The CMAC, Dr. Adebara declared the training opened with a speech on the training agenda at about 10.20am. He spoke on the essence of such trainings which he said will further help in the combat of (SARI). He wished everyone present a wonderful presentation and deliberation.

Dr. Kolawole, the helms man of the training took over by welcoming all medical personnel there present and equally seized the opportunity to introduce one of the presenters in person of Dr. Sandra Mba from the NCDC, who he said will talk on the topic ‘COVID-19. CASE DEFINITION.

DR. Sandra began her lecture with the following:

BACKGROUND TO COVID-19
*An alert came from Wuham in China on pneumonia of unknown origin on 31st December 2019.

*China announces first death on January 11th 2020.

* The disease is claimed to be highly infectious.

*Rapid spread globally.(A single City to 195 countries) Approximately within 30 days.

*NCDC was mandated to prevent, detect and control communicable disease.

*Inauguration of the Coronavirus group was done on 27th January 2020.

RESPONDING TO COVID-19 IN NIGERIA.

Dr. Sandra affirmed that early detection and confirmation must be carried out. As such facts have it that 17 laboratories have been put in place as at 17th April, 2020 for effective use.

As at 29th April 2020, 192 new cases discovered, bringing the total number of cases all over the country to 1728. 51 death and 307 discharged.

34 states in Nigeria and FCT are being affected.
Yobe state confirmed first case 29th April 2020.
The age group that are most affected are 31 to 40.

CHALLENGES.
* Fake news
*Misinformation.

STEPS TO BE TAKEN
1: Improve surveillance
2: Expanding capacity for testing.
3: Training of response officers.

In response to a question asked, Dr. Sandra said Kano State is under investigation, and that some of the cases there are attributed to COVID-19. But investigation is ongoing. She further said that Kano now has a testing capacity.

Still on COVID-19 in Nigeria, the speaker attributed cases in Nigeria to be mild. Nigeria only has 10% cases that needs ventilators. 80% are mild cases, people do not die from COVID-19 but from the complications that arise from it. For testing capacity, NCDC is working towards 1000 per day. This, she said may likely increase.

In between the lecture, the CMD, Prof. Adekunle Ajayi came in, and in his remark admonished that attention should be paid to the lectures. He spoke on the index case of COVID-19 at the hospital that everyone did well to the best of their ability, though the patient was lost. He advised everyone to prepare, protect and take precautionary measures, and this he said will help a lot in battling COVID-19. Further more, the CMD advised that if precautionary measures are not taken, personnel can also infect patients. He also commended the social distancing demonstrated by participants at the lecture. The CMD made reference to the huge volume of sanitizer at the hospital. 10 additional beds had been made available for the isolation centre at the hospital. He further claimed that powerful intelligent task force had been inaugurated in the hospital on COVID-19.

On fake news, the CMD advised staff to rely more on internal news rather than what they read from outside.

SECOND LECTURE
CLASSIFICATION OF COVID-19

Fever, cough and difficult in breathing.

PATIENTS CLASSIFICATION
1: Clinical.
2: Epidemiology.
3: Laboratory
Lagos, Ogun, Kano and Abuja have the high level of the disease, but no patient will come out to claim he or she has because of the fear of being rejected. Therefore doctors and other health workers are advised to be psychological in their approach on patients in order to gain their trust in getting the right information. Trick questions can be used to investigate and get in order to get very detail history.

A probable case is any suspected case for whom testing of COVID-19 is indeterminate. Test result or for whom samples were not collected before the demise of a suspected case.

SUSPECT CASE
1: Isolation
2: Notification.
3: Baseline clinical care.(do not run from patients)
4: Supportive care.

SUMMARY
* A Patient can present without symptoms.
* It is important to have high index of suspicions.
* I.P.C should be instituted at all times.

THIRD LECTURE BY MRS AWOTONA TITTLED ‘STANDARD PRECAUTION AND STANDARD BASED PRECAUTION’

She began by confirming that all materials and equipment needed at the infection disease control unit of the hospital have been provided and she lauded the management for the timely provision.

CONSIDERATIONS WHEN ISOLATING A PATIENT
* Patient placement
*Staff awareness.
*PPE
*Patient care equipment.
*Cutlery and crockery.
*Waste disposal.
*Linen
*Environment.
*Visitors and care givers.
*Patient transport
*When to discontinue the precautions.

HEALTH CARE SYSTEM REQUIREMENTS FOR ISOLATION PRECAUTIONS.
1: Administrative control
2: Engineering control.
3: Personal protective equipment.

TRANSMISSION
DIRECT: 1 Hands contact.
2: Nasal droplets.
3: Nose droplets.

INDIRECT
1: Bedpans and urinals.
2: Dressing trolleys.
3: Mattresses
4: Drip stands.
5: Mops and buckets.
6: Hand disinfection equipments.

TRANSMITTERS OF INFECTION.
* Staff contribute 75% to 90%
*Medical.
*Nursing.
* Domestic.
*Other support staff.
*Patient to patient (10%)
*Attendants family and friends (1%)
The hand is the commonest cause of infection.

ISOLATION ROOM
* Single room, door must be always closed.
* Inscriptions and notices on doors.

Furthermore on contact Isolation, perform hand hygiene, put on nose and mouth cover, wear gloves.

ADDITIONAL PRECAUTIONS FOR DIRECT PATIENT CARE: SAR- COV 2.
*Isolate the patient
*Laboratory test to confirm diagnosis.
*Restrict access to essential staff.

In the course of this presentation, the Honourable Permanent Secretary Hospital Management board Dr. Williams Afolabi came in at 11.57am.

THIRD LECTURE: SYNDROMIC ALORIACH TO COMPLICATED CASES: MANAGEMENT OF MILD CASES.
* Hydroxychloroquine
*Zinc.
*Azithomycin.

COVID-19 virus cannot travel far, because of its fairly large size before it drops from the air.

RECOGNIZING COVID-19 PATIENTS WITH ARDS.
*Severe shortness of breath.
* Inability to complete full sentence.

FOURTH LECTURE: COVID 19 IN CHILDREN DELIVERED BY DR. FAYEMI.
Before this lecture, the permanent secretary was asked to speak. He thanked everyone for a job well done. He admonished that people are looking up to health workers, and that more is still expected from health workers. He said a committee is being fashioned out to look into covid 19. Health workers he said should not fear. That pretty soon we shall win the war against covid-19.

DEMONSTRATION ON THE USE OF COSTUME IN ISOLATION CENTER.
Dr. Sandra, Dr. Fashola led the demonstration with Dr. Nasiru.
STEPS TO TAKE.
1: Sanitize the hand by rubbing sanitizer.
2: Put on the face mask.
3: Put on the boot
4: Wear the gloves.
5: Wear the body suits.
6: Put in the face goggle.
7: Put on the apron.
8: Spray the whole body.
When taking out the costumes wash hand at every stage of removal of each item.

Dr. Fayemi in his lecture said COVID-19 prevailance in children is low.

* Immunity.
*Role of A C E – 2.
* Lymphocyte count.
* Low mortality.

CLINICAL FEATURES
The symptoms are the same in children like in adults. Diarrhea can also be present.

April 2nd 2020, three death recorded in children in the United States of America.

MANAGEMENT
Same as in adults.
* Supportive care for children.
*Bed rest.
*Oxygen therapy.

No known drugs for the treatment and prevention of COVID-19 yet. It is not common in mother and child transmission, but it is possible. But it cannot be transmitted through breast feeding.

In summary, children of all ages can be infected with COVID-19.

The training was brought to a close with Mrs Omobowoje (HNS), who gave the closing remark and said the prayers.