Temperature checks
HealthJuly 24, 2020

Back to work: Are workplace temperature checks enough?

Public health leaders in many regions are giving a wary OK to slowly reopen businesses and public spaces with best practices to reduce transmission risks. In some areas, workplaces are reopening as government-phased policies permit. Employers are looking for ways to enhance workplace health and safety, and one popular measure being implemented is temperature scanning checks to look for persons with elevated temperatures, one possible symptom of COVID-19. But are temperature checks an effective measure to ensure workplace health and reduce risks of contagion?

Casting a net to screen for COVID-19

Mackenzie Weise, an epidemiologist and infection prevention clinical program manager at Wolters Kluwer, commented that temperature checks alone will not be effective and should be considered one of several tools used to identify COVID-19. She specified that only a subset of infectious cases present with fever and likens the limitations of temperature screening to using a net to catch butterflies. The net may catch some butterflies, but won’t catch them all and other insects may be inadvertently caught. Similarly, temperature checks can help identify people with high temperatures due to COVID-19, but may also result in false negatives and positives where some COVID-19 cases could go unidentified and some non-cases could be misidentified.

Why do workplace temperature checks often come up short in identifying workers who pose a risk?

A few factors include:

  • Training: Inadequate and inconsistent training for those conducting the checks can lead to improper use of the equipment. Mistakes can be as simple as an incorrect distance between the infrared thermometer and the person being checked — causing averaging errors that lower the temperature. Errors can also arise if the thermometer is aimed at the wrong part of the face — a forehead will be different than eyes near the tear ducts for example.
  • Symptoms: Not all infectious cases present with fever. Also, feverish symptoms can be easy to mask with over-the-counter antipyretic medicine like acetaminophen. World health experts also suggest individuals that may not have symptoms may be able to transmit the virus.

    “As many as 25% of infected individuals may actually remain asymptomatic according to the CDC so that adds to the complexity of temperature screenings for COVID-19,” cautions Mackenzie Weise

  • False results: Even if infrared thermometers are used correctly, there is still a chance of false negatives or false positives caused by environmental factors. Someone sitting in a car near an air conditioning vent just before entering work could chill his or her surface temperature just enough to mask symptoms. Running to avoid being late to work on a hot day or sitting in a hot car just minutes before testing may elevate one’s surface temperature enough for an improperly trained screener to identify a false positive. Another consideration is a stomach bug might be accompanied by a fever, and while that person should not be admitted to work, the false positive may result in unnecessary COVID-19 follow-up and testing.

Temperature checks are not a quick fix

Temperature checks implemented by themselves are not enough. If workplace health and safety managers screen workers, there needs to be a clear set of protocols to manage questions and scenarios encountered. For those identified as having a fever, says Weise, “Important next steps include promptly isolating infectious individuals from others, connecting them to care and/or testing, and providing clear information on how to prevent additional transmission. Simply restricting a person from entering a factory or office building due to a fever does not do enough to ensure the safety of the broader community.” Best practice policies and coordination with public health leaders is needed for communities to stay healthy. If temperature checks are used, they should be leveraged as one way to help people with COVID-19 symptoms receive the care they need.

Screening and privacy concerns

Screening employees and visitors as they enter a workplace may involve an infrared thermometer that takes a reading, but doesn’t record it or associate it with an employee. If any logging of temperatures is done, this raises questions about the protection of worker health data. Should it be treated like patient data? Who is conducting the checks? What will happen to the information collected? Companies should be prepared in advance with a well-defined process and policy that is communicated effectively to address these questions in order to respect worker privacy and to avoid confusion during the temperature check process.

After months of quarantine, employees may be eager to get back to the workplace to restore income or business as usual. A lot is at stake and it’s easy to think of temperature checks as a quick fix to put everyone’s minds at ease in the push to resume pre COVID normalcy. In reality, temperature screening will only catch some people with COVID-19 some of the time. While that will alleviate some anxieties, it may foster a false sense of security if workplaces do not also build broader, more comprehensive policies and job site modifications to tangibly reduce transmission risks that can further impact their employees, their businesses and their communities.

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