European Archives of Oto-Rhino-Laryngology https://doi.org/10.1007/s00405-020-06582-8 SHORT COMMUNICATION Risk of contagion of SARS‑CoV‑2 among otorhinolaryngologists in Spain during the “Two waves” Cristina Martin‑Villares1 · Manuel Bernal‑Sprekelsen2 · Carmen Perez Molina‑Ramirez3 · Margarita Bartolome‑Benito4 on behalf of COVID ORL ESP Collaborative Group Received: 23 November 2020 / Accepted: 20 December 2020 © The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature 2021 Abstract Introduction The aim of our study was to obtain data about the contagion rate among Otolaryngologists in Spanish ENT Departments and about the clinical outcomes in positive otolaryngologists. As a secondary objective, we aim to assess the rate of contagion in the first and the second Covid-19 wave in Spain among Otorhinolaryngologists and the regional distri- bution by ENT-Departments. Methods Study design and population: This is a prospective observational study in a cohort of 975 Otolaryngologists from 87 ENT Departments conducted from March 25 to November 17 in our collaborative group, COVID ORL ESP. COVID‐19 polymerase chain reaction (PCR) was the diagnostic standard. Hospitalization and/or intensive care admission and mortality was recorded as non-identified data. Results Data collected from 975 otolaryngologist from 87 Departments resulted in 157 (16.5%) otolaryngologists testing positive for SARS-CoV-19 by RT-PCR. Important geographic differences in contagion are reported. A total of 136 (86.6%) otolaryngologists were tested positive during the first wave and 21 (13.3%) during the second wave. At the last cut-off point of the study only 30/87 ENT Departments (34.5%) remained COVID19-free and 5 Departments reported more than 50% staff members testing positive. The majority of positive tested otolaryngologists (126/157; 80.2%) had only mild or no symptoms, 17 developed moderate symptoms (10.8%) and 3 had pneumonia not requiring hospitalization (2%). Five colleagues were admitted at hospital, 4 required ICU (2.5%) and 2 col- leges died from COVID-19. Conclusions During the first wave of the SARS-CoV-19 pandemic otolaryngologists in Spain have been overall the group suffering the highest rate of contagion, particularly during the first month. Subsequently, the Spanish Ministry of Health should include otorhinolaryngologists as a high-risk group in airborne pandemics. Keywords SARS-CoV-2 · COVID-19 · Otolaryngology · Morbidity · Mortality Introduction Cristina Martin-Villares, Manuel Bernal-Sprekelsen contributed equally to this work. According to data from the Ministry of Health (Novem- ber 12–30, 2020), with 79,771 confirmed cases, Spanish Collaborative group affiliations and members are listed in Acknowledgements section. healthcare workers (HCWs) are worldwide who were the most affected by the COVID-19 pandemic [1]. One rea- All authors contributed to the study conception and design. CMV son may be that, at the beginning of the pandemic, the had the responsibility of the data collection and analysis. CMV National protocol recommended PCR testing was only in and MBS wrote the manuscript and have equally contributed as main authors. MBS made final corrections. All authors have symptomatic HCW [2]. revised the manuscript and gave approval for the published The nationwide Spanish seroepidemiological study version. ‘ENE-COVID’ concluded that 10% of HCWs in our country had antibodies against SARS-CoV-2, while only * Cristina Martin‑Villares crismvillares@gmail.com; mmartv@unileon.es 5.2% antibodies were detected in the general