INTRODUCTION
The global pandemic tagged Coronavirus disease-2019 (COVID-19) started in December 2019 in Wuhan, Hubei Province of the Peoples Republic of China.¹ This disease is caused by a Ribonucleic Acid (RNA) virus known as the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov2). The World Health Organization (WHO) declared the disease a pandemic in January 30, 2020. Since then, it has affected over 190 countries with about 72 million cases and over 1.6 million deaths.^2–4 The confirmed index case in Nigeria was detected in the Southwestern state of Lagos on 27 February 2020; since then, the number of confirmed cases nationwide  rose to 164,719 and 2,062 deaths as of 27th April 2021.^2–4 During the first wave, there was an increased transmission to health workers with widespread panic in the health sector and many health facilities were shut down once a case was confirmed on their premises.

The index case in Ondo State, Southwest of Nigeria, was detected on 4th April 2020. As of 27th April 2021, the total number of reverse transcriptase polymerase chain reaction (RT-PCR) test confirmed cases in the state was 3,242, with 63 deaths.⁴ The state-owned University of Medical Sciences Teaching Hospitals (UNIMEDTH) which comprises three hospital complexes located in Akure (the capital city) and Ondo town; predominantly suburban settings, bore the brunt of the pandemic.

Radiodiagnosis plays a key role in the management of COVID-19 cases,^5–8 especially in the tropics where communicable respiratory disease prevalence is very high and there is an emerging trend of increasing non-communicable chronic respiratory conditions.⁹ High-Resolution Computerised Tomography of the Chest (HRCT), especially when the pre-test probability of the disease is high, has become a useful tool in assisting physicians to categorise risk for COVID-19 while awaiting the result of reverse transcriptase polymerase chain reaction (RT-PCR).⁶

Since the announcement of the first case in Ondo State, our department has been actively involved in the evaluation of suspected cases. The hospital’s standing protocol included triaging based on clinical presentation (cough, fever, breathlessness), history of contact with a confirmed case, travel to/from an endemic region, desaturation in room air, and HRCT scan for all suspected cases.

As the disease achieved pandemic proportions in January 2020, a global biting scarcity of personnel protective equipment (facemasks, protective gloves, goggles/face shields, and protective clothing) ensued.^10,11 Gradually, industrial production of these items was ramped up, especially after the subsidence of the epidemic in China. Despite increased exports from China, there was scarcity in developing countries.¹⁰ The combination of the developed nations massive purchase of these protective equipment as well the low financial capability of the developing nations may have been responsible for the scarcity and made the latter’s frontline healthcare workers, on the average, poorly protected against the COVID-19 virus while rendering health services. There were donations of funds, protective equipment and ventilators to some African countries, which made little impact on healthcare workers needs for protection.^10,11

This is a report of our approach to healthcare personnel and patient protection during the first wave of the COVID-19 pandemic at our department of radiology. This article should be of help to other radiology departments grappling with the COVID-19 pandemic under similar circumstances.

METHODOLOGY
This is an observational report on the approach for curtailment of COVID-19 disease transmission to departmental staff and the outcome, at the University of Medical Sciences Teaching Hospitals (UNIMEDTH), Ondo State Nigeria. The radiology department staff strength is 66 in the 3 complexes that make up our institution. The facility is resource constrained and the approach utilized to curtail COVID-19 disease transmission to departmental staff was observed between April 2020 and April 2021 by taking notes and pictures.

Below, the approach utilized is described, results are presented, discussed and conclusions and recommendations are made.

APPROACH
The general principles of radiation protection already established in radiology (Personnel Protection and Equipment, Distance, and Time)¹² were adapted to combat the pandemic.

Personnel Protection

Our hospital suffered a scarcity of protective gear. With increased role of our radiology department in the management of COVID-19 cases, wearing of facemasks by all patients and relatives passing through the Radiology department became compulsory. We also instituted the protection of the Radiology staff as follows;

Standard Protective Gear (Fig. 1A)

• Reusable Face Shields or protective goggles
• Disposable latex gloves.
• Face masks; N95 and KN95 varieties with respirators that were reused for up to 2 weeks wearing cloth/non-surgical face masks underneath. The hospital infection prevention and control (IPC) team trained the staff on a procedure of dipping the masks in detergent solution, rinsing, and airing to dry. One-ply surgical grade facemasks were reused to a lesser extent.
• Non-reusable disposable surgical gowns
• Reusable surgical gowns that are worn once and sent to be cleaned in the CSSD

Specific Donning and Doffing Sequence
Because of the compact nature of the Radiology departments in the 3 complexes, there were no demarcated ‘Donning/Doffing’ areas. Each active unit/room had specific closed lid plastic bins with foot pedals that were labelled “used” (Fig. 1B). These were placed in a remote corner of the rooms (areas with minimal traffic) and had 1.0m² perimeter box drawn on the surrounding floor. The worn gowns were placed in these as soon as they were taken off. The “sterile/unused” gowns were retrieved from a central bin storage in the departmental store by a health attendant (Sterile Health Attendant (SHA) designate for the day) and handed over to the staff. The process of donning follows the WHO and NCDC protocol.