PONE-D-24-17763Continuous quality improvement with a two-step strategy effective for large-scale SARS-CoV-2 screening at the Tokyo 2020 Olympic and Paralympic GamesPLOS ONE

Dear Dr. Miyachi,

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Etsuro Ito, Ph.D.

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: No

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: N/A

Reviewer #3: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: 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: This manuscript is interesting in the field of laboratory medicine. However, the purpose is obscure and completely retrospective fashion. I can not find the novel point in this manuscript. In addition, the conclusion is not new for the researcher engaged in the field.

Reviewer #2: In this study, Miyachi et al. described a process of two-step strategy for large-scale screening of SARS-CoV-2 at the Tokyo 2020 Olympic. Although this paper is submitted as a research article, almost no data presented. Important studies that are the scientific backbone of this airport quarantine system using saliva samples are missing. They should be introduced with comments and references (Yokota, Clin Infect Dis 2021: Yokota, Lancet Microbes 2021).

Reviewer #3: Miyachi et al. describe in this manuscript their experience with large-scale SARS-CoV-2 screening of participants at the Tokyo Olympics, and state that it provides a model for future infectious disease responses to large-scale sporting events. The two-stage strategy proposed and implemented by the authors, using antigen quantification testing prior to PCR, was presumably beneficial, but more information in support of this would be helpful.

Major comments.

(1) Page 7, lines 148-150: Although the mean of TAT is given, I feel that this alone makes it difficult to assess the bias of the values. Would it be possible to show the distribution in the raw data or information on quartiles?

(2) Page 8, lines 179-182: It seems to me that in order to assess the actual extent of disadvantage due to false-positive results, information such as the results of the second PCR test among those who were positive in the first stage of antigen quantification testing is needed. Although the final percentage of positives is shown in page 10, lines 230-231, I think that these should be included in the Result together with the above breakdown.

(3) Page 10, lines 226-227: It is mentioned that the PCR test has a potential risk of false positives, but I think that the risk of false positives for antigen quantification tests should also be mentioned. Rather, to reduce the risk of final false-positives, is the design of antigen quantification as a prior step to the PCR method more important?

Minor comments

(1) Page 3, Line 51: "Tokyo 2020 Games" should be changed to "Tokyo 2020 Olympic and Paralympic Games".

(2) Page 3, Line 63: "instead of PCR screening" alone does not make sense, so the wording should make it clear that it is a comparison with PCR alone.

(3) Page 7, lines 167-171: Can you give the information regarding sample number of quality assessment by amylase measurement?

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

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Continuous quality improvement with a two-step strategy effective for mass SARS-CoV-2 screening at the Tokyo 2020 Olympic and Paralympic Games

PONE-D-24-17763R1

Dear Dr. Miyachi,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Etsuro Ito, Ph.D.

Academic Editor

PLOS ONE

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Partly

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

Reviewer #2: N/A

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: No

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

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: Yes

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6. 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 #2: The authors responded all the issues raised and the manuscript has been improved. I have no more comments on this

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

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