Incidence of COVID-19 reinfection among Midwestern healthcare employees

Anne Rivelli; Veronica Fitzpatrick; Christopher Blair; Kenneth Copeland; Jon Richards

doi:10.1371/journal.pone.0262164

Peer Review History

Original SubmissionAugust 19, 2021
8 Sep 2021 Decision Letter - Alessandro de Sire, Editor PONE-D-21-26814Incidence of COVID-19 reinfection among Midwestern healthcare employeesPLOS ONE Dear Dr. Rivelli, 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 Oct 23 2021 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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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 ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes 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: Dear Authors, The manuscript is very interesting especially considering the hot topic in this specific historical moment. Moreover, the results are intriguing given the high number of subjects assessed. However, several critical issues should be addressed to improve the paper. My major concern is that many factors that potentially might affect reinfection/recurrence of COVID 19 (such as pharmacological treatment of first-time infection, post-disease rehabilitation/interventions) have not been assessed. Therefore, the study results might be significantly affected by these confounders. Concurrently, patients excluded by the study analysis should be clarified in the Results section, characterizing at least the main cause of exclusions. Furthermore, the Limitations subsection should underline that the specific population considered (the health care workers) severely limits the generalizability of the study results. Lastly, the manuscript should be improved following the “ Submission Guidelines” of the Journal. Major revisions INTRODUCTION. This Section should be largely improved, underlining the health system burden due to medical care and disabling sequelae, mentioning the role of post-COVID therapies/behavioral modifications in the lifestyle change and risk of recurrence. According to this, you should cite the following references: • Curci C et al. Functional outcome after inpatient rehabilitation in post intensive care unit COVID-19 patients: findings and clinical implications from a real-practice retrospective study. Eur J Phys Rehabil Med. 2021;57(3):443-450. doi:10.23736/S1973-9087.20.06660-5 • Iddir M et al. Strengthening the Immune System and Reducing Inflammation and Oxidative Stress through Diet and Nutrition: Considerations during the COVID-19 Crisis. Nutrients. 2020;12(6):1562. Published 2020 May 27. doi:10.3390/nu12061562 • Ferraro F et al. COVID-19 related fatigue: Which role for rehabilitation in post-COVID-19 patients? A case series. J Med Virol. 2021;93(4):1896-1899. doi:10.1002/jmv.26717 • Andrenelli E et al. Systematic rapid living review on rehabilitation needs due to COVID-19: update to May 31st, 2020. Eur J Phys Rehabil Med. 2020;56(4):508-514. doi:10.23736/S1973-9087.20.06435-7 Moreover, anecdotical data should be avoided, while each sentence should be followed by a reference. METHODS. Please data and numbers should be presented in the Results section rather than the Methods Section. Moreover, the examples of single cases enrolled in the study should be avoided. Please, refer to other studies to better clarify the study methods. RESULTS. Patients excluded by the study analysis should be clarified in the results section, characterizing at least the main cause of exclusions. Moreover, the number of patients excluded should be discussed in the discussion section, better characterizing the risk of BIAS due to the enrollment methods. RESULTS. Data about the viral load might provide useful information to compare first-time infections and recurrences. Please improve the limitation section accordingly if you could not provide these data. CONCLUSION. This section should follow the “Discussion” Section according to the “Submission Guidelines” of the Journal. DISCUSSION. Differences between female and male groups should be discussed in this section, providing some explanation to this interesting data. DISCUSSION. Limitations. Page 13. The Limitation subsection should underline that the specific population considered (the health care workers) severely limits the generalizability of the study results. DISCUSSION. Limitations. Page 13. The Limitation subsection should be improved highlighting that lack of data about pharmacological treatment/medical care of first-time infection might potentially affect the reinfection/recurrence. Minor revisions WHOLE TEXT. You should format your work according to the “Submission Guidelines” of the Journal. Therefore, you should include page numbers and line numbers in the manuscript