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Temperature in Nursing Home Residents Systematically Tested for SARS-CoV-2
James L Rudolph1, Christopher W Halladay2, Malisa Barber2
1Providence Veterans Administration Medical Center, Providence, RI; Brown University School of Public Health, Providence, RI; Warren Alpert Medical School of Brown University, Providence, RI.
Journal of the American Medical Directors Association
|July 18, 2020
Summary
Standard fever screening misses many nursing home residents with COVID-19. Monitoring temperature changes from a personal baseline is more sensitive for detecting SARS-CoV-2 (the virus that causes COVID-19) in this population.
Area of Science:
- Gerontology
- Infectious Diseases
- Public Health
Background:
- Many nursing home residents infected with SARS-CoV-2 are not detected by standard COVID-19 screening.
- Current screening relies on a fever threshold of 38.0°C, which may be insufficient.
- Nursing home residents are a vulnerable population requiring effective screening strategies.
Purpose of the Study:
- To describe temperature changes in nursing home residents before and after SARS-CoV-2 testing.
- To evaluate the effectiveness of the current fever threshold for COVID-19 screening in this setting.
- To identify potential improvements in screening protocols for SARS-CoV-2 in long-term care facilities.
Main Methods:
- A cohort study was conducted in 134 Veterans Affairs Community Living Centers (CLCs).
- Temperature data were collected for 14 days before and after universal SARS-CoV-2 testing for 7325 residents.
- Baseline temperatures were established using data from 5 days prior to the study window.
Main Results:
- SARS-CoV-2 was identified in 6.0% of residents.
- The average maximum temperature for SARS-CoV-2-positive residents was 37.66°C, compared to 37.11°C in negative residents (P=.001).
- Only 26.6% of SARS-CoV-2-positive residents met the 38.0°C fever threshold; however, 62.5% had at least two 0.5°C elevations above their baseline.
Conclusions:
- A single temperature screening is unlikely to detect all nursing home residents with SARS-CoV-2.
- Repeated temperature measurements using a patient-derived baseline can enhance detection sensitivity.
- The current fever threshold for SARS-CoV-2 screening in nursing homes should be reconsidered.
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