PONE-D-24-35333Experiences of Recently Diagnosed COVID-19 Outpatients: A Survey on Patient Worries, Provider-Patient Interactions and Neutralizing Monoclonal Antibody TreatmentPLOS ONE

Dear Dr. Fish,

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.

Please submit your revised manuscript by Mar 07 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.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Ranjan K. Mohapatra, PhD

Academic Editor

PLOS ONE

Journal Requirements:

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

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. In the ethics statement in the Methods, you have specified that verbal consent was obtained. Please provide additional details regarding how this consent was documented and witnessed, and state whether this was approved by the IRB

3. Thank you for stating the following financial disclosure:

“Funding for this project was by the National Center for Advancing Translational Sciences of the National Institutes of Health [grant numbers UL1TR002525, UL1TR002535-03S3, UL1TR002535-04S2, and 1UM1TR004399-01A1] and supported by the Health Data Compass Data Warehouse project (healthdatacompass.org).”

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.

4. Thank you for stating the following in the Competing Interests section:

“I have read the journal's policy and the authors of this manuscript have the following competing interests: Dr. Ginde reports grants from the National Institutes of Health (NIH) for the conduct of this study and other grants related to COVID-19 from the NIH, Centers for Disease Control and Prevention, Department of Defense, AbbVie, and Faron Pharmaceuticals, outside the submitted work. The other authors have no competing interests to report.”

Please confirm that this does not alter your adherence to all PLOS ONE policies on sharing data and materials, by including the following statement: "This does not alter our adherence to PLOS ONE policies on sharing data and materials.” (as detailed online in our guide for authors http://journals.plos.org/plosone/s/competing-interests). If there are restrictions on sharing of data and/or materials, please state these. Please note that we cannot proceed with consideration of your article until this information has been declared.

Please respond by return email with your amended Competing Interests Statement and we will change the online submission form on your behalf.

5. We note that you have indicated that there are restrictions to data sharing for this study. For studies involving human research participant data or other sensitive data, we encourage authors to share de-identified or anonymized data. However, when data cannot be publicly shared for ethical reasons, we allow authors to make their data sets available upon request. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions.

Before we proceed with your manuscript, please address the following prompts:

a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent.

b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. You also have the option of uploading the data as Supporting Information files, but we would recommend depositing data directly to a data repository if possible.

Please update your Data Availability statement in the submission form accordingly.

6. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information .

[Note: HTML markup is below. Please do not edit.]

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: Yes

**********

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

Reviewer #1: No

Reviewer #2: Yes

**********

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: Yes

Reviewer #2: Yes

**********

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: Yes

Reviewer #2: Yes

**********

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: I would like to thank you for the opportunity to review this paper.

First

Please insert in the text a line numbering (continuous) with a line spacing of 12 except for ( tables and figures) when you are submitting your revised manuscript for ease of tracking of change.

Title

1. Include the study setting in the title.

Abstract

I am wondering if this is the abstract format for PLOS ONE. The abstract lacks an in-depth summary of the study.

1. Cross-check the acronym for the word “neutralizing monoclonal antibodies” I am not sure if it is (mAb) but rather (nMAbs).

2. The description of methods lacks sufficient depth.

3. The study design is a "longitudinal prospective cohort," but you failed to tell us how longitudinal data was collected to measure worry, altered provider-patient interactions, and options to use novel treatments.

4. The key results are dense and not well contextualized. Rewrite these results "Patients of younger age, female sex, Hispanic ethnicity... to “Greater worry was reported among younger patients, females, Hispanic individuals, Medicaid beneficiaries, and those with ≥2 comorbidities and BMI >25.”

5. Rewrite the conclusion to reflect your results.

6. Please I suggest you rewrite the abstract.

Introduction

1. Provide a reference (s) to these sentences “Patients with recently diagnosed COVID-19 have varied experiences of emotional worry, interactions with health care professionals, and considerations regarding novel treatments such as neutralizing monoclonal antibodies (mAbs).”

Method and materials

1. Rewrite the outcomes section of the method to improve the manuscript and ensure clarity.

2. The BMI classification. What criteria does it based on?

Results

1. For the phrase “more likely to be non-Hispanic White (81.6% vs. 71.2%)”, I suggest including the total crosstab presentation of mAb treated and non-mAb treated in Table.

