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Background: Since the first wave of COVID-19, alternatives to conventional hospitalization have been proposed for the provision of different levels of care, ranging from shelter during quarantine to hospital-level medical care. Objective: To describe the adaptation of a hotel by a hospital-at-home team to provide hospital-level care to patients with COVID-19 during the first wave of the pandemic in Barcelona, Spain. Methods: Hospital Clínic de Barcelona (HCB) is a 750-bed, public, tertiary teaching hospital serving 560 000 persons in the metropolitan area of Barcelona, Spain. In March 2020, the hospital-at-home unit was instructed to medicalize a hotel ('health hotel' [HH]) in downtown Barcelona. The aim of this initiative was to help decongest hospitals in the area by admitting patients with low dependency (Barthel Index score >60) and mild to severe COVID-19 from emergency departments or COVID-19 hospital wards, according to Centers for Disease Control and Prevention clinical guidelines

Background: COVID-19 entails large overloads of hospitals’ capacity. Alternatives to conventional hospitalization are key to optimize health systems resilience during outbreaks of the pandemic. Methods: From March 25th to May 25th 2020 the Hospital at Home Unit (HaH) of Hospital Clinic Barcelona adapted a 500-bed hotel for treating patients with non-critical COVID-19. Findings: 516 patients were admitted to the hotel during the study period. Median age was 57 . 5 years (IQR 45-70), 304 (59%) were referred from hospital wards and 196 (38%) from the emergency room. Median length of stay was 9 days in the hotel (IQR 6-13). Bilateral infiltrates were present in the chest x-ray of 348 (68%) patients. Treatment for COVID-19 was administered to 494 (96%) patients, 137 (27%) of whom had it interrupted due to adverse events. Complications after 14 days from symptoms onset were detected in 85 (16 . 5%) patients: 24 (5%) pulmonary embolism, 23 (4 . 5%) pulmonary fibrosis, 50 (9.7%) organising pneumonia, 133 (26%) neutropoenia. History of smoking, oxygen requirement, bacterial infection and prior ICU admission were predictors of subacture complications. Twenty-eight (5 . 5%) patients required transfer back to hospital. Chronic kidney disease, oxygen requirement and previous shock were predictors of readmission. Two patients (0 . 4%) died after hospital readmission. Interpretation: The adaptation of hotels for the management of COVID-19 patients seems to be safe and efficacious, therefore providing a suitable alternative to alleviate hospital overload during the pandemic. Accurate selection of patients for transfer based on the clinic and potential severity is key. Funding: None. Declaration of Interests: None of the authors declare competing interests with regards to the current work or at all. Ethics Approval Statement: The Ethical Board of the Hospital Clinic evaluated and approved the study protocol (HCB.2020.0443). A waiver for informed consent was granted due to the state of infectious disease emergency

COVID‐19 has created the necessity to rapidly generate evidence to enlighten many blind spots encompassing the pandemic, from pathophysiology to management. Scientific journals have timely responded to this challenge by prioritizing COVID‐19 research, with proactive editorial efforts favoring open‐access to articles, launching calls for papers, implementing specific sections and special issues on COVID‐19, among others. However, the impact of all these measures on the overall quality and adequacy of research are largely unknown and several authors have shown concern in this regard.

Background: During COVID-19 outbreak healthcare professionals were at high risk of infection, due to increased assistance pressure, shortage of personal protection equipment and screening tests. Strategies to reduce in-hospital transmission between HCPs and to safely manage infected HCPs are lacking. Methods: Prospective cohort of SARS-CoV-2 infected healthcare professionals of a tertiary teaching hospital in Barcelona, Spain. An active strategy of weekly PCR screening for SARS-CoV-2 on HCPs was established by the Occupational Health department. Every positive HCP was admitted in the Hospital at Home Unit with daily virtual assessment and in-person discretionary visits. Clinical and epidemiological data was recorded. Findings: Of the 590 HCP included in the cohort, 134 (22%) were asymptomatic at diagnosis, and 15% (89 patients) remained asymptomatic during the follow up. One third of the positives were detected during routine screening. The most frequent symptoms were cough (68%), hyposmia/anosmia (49%) and fever (41%). 10% of the patients required specific treatment at home, while only 4% of the patients developed pneumonia. Seventeen patients required an extra visit to the hospital, while six patients (1%) required hospital readmission. None of them required ICU admission or died. Interpretation: The high percentage of asymptomatic HCPs detected in our study point out the necessity of an active screening for SARS-CoV-2 among HCPs for early diagnosis, and stopping in-hospital transmission chains. Follow up of HCPs in Hospital at Home units is safe and effective, with low rates of severe infection and readmission. Funding Statement: The authors received no specific funding for this work. Declaration of Interests: None of the authors declare competing interests with regards to the current work. Ethics Approval Statement: The study protocol was evaluated and approved by the Ethical Board of the Hospital Clinic (HCB/2020/0444). A waiver for informed consent was provided due to the state of infectious disease emergency.