Associations between COVID-19 infection, symptom severity, perceived susceptibility, and long-term adherence to protective behaviors: The Los Angeles pandemic surveillance cohort study

Chun Nok Lam; Nikhilesh Kumar; Shirin Emma Herzig; Jennifer B. Unger; Neeraj Sood

doi:10.1371/journal.pone.0326097

Peer Review History

Original SubmissionNovember 15, 2024
15 Nov 2024 Author Response https://doi.org/10.1371/journal.pone.0326097.r001
Decision Letter - Yury Khudyakov, Editor Dear Dr. Lam, 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. ============================== Your manuscript was reviewed by two experts in the field. Both identified some problems in your submission which require your attention. Please review the attached comments and provide point-by-point responses. ============================== Please submit your revised manuscript by May 05 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 . 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Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [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? Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: I Don't Know ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: The study present a very important aspect of pandemic management. Please: 1- Reflect on the rational of the study. 2- Detail the impact of this study on macro and micro levels 3- Link findings of this study with the ongoing WHO activities to prepare for fighting pandemic X 4- Expand the discussion section. Reviewer #2: Interesting paper The participants are almost all vaccinated. it would be interesting to see what the pattern is in unvaccinated participants. Similarly, subgroup analysis by territory/areas worst hit by COVID vs those less affected will make the paper better ****** 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? 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If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org https://doi.org/10.1371/journal.pone.0326097.r002
Revision 1
15 May 2025 Author Response Reviewer #1: Reflect on the rational of the study. Response: Thank you for this suggestion. We have added a sentence in the introduction to be exact about the exact rationale and purpose for our study: “Our study aims to better understand the drivers of long-term protective behavior use after people recover from COVID-19 infection. As COVID-19 has become endemic, our research will provide key insights into protective behavior use and guide public health strategies for both COVID-19 and future communicable disease outbreaks.” We have also added context to the conclusion summarizing why we conducted this study, which is outlined in our response to the second reviewer’s suggestion. Detail the impact of this study on macro and micro levels. Response: Thank you for pointing out an area where we can add valuable context to our study. We detail the impact of the study on macro levels by outlining how our study can inform policy to curb future pandemics. Please see: “Our findings contain key implications for public health responses to future pandemics. Differences in protective behavior adherence by demographic characteristics (e.g., lower adherence in men and younger people) underscores the need for tailored messaging to specific demographic groups to promote adherence. Funding may also be allocated to higher-risk areas and populations. Messaging may also need to target perceived susceptibility as a driver of lower protective behavior use – highlighting the long-term risks of infection, for example – may heighten perceived susceptibility and sustain protective behavior use after infection. Initiatives like the WHO’s Preparedness and Resilience for Emerging Threats (PRET), which aims to build international collaboration to prepare for future pandemics, may consider integrating specific regional data on protective behavior adherence to better tailor interventions.” The impacts of our study on micro levels have also been added throughout. For one, we added analysis throughout the paper examining the impacts of living in high-mortality areas with adherence to protective behaviors, showing how individual behavior changes based on environment. Additionally, we add reference to studies linking individual beliefs to protective behavior use, including a study that found that belief in misinformation around the pandemic was a negative predictor of protective behavior use and vaccination. We explain in the discussion how our results provide insight into the way identity and personal characteristics can be linked to protective behavior use and can inform how interventions to increase protective behavior are designed and targeted. Link findings of this study with the ongoing WHO activities to prepare for fighting pandemic X Response: As outlined in our response to the last suggestion, we link our discussion of future policy to the WHO Preparedness and Resilience for Emerging Threads (PRET) program which is in use to prepare for future pandemics. Expand the discussion section. Response: Please see the prior responses to see how we have expanded the discussion. Reviewer #2: The participants are almost all vaccinated. it would be interesting to see what the pattern is in unvaccinated participants. Response: Results from bivariate analyses show that participants who were not vaccinated were more likely to report always practicing physical distancing (21%) than other vaccination groups (13%). They were also more likely to always wear masks (24%) compared the 1 vaccine group and the 1 booster group (10%). However, when controlling for other covariates, especially the baseline protective behavior level, the difference on protective behaviors at follow-up by vaccination status was no longer significant (Table 3). Similarly, subgroup analysis by territory/areas worst hit by COVID vs those less affected will make the paper better. Response: Thank you for the great suggestion. We adopted the approach used in Lam et al. (2024) to include regional assessment on COVID-19’s impact on the community based on death rates during the first year of the pandemic. We included the newly added variable, COVID-19 mortality impacted area, as a covariate in the regression models, as well as in a subgroup analysis analyzing the association between mask wearing and COVID-19 test positivity. Multiple changes have been made to the methods, results and discussion sections. We found that participants who lived in areas that were hit hardest by COVID-19 mortality were more likely to practice social distancing and wear masks. In the subgroup analysis, now shown in Figure 3, the more frequent use of masks in the hardest hit area was among those who had never tested positive for COVID-19. This finding supports the adoption of protective behavior based on one’s perceived immunity and perceived susceptibility of COVID-19 based on positivity status and surrounding environment. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0326097.r003
Decision Letter - Yury Khudyakov, Editor Associations between COVID-19 Infection, Symptom Severity, Perceived Susceptibility, and Long-Term Adherence to Protective Behaviors: The Los Angeles Pandemic Surveillance Cohort Study PONE-D-24-51022R1 Dear Dr. Lam, 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, Yury E Khudyakov, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0326097.r004
Formally Accepted
Acceptance Letter - Yury Khudyakov, Editor PONE-D-24-51022R1 PLOS ONE Dear Dr. Lam, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Yury E Khudyakov Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0326097.r005

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