population [3]. In another seroprevalence study, among 578 HCW Extended author information available on the last page of the article 13 Vol.:(0123456789) European Archives of Oto-Rhino-Laryngology from a referral hospital in Barcelona, Spain, the cumula- tive prevalence of SARS-CoV-2 infection was 11.2% and 40% of HCWs with past or present infection had not been previously diagnosed with COVID-19 [4]. The aim of our study was to obtain data about the con- tagion rate among otolaryngologists, in Spanish ENT Departments and about the clinical outcomes in positive otolaryngologists. As a secondary objective, we aim to assess the rate of contagion in the first and the second Covid-19 wave in Spain among otorhinolaryngologists and the regional distribution by ENT-Departments. Methods Study design and population Fig. 1  Regional distribution of ENT Departments of COVID ORL ESP collaborative group This is a prospective observational study in a cohort of 975 otolaryngologists conducted from March 25 to Novem- ber 13. The study population was collected from our col- laborative group, COVID ORL ESP, created on March 25, among 252 otolaryngologists of 87 Spanish ENT Depart- ments, to share the information by instant messaging about tested PCR positive was on March 9, 2020 at a hospital in tracheostomies and other issues related to COVID-19 Madrid. The last otolaryngologist who tested positive was patients [5]. The study was designed to obtain representa- on November 9 in Zaragoza Fig. 2 and Table 1. tive data at national and regional levels. Otolaryngologists Important geographic differences in contagion among of all regions participated in the study (Fig. 1). otolaryngologists are reported in Fig. 1. Madrid, Castilla, Participants of the collaborative group collected data and León and Castilla-La Mancha displayed the highest from all included ENT-Departments along 8 months, from incidence of otolaryngologists who were tested positive March 25 to November 13. COVID‐19 polymerase chain (Table 1). The majority of positive tested otolaryngologists reaction (PCR) was the diagnostic standard. Date of diag- (126/157; 80.2%) had only mild or no symptoms (Table 2). nosis, the need for hospitalization and/or intensive care Seventeen otolaryngologists developed moderate symp- admission and mortality was recorded as non-identified toms (10.8%) and three of them had pneumonia not requir- data. The severity of clinical outcomes of otolaryngolo- ing hospitalization (2%). Five colleagues were admitted gists tested positive was scored by a scale: (1) non-hospi- in hospital with moderate-severe pneumonia. Four otolar- talized cases, (2) hospitalized cases, (3) ICU admission, yngologists required ICU (2.5%) for critical pneumonia and (4) death. The two COVID-19 “waves” were defined and finally, one otolaryngologist died from COVID-19 in following the official MoMo data from Spain (momo.isciii. March and another colleague died in November. es): A total of 136 (86.6%) otolaryngologists was tested positive during the first wave and 21 (13.3%) during the -“First wave” from March 10 to May 10 (with a 66.9% second wave. After the first wave, 35/87 ENT Depart- excess deaths). ments of our study group (40.2%) remained COVID19-free -“Second wave” from September 1 to November 16 (Table 3). At the last cut-off point of the study, only 30/87 (with 16.9% excess of deaths). ENT Departments (34.5%) remained COVID19-free and five Departments reported more than 50% staff members testing positive. Results After two waves of the pandemic in Spain, data collected