We identified 314 COVID-19-related manuscripts: 95 manuscripts with 461 authors were accepted for publication and 219 manuscripts from 1,094 authors were submitted but rejected for publication. Forty-one (43%) accepted and 176 (80%) rejected manuscripts were authored outside of Canada, with the top countries including the USA, China, and India. The authors of accepted and rejected manuscripts represented 18 and 26 countries, respectively (see Electronic Supplementary Material [ESM] Figs. 1–2). Using World Bank country income categories,14 16%, 19%, and 65% submission were from lower-middle, upper-middle, and high-income countries, respectively; there were no submissions from low-income countries (ESM Table 1). The specialty focus of included articles was 65% anesthesiology (205/314), 22% critical care (68/314), and 13% (41/314) combination.

Percentage of women authors overall, in the lead author position, and senior author position across all (accepted and rejected) COVID-19 manuscripts from February 2020 to April 2021. Across all manuscripts (accepted and rejected), the percentage of women lead authors (orange line) increased by approximately 2% per month (95% CI, 0.04% to 4%; P = 0.041); however, this result was not significant after adjustment for multiple comparisons (P < 0.004). The changes in percentages of total women authors (0.96% per month; 95% CI, -0.42% to 2%; P = 0.16) and women senior authors (0.77% per month; 95% CI, -2% to 3%; P = 0.52) were not statistically significant.

We were able to establish the gender, POC status, and geographical location of all authors using the approach outlined in the methods. For most authors, gender and POC status data were reported by the lead or corresponding author. Gender and POC status were assigned (using NamSor software and internet searches, as listed in the Methods) to 4% (18/461) and 12% (127/1,094) authors of accepted and rejected manuscripts, respectively.

The characteristics of included manuscripts are provided in Table 1. Of 1,555 total authors, 515 (33%) were women, with a similar proportion in accepted and rejected manuscripts (n = 154 [33%] and n = 361 [33%], respectively; P = 0.92). Women were the lead and senior authors of 101 (32%) and 69 (23%) of all manuscripts, respectively, with no differences between accepted and rejected manuscripts (Table 1). Across all authors, 1,040 (67%) identified as men, and no authors identified with a non-binary gender.

Overall, 923 (59%) authors were POC; with 188 (41%) and 735 (67%) POC authors among the accepted and rejected manuscripts, respectively. Persons of colour authors were the lead and senior authors of 50 (53%) and 43 (51%) accepted manuscripts, respectively. The proportion of total POC authors was lower across accepted compared with rejected manuscripts (41%, 188/461 vs 67%, 735/1094; difference, -26%; 95% confidence interval [CI], -32 to -21; P < 0.001). Similarly, the proportion of POC lead authors was lower in accepted manuscripts than in rejected manuscripts (53%, 50/95 vs 73%, 160/219; difference, -20%; 95% CI, -33 to -8; P < 0.001). The proportion of POC senior authors was similar across accepted vs rejected manuscripts after correcting for multiple comparisons (51%, 43/85 vs 69%,144/210; difference, -18%; 95% CI, -31 to -5; P = 0.007). In the 50 accepted manuscripts with POC lead authors, a greater proportion of coauthors identified as POC compared with manuscripts with white lead authors (56%, 89/158 vs 23%, 49/208; Table 1).

Among all authors, 21% (330/1,555) identified as both women and POC; this proportion was lower among accepted vs rejected manuscripts (15%, 67/461 vs 24%, 263/1,094; difference, -10%; 95% CI, -14 to -5; P < 0.001). After correcting for multiple comparisons, the proportion of women POC lead authors was similar across accepted vs rejected manuscripts (11%, 10/95 vs 24%, 53/219; difference, -14%; 95% CI, -23 to -5; P = 0.009). There were no significant differences in the proportion of women POC senior authors (Table 1).

Across all manuscripts (accepted and rejected), there was an increase in women lead authors over the study period from 28% (55/200) during the first five months to 34% (13/38) in the last five months (2% increase per month; 95% CI, 0 to 4; P = 0.041); however, this result was not significant after adjusting for multiple comparisons (P < 0.004) and our study included only a small number of manuscripts in the final five months of the study period. The overall percentage of total women (1% per month; 95% CI, -0 to 2; P = 0.16) and women senior authors (0.8% per month; 95% CI, -2 to 3; P = 0.52) was similar across the study period (Figure). We found similar proportions of overall women authors of accepted and rejected manuscripts across the study period (ESM Fig. 3), with a similar finding in total, lead, and senior POC authors over the 15-month period (ESM Fig. 4).

Of 314 total manuscripts, the most common manuscript categories were letters to the Editor presenting original material (41%, n = 129) followed by reports of original investigation (19%, n = 59), and editorials (9%, n = 29) (ESM Table 2).