Abstract
BackgroundMany persons with active SARS-CoV-2 infection experience mild or no symptoms, presenting barriers to COVID-19 prevention. Regular temperature screening is nonetheless used in some settings, including university campuses, to reduce transmission potential. We evaluated the potential impact of this strategy using a prospective university-affiliated cohort.MethodsBetween June and August 2020, 2912 participants were enrolled and tested for SARS-CoV-2 by PCR at least once (median: 3, range: 1–9). Participants reported temperature and symptoms daily via electronic survey using a previously owned or study-provided thermometer. We assessed feasibility and acceptability of daily temperature monitoring, calculated sensitivity and specificity of various fever-based strategies for restricting campus access to reduce transmission, and estimated the association between measured temperature and SARS-CoV-2 test positivity using a longitudinal binomial mixed model.ResultsMost participants (70.2%) did not initially have a thermometer for taking their temperature daily. Across 5481 total person months, the average daily completion rate of temperature values was 61.6% (median: 67.6%, IQR: 41.8–86.2%). Sensitivity for SARS-CoV-2 ranged from 0% (95% CI 0–9.7%) to 40.5% (95% CI 25.6–56.7%) across all strategies for self-report of possible COVID-19 symptoms on day of specimen collection, with corresponding specificity of 99.9% (95% CI 99.8–100%) to 95.3% (95% CI 94.7–95.9%). An increase of 0.1 °F in individual mean body temperature on the same day as specimen collection was associated with 1.11 increased odds of SARS-CoV-2 positivity (95% CI 1.06–1.17).ConclusionsOur study is the first, to our knowledge, that examines the feasibility, acceptability, and effectiveness of daily temperature screening in a prospective cohort during an infectious disease outbreak, and the only study to assess these strategies in a university population. Daily temperature monitoring was feasible and acceptable; however, the majority of potentially infectious individuals were not detected by temperature monitoring, suggesting that temperature screening is insufficient as a primary means of detection to reduce transmission of SARS-CoV-2.
Highlights
Many persons with active severe acute respiratory syndrome (SARS)-CoV-2 infection experience mild or no symptoms, presenting barriers to COVID-19 prevention
Temperature monitoring was feasible and acceptable; the majority of potentially infectious individuals were not detected by temperature monitoring, suggesting that temperature screening is insufficient as a primary means of detection to reduce transmission of SARS-CoV-2
All participants with at least one valid polymerase chain reaction (PCR) test result who reported not having tested positive for SARS-CoV-2 prior to enrollment were included in this analysis (n = 2912)
Summary
Many persons with active SARS-CoV-2 infection experience mild or no symptoms, presenting barriers to COVID-19 prevention. One of the most challenging features of the COVID-19 epidemic to date is considerable pre-symptomatic [2] and asymptomatic transmission [3, 4], currently estimated to comprise anywhere from 6 to 41% of infectious individuals [5]; many other individuals may experience only mild symptoms. This presents barriers to epidemic control by impeding rapid isolation of cases, and makes it necessary to develop nuanced screening approaches that will both limit infectious exposure and be a useful trigger for SARS-CoV-2 testing. The United States Food and Drug Administration (FDA) released a statement in June 2020 noting that non-contact temperature assessment devices “are not effective if used as the only means of detecting a COVID-19 infection” [16]
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