Peer Review History

Original SubmissionAugust 19, 2021
Decision Letter - Cristian Apetrei, Editor
Transfer Alert

This paper was transferred from another journal. As a result, its full editorial history (including decision letters, peer reviews and author responses) may not be present.

PONE-D-21-25144Potential SARS-CoV-2 infectiousness among asymptomatic healthcare workersPLOS ONE

Dear Dr. Pimenoff,

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Cristian Apetrei, MD, PhD

Academic Editor

PLOS ONE

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"This work was supported by the Karolinska University Hospital (KUH); the County Council of Stockholm; Erling-Persson family foundation; KTH Royal Institute of Technology; Creades and SciLifeLab. There were no roles for the funders in design or execution of the study, in analysis and interpretation of data or in the decision to submit for publication"

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"This work was supported by the Karolinska University Hospital (KUH); the County Council of Stockholm; Erling-Persson family foundation; KTH Royal Institute of Technology; Creades and SciLifeLab. There were no roles for the funders in design or execution of the study, in analysis and interpretation of data or in the decision to submit for publication."

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Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. 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 If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.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?

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: No

Reviewer #2: Yes

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

Reviewer #1: No

Reviewer #2: I Don't Know

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

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Reviewer #1: No

Reviewer #2: Yes

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

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Reviewer #1: Yes

Reviewer #2: 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: The primary objective of a secondary study was to quantify the proportion of healthcare workers who were potentially infectious. Their sick leave was classified as post-symptomatic or pre-symptomatic, and virus-positive subjects with no sick leave were considered asymptomatic. About 0.2% of he HCW at work were potentially infectious and pre-symptomatic (later had disease) and 0.17% were potentially infectious and asymptomatic (never took sick leave). In summary, 33% and 28% of all the 57 potentially infectious subjects were pre-symptomatic or asymptomatic, respectively.

Major revisions:

Include a statistical analysis section which lists and describes all the statistical methods used to analysis the data; cite the statistical software used.

Minor revisions:

1- Abstract: Replace “neither” with “either.”

2- Provide the percentage that corresponds to 16/57.

3- Table 2: Provide corresponding percentages for categorical factors. For instance, for sex provide the percentage corresponding to 44/(44+13) Female & 13/(44+13) Male, and 7488/(7488+1961) Female & 1961/(7488+1961) Male.

4- To assist in the review process, please add page and line numbers to the document.

Reviewer #2: This study identified the proportion of potentially infectious, nonsymptomatic HCWs which are either pre-symptomatic, asymptomatic or post-symptomatic. This topic is highlighted by WHO which mention the importance of this decisive factor on the spread of the pandemic.

The authors tested an impressive number of HCWs from Karolinska University hospital, using methods described in detail in references 7 and 8: serology and RT PCR. Previously published studies (references 6, 9 and 10) by the same team of researchers, support the authors' interest in the real-time pandemic situation in Stockholm.

The results of this study that the younger HCWs are potentially more infectious, based on real laboratory data, and the conclusion that they should get vaccinated, could be used like a model for other EU countries, to motivate their HCWs and general population to vaccinate themselves.

**********

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Reviewer #1: No

Reviewer #2: No

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Revision 1

Following the Editors request and guidelines we have addressed the four points below, followed by our response to the reviewers comments.

1. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide.

Response: The anonymized individual-level HCWs COVID-19 results (RT-PCR and serology) data (N=9449) with clinical features used in this study are deposited into b2share (https://b2share.eudat.eu/). The separate clinical dataset of 3981 HCWs who completed serology testing and a questionnaire about symptoms is only available in aggregated age-group format but made also available in the b2share portal. We will make the data files publicly available as soon as the paper is accepted for publication.

2. Your ethics statement should only appear in the Methods section of your manuscript. If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript.

Response: Modified accordingly

3. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. 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.

Response: Revised and corrected one in press – article with the up-to-date citation information.

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

Reviewer #1: No

Reviewer #2: Yes

Response: Please, see our response to the Q1 above.

Please, see below our on-by-one responses to the reviewers comments:

Reviewer #1:

The primary objective of a secondary study was to quantify the proportion of healthcare workers who were potentially infectious. Their sick leave was classified as post-symptomatic or pre-symptomatic, and virus-positive subjects with no sick leave were considered asymptomatic. About 0.2% of he HCW at work were potentially infectious and pre-symptomatic (later had disease) and 0.17% were potentially infectious and asymptomatic (never took sick leave). In summary, 33% and 28% of all the 57 potentially infectious subjects were pre-symptomatic or asymptomatic, respectively.

Major revisions:

1. Include a statistical analysis section which lists and describes all the statistical methods used to analysis the data; cite the statistical software used.

Response: Statistical analysis paragraph was included into the methods section. Line 100.

Minor revisions:

2. Abstract: Replace “neither” with “either.”

Response: Modified accordingly. Line 31.

3. Provide the percentage that corresponds to 16/57.

Response: Modified accordingly. Line 109.

4. Table 2: Provide corresponding percentages for categorical factors. For instance, for sex provide the percentage corresponding to 44/(44+13) Female & 13/(44+13) Male, and 7488/(7488+1961) Female & 1961/(7488+1961) Male.

Response: Modified accordingly. Table 2.

5. To assist in the review process, please add page and line numbers to the document.

Response: Added accordingly.

Reviewer #2:

This study identified the proportion of potentially infectious, nonsymptomatic HCWs which are either pre-symptomatic, asymptomatic or post-symptomatic. This topic is highlighted by WHO which mention the importance of this decisive factor on the spread of the pandemic. The authors tested an impressive number of HCWs from Karolinska University hospital, using methods described in detail in references 7 and 8: serology and RT PCR. Previously published studies (references 6, 9 and 10) by the same team of researchers, support the authors' interest in the real-time pandemic situation in Stockholm. The results of this study that the younger HCWs are potentially more infectious, based on real laboratory data, and the conclusion that they should get vaccinated, could be used like a model for other EU countries, to motivate their HCWs and general population to vaccinate themselves.

Response: We thank the reviewer for this important comment. We also believe that these results should motivate intervention policies for vaccinating the healthcare personnel at all ages in a systematic fashion.

Attachments
Attachment
Submitted filename: Response to Reviewers.docx
Decision Letter - Cristian Apetrei, Editor

Potential SARS-CoV-2 infectiousness among asymptomatic healthcare workers

PONE-D-21-25144R1

Dear Dr. Pimenoff,

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,

Cristian Apetrei, MD, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Formally Accepted
Acceptance Letter - Cristian Apetrei, Editor

PONE-D-21-25144R1

Potential SARS-CoV-2 infectiousness among asymptomatic healthcare workers

Dear Dr. Pimenoff:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

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.

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Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Cristian Apetrei

Academic Editor

PLOS ONE

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