Authors
Pasquale Di Maio, M.D.,1 Oreste Iocca, M.D., D.D.S.,2 Antonio Cavallero M.D.,1 Marco Giudice M.D. 
1Giovanni Borea Civil Hospital, Department of Otolaryngology-Head and Neck Surgery, Sanremo, Italy 2Humanitas Clinical and Research Center – IRCCS -, via Manzoni 56, 20089 Rozzano (MI)
Corresponding author: Pasquale Di Maio, M.D.  Giovanni Borea Civil Hospital, Via Giovanni Borea, 56, 18038, Sanremo (IM), Italy +39 3930200889 email: dimaio.p86@aliceposta.it
Acknowledgments
The authors would like to thank Dr. Giuseppe Garo, Dr. Cristina Ghirardi and Dr. Carlotta Tola for participating in the video recording. In addition, we are grateful to Ms. Rachel A. Elliott and Ms. Cristina Marconi for their support in editing the manuscript and video.
INTRODUCTION
Since its first appearance in Wuhan, China, in December 2019, the SARS-CoV-2 virus responsible for coronavirus disease 2019 (COVID-19) has progressively spread around the world.1 And to date (April 15, 2020), according to the Johns Hopkins Coronavirus Resource Center, the outbreak involved 185 countries worldwide, with 128,011 people dead.2 Healthcare workers were among the hardest hit by this infection. This was evident from reports, both from China and Italy, which revealed infection rates between medical staff between 3.8 and 20%.1
The tests currently used for the direct identification of SARS-CoV-2 are mainly aimed at detecting viral RNA through nucleic acid amplification, generally using the polymerase chain reaction (PCR). The nasopharynx and/or oropharynx are the most tested sampling sites using swabs, with a slightly greater sensitivity shown by the nasopharyngeal swab.3 This video shows the step-by-step procedure for properly dressing and undressing, demonstrates how to wear the personal protective equipment (PPE), and provides some technical notes on the execution of the nasopharyngeal and oropharyngeal swab for COVID-19. All of this serves to avoid the risk of contagion of the health worker. The video is based on our experience at the Giovanni Borea Civic Hospital in Sanremo, where in the last month, strictly following the CDC and WHO guidelines,4,5 the otolaryngology team has performed about 900 nasopharyngeal (95%) and oropharyngeal (5%) swabs. Following these steps, none of the operators have been infected as of the present date.