2. Tables 2 and 3. Part of the tables were cut off so I cannot access the full tables.

Reviewer #2: The manuscript (PONE-D-24-35333) offers a thorough summary of the study, encompassing its objectives, methodology, key findings, and conclusions. It effectively highlights the study's significance by connecting patient experiences, healthcare disparities, and treatment accessibility within the context of COVID-19. The study design is meticulously documented, providing clear details on participant selection, survey implementation, and statistical analyses. The manuscript may be accepted after major revision.

Revisions Needed:

1. Streamline content to emphasize critical findings (e.g., key socio-demographic factors).

2. Avoid redundant phrases like “Limited research has been performed...” which i

3. s already implicit in the introduction.

4. Include actionable insights to make the conclusion more impactful.

5. Condense background information to avoid over-explaining concepts such as monoclonal antibody (mAb) efficacy.

6. Clarify the novelty of the study by explicitly contrasting it with prior research.

7. Focus on the specific research gap that this study addresses.

8. Provide more detail on survey development, including pilot testing outcomes and psychometric validation.

9. Clarify the rationale for categorization and thresholds (e.g., Likert scale recategorization from 1-10 to 1-3, 4-6, and 7-10).

10. Discuss potential biases introduced by reliance on telephone surveys and verbal consent.

11. Improve clarity by summarizing findings for each outcome variable in dedicated subheadings (e.g., “Trust in Providers,” “Worry About COVID-19”).

12. Address potential confounding variables, particularly for outcomes related to mAb treatment and worry levels.

13. Enhance the discussion on why specific sociodemographic groups (e.g., vaccinated patients) reported higher worry levels.

14. Provide more actionable solutions to address disparities (e.g., interventions to improve trust in walk-in clinics or reduce barriers for Medicaid patients).

15. Address broader implications of findings, such as policy-level recommendations for equitable healthcare delivery.

16. Ensure all figures and tables are self-explanatory by adding detailed captions.

17. Simplify complex visualizations, particularly in Figures 1 and 2, to enhance readability.

18. Add comparative summaries in tables for quicker reference.

19. Edit for grammatical consistency and conciseness. For example, “Patients of younger age, female sex…” could be simplified to “Younger and female patients.”

20. Avoid repetitive phrases and overuse of technical jargon that could be streamlined for readability.

21. Use active voice where appropriate to improve flow (e.g., “We conducted a survey” instead of “A survey was conducted”).

22. Expand on how the urban-centric and English-speaking population limits the applicability of findings to diverse settings.

23. Address the limitation of self-reported data and potential underreporting or over-reporting biases.

24. Ensure all references are correctly formatted according to journal guidelines.

**********

6. 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 #1: Yes:  Lawrence Sena Tuglo

Reviewer #2: No

**********

[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 . Please note that Supporting Information files do not need this step.

Attachments

Attachment

Submitted filename: PONE-D-24-35333 Review report.docx

Experiences of recently diagnosed urban COVID-19 outpatients: a survey on patient worries, provider-patient interactions and neutralizing monoclonal antibody treatment

PONE-D-24-35333R1

Dear Dr. Fish,

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,

Ranjan K. Mohapatra, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

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 #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

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 #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: I Don't Know

**********

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 #1: Yes

Reviewer #2: Yes

**********

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 #1: Yes

Reviewer #2: Yes

**********

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 #1: I recommend acceptance because the authors have addressed my comments.I recommend acceptance because the authors have addressed my comments. I recommend acceptance.

Reviewer #2: The study provides significant insights into the experiences of COVID-19 outpatients and contributes valuable information on an important public health topic. Given the satisfactory revisions and the importance of the subject matter, I recommend that the manuscript be accepted for publication in PLOS ONE. Additionally look for the references style and other things to rule out any errors that are not in the preview of journal’s guidelines.

**********

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 #1: Yes:  Lawrence Sena Tuglo

Reviewer #2: Yes:  Dr. Puneet Kumar Singh

**********

Attachments

Attachment

Submitted filename: Acceptance letter to PONE-D-24-35333R1.docx