The Impact of SARS-CoV-2 (COVID-19) Pandemic on International Dermatology Conferences in 2020

To limit the spread of the SARS-CoV-2 (COVID-19) outbreak, humans have been significantly restricted in their ability to travel and interact with others worldwide. Consequently, dermatology conferences were forced to adapt to such changes. The aim of this study is to investigate the impact of COVID-19 on international dermatology conferences. We retrospectively investigated decisions made for international dermatology conferences scheduled for 2020. Thirty-three major conferences were analyzed. Their data were obtained from their respective websites (data was accessed 2 June 2021). Among 33 conferences analyzed, 13 (39.4%) were conducted as scheduled, nine (27.3%) were canceled, eight (24.3%) were postponed to 2021 or 2022, and three (9.1%) were delayed but conducted in 2020. The number of the cancellation (44.4%) and postponement (75%) was the largest in the second quarter of the year. During the fourth quarter, most conferences were held on schedule (70%) but were run virtually. Eight out of 13 virtual conferences shortened their duration (61.5%). Most (90.9%) conferences have decided on the schedule of their meetings for 2021 or 2022 while three (9.1%) remain undecided. Twelve (40%) are planned to run virtually, eight (26.7%) have opted for a hybrid form, five (16.7%) are planned to run in-person, four (13.3%) have not decided on the format, and one (3.3%) has been canceled. Virtual and hybrid conference formats have facilitated people to share knowledge despite the travel restrictions posed by the COVID-19 pandemic. Such formats are environmentally friendly, are able to attract a large audience, and save delegates time and costs involved in attending. Therefore, virtual platforms should continue to be integrated within conferences in the post-pandemic era.


INTRODUCTION
The novel coronavirus disease 2019 (COVID-19) forced innumerable events to make significant adjustments in 2020 (1). Cancellation, postponement or online reformatting of major events, such as the Olympics and major film festivals, prevented expected attendees from participating in-person.
International conferences facilitate thousands of delegates to meet and discuss ideas and update each other on their topics of interest (2). However, as gatherings and international travel significantly increase the risk of viral transmission, governments worldwide have implemented strict quarantine and social distancing restrictions. Consequently, conferences have been forced to cancel, postpone or reformat their meetings in order to protect their attendees and local communities (3,4). International dermatology conferences were no exception. In this study, we analyzed the decisions made due to COVID-19 by the major dermatological conferences regarding their meetings scheduled for 2020.

Study Design
We searched for international dermatology conferences arranged in 2020. Thirty-three major conferences were analyzed. Their data were obtained from their respective websites. Data collected included the venue, originally planned date, decision on cancellation or postponement and relevant details, original meeting format (in-person or virtual), change in meeting duration, date and format of the next meeting [in-person, virtual or hybrid (mix of in-person and virtual)], and the number of confirmed and deceased COVID-19 cases during 2020 in the host country ( Table 1, last accessed 2 June 2021).
For the conferences of which the upcoming meeting dates are confirmed, their final schedules are described in Table 1. We applied "Not Determined (ND)" for the undecided schedules. The format of subsequent meetings was also marked as "ND" if the conferences did not decide whether they would be in-person, virtual or hybrid. Furthermore, we recorded the official World Health Organization (WHO) reported total number of confirmed and deceased COVID-19 cases in the hosting countries until December 31, 2020. This study was exempted from ethics review as it investigated publicly available data.

Classification of the Decision Made
We classified the decisions made for each conference into four categories: "Conducted on original date", "Conducted on delayed date", "Postponed (to 2021 or 2022)", or "Cancelled". "Conducted on original date" refers to the meetings that were hosted on the originally planned date. "Conducted on delayed date" stands for the conferences that were held on delayed dates within 2020. If an annual conference which is always held in one country is postponed a year, it was classified as "Cancelled". Indefinitely postponed conferences were classified as "Cancelled" as well. The 20th Edition of Dubai World Dermatology and Laser conference and the Australasian Melanoma Conference 2020 (6th and 27th on Table 1) were such cases. However, if a conference which is held in a different country each time is postponed for >1 year, it was marked as "Postponed (to 2021 or 2022)" as long as the hosting country remained the same.

