Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID- 19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. CORRESPONDENCE Appendix A. MAPAC Committee Members 9. Bishop TF, Cea M, Miranda Y, Kim R, Lash-Dardia M, Lee JI, et al. Academic physicians’ views on low-value services and the choosing wisely campaign: a qualitative study. Healthc (Amst). Ana Álvarez, Ignacio Blanco, Garbiñe Ezcurra, Magí Farré, 2017;5:17---22. Cristina Gaona, José Ángel Jiménez, Rosa Morillas, Angélica 10. Zikmund-Fisher BJ, Kullgren JT, Fagerlin A, Klamerus ML, Bern- Pocino, Laia Pratcorona, Ana Belén Rajo, Josep Roca, Carlos stein SJ, Kerr EA. Perceived barriers to implementing individual Rodrigo, Pere Tudela, Agustín Urrutia. Choosing Wisely® recommendations in two national surveys of primary care providers. J Gen Intern Med. 2017;32:210---7. References 11. Colla CH, Mainor AJ, Hargreaves C, Sequist T, Morden N. Inter- ventions aimed at reducing use of low-value health services: a systematic review. Med Care Res Rev. 2017;74:507---50. 1. García-Alegría J. El reto de no hacer. Rev Clin Esp. 12. Morgan DJ, Dhruva SS, Coon ER, Wright SM, Korenstein D. 2017;217:208---9. 2019 Update on medical overuse: a review. JAMA Intern Med. 2. Zapata JA, Lai AR, Moriates C. Is excessive resource utilization 2019;179:1568---74, doi:10.1001/jamainternmed.2019.3842. an adverse event? JAMA. 2017;317:849---50. 13. Embrett M, Randall GE. Physician perspectives on Choosing 3. García-Alegría J, Vázquez-Fernández del Pozo S, Salcedo- Wisely Canada as an approach to reduce unnecessary medical Fernández F, García-Lechuz Moya JM, Zaragoza-Gaynor care: a qualitative study. Health Res Policy Syst. 2018;16:95, GA, López-Orive M, et al. Compromiso por la calidad doi:10.1186/s12961-018-0370-5. de las sociedades científicas en España. Rev Clin Esp. 14. Berwick DM. Disseminating innovations in health care. JAMA. 2017;217:212---21. 2003;289:1969---75. 4. Rosenberg A, Agiro A, Gottlieb M, Barron J, Brady P, Liu Y, et al. 15. Varela J. Cinco recomendaciones para aumentar el valor de la Early trends among seven recommendations from the Choosing práctica clínica. Med Clin (Barc). 2021;156:187---90. Wisely Campaign. JAMA Intern Med. 2015;175:1913---20. 5. Colla CH, Mainor AJ. Choosing Wisely Campaign: valuable for providers who knew about it, but awareness remained constant, P. Tudela ∗ , G. Ezcurra, C. Gaona, A. Urrutia, on behalf of 2014-17. Health Aff (Millwood). 2017;36:2005---11. the Committee for the improvement and adaptation of 6. Zambrana-García JL, Lozano Rodríguez-Mancheño A. Actitudes clinical care practice (MAPAC)1 de los médicos hacia el problema de las pruebas y los proced- imientos innecesarios. Gac Sanit. 2016;30:485---6. Hospital Universitario Germans Trias i Pujol, Badalona, 7. Mira JJ, Carrillo I, Pérez-Pérez P, Olivera G, Silvestre C, Nebot Universidad Autònoma de Barcelona, Barcelona, Spain C, et al. Grado de conocimiento de la campaña Compromiso por ∗ Corresponding author. la Calidad y de las recomendaciones no hacer entre médicos de familia, pediatras y enfermería de Atención Primaria. An Sist E-mail address: ptudela.germanstrias@gencat.cat Sanit Navar. 2018;41:47---55. (P. Tudela). 1 8. Lin MP, Nguyen T, Probst MA, Richardson LD, Schuur JD. Emer- The members of the MAPAC Committee are listed in the gency physician knowledge, attitudes, and behavior regarding Appendix A. ACEP’s Choosing Wisely recommendations: a survey study. Acad Emerg Med. 2017;24:668---75. 2254-8874/ © 2021 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved. Healthcare professionals diagnosed Up until 29 May 2020, a total of 250,273 cases of COVID- 19 had been communicated to the National Epidemiological by COVID-19 at work: The right for it Surveillance Network, of which 40,961 (16.36%) were HPs, to be classified as an occupational these being predominantly women (76.5%).3 disease夽 This situation, as is to be expected, has had significant repercussions in the occupational health setting.4,5 It seems Profesionales sanitarios diagnosticados de clear that the contingency presented in HPs as a conse- COVID-19 en el trabajo: un derecho a la quence of illness caused by SARS-CoV-2 should be classified as an occupational disease (OD).4 Nevertheless, according calificación como enfermedad profesional to Royal Decree-Law 13/2020, of 7 April, by which certain emergency measures