1. Preamble - This update is aimed to meet the desires of our people to get well informed and transparent update on our various activities since the taskforce set to work about 5 months ago. This public update seeks to build confidence from the following disclosures of the key activities of the CRS COVID-19 TASKFORCE so far. In a moment, we will try to review the response system as we continue to value the supports of all and sundry. We underscore the role of our support partners and all those who continue to volunteer in our various activities. To this end, we appreciate the Governor of Cross River State for the excellent role and support he has given to this response. We also appreciate all key stakeholders, media the works of UN, UNICEF, WHO, NCDC, JHPIEGO, USAID, ECEWS, UNFPA and the CA-COVID private sector group. The UCTH cannot be overemphasized for their supports with facility and personnel. We continue to emphasize the need for citizens to take full responsibility for their safety and the safety of those around them.

As you well know, our response have been in all fronts of the prevention, treatment and control of the novel COVID 19 pandemic. Our leverage on prevention started with activation of  Emergency Operations Center, sensitization in both rural and urban areas, border and other movement restrictions and the surveillance of our wide expanse of populations for index case tracing and contacts tracing. We closed worship centers, schools and recreational grounds and stopped all public gatherings. We started the no mask, no movement policy that soon became the global way forward. We provided free face mask for 1.5 million Cross Riverians and our garment factory has been working tiredlessly to provide PPEs for health workers as well as face shield for the public. We have continued to set up treatment and holding centres across the state for care of the sick and any possible exposed member of our citizenry. The various activities are being coordinated by well qualified pillar heads of the various expert groups. Amongst them is the epidemiology and surveillance team, the case management team, the planning, the laboratory and point of entry teams. 

2. *Epidemiology/Surveillance* - this pillar has health personnel spread across facilities in the entire state with coordination from the state epidemiologist. Toll free lines are available for unhindered access to the pillar head who is an NCDC trained personnel. The team is saddled with surveillance, contact tracing, sample collection and transportation to testing sites and the isolation of contacts or monitoring of persons in self isolation where necessary. We are conscious of the various limitations in this vital team and have worked assiduously to improve daily.

The surveillance pillar consist of the state team and the LGA team. 
At the state level there is a Rapid Response team working from the Emergency Operation center responding to all alert and calls at very short notice. Vehicles from the state government was provided for the team to speed up their response time. The investigate any suspected case, do contact tracing at prime locations, do monitoring and follow up for persons of interest whether on self isolation or not. The follow up people who come into the state for essential duties and give daily update on state dash board.
There are 20 rapid response team members at the State level, 90 (5 in each LGA) at the LGA level, totaling 110. We also have 30 contact tracers at the State level, and 10 per LGA, totaling 210 persons.

At the level of the various Local Governments, Disease Surveillance and Notification Officers (DSNO), Assistant DSNO as well as rapid response team exist. The work with Primary health Care directors and incharge of facility to pull up a response at that level. All Primary health care workers have been trained on COVID-19 Infection Prevention And Control Protocol by the Cross River State Primary Health Care Development Agency with support from National Primary Health Care Development Agency  and State Ministry of Health. The team at LGAs do active case search at health Facilities, borders and community level and report same on EOC dash board daily. 
Their phone numbers are in public domain, the receive alert and calls for suspected case which the work with the laboratory personnel at LGA levels to collect samples of cases that fit case definition and send same for testing immediately. The also report to the state epidemiologist who reports through the director of Public Health to the Commissioner for health and Chairman of COVID-19 Taskforce daily At situation room.

Challenges: Failure of NCDC to respond to our request for testing site at Lawrence Henshaw Memorial Hospital and UCTH despite the provision by the CRS govt of a PCR machine and Gene-Xpert machines in at least two facilities in Calabar. The travel distance, risks, delays at the testing center sometimes due to lack of reagents, extraction kits, Etc and costs involved may have possible effects on waiting time of the various samples which eventually gets tested. We continue to work and improve on all these fronts, provide vehicles for the teams to move around easily and carry out their duties.

