PONE-D-20-16713

Determinants of self-reported symptoms and testing for COVID-19 in Canada using a nationally representative survey

PLOS ONE

Dear Dr. Jha,

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.

Abstract to be structured as per PLOS ONE policy

Introduction should be more explicit, authors may wish to use pubmed https://pubmed.ncbi.nlm.nih.gov/?term=Determinants+of+self-reported+symptoms+and+testing+for+COVID-19 and other literature search platform.

There is a need to describe the outcome variables and the independent variables including plausible covariates, this will assist reader to understand the variables of interests for determinant of self-reported symptoms and testing for COVID-19.

A bit of explanation on how data was managed to de-identify and assign unique identifier.

The statement of ethics should be very clear and the waiver reference number should be provided.

Include the statement for authors contribution

Please submit your revised manuscript by 24th July. 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,

Olanrewaju Oladimeji, Ph.D., MB; BS

Academic Editor

PLOS ONE

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"PJ received funding from the Canadian Institutes of Health Research (https://cihrirsc.

gc.ca/e/193.html; grant number: FDN 154277), and AR is funded by the Angus

Reid Institute (http://angusreid.org/). The Angus Reid Institute collected the data used

in this study and reviewed the manuscript."

We note that one or more of the authors are employed by a commercial company: "deltaDNA Biosciences, Inc.,".

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8. One of the noted authors is a group or consortium "Action to Beat Coronavirus in Canada/Action pour Battre le Coronavirus (Ab-C) Study Group". In addition to naming the author group, please list the individual authors and affiliations within this group in the acknowledgments section of your manuscript. Please also indicate clearly a lead author for this group along with a contact email address.

Additional Editor Comments (if provided):

Abstract to be structured as per PLOS ONE policy

Introduction should be more explicit, authors may wish to use Pubmed https://pubmed.ncbi.nlm.nih.gov/?term=Determinants+of+self-reported+symptoms+and+testing+for+COVID-19 and other literature search platform.

There is a need to describe the outcome variables and the independent variables including plausible covariates, this will assist reader to understand the variables of interests for determinant of self-reported symptoms and testing for COVID-19.

A bit of explanation on how data was managed to de-identify and assign unique identifier.

The statement of ethics should be very clear and the waiver reference number should be provided.

Include the statement for authors contribution

[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: Yes

Reviewer #2: Yes

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

Reviewer #1: I Don't Know

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

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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: 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: REVIEWER COMMENT

The authors have presented a self-reported symptom and testing sampling of COVID-19 in Canada. Though a survey polling of this nature could come with some anecdotal exaggerations and biases, the study shows that the polling represents to a greater extent the Canadian census demographics.

MINOR COMMENTS

- The authors reported lower self-reported symptoms amongst the older age group, which they justified by the fact of differential presentation with dizziness and confusion, unlike the major listed symptoms for COVID.

- In addition, the authors reported “living in Quebec” (See line 133) as a determinant of “being tested”. It should be noted that Quebec has been the hardest hit province and this presupposes that the testing rates ought to be higher. If the authors want to make the assertion that “living in Quebec” is a determinant of “being tested”, they should try and run a regression with the testing rates and the number of reported COVID positive cases across the provinces when this data was collected. Otherwise, the authors may decide not to include that as a determinant.

Overall, the presentation and the flow are generally good for the readers to understand.

Reviewer #2: Title:

1.The author may consider revising the title to predictors of self-reported symptoms and testing for COVID 19 in Canada using a nationally representative survey. In view of the depth of the statistical analysis done.

Abstract:

1.The authors should consider including a sentence or two on COVID 19 as the opening narration of the abstract. This will bring to context the essence of the study.

Introduction:

1. The introduction will benefit from additional information on the subject matter (COVID 19) and not just the expression of what the study was all about.