for agricultural work are adopted,6 in Dear Director, some cases this situation was described as an industrial acci- dent (IA), alluding to the fact that when it can be proven Around the world, Spain is the country with the most health that the disease was caught exclusively while working, there professionals (HP) affected by COVID-19.1 SARS-CoV-2 infec- exists the possibility to classify it as an IA. tion has affected many HPs who are exposed to undeniable Subsequently, in Royal Decree-Law 19/2020, of 26 May, risk in the performance of their jobs.2 additional measures were adopted in terms of agricultural, scientific, economic, labour, Social Security and tax matters to alleviate the effects of COVID-19.7 It was specified that 夽 Please cite this article: Martí Amengual G, Sanz Gallen P, Martin- IA classification would apply to all infections that occurred Fumadó C, Arimany-Manso J. Profesionales sanitarios diagnosticados until the month following the end of the state of alarm, de COVID-19 en el trabajo: un derecho a la calificación como enfer- accredited by the pertinent IA report that must be issued medad profesional. Rev Clin Esp. 2022;222:120---122. within the same period of reference. 120 Revista Clínica Española 222 (2022) 116---122 For many collectives (including union representatives), this list is neither exhaustive nor closed, but rather may classification as an OD or IA may go unnoticed with the be extended to cover other jobs. understanding that the differences are small: both are labour contingencies.8,9 However, this distinction is key and In light of all of this, we understand that all HPs infected classification as an OD is far more beneficial to the worker. by SARS-CoV-2 while at work have the right, without a doubt, Firstly, OD classification entails a requirement to carry to classification as an OD and to benefit from the advantages out inspections, both previous and periodically, to pre- of this contingency. vent disease-related risks. This is not the case with the IA designation.10 Secondly, when a worker is unable to perform her or References his professional activity, OD classification gives the worker the right to be assigned to another job, within the same 1. Trullàs JC, Vilardell I, Blasco M, Heredia J. COVID-19 en traba- company, with the same salary. This is not the case for IA jadores sanitarios del Hospital comarcal de Olot (Girona). Rev classification, where workers can even be required to accept Clin Esp. 2020;220(8):529---31, doi:10.1016/j.rce.2020.07.002. permanent disability status, a condition that amounts to 55% 2. Barbería E, Pujol-Robinat A, Arimany-Manso J. Aspectos médico- of their contributions. legales de la pandemia por COVID-19. Rev Esp Med Legal. 2020;46:89---92, doi:10.1016/j.reml.2020.05.012. Thirdly, OD classification includes the right to receive, 3. Equipo COVID-19. RENAVE. CNE. CNM (ISCIII) [Accessed where applicable, compensation for death or permanent 15 October 2020]. Available from: https://www.isciii.es/ disability of an indefinite nature, even after death. On the QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/ other hand, in the case of an IA, the temporary period for EnfermedadesTransmisibles/Documents/INFORMES/Informes said benefit is the 5 years following the accident or equiva- %20COVID-19/COVID-19%20en%20personal%20sanitario%2029 lent incident. %20de%20mayo%20de%202020.pdf. Lastly, in light of a suspected OD, there exists the option 4. Martí-Amengual G, Sanz-Gallen P, Arimany-Manso J. Val- to classify it as an OD observation period (with the same oración medicolegal de la infección por COVID-19 en coverage) for a period of 6 months, which can be extended el ámbito laboral. Rev Esp Med Legal. 2020;46:146---52, 6 more months while the case is being resolved. This option doi:10.1016/j.reml.2020.05.011. 