from 975 otolaryngologist from 87 Departments resulted in 157 (16.5%) otolaryngologists testing positive for SARS-CoV-19 by RT-PCR. The first otolaryngologist who 13 European Archives of Oto-Rhino-Laryngology Table 1  Distribution of Spanish regions (CA, Autonomous Community) Otolaryngologists otolaryngologists testing positive by Spanish regions 157 infected 975 total otolaryngolo- gists CA Madrid (6 663 394 inhabitants*) 58 271 CA Castilla León (2 399 548) 19 102 CA Castilla La Mancha (2 032 863) 18 55 CA Islas Canarias (2 153 389) 14 64 CA Cataluña (7 675 217) 11 109 CA Aragón (1 319 291) 10 52 CA País Vasco (2 207 776) 7 42 CA Extremadura (1 067 710) 5 22 CA Galicia (2 699 499) 5 34 CA Islas Baleares (1 149 460) 3 38 CA Valencia (5 003 769) 3 67 CA Navarra (654 214) 3 24 CA Asturias (1 022 800) 1 25 CA Cantabria (581 078) 0 17 CA Murcia (1 493 898) 0 20 CA Andalucia (8 414 240) 0 33 *Demographic data from Spanish National Statistics Institute (INE) in 2019 https​://www.ine.es/dynt3​/ ineba​se/es/index​.htm?padre​=517&capse​l=523 seroprevalence of 5.2% of IgG antibodies against SARS- Cov2, and also above the 10% rate of antibodies among HCWs found in the same study [3]. In a large Spanish referral hospital seroprevalence of anti-bodies against SARS-CoV-2 among all HCWs reached 11.2% [4]. Data from other invasive airways physician collaborative group [6] reported a contagion rate of 10.5% among anaesthesi- ologists (n = 150/1328) and 12.3% among intensive care physicians (n = 31/251). Because the study was designed to obtain representative data at both national and regional levels, we were able to observe marked regional differences in contagion, particu- larly between the centre of Spain (Madrid, Castilla y León, Fig. 2  Regional distribution of ENT positive tested and Castilla La Mancha) and peripheral regions. Similar results about regional differences were reported in a large nationwide study about seroprevalence of SARS-CoV-2 in Discussion Spain (ENE-COVID) [3] with prevalence five times higher in Madrid and central parts of Spain than that observed in The aim of our study was to obtain data about contagion low-risk regions. among otolaryngologists and ENT Departments in Spain Inadequate personal protection at the beginning of the during the two waves of the current coronavirus pandemic, pandemic, shortage of personal protective equipment (PPE), as well as potential regional differences of contagion. and long-time exposure to large numbers of infected patients Data collected over an eight-month period from 87 was established at the Shanghai International Forum as the hospitals in Spain, showed an overall rate of contagion most impact reasons for HCWs becoming infected [7]. In of 16.5%, with 157/952 otorhinolaryngologists testing our study, 86% of the reported contagion happened during positive for SARS-CoV-19. This rate is three times higher the first wave, coinciding with a shortage of PPEs and lim- as compared with the general population in Spain with a ited number of PCR testing performed at the beginning of the pandemic in our country. Monitoring the prevalence of 13 European Archives of Oto-Rhino-Laryngology Table 2  Clinical outcomes of Clinical outcomes Otolaryngologist with test otolaryngologists positive tested positive for COVID-19 during pandemic (from March to November 2020) Total (n = 157) % No symptoms 11 7% Mild symptoms 115 73.2% At least one symptom asso- ciate with COVID-19 Moderate symptoms without hospitalization 17 10.8% Pneumonia without hospitalization 3 2% Hospitalization 5 3.2% ICU