The Lagos State COVID-19 Think-tank, a Potential Framework for Decision-making in a Pandemic Era.

Lagos state remains the epicenter of COVID-19 infection in Nigeria. To facilitate the emergency preparedness and response to COVID-19, the State Governor and Incident Commander constituted a Think Tank comprising 13 experts from various disciplines committed to the health of the public. The Think Tank assisted the government with decision-making strategies and supported the emergency operation centre (EOC) for the COVID-19 response. Their main achievements were developing frameworks for decision-making and strategies for phased easing of the State-wide lockdown. The challenges encountered were that it was often viewed as a parallel structure to the EOC and separated from the traditional civil service structure; causing some reluctance to implement ideas generated by the Think Tank. Nevertheless, the Think Tank played an important role during the COVID-19 pandemic; the lessons learned might help other states and resource-limited countries wishing to adopt this approach to emergency response.

RésuméL'État de Lagos reste l'épicentre de l'infection au COVID-19 au Nigeria. Pour faciliter la préparation et la réponse aux situations d'urgence (EPR) face au COVID-19, le gouverneur de l'État a constitué un groupe de réflexion composé de 13 experts de diverses disciplines. Le concept du groupe de réflexion était d'impliquer le secteur privé et le milieu universitaire dans la réponse COVID de l'État de Lagos, reconnaissant qu'un résultat réussi de l'EPR nécessite une expertise dont certaines n'existaient pas au sein de la fonction publique. Le Think Tank a aidé le gouvernement à élaborer des stratégies de prise de décision et a soutenu le centre des opérations d'urgence (COU) pour la réponse à la COVID-19. Leurs principales réalisations ont été l'élaboration de cadres de prise de décision et de stratégies d'assouplissement progressif du confinement à l'échelle de l'État. Les défis rencontrés étaient qu'il était souvent considéré comme une structure parallèle à l'EOC et séparé de la structure traditionnelle de la fonction publique; provoquant une certaine réticence à mettre en œuvre les idées générées. Le groupe de réflexion de l'État de Lagos a démontré un modèle réussi de partenariat public-privé dans le domaine de la santé mis en œuvre par une diversité d'acteurs dans des secteurs critiques. Cela pourrait être considéré comme un modèle utile pour faire face à une myriade de crises similaires auxquelles le secteur de la santé est souvent confronté. Les enseignements tirés pourraient aider d'autres États et pays aux ressources limitées souhaitant adopter cette approche dans les interventions d'urgence.

Clinical and Demographic Characteristics of COVID-19 patients in Lagos, Nigeria: A Descriptive Study.

INTRODUCTION: COVID-19 is an emerging, rapidly evolving global situation, infecting over 25 million people and causing more than 850,000 deaths. Several signs and symptoms have been described to be characteristic of the disease. However, there is a dearth of report on the description of the clinical characteristics of the disease in patients from Nigeria. This study was designed to provide a description of the clinical and demographic characteristics of COVID-19 patients in Nigeria. METHODS: This study is a case series that includes patients that are evaluated between May and August 2020, and diagnosed with COVID-19. Patient health records were reviewed and evaluated to describe the clinical characteristics on presentation. RESULTS: A total of 154 COVID-19 patients were included in this study, with a mean age (S.D.) of 46.16 (13.701). Most of the patients survived (mortality rate of 2.6%), and were symptomatic (89.6%). There were more males (74.7%) than females, and the most common symptoms were fever, breathing difficulty, dry cough and malaise. Co-morbidities were also present in almost half of the study participants (49.4%). CONCLUSION: This study presents the most extensive description, to date, on the clinical and demographic characteristics of COVID-19 patients in Nigeria. Males are more likely than females to be infected with COVID-19 and the most occurring symptoms are fever, breathing difficulty, malaise, dry cough and chest pain. Old age and the presence of co-morbidities may also be associated with developing the severe disease.

Performance of the Panleucogating protocol for CD4+ T cell enumeration in an HIV dedicated laboratory facility in Barbados.

OBJECTIVE: To compare the Panleucogating (PLG) protocol with the routinely used four-color protocol for CD4+ T cell count enumeration. DESIGN AND METHODS: One hundred fifty-three blood samples were randomly selected from samples received at the National HIV Laboratory for routine immunological monitoring. Samples were prepared using Coulter CYTO-STAT tetraCHROME monoclonal antibodies and FlowCARE PLG CD4 reagent for four-color and PLG, respectively, and analyzed on the Beckman Coulter EPICS XL flow cytometer. The PLG protocol used a sequential gating strategy where CD4+ T cells were identified using side scatter properties of cells and CD45 staining. The four-color protocol used CD45 and CD3 to identify CD4+ T cells. RESULTS: Absolute CD4+ T cell counts and percentages ranged from 4 to 1,285 cells/microL and 0.9 to 46.7%, respectively. Linear regression analyses revealed good correlation of PLG with the four-color protocol (absolute counts, R2 = 0.95; percentages, R2 = 0.98) over the entire range including the clinically relevant range. Bland Altman statistics revealed no bias for CD4 counts <500 cells/microL and a slight underestimation by PLG for counts >500 cells/microL (Bias = -32.7 cells/microL; 95% agreement limits = -151.3- +86.0). CD4+ T cell percentages were the similar over the entire range (Bias = 0.6%; 95% agreement limits = -1.97 +/- 3.18). CONCLUSIONS: PLG is an accurate method for enumerating CD4+ T cells and has resulted in major cost savings to the Government of Barbados. This has implications for the sustainability of the National HIV containment program in Barbados and the other resource limited Caribbean countries. The PLG technique is now being routinely used in Barbados.