file. Furthermore, the reference number in the text must be cited in square brackets. WHOLE TEST. Please use the bold type, 18pt font for the Titles of the sections, following the Submission Guidelines” of the Journal. ABSTRACT. You should improve this section following the “Submission Guidelines” of the Journal, Moreover, this section should not exceed 300 words. METHODS. This section should be named “Material and Methods” accordingly with “Submission Guidelines” of the Journal Reviewer #2: The article is of scientific interest and in line with the aims of the journal. The authors guidelines have been respected and the article does not require a revision of the English language. There are minor concerns to be addressed. ABSTRACT It is well structured. KEYWORDS In order to increase the visibility of the article, do not use keywords already present in the title. INTRODUCTION The introduction fully discusses the topics covered. The purpose of the study is well specified. MATERIALS AND METHODS I suggest to give information about the number of subjects included just into the results section and not also in the methods. Considering the current pandemic and its global duration, your choice of a convenience sample appears to be methodologically correct. Nevertheless, it could be useful to better clarify how the recruitment was conducted. Was it necessary to express informed consent and therefore choose whether to join the study or not? If yes, do You think there may be a significant number of healthcare workers who did not want to join the study despite having an already properly registered first infection? RESULTS AND CONCLUSIONS They are adequate. DISCUSSION A strength of this research seems to be overshadowed. It examines the incidence of COVID-19 reinfection and recurrence in a population of healthcare workers: what useful implications can be derived from it for the purpose of protecting these workers, especially from a psychological point of view, given their awareness of the risk of infection and reinfection? I suggest You to deep these aspects in the implications-section of the discussion using the following reference: Farì G, de Sire A, Giorgio V, Rizzo L, Bruni A, Bianchi FP, Zonno A, Pierucci P, Ranieri M, Megna M. Impact of COVID-19 on the mental health in a cohort of Italian rehabilitation healthcare workers. J Med Virol. 2021 Aug 13. doi: 10.1002/jmv.27272. Epub ahead of print. PMID: 34387886. TABLES The tables are clear and adequately complement the text. ****** 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:** Lorenzo Lippi 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. https://doi.org/10.1371/journal.pone.0262164.r001
Revision 1
2 Nov 2021 Author Response REVIEWER 1 The manuscript is very interesting especially considering the hot topic in this specific historical moment. Moreover, the results are intriguing given the high number of subjects assessed. However, several critical issues should be addressed to improve the paper. My major concern is that many factors that potentially might affect reinfection/recurrence of COVID 19 (such as pharmacological treatment of first-time infection, post-disease rehabilitation/interventions) have not been assessed. Therefore, the study results might be significantly affected by these confounders. Concurrently, patients excluded by the study analysis should be clarified in the Results section, characterizing at least the main cause of exclusions. Furthermore, the Limitations subsection should underline that the specific population considered (the health care workers) severely limits the generalizability of the study results. Lastly, the manuscript should be improved following the “ Submission Guidelines” of the Journal. Thank you for this comment, this is an epidemiological look at the incidence of reinfection with no information on symptoms or treatments. We understand this is a limitation and it has been addressed in the limitations section. Patients were not “excluded” from this study for any reason other than they did not meet the criteria of having more than one positive covid test. We do not feel that this being a healthcare system setting is a limitation given that the original sample included remote employees. The fact that the clinical workers had higher exposure to COVID and did experience reinfection at higher rates is one of the primary findings. However, I have added a sentence about this limitation to make it more explicit. Updated submission via guidelines INTRODUCTION. This Section should be largely improved, underlining the health system burden due to medical care and disabling sequelae, mentioning the role of post-COVID therapies/behavioral modifications in the lifestyle change and risk of recurrence. According to this, you should cite the following references: • Curci C et al. Functional outcome after inpatient rehabilitation in post intensive care unit COVID-19 patients: findings and clinical implications from a real-practice retrospective study. Eur J Phys Rehabil Med. 2021;57(3):443-450. doi:10.23736/S1973-9087.20.06660-5 • Iddir M et al. Strengthening the Immune System and Reducing Inflammation and Oxidative Stress through Diet and Nutrition: Considerations during the COVID-19 Crisis. Nutrients. 