admission 4 2.5% 1 with neurological sequelae Deaths (in-Hospital) 2 1.3% 1 in March 2020 1 in November 2020 infection among different activities during pandemics will and Neck surgeons with COVID-19 in 19 countries [12]. be useful for assessing the potential level of exposure and Here, Spain is listed with just 11 cases for a total of 361. identifying high-risk diagnostic or therapeutic procedures The methodology of this registry remains unclear as it does performed by otorhinolaryngologists, thus reinforcing the not explain which inclusion period had been considered. Our critical role of PPE in our speciality to prevent contagion. contagion rate is higher than the one found in the recent Lessons learned from the SARS 2003 outbreak in Hong national web-based survey on the SARS-CoV-2 infections Kong, Singapore and Canada validated the effectiveness of among otorhinolaryngologists in Germany [13] with 54/970 standard protective personal equipment (PPE) on aerosol (5.56%) ORLs reported testing positive. At that point, the generating procedures in our speciality [8]. A study from prevalence in the general population in Germany was lower. one referral hospital participating in our collaborative In any case, the German study concluded that otolaryngol- group reported no contagion among the surgical team along ogists have an almost 3.7-fold risk of contracting SARS- with the first wave with high standards of protection in 50 CoV-2 compared with the population baseline level, similar COVID-19 tracheostomies [9]. to our results. Despite being otolaryngologists an obvious high-risk The limitations of our survey are the data acquired group, recent recommendations of the Spanish Ministry of through social media: the maximum number of partici- Health about safety measurements for HCWs in aerosol- pants in a WhatsApp-group is 256. Large studies also used generating procedures (AGP) left otolaryngologists out of a smartphone app to recollect prospective data on pandemic the list of groups at risk [10], while e.g. the UK Govern- in real time [14]. Thus, we missed two additional deceased ment [11] considered any upper ENT airway procedures that otorhinolaryngologists from hospitals not included in the involve suctioning as the potentially infectious AGPs for study group. Also, results do not necessarily reflect the COVID-19 and recommended full PPE for ENT specialist rate of nosocomial infection. However, the latter would not while visiting any patient in the office. However, recommen- explain the differences in the contagion rate in comparison dations as to how physicians, and particularly otorhinolaryn- to other specialists handling the upper airway. gologists, had to protect themselves had not been established back then. In fact, at the beginning of the pandemic PPE, let alone PAPR, were available in sufficient numbers and, as Conclusions stated above, diagnostic or therapeutic procedures performed by otorhinolaryngologists have even not yet been listed as During the first wave of the SARS-CoV-19 pandemic otolar- a risk. All this might contribute to explain the high rate of yngologists in Spain have been overall the group suffering contagion registered during the first weeks among otorhi- the highest rate of contagion, particularly during the first nolaryngologists in Spain. month. Subsequently, the Spanish Ministry of Health should The results of our survey are in full contrast to a recent include otorhinolaryngologists as a high-risk group in air- international study, registering Otolaryngologists—Head borne pandemics. 