Materials and Methods:

1.The authors should consider defining what constitutes the outcome variable (COVID 19) symptoms (present or absent) properly in the methodology as it was done in the abstract (COVID symptoms, defined as fever plus difficulty breathing/shortness of breath, dry cough so severe that it disrupts sleep, and/or loss of sense of smell). The abstract is expected to represent an excerpt of the content of the manuscript.

2.This manuscript will benefit from the details of how the survey weights was applied to the prevalence. Though a reference was provided but the cited document does not provide the needed clarity.

3.More information has to be provided by the authors on why IRB was not required for the study of this magnitude. It is also unclear what the statement "as per Unity Health Toronto Research Ethics Board" means. Was the ethics approval waived by unity Toronto Research Board? if so, reasons for such waiver have to be provided.

Results:

1. The information on the representativeness of the respondents by comparing the demographic characteristics with the Canadian population of 2019 will be more appropriate in the method as a standardization measure built into the study rather than having it in the results section.

2.Table 1; it is unclear what gender constitutes others in the absence of an appropriate footnote.

3. The authors should consider expunging the information on part of lines 133 to 115" Results using a narrower definition of COVID symptoms, namely having fever, difficulty breathing/shortness of breath, and severe dry cough were similar (data not shown) " as it is not adding any credence to the study.

4.Table 2; the authors may consider revising the expression used for categorizing the outcome variable (COVID symptoms) from positive/negative to present or absent. This revision may bring clarity to the fact that these symptoms were not tested for but rather self reported.

Discussion:

1.The discussion will be benefit from some revision by bringing in other similar available studies though it is a common knowledge that there is a paucity of such studies. Efforts should be made to get some of those studies available so as to enrich the discussion

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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: Stanley Meribe

Reviewer #2: Yes: Tolulope Olumide Afolaranmi

[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.

PONE-D-20-16713R1

Predictors of self-reported symptoms and testing for COVID-19 in Canada using a nationally representative survey

PLOS ONE

Dear Dr. Jha,

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.

Reviewer 2 still has some minor clarification issues that should not be difficult to address.

Please submit your revised manuscript by Nov 05 2020 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: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

We look forward to receiving your revised manuscript.

Kind regards,

Gabriel A. Picone

Academic Editor

PLOS ONE

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

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: Yes

**********

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 do not have any further comments to the Authors. My earlier comments have been responded to and clarified.

Reviewer #2: The authors have painstakingly revised the manuscript in line with the review comments. However, the following revision will be required in order to make the manuscript publication worthy.

1. It is still unclear how the weighting of the sample size was done. This will require the authors to provide more details so as to bring clarity to it.

2. It is important for the authors to provide information on the source of the data collection instrument; was it adopted, adapted or developed for this study? Also, the method(s) of validating or assessing the reliability of the tool may be required. The statement on line 79 is unclear, which sampling frame were the authors referring to? The pretesting should not have been done among the same subjects who participated in the survey because it would have pre-empted them "The survey instrument was pre-tested in 60 individuals within the sampling frame."

3. It will also be good if the authors provide some sentence on the measures of used e.g. crude and adjusted odds ratio and the 95% confidence interval and rationale for using them in the data analysis section.

4. There is the need to provide footnotes for other ethnicity in tables 2 and 3.

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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 #1: Yes: Stanley Meribe, MD, PhD

Reviewer #2: Yes: Tolulope Olumide Afolaranmi

[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: Review comments for PLoS One manuscript.docx

Predictors of self-reported symptoms and testing for COVID-19 in Canada using a nationally representative survey

PONE-D-20-16713R2

Dear Dr. Jha,

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 for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, 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,

Gabriel A. Picone

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 #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 #2: Yes

**********

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

Reviewer #2: Yes

**********

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: 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 #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 #2: The authors have revised the manuscript in line with all the review comments. I am positive that this manuscript is publication worthy and will be of interest to readers in the scientific community.

**********

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: Yes: Tolulope Olumide Afolaranmi