key: cord-1015275-qgbhjjc7
authors: Vilke, Gary M.; Brennan, Jesse J.; Cronin, Alexandrea O.; Castillo, Edward M.
title: Clinical features of covid-19 patients: is temperature screening useful?
date: 2020-09-21
journal: J Emerg Med
DOI: 10.1016/j.jemermed.2020.09.048
sha: 3affeba181c47545758a6aef76c8f9459a5c60d2
doc_id: 1015275
cord_uid: qgbhjjc7

Background As many businesses reopen following government-induced restrictions, many public agencies and private companies, such as banks, golf courses and stores, are using temperature screening to assess for possible COVID-19 infection for patrons and employees. Study Objective To assess the frequency of a fever of 100.4°F or higher and other symptoms associated with COVID-19 among Emergency Department (ED) patients who are tested in the ED for the illness. Methods This is a retrospective review of data from patients who were tested for acute COVID-19 infection from March 10, 2020 through June 30, 2020 at two EDs within the same health system. Data collected included temperature, the presence or recent history of COVID-19 related symptoms and COVID-19 test results. Descriptive statistics are reported for presenting fever and other COVID-19 related symptoms alone and in combination with presenting fever. Results A total of 6,894 patients were tested for COVID-19 infection. Among these, 330 (4.8%) tested positive for active infection. Of these patients, 664 (19.4%) presented with a fever of at least 100.4ºF (38.0ºC). Increasing the number of COVID-19-related symptoms in combination with a presenting fever of at least 100.4°F increased the number of people who could be identified as having COVID-19 infection. Conclusion About a quarter of patients who were tested positive for COVID-19 in our ED do not have a fever at presentation greater than or equal to 100.4°F. Using temperature only to screen for COVID-19 in the community setting will likely miss the majority of patients with active disease.

The novel coronavirus, COVID-19, pandemic has caused challenges in both medical and 29 economic communities worldwide. While many medical systems dealt with an exponential increase in 30 census that left them short on resources to safely manage patients and protect healthcare providers, other 31 systems planned for a surge of COVID-19 patients that never came potentially due to the government-32 issued stay-at-home order, social distancing, non-essential business closures and public gathering 33 restrictions to reduce the spread of the virus and "flatten the curve". As businesses such as banks, golf 34 courses and restaurants reopen, many are using temperature screening as the primary way to assess 35 patrons and employees for possible COVID-19 infection.

Although elevated temperature is not specific to having a COVID-19 infection, it has been 37 considered a main clinical finding of the viral infection among other symptoms at initial presentation (1- 38 3). However, a fever is consistent with other potentially contagious illnesses for which avoiding public 39 places is also beneficial to others. Many medical facilities are using temperature in addition to wellness 40 questionnaires to screen patients and staff (4-5). The question that remains, however, is whether elevated 

The purpose of this study is to assess the frequency of a fever of 100.4°F or higher and other 50 symptoms associated with COVID-19 among patients tested for the illness when they present to the 51 Emergency Department (ED). 

We conclude that a majority of patients who were tested positive for COVID-19 in our ED do not J o u r n a l P r e -p r o o f 

COVID-19 patients' clinical characteristics, discharge rate, and 160 fatality rate of meta-analysis

Characteristics of COVID-19 infection in Beijing

Clinical characteristics of 3,062 COVID-19 patients: a meta-analysis 165

The role of triage in the prevention and control of COVID-19 168

Coronavirus Disease 2019 (COVID-19) and Pregnancy: 171 Responding to a Rapidly Evolving Situation

Clinical and epidemiological features of 36 176 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort 177 study

Analysis of factors associated with disease outcomes in 179 hospitalized patients with 2019 novel coronavirus disease

Preliminary Results of Initial Testing for Coronavirus 182 (COVID-19) in the Emergency Department

Communities that have re-opened or considered reopening need more accurate measures than 193 fever alone to screen individuals for COVID-19 infection to prevent the spread of the virus

What does this study attempt show?

Our study demonstrates the need for more accurate and appropriate symptom-based screening 196 measures to be used to guide the economic reopening of communities amid the COVID-19

It also demonstrates that fever alone is not a sufficient marker of COVID-19 infection 198 and thus should not be the sole metric used for screening

What are the key findings?

We found that fever is not present in all cases of COVID-19. In fact, there are inconsistencies in 201 the reported and observed symptoms of COVID-19, none of which have proven to be an 202 effective screening measure for detecting viral infection

How is patient care impacted?

Allowing for premature reopening without safe, accurate guidelines to prevent additional 205

This false 206 sense of security creates a degree of risk in spreading the virus that can further impact the health 207 system unnecessarily and reduce the ability to care for COVID-19 patients as well as other 208 patients in need of healthcare resources