Overall Fate of Conferences in 2020
Out of the 33 international dermatology conferences, 13 (39.4%) were conducted as scheduled, nine (27.3%) were canceled, eight (24.3%) were postponed to 2021 or 2022, and three (9.1%) were delayed but conducted in 2020. Among 16 meetings held in 2020, 13 (81.25%) were held virtually, and three (18.75%) were held in-person. All in-person meetings were held in January 2020.

Change in Conference Schedules per Quarter
In each quarter of 2020, 6, 12, 5, and 10 conferences were originally scheduled to be held. Out of the conferences scheduled January-March, three (50%) were conducted on their original dates, two (33.3%) were canceled and one (16.6%) was conducted on delayed dates. Out of the conferences scheduled April-June second quarter, six (50%) were postponed, four (33.3%) were canceled, one was (8.3%) conducted on its original date and one (8.3%) was delayed but conducted in 2020. Out of the conferences scheduled July-September, two (40%) were conducted on their original dates, two (40%) were canceled and one (20%) was conducted on a delayed date. Out of the conferences scheduled October-December, seven (70%) were conducted on their original dates, two (20%) were postponed and one (10%) was canceled.
The number of conferences conducted on their original dates was the largest in the fourth quarter of the year (53.8%), followed by the first quarter (23.1%), the third quarter (15.4%) and the second quarter (7.7%). The number of canceled conferences was the largest in the second quarter (44.4%), followed by third (22.2%), first (22.2%) and fourth (11.1%). COVID-19 appears to have had the most significant impact on conferences in the second quarter of 2020, when the World Health Organization (WHO) declared it as a pandemic. All the conferences held on their original dates in the fourth quarter were held virtually. Three conferences which were delayed but conducted in 2020 ran virtually.

Duration of Conferences Held
Of the 16 completed meetings, eight (50%) were shortened, seven (43.75%) were conducted as scheduled and one (6.25%) was lengthened. All in-person conferences in January 2020 were run as scheduled, while most virtual meetings (eight out of 13, 61.5%) shortened their duration (the original duration: 3.70 ± 0.9, the changed duration: 3.31 ± 1.1 days, mean ± standard deviation).

Decision on Upcoming Meetings
Most (93.9%) conferences have decided on the schedule of their meetings for 2021 or 2022 while two (3.1%) remain undecided. Of the 31 arranged conferences, 12 (38.7%) are planned to run virtually, eight (25.8%) have opted for a hybrid format, five (16.1%) are planned to run in-person, four (12.9%) are  In-person 60,734 (900) * When the annual conference which always takes the same venue was postponed one year, we classified it as "Cancelled" even though it announced postponement. When the conference, which rotates its venue internationally, is postponed for more than one year, we marked it as "Postponed to next years (2021 or 2022)" as long as the venue is still the same. **Confirmed and deceased cases refer to those of the host countries; #ND stands for "not determined".

Can host a large number of attendees Limit mentorship and interaction between experts and residents or students
Can allow delegates to attend regardless of location Lose human contact, affections and emotions (5) Reduce carbon footprint of meeting travel (6) Lose networking opportunities amongst delegates Reduce or eliminate registration fees becoming more affordable Restrict interaction with dermatology-related industries (e.g., cosmetics, laser, pharmaceutical) Reduce costs for hosting organizations (e.g., venue hire, staffing) Prevent speakers from sufficiently engage with audience Save travel and accommodation costs for delegates Prevent delegates of developing countries with poor internet connection from participating undecided, and two (6.5%) have been canceled. Among nine meetings scheduled for the first half of 2021, seven (77.8%) were virtual and two (22.2%) were hybrid. Of the 15 conferences scheduled for the second half of 2021, five (33.3%) are scheduled to run virtually, five (33.3%) have opted for a hybrid format, four (26.7%) are planned to run in-person and one (6.7%) remains undecided.