2020;12(6):1562. Published 2020 May 27. doi:10.3390/nu12061562 • Ferraro F et al. COVID-19 related fatigue: Which role for rehabilitation in post-COVID-19 patients? A case series. J Med Virol. 2021;93(4):1896-1899. doi:10.1002/jmv.26717 • Andrenelli E et al. Systematic rapid living review on rehabilitation needs due to COVID-19: update to May 31st, 2020. Eur J Phys Rehabil Med. 2020;56(4):508-514. doi:10.23736/S1973-9087.20.06435-7 Moreover, anecdotical data should be avoided, while each sentence should be followed by a reference. Thank you for this suggestion. As stated above this is an epidemiological look at reinfection and not a paper on the burden of covid. Although the burden is very high, this paper is assessing frequent exposure with the odds of experiencing reinfection in a health system where people are likely to get tested for job related reasons and because of the convenience of testing. Anecdotal data is not being used, it’s making the case for the importance of assessing reinfection. The manuscript was double checked and all declarative statements have a citation. METHODS. Please data and numbers should be presented in the Results section rather than the Methods Section. Moreover, the examples of single cases enrolled in the study should be avoided. Please, refer to other studies to better clarify the study methods. There are no results presented in the methods section. There is an example given to help clarify the operational definitions of recurrence and reinfection. RESULTS. Patients excluded by the study analysis should be clarified in the results section, characterizing at least the main cause of exclusions. Moreover, the number of patients excluded should be discussed in the discussion section, better characterizing the risk of BIAS due to the enrollment methods. CONCLUSION. This section should follow the “Discussion” Section according to the “Submission Guidelines” of the Journal. UPDATED DISCUSSION. Differences between female and male groups should be discussed in this section, providing some explanation to this interesting data. There was no statistical difference between males and females in whether they were more likely to experience recurrence or reinfection. The huge difference in percentage is due to the fact that women are much, much more likely to be in clinical roles in a healthcare setting – typically as nurses or medical assistants. DISCUSSION. Limitations. Page 13. The Limitation subsection should underline that the specific population considered (the health care workers) severely limits the generalizability of the study results. Added; lines: 257-259 DISCUSSION. Limitations. Page 13. The Limitation subsection should be improved highlighting that lack of data about pharmacological treatment/medical care of first-time infection might potentially affect the reinfection/recurrence. Lines 253-256 WHOLE TEXT. You should format your work according to the “Submission Guidelines” of the Journal. Therefore, you should include page numbers and line numbers in the manuscript file. Furthermore, the reference number in the text must be cited in square brackets. Updated - citations are in parentheses, as per guidelines WHOLE TEST. Please use the bold type, 18pt font for the Titles of the sections, following the Submission Guidelines” of the Journal. Updated ABSTRACT. You should improve this section following the “Submission Guidelines” of the Journal, Moreover, this section should not exceed 300 words. Updated METHODS. This section should be named “Material and Methods” accordingly with “Submission Guidelines” of the Journal Updated REVIEWER 2 The article is of scientific interest and in line with the aims of the journal. The authors guidelines have been respected and the article does not require a revision of the English language. ABSTRACT: It is well structured. NO CHANGES KEYWORDS: In order to increase the visibility of the article, do not use keywords already present in the title. WILL UPDATE IN ONLINE PORTAL INTRODUCTION: The introduction fully discusses the topics covered. The purpose of the study is well specified. NO CHANGES MATERIALS AND METHODS: I suggest to give information about the number of subjects included just into the results section