3. Case management pillar activities - pillar handles training, staffing, treatment logistics and directly supervises clinical care of patients at the isolation/treatment centres. The pillar oversees 3 isolation centres, 2 are located in Calabar and 1 in Ogoja with a 130 bed space capacity. It also oversees holding centers in all General hospitals in the state. This pillar has so far conducted 8 batches of scheduled infection prevention and control (IPC) training of all cadres of volunteer healthcare workers in efforts to meet our initial target of 400 volunteer healthcare workers. The first three training in this target took place between Feb and March 2020 in the UCTH isolation facility. Doctors, nurses, pharm, scientists, cleaners, sanitarians, morticians, technicians and sundry staff, as well as ambulance drivers were trained. In all, a total of 40 workers pulled from private, military and federal healthcare facilities in Calabar and environs were trained in the first phase. The next (4th phase) was the training of trainers (TOT) which took place in two sites (PH &  UCTH in Calabar). A total of 26 trainers were trained in a 7 day training program at the instance of the state Government in the presence of NCDC trainers. The NCDC staff participated as resource persons in both the Port Harcourt and Calabar training programs. 

The 3rd large scale training of 140 Volunteer clinical healthcare professionals followed in a 16 day training program using UNICAL as venue. The next training phase saw a total of 72 healthcare volunteers, including doctors, nurses, and the paramedicals held in Abakpa, Ogoja. 

Finally, a large scale training of 70 healthcare support volunteer staff including technicians, sanitarians, orderlies and cleaners were trained last week in UNICAL. 18 Disease surveillance and Notification officers as well as 24 Assistant Disease Surveillance and Notification officers and 14 Rapid response team have been trained by WHO and NCDC supported by Cross River Ministry of Health.

From our Data, over 400 healthcare workers have been trained which is more than enough for a 6 months deployment with each one working only two weeks in a 5 weeks rotation plan. They have IPC and other retraining programs in between the deployment period.

The COVID 19 case treatment - . knowing that we have testing challenges, the taskforce has continually revised our care to reflect standard WHO/ NCDC approved treatment guidelines for COVID 19. Our clinical team is made up nearly entirely of consultant infectious disease experts who have NCDC/WHO IPC certification. The team has a great decade old experience having been involved in the management of Ebola, Lassa fever and sundry infectious disease conditions so far. Under their watch, a total of 15 admissions have been registered in the CRS COVID-19 Facility in UCTH. All cases were treated as COVID 19 and all care that any COVID-19 patient would receive was given to them free of charge. We have recorded 4 mortalities and all test results have been negative. Other patient who were suspected cases in other facilities were triaged and most didn’t meet case definition but were all treated and discharged home in good health and have all remained well on follow up while no one around them have showed any sign or symptoms of COVID-19 as well as the care givers who attended to them. Those who passed on were aged and had serious health condition before this time including asthma, diabetes, Chronic renal failure hypertension, etc. We send our sincere condolences to the families and friends of those who have passed away in circumstances which pathologists are still investigating. 

The public must know that testing for COVID-19 does not work any magic as we are made to think. It does not change the treatment protocol in our centers as case management requirement are largely based on clinical presentations and other inter-current conditions. Testing Data are useful for purposes of protecting contact and for research purposes. It doesn’t add to how the patient should be treated. We start on antibiotics and anti malaria as well as other empirical treatment methods. As such a positive or a negative result doesn’t change the clinical care given to patient even after the results are out!

Once there is a suspected case IPC protocol is used with a zero-error approach where all contact use PPE and other protective measures as if all our suspected cases are positive for COVID-19. This is an expensive approach but the over ridding interest of our people have made us to adopt this method while we continue to push for the establishment of our testing laboratory in the state. The State Government has put together mortality data from 2018, 2019, 2020 in the public hospitals in the state and 2020 has showed the least mortality in the state.

