Should Workplaces be Doing COVID-19 Temperature Screening?

Responses to the COVID-19 pandemic need to be proportionate to the assessed level of risk. During all phases of a pandemic we need to do this based on world best practice and with reference to the Australian Government Department of Health COVID-19 SoNG (Series of National Guidelines); developed by the Communicable Diseases Network Australia and endorsed by the Australian Health Protection Principle Committee which advised our National Cabinet.

The USA CDC Alert levels for travel is a useful tool for stratifying the specific tactics that can be employed:

Level 1 – practise usual precautions – enhanced communication
Level 2 – practise enhanced precautions
Level 3 – avoid non-essential travel
Level 4 – do not travel

Our recommendation:

At the Pandemic Alert Level 2: All personnel (staff, contractors, visitors, etc.) with a core body temperature greater than 37.4°C should be prohibited from entering a business-continuity critical workplace. (Body temperature checking may be added or removed to the suite of tactical responses if leaving or re-entering Pandemic Alert level 1.)

Reasoning:

1. “If unwell – stay away”. Normal human behaviour means we cannot rely on people who are ‘viral shedders’ doing the right thing. Most people do, but clearly, some do not. They place their self-interest ahead of, and usually naive to, their employer’s business continuity needs.

2. The 3-D principles of effective workplace behavioural modification are: Deter, Detect and Deal with people fairly. All three principles must apply to achieve the desired behaviour.

3. The only surrogate feature of infectivity that can be objectivity assessed, and on which a discriminatory act may be founded, is elevated core body temperature, not surface body temperature. Real-time POCT (on-site swab tests) for SARS-CoV-2 using RT-PCR testing is not yet widely available.

4. No screening tool is perfect. A screening test leading to a discriminatory act must be confirmed, and if necessary, verified, before the discriminatory action is enforced. Appropriate protocols are essential.

5. While asymptomatic and pre-symptomatic viral shedding may occur, the epidemiology clearly indicates that symptomatic persons with an elevated temperature are much more likely to generate a significant viral load which might then contaminate their environment.

6. Once inside a controlled area all individuals should be monitored. Strategies are necessary to identify and locally quarantine a person if symptoms are suspected and subsequently confirmed by corroboration by an authorised person.

7. Excluding people predictably shedding a potentially infectious virus (of any type) will protect everyone, especially as the COVID-19 pandemic is confounded by seasonal Influenza.
While temperature checking before arrival / site entry will only detect a proportion of all potential viral shedders, it provides a visible deterrent to unwanted behaviour. Checking body temperature will:

(i) visibly demonstrate care and concern for all personnel,

(ii) significantly diminish the concern and anxiety of the well worker, especially if they observe someone who appears unwell while in the controlled area,

(iii) acts as a deterrent to those persons who might otherwise think they are fit to attend the work site.

Author

This article was prepared by Dr. Graeme Edwards on 15th June 2020. Dr. Edwards is a Senior Consulting Physician with extensive experience in Occupational and Environmental Medicine.

Key references:

https://www1.health.gov.au/internet/main/publishing.nsf/Content/cdna-song-novel-coronavirus.htm (updated 4 June 2020)
https://www.who.int/publications-detail/considerations-in-adjusting-public-health-and-social-measures-in-the-context-of-covid-19-interim-guidance (See Annex 3, 12 May 2020)
https://www.iata.org/contentassets/f1163430bba94512a583eb6d6b24aa56/covid-medical-evidence-for-strategies-200525.pdf (updated 25 May 2020