and not also in the methods. Number of subjects is in results and discussion section under ‘Covid-19 Reinfection’ header; lines: 180-182 Considering the current pandemic and its global duration, your choice of a convenience sample appears to be methodologically correct. Nevertheless, it could be useful to better clarify how the recruitment was conducted. Was it necessary to express informed consent and therefore choose whether to join the study or not? If yes, do You think there may be a significant number of healthcare workers who did not want to join the study despite having an already properly registered first infection? Recruitment is addressed in Procedures; lines: 126-130 An alteration of consent was attached to the email and this is explained in Procedures; lines: 127-130 RESULTS AND CONCLUSIONS: They are adequate. NO CHANGES DISCUSSION A strength of this research seems to be overshadowed. It examines the incidence of COVID-19 reinfection and recurrence in a population of healthcare workers: what useful implications can be derived from it for the purpose of protecting these workers, especially from a psychological point of view, given their awareness of the risk of infection and reinfection? I suggest You to deep these aspects in the implications-section of the discussion using the following reference: Farì G, de Sire A, Giorgio V, Rizzo L, Bruni A, Bianchi FP, Zonno A, Pierucci P, Ranieri M, Megna M. Impact of COVID-19 on the mental health in a cohort of Italian rehabilitation healthcare workers. J Med Virol. 2021 Aug 13. doi: 10.1002/jmv.27272. Epub ahead of print. PMID: 34387886. ADDED; Lines: 259-261 TABLES The tables are clear and adequately complement the text. NO CHANGES https://doi.org/10.1371/journal.pone.0262164.r002
29 Nov 2021 Decision Letter - Alessandro de Sire, Editor PONE-D-21-26814R1Incidence of COVID-19 reinfection among Midwestern healthcare employeesPLOS ONE Dear Dr. Rivelli, 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. ============================== Dear Authors, the paper could be considered suitable for publication after minor revisions. Best regards ============================== Please submit your revised manuscript by Jan 13 2022 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, Alessandro de Sire, M.D. Academic Editor PLOS ONE Journal Requirements: 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. 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: (No Response) 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: No 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: Dear Authors, The manuscript is very interesting especially considering the hot topic in this specific historical moment. Moreover, the results are intriguing given the high number of subjects assessed. You have significantly improved the manuscript; however, a few issues should be addressed. Major revisions INTRODUCTION: I understand the Author's point of view. However, I abide by my previous comment. The introduction should highlight the needing for evidence in this topic in this specific historical moment. Therefore, it should be highlighted the health system burden due to medical care and disabling sequelae, mentioning the role of post-COVID therapies/behavioral modifications in the lifestyle change and risk of recurrence. According to this, you should cite the following references: • Curci C et al. Functional outcome after inpatient rehabilitation in post intensive care unit COVID-19 patients: findings and clinical implications from a real-practice retrospective study. Eur J Phys Rehabil Med. 2021;57(3):443-450. doi:10.23736/S1973-9087.20.06660-5 • Iddir M et al. Strengthening the Immune System and Reducing Inflammation and Oxidative Stress through Diet and Nutrition: Considerations during the COVID-19 Crisis. Nutrients. 2020;12(6):1562. Published 2020 May 27. doi:10.3390/nu12061562 • Ferraro F et al. COVID-19 related fatigue: Which role for rehabilitation in post-COVID-19 patients? A case series. J Med Virol. 2021;93(4):1896-1899. doi:10.1002/jmv.26717 • Andrenelli E et al. Systematic rapid living review on rehabilitation needs due to COVID-19: update to May 31st, 2020. Eur J Phys Rehabil Med. 2020;56(4):508-514. doi:10.23736/S1973-9087.20.06435-7 METHODS. The number of patients enrolled in a prospective study represents a study result. Please present these data in the Results section rather than the Methods Section. DISCUSSION. Please discuss the huge difference in percentage between females and males probably because women are much, much more likely to be in clinical roles in a healthcare setting – typically as nurses or medical assistants. RESULTS AND DISCUSSION. This section should be divided into two different sections. The manuscript form is not suitable for the journal without the suggested improvements. Reviewer #2: The final version of the paper seems well structured. All the required corrections have been done. In my opinion, the study is now acceptable for publication. ****** 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: No 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. https://doi.org/10.1371/journal.pone.0262164.r003
