9ba authors: Carlos, Ruth C. title: Coronavirus Disease 2019 (COVID-19): The Long Tail Looking Back date: 2020-09-01 journal: J Am Coll Radiol DOI: 10.1016/j.jacr.2020.08.014 sha: a787e1f8da17b3d19a569e185a561aea7ce0ba07 doc_id: 49432 cord_uid: 9aagb9ba nan Reports that say that something hasn't happened are always interesting to me, because as we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. -Donald J. Rumsfeld Q2 Donald Rumsfeld did not get enough credit for acknowledging that we make decisions under conditions of incomplete evidence and, occasionally, profound uncertainty. Science and the recommendations resulting from the evidence work the same way. Once published, it is not immutable. Recommendations change when new evidence augments, supplements, or replaces the old. Otherwise, we would be bloodletting for the common cold. Similarly, with coronavirus disease 2019 (COVID-19), we predict future outcomes using what we have available. These outcomes range from current and future practice volume [1] [2] [3] , to job and insurance loss and the effects on cancer screening [4] , to research productivity and gender [5] . The effects on practice volume and income are immediate outcomes. Others, such as loss of academic productivity among women and the consequences on career advancement and leadership opportunities, will manifest much later, unless we pay attention now and provide appropriate support at the institutional level. Using a 5-year period and data from Scopus, Gupta et al demonstrated significant disparity in authorship of imaging publications by women compared with men at all career stages [6] . The productivity gap widens as authors advance in their careers ( Fig. 1 Q3 ). This pattern among 71,754 contributing authors is static over the 5-year period. COVID-19 brought uncomfortable attention to one potential reason: persistent gendered expectations of household work. The JACR evaluated the immediate effects of this disparity on our authors (Fig. 2 ). In the first 3 months of 2020, women authors as a proportion of all authors grew compared with 2019, with a precipitous drop during the initial phase of the pandemic. Most concerning is the impact of COVID-19 on original research authored by women, a critical benchmark of academic promotion and success and a marker of future leadership. We have 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 worked to institutionalize culture change, bias training, and processes to support women. As the pandemic surges and resurges, a known unknown is pattern of productivity loss among women and the downstream effect on gender distribution of leadership over the next decades. The effect on women of color has the potential to amplify existing barriers as gender intersects with race and ethnicity. Whatever the magnitude of loss, the gains made in improving the representation of women in all spheres of academic and private practice. The goal is not a quota by gender. As a specialty, we must decrease systemic barriers to help everyone achieve their personal and professional goals. Cultural expectations as highlighted by COVID-19 is one such barrier. Scholarly publications are a lagging indicator of pipeline and productivity barriers. Nevertheless, the journal will continue to provide opportunities for women to participate in scholarly activities. We will continue to highlight equity, diversity, and inclusion. As a specialty, I charge all of you to develop innovative solutions to support each other in the new normal. 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 Early-stage radiology volume effects and considerations with the coronavirus disease 2019 (COVID-19) pandemic: adaptations, risks, and lessons learned Operational radiology recovery in academic radiology departments after the COVID-19 pandemic: moving toward normalcy Variables influencing radiology volume recovery during the next phase of the coronavirus disease 2019 (COVID-19) pandemic The coronavirus disease 2019 (COVID-19) pandemic: a patient-centered model of systemic shock and cancer care adherence COVID-19's gendered impact on academic productivity Research authorship and gender parity: are we there? Paper presented at is editor-in-chief of the JACR. Elsevier provided in-kind support for generating data on gender and academic productivity