13 European Archives of Oto-Rhino-Laryngology Table 3  ENT Departments with otolaryngologist tested positive dur- Table 3  (continued) ing both waves of the pandemic in Spain ENT Depart- Otolaryngologist + (n = 157/952) ENT Depart- Otolaryngologist + (n = 157/952) ments (n = 87) First wave + Second Total ENT + at Depart- ments (n = 87) First wave + Second Total ENT + at Depart- wave (136 + 21 ENT +) ment/total ENT at Depart- wave (136 + 21 ENT +) ment/total ENT at Depart- ment ment D 47 1+0 1/8 D1 11 + 2 13/22 D 48 1+0 1/8 D2 6+0 6/14 D 49 1+0 1/6 D3 6+0 6/13 D 50 1+0 1/6 D4 6+0 6/7 D 51 1+0 1/6 D5 5+0 5/18 D 52 1+0 1/5 D6 3+2 5/12 D 53 1+1 1/5 D7 4+0 4/28 D 54 1+1 ¼ D8 2+2 4/26 D 55 1+0 ¼ D9 3+1 4/22 D 56 0+0 0/23 D 10 2+2 4/21 D 57 0+0 0/21 D 11 4+0 4/16 D 58 0+0 0/17 D 12 0+4 4/15 D 59 0+0 0/17 D 13 4+0 4/15 D 60 0+0 0/15 D 14 4+0 4/13 D 61 0+0 0/14 D 15 4+0 4/10 D 62 0+0 0/13 D 16 4+0 4/7 D 63 0+0 0/12 D 17 4+0 4/7 D 64 0+0 0/11 D 18 2+1 3/24 D 65 0+0 0/8 D 19 2+1 3/21 D 66 0+0 0/7 D 20 3+0 3/19 D 67 0+0 0/6 D 21 3+0 3/15 D 68 0+0 0/6 D 22 3+0 3/14 D 69 0+0 0/6 D 23 2+1 3/13 D 70 0+0 0/6 D 24 3+0 3/13 D 71 0+0 0/6 D 25 2+1 3/13 D 72 0+0 0/6 D 26 2+1 3/9 D 73 0+0 0/5 D 27 3+0 3/8 D 74 0+0 0/5 D 28 3+0 3/7 D 75 0+0 0/5 D 29 3+0 3/3 D 76 0+0 0/5 D 30 2+0 2/24 D 77 0+0 0/4 D 31 2+0 2/19 D 78 0+0 0/4 D 32 2+0 2/16 D 79 0+0 0/4 D 33 2+0 2/13 D 80 0+0 0/4 D 34 2+0 2/12 D 81 0+0 0/3 D 35 3+0 3/10 D 82 0+0 0/3 D 36 2+0 2/8 D 83 0+0 0/3 D 37 2+0 2/7 D 84 0+0 0/2 D 38 1+1 2/5 D 85 0+0 0/2 D 39 1+0 1/26 D 86 0+0 0/2 D 40 1+0 1/19 D 87 0+0 0/2 D 41 1+0 1/17 D ENT department, ENT otolaryngologist, ENT + otolaryngology D 42 0+1 1/14 tested positive for COVID-19 D 43 0+1 1/12 D 44 1+0 1/10 D 45 0+1 1/10 D 46 1+0 1/8 13 European Archives of Oto-Rhino-Laryngology Acknowledgements This study is dedicated to our ENT colleges and Hospital: Carla Meler-Claramonte, Juan Carlos Flores-Martín; La Can- to all the HCWs who lost their health and their lives during this pan- delaria Tenerife Hospital: Juan Jose Artazkoz-del Toro; La Fe Valencia demic.The authors thank the Spanish Society of Otorhinolaryngology Hospital: Alfonso Garcia-Piñero, Noelia Muñoz-Fernandez; La Paz and Head and Neck Surgery (SEORL-CCC). CMV would like to Madrid Hospital: Antonio del Palacio, Blanca Mateos-Serrano, Isabel acknowledge Professor Jesus M Culebras MD PhD, Professor of Sur- Garcia-Lopez, Laura Rodrigañez-Riesco, Paula Aragon, Teresa Rivera; gery, for improved the work in innumerable ways and for his support J Manuel Morales; La Princesa Madrid Hospital: Gustavo Eisenberg- anytime. My grateful for the expert comments offered by Miguel Aris- Plaza, Inmaculada Fernandez-Robledo, Jorge Prada-Pendolero; Leon tegui, Head of Department of Gregorio Marañón Hospital, Madrid. CAULE Hospital: Ignacio Alvarez-Alvarez, Maria Puente-Verez; Locus Affiliations of Collaborators of COVID ORL ESP Collaborative Group Agusti Lugo Hospital: Ana Quintana-Sanjuas, Pablo Parente-Arias; (listed alphabetically): Albacete General Hospital: Aranzazu Perez- Mar Menor Murcia Hospital: Francisco García-Cordoba, Francisco Fernandez, Sara Alcantara-Armenteros. Altahaia Xarxa Asistencial Jose Garcia-Purriños; Marques de Valdecilla Santander Hospital: Car- Manresa Hospital: M Dolors Deola-Trasserra, Vanessa Villarraga- melo Morales-Angulo; Mateu Orfila Menorca Hospital: Simara Rod- Cova, Azor Carreras-Alcaraz, Esther Montane-Sala; Alvarez Buylla riguez-Rondon, Diana Lopez-Lopez; Miguel Servet Zaragoza Hospital: Mieres Hospital: Esther Sota-Eguizabal; Araba Vitoria Hospital: Aih- Rafael