Revision 2
13 Dec 2021 Author Response Below are the points raised and subsequently addressed: INTRODUCTION: I understand the Author's point of view. However, I abide by my previous comment. The introduction should highlight the needing for evidence in this topic in this specific historical moment. Therefore, it should be highlighted the health system burden due to medical care and disabling sequelae, mentioning the role of post-COVID therapies/behavioral modifications in the lifestyle change and risk of recurrence. According to this, you should cite the following references: • Curci C et al. Functional outcome after inpatient rehabilitation in post intensive care unit COVID-19 patients: findings and clinical implications from a real-practice retrospective study. Eur J Phys Rehabil Med. 2021;57(3):443-450. doi:10.23736/S1973-9087.20.06660-5 • Iddir M et al. Strengthening the Immune System and Reducing Inflammation and Oxidative Stress through Diet and Nutrition: Considerations during the COVID-19 Crisis. Nutrients. 2020;12(6):1562. Published 2020 May 27. doi:10.3390/nu12061562 • Ferraro F et al. COVID-19 related fatigue: Which role for rehabilitation in post-COVID-19 patients? A case series. J Med Virol. 2021;93(4):1896-1899. doi:10.1002/jmv.26717 • Andrenelli E et al. Systematic rapid living review on rehabilitation needs due to COVID-19: update to May 31st, 2020. Eur J Phys Rehabil Med. 2020;56(4):508-514. doi:10.23736/S1973-9087.20.06435-7 RESPONSE: Thank you for this suggestion. As stated earlier, this study is strictly an epidemiological look at reinfection with no information on symptoms, treatments or interventions. This is not a paper on the burden of COVID nor do we have any data to support the role of therapies or modifications in the prevention of recurrence. However, we added your resources and the need for research on the relationship between lifestyle changes, like behavioral modifications and post-COVID therapies, and risk of recurrence in the Discussion section. METHODS. The number of patients enrolled in a prospective study represents a study result. Please present these data in the Results section rather than the Methods Section. RESPONSE: The only section of the Methods that describes number of patients is in the “Participants” sub-section in order to provide context, as this study’s sample was drawn from a larger prospective study. The number of patients enrolled in the larger prospective study is described in the Methods. This study’s number of patients is provided in the Results section, as you suggested and we agree that it represents a study result. DISCUSSION. Please discuss the huge difference in percentage between females and males probably because women are much, much more likely to be in clinical roles in a healthcare setting – typically as nurses or medical assistants. RESPONSE: Thank you for this suggestion. The Discussion section has been updated to reflect this. RESULTS AND DISCUSSION. This section should be divided into two different sections. The manuscript form is not suitable for the journal without the suggested improvements. RESPONSE: The Discussion section is, indeed, a separate sub-section, just nested within the Results and Discussion heading, per PLOS ONE’s style requirements as provided to us in this link in a prior round of reviews: https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf Attachments Attachment Submitted filename: Resonse to Reviewers 12.16.2021.docx https://doi.org/10.1371/journal.pone.0262164.r004
19 Dec 2021 Decision Letter - Alessandro de Sire, Editor Incidence of COVID-19 reinfection among Midwestern healthcare employees PONE-D-21-26814R2 Dear Dr. Rivelli, 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, Alessandro de Sire, M.D. Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0262164.r005
Formally Accepted
23 Dec 2021 Acceptance Letter - Alessandro de Sire, Editor PONE-D-21-26814R2 Incidence of COVID-19 reinfection among Midwestern healthcare employees Dear Dr. Rivelli: 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. If we can help with anything else, please email us at plosone@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 Prof. Alessandro de Sire Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0262164.r006

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