5. Arimany-Manso J, Martin-Fumadó C. Aspectos médico-legales does not exist in the case of IAs either. derivados de la pandemia de la COVID-19. Med Clin (Barc). In addition, there are multiple reasons why SARS-CoV-2 2020;155:344---6, doi:10.1016/j.medcli.2020.06.010. infection in HPs should be classified as ODs (for employed 6. Real Decreto-ley 13/2020, de 7 de abril, por el que se adoptan workers and the self-employed, provided they pay contribu- determinadas medidas urgentes en materia de empleo agrario. tions for this reason): Boletín Oficial del Estado, núm. 98, de 8 de abril de 2020, páginas 28524---28542. a) This is an Appendix 1 pathology, according to the provi- 7. Real Decreto-Ley 19/2020, de 26 de mayo, por el que se adop- sions of Royal Decree 1299/2006, of 10 November, which tan medidas complementarias en materia agraria, científica, approved the table of ODs caused by biological agents11 , económica, de empleo y Seguridad Social y tributarias para paliar los efectos del COVID-19. Boletín Oficial del Estado, núm. which literally states that ‘‘infectious diseases caused by 150, de 27 de mayo de 2020, páginas 34486---34517. the work of persons who are employed in the prevention, 8. Martí-Amengual G, Puig Bausili L, Gómez Montoro J, Jiménez medical treatment, and activities in which a risk of infec- Jiménez AJ. Aspectos médico-legales de las incapacidades lab- tion has been proven (excluding those microorganisms orales. Med Clin (Barc). 2006;126:671---5. included in group 1 of RD 664/1997, of 12 May, regu- 9. Martin-Fumadó C, Martí Amengual G, Puig-Bausili L, lating the protection of workers against risks associated Arimany-Manso J. La incapacidad temporal y sus implica- with exposure to biological agents while working’’.12 This ciones legales. Med Clin (Barc). 2014;142 Supl 2:37---42, circumstance is fulfilled by SARS-CoV-2 infections in HPs doi:10.1016/S0025-7753(14)70070-3. considering that the coronavirus family is listed in group 10. Martí-Amengual G, Sanz-Gallen P, Calvo-Cerrada B, López- 2, and Directive 2020/739 of the European Union, of 3 Guillén A, et al. Work-related disabilities due to occupational diseases in Spain. In: Arezes P, Baptista JS, Barroso MP, Carneiro June 202013 , includes SARS-CoV-2 in group 3. P, Cordeiro P, Costa N, editors. International Symposium on b) When issuing a medical certificate for sick leave, it is an Occupational Safety and Hygiene: Proceedings Book of the obligation for family doctors in the National Health Sys- SHO2018. Guimarães: Sociedade Portuguesa de Segurança e tem, in compliance with the provisions of Art. 5 of Royal Higiene Ocupacionais (SPOSHO); 2018. p. 46---8. Decree 1299/2006, of 10 November, which approved the 11. Real Decreto 1299/2006, de 10 de noviembre, por el que se table of ODs,11 to establish that ‘‘when National Health aprueba el cuadro de enfermedades profesionales en el sistema System doctors, while acting professionally, learn of the de la Seguridad Social y se establecen criterios para su notifi- existence of a disease included in Appendix 1, they are to cación y registro. Boletín Oficial del Estado, núm. 302, de 19 de report this for applicable purposes through the compe- diciembre de 2006, páginas 44487---44546. tent body of each autonomous community and the cities 12. Real Decreto 664/1997, de 12 de mayo, sobre la protección de los trabajadores contra los riesgos relacionados con la with a Statute of Autonomy, to the managing entity, for exposición a agentes biológicos durante el trabajo. Boletín Ofi- the purposes of classification envisaged to be classified cial del Estado, núm. 124, de 24 de mayo de 1997, páginas as an OD’’. 16100---16111. c) Lastly, Royal Decree 1299/2006, on the protection of 13. Directiva (UE) 2020/739 de la Comisión de 3 de junio de 2020 workers against the risks associated with exposure to por la que se modifica el anexo III de la Directiva 2000/54/CE biological agents11 also specifies that this classification del Parlamento Europeo y del Consejo en lo que respecta a la corresponds to the jobs defined in the OD table, although inclusión del SARS-CoV-2 en la lista de agentes biológicos que 121 CORRESPONDENCE b son patógenos humanos conocidos, así como la Directiva (UE) Departamento de Medicina, Facultad de Medicina y 2019/1833 de la Comisión. Diario Oficial de la Unión Europea, Ciencias de la Salud, Universitat Internacional de de 4.6.2020, L 175/11-14. Catalunya, Barcelona, Spain c Cátedra de Responsabilidad Profesional Médica y G. Martí Amengual a,∗ , P. Sanz Gallen a , Medicina Legal, Universitat Autònoma de Barcelona, C. Martin-Fumadó b,c , J. Arimany-Manso a Barcelona, Spain a ∗ Unidad de Medicina Legal, Laboral y Toxicología, Corresponding author. Departament de Medicina, Facultat de Medicina, E-mail address: gabrielmarti@ub.edu (G. Martí Amengual). Universitat de Barcelona, Barcelona, Spain 2254-8874/ © 2021 Published by Elsevier España, S.L.U. 122