Dear Dr. Spatz,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’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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Dear Authors, this manuscript is in need of a minor revision before it's ready for next steps. Please kindly address our reviewers' concerns to enhance the quality of your work. Thank you very much!

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Please submit your revised manuscript by Mar 09 2025 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 plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ 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,

Harapan Harapan, MD, PhD

Academic Editor

PLOS ONE

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When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

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2. Thank you for stating the following financial disclosure:  [The Innovative Support for Patients with SARS-COV-2 Infections Registry (INSPIRE) is funded by the Centers for Disease Control and Prevention (CDC, www.cdc.gov), National Center of Immunization and Respiratory Diseases (NCIRD) (contract number: 75D30120C08008; PI, Robert A. Weinstein, MD).].  Please state what role the funders took in the study.  If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." If this statement is not correct you must amend it as needed. Please include this amended Role of Funder statement in your cover letter; we will change the online submission form on your behalf.

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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?

Reviewer #1: Yes

Reviewer #2: Partly

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: This ia an important article to address the patient-reported outcomes among essential workers compared with the general working population following SARS-CoV-2 infection and in the context of the COVID-19 pandemic.. I recommended acceptance for publication. The only interested further analysis is whether the patient-reported outcomes are different among different SARS-CoV2 variants.

Reviewer #2: A review of the manuscript entitled “Impact of SARS-CoV-2 on Healthcare and Essential Workers: A Longitudinal Study of PROMIS-29 Outcomes”

1. The authors have clearly written this manuscript in professional, unambiguous language. I appreciate the authors for their extensive data set, which included participants from eight US sites. However, there are some minor things that need to be rectified to increase the quality of this study.

2. (page 16) please revise the study timing from this sentence using a unified format: “A total of 8950 participants enrolled in the study between 12/7/2020 and 8/29/22, of which 6,044 were eligible for follow-up based on the three sets of eligibility criteria above.”

3. Authors are suggested to proofread the manuscript after addressing all comments to avoid any typological, grammatical, and lingual mistakes and errors. For example, “Each site began their enrollment” on page 16; “…after (omicron) this period.” on page 20; “Among essential non-HCWs…” on page 24.

4. Before delving further into COVID-19 in the US, I suggest that authors elaborate more on what COVID-19 itself is first. For example, “The COVID-19 pandemic has profoundly impacted millions of lives worldwide. By June 2023, the global count of confirmed COVID-19 cases exceeded 767 million, with over 6.9 million fatalities. Healthcare workers have borne the brunt of the pandemic's effects, with the World Health Organization (WHO) reporting that over 14% of COVID-19 cases involve this group. The rising incidence of COVID-19 among healthcare professionals risks significantly straining healthcare systems, reducing service quality, and leading to adverse health outcomes.” This information can be cited from “Fatigue in healthcare workers with mild COVID-19 survivors in Indonesia”.

5. (page 14, introduction) This sentence “Frontline workers risked their personal and household’s health and well-being, with ongoing exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)…” also shares the same idea with a similar study by Hamdan et al. entitled “Coping strategies used by healthcare professionals during COVID-19 pandemic in Dubai: A descriptive cross-sectional study”. Kindly include this reference to make the sentence stronger.

6. (page 15, methods) I suggest that authors arrange the information on the start dates for each institution in a table to make it more organised.

Reviewer #3: Dear Authors,

Thank you for this article. It is an exciting article to publish. The title is Impact of SARS-CoV-2 on Healthcare and Essential Workers: A Longitudinal Study of PROMIS-29 Outcomes, and the ID number is (PONE-D-24-50826). The findings can be compared to general workers; essential HCW status had higher cognitive function in the absence of SARS-CoV-2 infection at all time points, while essential non-HCWs were most vulnerable to poor recovery in long-term physical health following SARS-CoV-2 infection. Preparation efforts for future pandemics may consider enhanced protection and post-infection resources for frontline workers.

- The results in this article are good.

Finally, this article is acceptable for publishing because it is the new result and well written.

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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 #1: Yes:  Tun-Chieh Chen

Reviewer #2: No

Reviewer #3: No

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org

Impact of SARS-CoV-2 on Healthcare and Essential Workers: A Longitudinal Study of PROMIS-29 Outcomes

PONE-D-24-50826R1

Dear Dr. Spatz,

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.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager®  and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Harapan Harapan, MD, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #2: All comments have been addressed

Reviewer #4: (No Response)

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

Reviewer #2: Yes

Reviewer #4: Yes

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

Reviewer #2: Yes

Reviewer #4: Yes

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

The PLOS Data policy

Reviewer #2: Yes

Reviewer #4: Yes

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

Reviewer #2: Yes

Reviewer #4: Yes

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Reviewer #2: I commend the authors for addressing my concerns. Now the manuscript has improved a lot and is ready for further consideration.

Reviewer #4: The review of this study has been highly enriching, as it constitutes a work of notable scientific relevance. I consider its publication to be fully justified, as it addresses a medical and social issue with direct implications for the quality of life of a population subgroup that requires specific and comprehensive care. With the aim of contributing to its proper presentation, I offer the following observations:

- It is recommended to standardize the format of the bibliographic references, as inconsistencies have been observed in various sections of the article regarding the spacing before brackets ([#]).

- One potential limitation of the study is the lack of consideration for individuals with pre-existing psychopathological conditions within the inclusion or exclusion criteria. This omission may have influenced the findings related to mental health outcomes. As highlighted by Manchia et al. (2021) in their review "The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: A critical review across waves", such conditions may predispose individuals to internalizing symptoms. Future studies would benefit from accounting for this variable in order to provide a more nuanced interpretation of psychological outcomes and to contribute to a more comprehensive understanding of factors influencing mental resilience during public health crises.

- While the study distinguishes between two categories of workers, it does not delve into the occupational heterogeneity within each group, which could have allowed for more precise analyses. This omission limits the ability to identify particularly vulnerable or resilient occupations within each group, which is essential for designing more targeted and effective interventions in the face of future health crises.

I would like to thank the editor for the opportunity to review this important study. I believe it is essential to continue investigating the effects of the COVID-19 pandemic, not only on health but across all aspects of human life. Studies like this provide valuable information that can help guide strategies to more effectively address future public health crises.

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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

Reviewer #4: Yes:  Araceli Guerra Martínez

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