DISCUSSION
In this study, we analyzed how major dermatology conferences in 2020 adapted to restrictions set by the COVID-19 pandemic.
The results denote close association between the date and the decisions made by the conferences. The WHO declared the outbreak of COVID-19 on January 30, 2020. Before the declaration, all three conferences in January were conducted in-person. However, all 30 conferences planned from February to December 2020 were canceled, rescheduled or switched to virtual form. COVID-19 had the most significant impact on conferences during the second quarter of 2020 when the WHO declared it as a pandemic. Eleven out of 12 conferences planned for the second quarter deferred or canceled their meetings. The second quarter accounted for the largest percentage of cancellations (44.4%) among four quarters. In contrast, seven out of 10 meetings originally scheduled for the fourth quarter were run as scheduled but in virtual form. These results show how the conference hosts with meetings scheduled near the end of the year had sufficient time to re-organize and run their events virtually to adapt to COVID-19 restrictions. Success of these virtual conferences was enabled by audio-visual e-platforms, such as Zoom (Zoom Video Communications, California, U.S.), Cisco Webex (Cisco Webex, California, U.S.) and Google Hangout (Google, California, U.S.), which developed rapidly due to the exponential increase in demand during the pandemic.
Running conferences virtually has several advantages and disadvantages ( Table 2). The greatest advantage is that virtual conferences have significant flexibility in timing and location. Thus, they can host a much larger number of attendees compared to in-person conferences, thereby offering economy of scale to reduce registration fees (7). Running conferences virtually may be more profitable for the hosting organizations as they may reduce costs on venue hire and staffing (8). Affordable fees can make meetings more accessible for a larger audience (9). Talks may even be recorded and transmitted via delayed streaming to let attendees choose their best time to view the lecture. (5) In addition, virtual conferences are more environmentally friendly as they can reduce the carbon footprint of traveling (10,11). Finally, given that much of dermatology is image-based, it is well suited to this virtual method of knowledge distribution. (12).
However, in-person conferences have characteristics which cannot be mimicked by virtual means. In-person conferences allow attendees of all career stages to interact, share ideas and learn from one another (5,13). Furthermore, virtual conferences cannot provide opportunities for hands-on learning, such as dermatologic surgery skills, or mentorship between leading dermatology experts and junior doctors as well as students. Virtual meetings are, by nature, not as engaging as in-person interactions, as audience members are reduced to names on screens. In our data, alteration to virtual format was accompanied by shortening of conference duration in the majority of conferences. The average conference duration decreased from 3.7 to 3.3 days. This may be due to the deletion of activities only feasible in-person, such as workshops and welcome receptions, which further reduces networking opportunities for attendees.
Technical issues including intermittent connection, poor audio and video quality significantly disrupt delegates' ability to distribute information and interact with one another (14). Hyper-efficient telecommunication networks and optimal image quality are prerequisites for real-time video and audio interaction. Therefore, attendees from underdeveloped societies may not be able to participate, leading to an imbalance of knowledge distribution and opportunities. Virtual conferences also restrict dermatology experts from interacting with dermatology-related industries, such as cosmetics, pharmaceutical and laser companies, and helping them manufacture evidence-based products.
It is likely that most conferences in 2021 will run virtually due to the COVID-19 pandemic. All nine conferences scheduled for the first half of 2021 were run virtually (77.8%) or in hybrid form (22.2%). For the second half of 2021, 10 (66.7%) out of 15 conferences are planned to be held in virtual or hybrid formats. Some organizations have even launched independent virtual conferences, rather than temporarily adopting virtual platforms to run their in-person conferences. For example, the American Academy of Dermatology (AAD) canceled their 2020 Annual Meeting. Instead, they launched the Annual Meeting of the American Academy of Dermatology Virtual Meeting Experience (AADVMX), which ran live from June 12 to 14, and academic content was made accessible until December 31, 2020. AADVMX was held from 23 to 25 April 2021 as well.
Our study has a few limitations. First, not all conferences were analyzed due to the absence of a platform that shows every dermatological conference at a glance. We however attempted to include all major gatherings that attract hundreds of attendees nationally and internationally. Second, biennial conferences which were not scheduled for 2020 but for 2021 were not included. Despite these limitations, this study sufficiently captures the effect of COVID-19 on the 2020 dermatological society and informs future decision-making for overcoming travel restrictions when organizing internationall conferences, especially when facing another pandemic.

CONCLUSION
The restrictions posed by COVID-19 provided a unique opportunity for conference hosts to experiment running their events virtually. Although virtual conferences have limitations, such as technical issues and loss of networking opportunities, they allow participants across the globe to overcome physical limitations and congregate to share knowledge. Removing the need for delegates to travel long distances is also beneficial for the environment and saves delegates' time and costs when compared to attending in-person conferences. By optimizing the technicalities of virtual platforms and increasing opportunities for more liberal interaction amongst delegates, conferences should continue integrating virtual experiences for their future meetings.

DATA AVAILABILITY STATEMENT
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.