Fernandez-Liesa; Militar Zaragoza Hospital: Amaya Lázaro- noa Tolosa, Belen De la Iglesia, Rafael Garcia-Sardon; Basurto Bilbao Sánchez, I Alonso-Alonso; Moises Brogui Barcelona Hospital: Hospital: Kiara Tudela-Cabello, Aitor Zabala-LopezdeMaturana; Michalina Rusiecka, Rosa Delia Ramirez, Javier Vila; Mollet Barcelona Bellvitge Barcelona Hospital: Gabriel Huguet-Llull, Marta Mesalles- Hospital: Angela Bellmunt-Fontanet, Victoria Montoro-Martinez; Ruíz, Ramon Jimenez-Montoya; Burgos HUBU Hospital: Ana Navazo- Morales Meseguer Murcia Hospital: Carlos Escobar-Sanchez; Mutua Eguïa, Blanca Galindo-Torres; Cabueñes Gijon Hospital: Marta Fer- Terressa Barcelona Hospital: Gabriela Simonetti, Laura Palomino, nandez-Pello, Nuria Rodriguez-Prado; Caceres Hospital: Carmen Ignacio Clemente; Ntra Stra Sonsoles Avila Hospital: Maria Jesus Salazar, Francisco Ramos; Can Mises Ibiza Hospital: Juan Carlos Velasco; Parc Tauli Sabadell Hospital: Carlota Rovira-Ramos, Juan Amor-Dorado; Castellon General Hospital: Marta Faubel-Serra, Jose Diaz-Argüello, Yolanda Escamilla-Carpintero; Perpetuo Socorro Rosana Almela-Cortes; CH Navarra Hospital: María Uzcanga-Lacabe, Badajoz Hospital: Pablo Torrico-Roman; Plato Barcelona Hospital: Marisela Cardier-Suárez; Ciudad Real General Hospital: Esther Úbeda- Carlos Calvo-Navarro, Ignacio Viza-Puiggros; El Bierzo Ponferrada Fernández, Miguel Ángel Alañon-Fernández; San Carlos Madrid Hospital: Diana Luorido, Monica Granda, Jose Miguel Tejeda; Principe Clinic Hospital: Mari Cruz Iglesias-Moreno, Jesus Gimeno-Hernández, Asturias Alcala Madrid Hospital: Raquel Ortiz-Rodrigo, Juan Higuera- Sara Tamboura; Salamanca Clinic Hospital: Angel Muñoz-Herrera, Lucas, Jose Ignacio Tato, Teresa Rivera-Rodriguez; Punta de Europa Marta Calvo; Valladolid Clinic Hospital: Jaime Santos-Pérez; Zaragoza Algeciras Hospital: Diego Rodriguez-Contreras, Antonio Caravaca- Clinic Hospital: Guillermo Gil-Grasa, Maria Jose Lavilla-Martin de Garcia; Quiron Salud Zaragoza Hospital: Jorge Alfaro-Garcia; Ramon Valmaseda, Jose Miguel Sebastian. Ciudad de Coria Hospital: Carlos y Cajal Madrid Hospital: Fatima Sanchez-Fernandez, Lourdes Montes- Sanchez-Herrero; Henares Coslada Hospital: Beatriz Molina-Montes, Jovellar, Mar Medina, Rafael Barbera; Reina Sofia Murcia Hospital: Raquel De la Fuente-Hernandez; Cruces Barakaldo Hospital: Jose Alfonso MarcoGarrido, Isabel Cremades-Navalon; Rey Juan Carlos Antonio Municio-Martin, Luis Pascua-Gomez; Cruz Roja Madrid Hos- Madrid Hospital: C Garcia Bastida, Raimundo Gutierrez-Fonseca; pital: Sergio Andrino-Martin, Alejandra Ayala; CUN Madrid Hospital: Requena Valencia Hospital: Javier García. Rio Hortega Valladolid Hos- Bárbara Molina-Gil, Jorge De Abajo-Larriba; 12 de Octubre Madrid pital: Elisa Gil-Carcedo, Javier Herrero-Agustín, Jorge Freijanes-Otero, Hospital: Alfredo Garcia-Fernandez, Ignacio Jimenez-Huerta; Dr Mario Cuetos-Azcona; San Agustin Aviles Hospital: Carmen Rosal- Negrin Gran Canaria Hospital: Jesus Benitez-del Rosario, Alberto Fraga; San Pau i Sta Tecla Tarragona Hospital: Fabian Alzate-Amaya; Sanchez-Tudela; Dr Peset: Jose Dalmau. Elche Alicante Hospital: San Pau Barcelona Hospital: Cesar Orus; Sant Joan de Reus: María Antonio Almodovar-Iniesta; El Escorial Madrid Hospital: Antonio Foglia-Fernandez, Coia Romeu-Figuerola; Sanitas La Zarzuela Madrid MartinezRuiz-Coello; Esperit Sant Barcelona: Alberto Codina-Aroca; Hospital: Estefanía Hernández-Garcia, Laura Palomino, Marta Alcaraz; Ferrol Hospital: Jacobo Chao-Vietes; Fundacion Jimenez Diaz: Jose San Juan de Dios Barcelona Hospital: Cristina A Vázquez-Romero; Miguel Villacampa-Auba, Alfonso Campos-Gonzalez, L Rubio-Yan- Santiago de Compostela Hospital: Cristina Dios-Loureiro, Isabel Gon- guas, Lucia Baguena-Campos, Alberto Encinas-Vicente; Fuenlabrada zalez-Guijarro; Segovia Hospital: Rosa Sancho-Calvo; Severo Ochoa Hospital: Estefanía Hernández-Garcia, Guillermo Plaza; Gregorio Leganes Madrid Hospital: Jesus Jose Ramos-Fernandez, Jose Carlos Marañon Madrid Hospital: Alejandro Lowy-Benoliel, Daniel Poletti- Casqueiro, Mar Lasso-delaVega, Paula Martinez-Pascual, Silvia Serafni, Juan Antonio Pasamontes-Pingarron, Miguel Aristegui-Ruiz, Dominguez-Ovejas; Son Espases Mallorca Hospital: Eduardo Morera- Monica Hernando-Cuñado, Rosalia Souviron-Encabo, Tomas Mar- Serna, Jacoba Alba-Mesquida; Son Llatzer Mallorca Hospital: Alfonso tinez-Guirado, Mario Fernandez-Fernandez, Ricardo Gonzalez-Orus; Bonilla-Perez; Santa Barbara Soria Hospital: Javier Martinez-Subias; Catalunya General Hospital: Valery Nuñez-Carrasco, Adriana Agüero- Sureste Arganda del Rey Madrid Hospital: Jesus M Martinez-Salazar; Medina, Juan Carlos-Villatoro, Roser Lopez-Diu, Selvyn Gonzalez- Talavera de la Reina Hospital: Antonio Martinez-Lapeña; Toledo Melgan; Alicante General Hospital: Manuela Sancho-Mestre, Oscar Virgen de la Salud Hospital: Rocio Corrales-Millan, Rosario Ruiz- Alemán-Lopez, Irene Monjas-Cánovas; Valencia General Hospital: Gomez; Urduliz Vizcaya Hospital: Laura Gerarda Cianci-Jaimes; Enrique Zapater-Latorre, Jose Ramon Alba-Garcia, Miriam Natsuki Virgen Arreixaca Murcia Hospital: Ruben Jara-Rubio; Virgen del Oishi-Konari, Beatriz Pallares-Marti, Andrea Rubio-Fernandez; Infan- Rocio Sevilla Hospital: Estefanía Lozano, Isabel Tirado-Zamora; Vic til Universitario Niño Jesus de Madrid: Angel Moreno-Juara, Enrique Hospital: Albert Idigora-Planas; Villaba General Hospital: Alvaro Guillén-Lozada, Saturnino Santos-Santos, Maria Jesús-Dominguez; Sanchez-Barrueco, Ignacio Alcala-Rueda; Zamora Virgen de la Concha Infanta Elena Huelva Hospital: Jesús Crovato-Rojas; Infanta Elena Hospital: Enrique Coscaron-Blanco, Soledad Suarez-Ortega; Univer- Valdemoro Madrid Hospital: Cristian Ruminot, Daniella Laguado, sity Hospitals of Derby and Burton Nottigham (GB)* invited hospital, Hander Acosta, María José Hernández-Garcia; Infanta Leonor Madrid Hazem Nijim. 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Shanghai International Forum for Infection Control and Preven- e483. https​://doi.org/10.1016/S2468​-2667(20)30164​-X tion (2020) Rational, scien-tific, and standardized protection: the core of infection prevention and control of COVID-19 in medical Publisher’s Note Springer Nature remains neutral with regard to institutions. https​://mp.weixi​n.qq.com/s/G5Nwd​d9kW9​yVD- jurisdictional claims in published maps and institutional affiliations. hTdws​Ktg Authors and Affiliations Cristina Martin‑Villares1 · Manuel Bernal‑Sprekelsen2 · Carmen Perez Molina‑Ramirez3 · Margarita Bartolome‑Benito4 on behalf of COVID ORL ESP Collaborative Group 1 3 Department of Otorhinolaryngology, Anatomy Department of Otorhinolaryngology, Complejo Universitario of Department of Medicine, Surgery and Anatomy, Hospital Hospitalario de Segovia, University of Valladolid, Valladolid, Universitario El Bierzo, University of León, Médicos sin Spain Fronteras s/n. 24401‑Ponferrda, León, Spain 4 Department of Otorhinolaryngology, Hospital Infantil 2 Chair of ORL, Head of ORL‑Dept., University of Barcelona, Universitario Niño Jesús, Autonomous University of Madrid, Hospital Clinic, Barcelona, Spain Madrid, Spain 13