4. Point of Entry- 
The Government of Cross River started screening of persons coming into the state as early as January with a holding bay at the Margret Ekpo international airport working with the health port officials. We had screening at motor parks, seaport,  airport, interstate borders and major roads. state purchased 50 vehicles initially for the COVID-19 Taskforce monitoring activities and later increased same to make 100. These vehicles were deployed to all our border points across the state ( both Legal and illegal routes) as well as calabar metropolis for enforcement. The Governor of the state Sen. Ben Ayade who some times kept vigil himself at entry points, detailed commissioners, Special advisers, political appointees, traditional rulers, local vigilante and security agencies to man this points. The point of entries also have health workers detailed there to screen persons coming into the state for essential services using infrared thermometers, while the make them wash their hands, use mask and hand sanitizers. Some temporal quarantine bay exist at some borders where suspected cases can be kept awaiting the arrival of the rapid response team.

5. Risk Communication:
The state started massive sensitization of the public in January this year. Several jingles in various dialects, TV shows, radio shows, press releases, IEC materials, billboards, posters town criers in villages etc have been used to sensitize the public. We have also collaborated with Christian Association of Nigeria, Muslim groups and traditional rulers as well as ward development committee to take information down to grass roots. The independent verification by staff of NPHCDA showed 100% of persons in a village randomly asked knew about Corona Virus and how to prevent it. We have not relented in using all available mediums including social media to reach out to our teaming population.

6) Legislation- 
As part of the response, the Cross River state Government have partnered with the Cross River State house of assembly to pass a bill for public health safety during pandemics or outbreaks which has been signed into law by the Governor. The law stipulates very hard sanctions for persons who violate public health guidelines in the state. Enforcement has received a boost from the judiciary who provided mobile court across the state where offenders can be tried on the go!

7) Welfare and sustainable palliative- 
While protecting lives, the Government of Cross River State has worked hard to protect livelihood of its citizens. We provided food stuff and other commodities for the old and vulnerable in society through three gateways; Religious gateway, traditional rulers council and the third gate way was using the World bank register for persons who are poor and vulnerable. Palliatives have also been given to vulnerable groups like physically challenged, sickle cell society amongs others. The Governor also approved the employment of 8000 workers with the health sector receiving approval for 400 doctors, 600 nurses and 1000 surveillance officers. Others were employed to work at Cross River state garment factory, security outfits, environmental beautification, Agricultural sector were the plant and distribute rice seedling as well as support food production in the state etc.

8) Other response activities - 
the task force has sustained a public health policy enforcement teams located in the various borders, major city and highway intersections and our major urban streets. Their aim is to enforce compliance on public health safety guidelines so far provided by the executive Governor, NCDC and the WHO. Such include, use of facemasks while in the public, physical distancing, ban on crowding activities such as churches/ mosque, markets and sports, recreation/clubs/entertainment places within our states.
Despite our meagre monthly allocations from the federal government, these activities have come at a huge financial cost to the state. Despite these challenges, our routine healthcare services have remained opened for our men, pregnant women, children and the aged. 

8) What’s New?- 
The state Government has commenced massive screening for persons at border communities and areas of interest using the antigen RDT method that has 100% specificity and 95% sensitivity. Furthermore, we will commence training for Head teachers and principals of schools working with the Ministry of Education to prepare them for school resumption which might happen anytime soon.

5. Appeals - We continue to solicit well meaning individuals for enforcement of safety public health guidelines in our populations. Churches, CSOs, private sector organizations and the traditional institutions to promote the need for our citizens to take personal responsibilities for full implementation of our preventive measures. 

- Even as we welcome all the criticisms that continue to come, we call on the members of our health industry academia to dedicate their time and resources in researches into COVID 19. You have the capacity to take full advantage of the pandemic as has been the cases in other climes of the world. On our part, we will be ready to support such research proposals that generate the much needed data, treatment, vaccines, and other useful response to the COVID 19 pandemic. 
It is very disheartening to note that our health research ethics bench has not received any such proposal from our teaming professors and young researchers in the numerous faculties of our federal and state academia communities.

- We continue to request assistance from the federal govt and NCDC for a COVID 19 testing facility in IDH Calabar. We want to clarify that there is no award for a COVID 19 free state in this pandemic. We take no pride in attaining a negative status at the expense of our innocent citizens who depend on us in a time like this.

We are calling on Cross Riverians to use their mask always and observe all the measures put out. It’s not about Government but about you, protect yourself!

Comrade Daniel Williams
Personal Assistant On New Media 
To the Governor Of CRS

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