During the COVID-19 pandemic, a common ritual at hospital entry for healthcare workers is having their temperature and/or symptoms checked upon showing up for their shift. The problem and it is no small one, given the time and resources required for screening is that it rarely works.

“Perhaps surprisingly, there are very few publications about the ability to detect cases among healthcare personnel [during the pandemic],” said David Kuhar, MD, a medical officer in the division of healthcare quality promotion at the Centers for Disease Control and Prevention. “However, we received anecdotal reports from professional societies, state and local health departments, and facilities that temperature screening was just not identifying many cases, if any cases at all.”

Airports have widely implemented screening among passengers, but modeling estimates show they are missing at least half of the cases, Kuhar said at the IDWeek 2021 virtual meeting, held Sept. 29-Oct. 4, 2021.

A healthcare report indicated that, among patients who were admitted with SARS-CoV-2 and had positive tests, only 16 (19%) out of 68 had a fever.1

“Temperature screening during the pandemic has not efficiently identified cases and — it’s not a stretch of the imagination — it is not likely an efficient strategy for detection of other respiratory illnesses,” he said. “We know that people can have influenza and not have fevers, [even though] there may be presymptomatic [viral] shedding.”

Symptom screening has the advantage of looking for more data points, such as a sore throat, shortness of breath, and cough.

“You’re able to cast a wider net,” Kuhar said. “The biggest cons are that it is not objective, and symptom screening really is only ever as good as people are aware of [symptoms] and willing to share them.”

Some hospitals have gone to electronic reporting of symptoms to speed the process up and allow those with no symptoms to enter quickly.

“There are minimal reports of symptom screening alone detecting infected healthcare personnel, which I found a little surprising,” Kuhar said. “However, from anecdotal reports, we heard from many facilities, as well as health departments, that very few cases were being identified with symptom screening at all, with some places reporting none.”

Could Work as Deterrent

That does not necessarily mean symptom screening has no value, Kuhar added, noting that it still may discourage workers from coming in sick.

“Active screening may end up discouraging personnel with symptoms from even testing the [facility] doorway and just staying home,” he said.

For a variety of reasons, from a facility’s work culture to its policy on paid sick leave, the oft-described phenomenon of “presenteeism” persists in healthcare.

“It can depend upon the job of the employee, their social status in the organization, and the care demands of their work,” he said. “Commonly identified reasons include local [work] culture, an unwillingness to disappoint colleagues, even a fear of consequences for taking days off. Are you going to develop a reputation for leaving work to colleagues? Someone’s individual work ethic can affect this.”

Healthcare leadership sets the tone for the work culture, so unless the problem of presenteeism rises to their level, any substantive change is unlikely.

“Without it coming from the top, it’s generally not going to happen,” Kuhar said.

For example, leadership can remove barriers for personnel in taking sick days, such as providing pay for those days to remove the financial pressure that drives presenteeism.

“Create policies that require restriction from work when ill,” he said. “It’s very different when the message is ‘We don’t want you to come to work when you are sick’ vs. ‘If you’re not feeling well, you don’t have to come to work.’ It’s really a different message when it’s clearly, ‘do not do this.’”

The current challenge of staffing certainly is a factor, but there has always been some element of threadbare resources and limited backup in many facilities.

“There are actually reports of healthcare workers coming to work when ill — even with respiratory symptoms — and they have paid sick days that they simply haven’t taken,” Kuhar said. “If there’s no backup, if there’s no person to cover their job, people are going to be much less likely to stay out of work when they’re sick.”

REFERENCE

  1. Mitra B, Luckhoff C, Mitchell RD, et al. Temperature screening has negligible value for control of COVID-19. Emerg Med Australas 2020;32:867-869.