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

Abstract

Background During the COVID-19 pandemic, protective behaviors like mask wearing or social distancing were encouraged to limit viral spread. While pandemic fatigue is tied to the reduction of protective behaviors over time, little evidence exists examining predictors of long-term protective behaviors after recovering from COVID-19. Purpose This study investigates the association between COVID-19 infection status and future use of protective behaviors. Methods We analyzed data from 676 adults who completed questionnaires in May 2021 and January 2023 as part of the Los Angeles Pandemic Surveillance Cohort Study. Measures included self-reported COVID-19 infection status and symptom severity, and mask wearing, hand washing, social distancing and perceived susceptibility to COVID-19. We performed Wilcoxon signed-rank tests, ordinal logit regression models, and mediation analysis to assess behavior change, associations, and whether perceived susceptibility mediated the effects. Results The use of protective behaviors declined significantly from baseline to follow-up. Self- reported asymptomatic or mild COVID-19 infection was associated with less social distancing (aOR=0.57, 95% CI [0.35, 0.92]), less mask wearing (aOR=0.63, 95% CI [0.40, 0.99]), and lower perceived susceptibility (aβ = −0.17, 95% CI [−0.33, −0.02]) at follow-up. Moderate or severe COVID-19 infection was associated with less mask wearing (aOR=0.55, 95%CI [0.38, 0.81]). Perceived susceptibility to COVID-19 mediated 15% of the effect of mild COVID-19 infection on mask wearing (indirect effect aβ = −0.16, 95% CI [−0.31, −0.02]). Conclusions These results provide novel insights into the drivers of decreased use of protective behaviors over the course of the pandemic, particularly after an asymptomatic or mild COVID-19 infection. More research is needed on the effect of COVID-19 infection on long-term adherence to preventive measures against future pandemics.