PGPH-D-22-01487

Risk factors for COVID-19 mortality among 290,488 telehealth patients in Bangladesh: a prospective cohort study

PLOS Global Public Health

Dear Dr. Sania,

Thank you for submitting your manuscript to PLOS Global Public Health. After careful consideration, we feel that it has merit but does not fully meet PLOS Global Public Health’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Thank you for your submission, which we have assessed carefully. Below and attached you will find some suggestions from reviewers. In addition I have some suggestions myself:

- A major concern is the lack of ethical approval in Bangladesh. Please explain why this is not required; these are highly sensitive data(sets).

- 10% missing data on mortality outcomes is a very large proportion (much larger than the amount of deaths); the authors do mention this in the limitations. Seeing you will have most other data on these patients, have the authors done a comparison of the (baseline) characteristics to try to gauge the extent of the bias introduced by these missing data?

- The baseline table lacks information about physician assessment. Also, are there no data on hospitalisations? (And on what the physician's advice was, and whether this was followed up?)

- The added value of the regression trees is not clear to me. Please spell out the implications for the Bangladesh situation (or remove entirely)

- The methods lack clarity on merging of databases with death registry data

- The three different multivariable models based on the conceptual framework are difficult to understand (hence the question from reviewer 1, who clearly misunderstood that these were in fact multivariable models). I would suggest annotating the framework with the three models so it becomes more clear, and revise the text. 

- I support the concern from reviewer 1 about the large number of missing data and how they were treated. Did you consider multiple imputation?

- Please add rationale for the categorisation in periods. The data only go up to June 2021, why is this the case? Please also give some context about the covid vaccination status; was the entire cohort unvaccinated? 

- Did you consider including the time periods in one of your models? The time period effect on mortality in covid waves is very strong.

- The number of mobile phones in the discussion is difficult to interpret without a total population size to give indication of mobile phone penetration.

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Please submit your revised manuscript by Feb 02 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at globalpubhealth@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pgph/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Sabine Hermans

Academic Editor

PLOS Global Public Health

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Additional Editor Comments (if provided):

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Does this manuscript meet PLOS Global Public Health’s publication criteria? Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe methodologically and ethically rigorous research with conclusions that are appropriately drawn based on the data presented.

Reviewer #1: No

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available (please refer to the Data Availability Statement at the start of the manuscript PDF file)?

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Reviewer #1: No

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Overall, the manuscript is well-written. However, I have some comments available in the uploaded file.

Reviewer #2: This manuscript examined the contributing risk factors of mortality due to Covid-19. The study does provide some novel findings on identifying a few important risk factors of mortality due to Covid-19 among the Bangladeshi population.

However, there are a few issues which need to be improved before publishing this manuscript.

1. In the abstract the objective does not clearly state the problem for the research. Is this research only crucial because there is a lack of high-quality individual-level data?

2. In the main manuscript, though the introduction states the problem for the research in the second paragraph it explained the methodology of this research. The introduction should consist of the existing background information and the objective and rationale of the study, not the methodology.

3. The data is collected from the telehealth services which were self-reported by the patients. Did the researchers do any validity checks of the data to assess the accuracy of telemedicine assessments? If not, it should be listed as a limitation.

4. One of the most important findings of this research is physicians' assessment of the patients provides high predictability of mortality. But, how accurate this assessment is through telemedicine services? Its strength and limitations should be discussed in the discussion part.

5. Lastly, As both the incidence and mortality of Covid-19 is decreased and Bangladesh is successfully rolling out mass vaccination programmes, What is the implication of this study now? If there is any, then it should be discussed both in the introduction and discussion part.

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Reviewer #1: No

Reviewer #2: No

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Risk factors for COVID-19 mortality among telehealth patients in Bangladesh: a prospective cohort study

PGPH-D-22-01487R1

Dear Dr. Sania,

We are pleased to inform you that your manuscript 'Risk factors for COVID-19 mortality among telehealth patients in Bangladesh: a prospective cohort study' has been provisionally accepted for publication in PLOS Global Public Health. Apologies for the delay in getting back to you. We appreciate the thorough revision based on our suggestions.

Before your manuscript can be formally accepted you will need to complete some formatting changes, which you will receive in a follow up email. A member of our team will be in touch with a set of requests.

Please note that your manuscript will not be scheduled for publication until you have made the required changes, so a swift response is appreciated.

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Thank you again for supporting Open Access publishing; we are looking forward to publishing your work in PLOS Global Public Health.

Best regards,

Sabine Hermans

Academic Editor

PLOS Global Public Health

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Reviewer Comments (if any, and for reference):