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      The non-contact handheld cutaneous infra-red thermometer for fever screening during the COVID-19 global emergency

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      The Journal of Hospital Infection
      The Healthcare Infection Society. Published by Elsevier Ltd.

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          Abstract

          Sir, The recent article ‘Novel coronovarus is putting the whole world on alert’ highlighted the need for a large-scale programme to screen or detect individuals who may be infected by the novel coronavirus COVID-19 [1]. International media coverage of the COVID-19 global emergency has repeatedly depicted the popular but, to the author, disturbing use of the non-contact handheld infra-red thermometer to screen for fever at hospitals, primary care clinics, and commercial buildings. Pulmonary artery catheterization is the reference standard to measure core body temperature, but is invasive, requires specialized skills and equipment, and is not suitable for screening of large cohorts [2]. Instead, surrogates such as rectal and oral thermometers are less invasive and moderately correlate with core body temperature but require contact with bodily fluids and hence risk contamination. The tympanic infra-red thermometer frequently used in patient care has been shown to correlate with core body temperature [2,3]. Although the handheld cutaneous infra-red thermometer is popularly used to screen large cohorts as it is portable, does not require contact and does not cause discomfort to the individual being assessed, there is little data to support its use. Among common cutaneous infra-red thermometers evaluated for their ability to measure temperature traceable to the International Temperature Scale of 1990 (ITS-90), the majority performed outside the accuracy range stated by the manufacturers and the medical standard [4]. The handheld cutaneous infra-red thermometer was less accurate than the tympanic thermometer and other infra-red thermal systems for temperature measurements and fever detection [3,[5], [6], [7]]. A local study found the handheld infra-red thermometer to have a low sensitivity of 29.4% when compared with the oral thermometer to detect fever [7]. In addition, its performance is operator-dependent, as the thermometer is aimed at the temple or forehead, and distance between the thermometer and skin may affect its accuracy. It is not unlikely that sub-optimally trained operators, shying away from close contact with those being screened, hold the thermometer further away than the required proximity and thus compromise its effectiveness. In a possible pandemic, a false negative is a false reassurance and a potential future infection cluster. Conflict of interest statement None declared. Funding sources None.

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          Most cited references7

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          Novel coronavirus is putting the whole world on alert

          The year of 2020 began with deep concern associated with the onset of a novel coronavirus outbreak in Wuhan, China. Coronaviruses have become associated with deadly respiratory infections in humans following the emergence of severe acute respiratory syndrome coronavirus (SARS-CoV) in Guangdong, China, during 2002, which affected 8098 people in 37 countries [1]. There then followed the Middle East respiratory syndrome coronavirus outbreak (MERS-CoV) [2]. While the world was still dealing with the MERS-CoV, another highly pathogenic coronavirus, currently named 2019-novel coronavirus (2019n-CoV), emerged in Wuhan, China. Similar to the transmission of SARS-CoV and MERS-CoV, 2019n-CoV has also been reported to be transmitted to humans from wild animals, in this case in a wet market. However, whereas likely animal sources of SARS-CoV and MERS-CoV have been identified, the likely animal source of 2019n-CoV has yet to be confirmed [3]. Early in the 2019n-CoV outbreak it has become clear that the virus can be transmitted from human to human. Due to the high rate of mortality and potential to cause further epidemics, it is necessary to develop therapeutic and preventive strategies. A group of Chinese scientists at the National Engineering Research Center for the Emergency Drug, Beijing Institute of Pharmacology and Toxicology, 100850, Beijing, China has started work on designing an effective drug against 2019n-CoV. Also, Rolf Hilgenfeld (University of Lübeck, Germany) has plans to test two compounds for their efficacy against 2019n-CoV. Furthermore, a research team in Shenzhen and Shanghai has already isolated the 2019n-CoV and developed the first candidate vaccine. The vaccine is said to be ready for trials next month. A study reported that 2019n-CoV infection in most of the patients is associated with the onset of pneumonia and the development of complications including acute respiratory distress syndrome [4]. During the first 20 days of its outbreak, 2019n-CoV has caused the death of 106 individuals and has affected 4515 individuals. However, the number of affected people is rising by the hour. The infection has spread throughout China and has reached several other countries, thus creating global concern. To prevent the further spread of infection, the Chinese government has imposed a partial or full lockdown on approximately 60 million people including the inter-provincial bus services in Beijing and Shanghai. Other control measures have included cancellation of public events, including the new year festival, restrictions on human contact with wild animals, screening at airports, deployment of army medical units, and the construction of two emergency hospitals in Wuhan [5,6]. The hope is that the early implementation of these measures will be effective in preventing large-scale spread of the virus. According to the mayor Zhou Xianwang, at a press conference on January 26th, 2020, approximately five million residents left Wuhan for other provinces within China and thousands of people left Wuhan for other countries before the lockdown. Wuhan is home to a large number of immigrants, and thousands of international students in its 89 universities and colleges were also heading home for the holidays [7]. Therefore, we can expect this large-scale movement of people to lead to the outbreak spreading within China to other provinces, as well as to other countries. A large-scale programme to identify and screen exposed persons should help control the virus. However, this is a very challenging and time-consuming task; the Governments of China and other susceptible countries need to be on red alert and to design strategies for this and for future outbreaks of infection with novel viruses. In China and other countries this may necessitate more regulation around the retail market in wild animals. The control of 2019n-CoV will remain challenging as travel restrictions are lifted and potentially infectious people begin to move around more. Screening at airports is one key control measure, but already one lady has managed to mask her symptoms and signs, evading coronavirus health checks at the airport [8]. It is not yet clear whether 2019n-CoV has the potential to cause a global pandemic. However, in the mean time, as well as the obvious concerns about the lack of specific treatment or a vaccine, the psychological and economic stresses resulting from control measures such as mass quarantining should not be underestimated. 2019n-CoV is perhaps the first novel infection with pandemic potential to emerge in the era of large-scale social media use. Authorities need to be mindful of both the potentially negative and positive impacts of social media in managing outbreaks of infection in the community.
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            Cutaneous Infrared Thermometry for Detecting Febrile Patients

            We assessed the accuracy of cutaneous infrared thermometry, which measures temperature on the forehead, for detecting patients with fever in patients admitted to an emergency department. Although negative predictive value was excellent (0.99), positive predictive value was low (0.10). Therefore, we question mass detection of febrile patients by using this method.
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              Limitations of forehead infrared body temperature detection for fever screening for severe acute respiratory syndrome.

              We investigated alternative measurement methodology for infrared body thermometry to increase accuracy for outdoor fever screening during the 2003 SARS epidemic. Our results indicate that the auditory meatus temperature is a superior alternative compared with the forehead body surface temperature due to its close approximation to the tympanic temperature.
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                Author and article information

                Contributors
                Journal
                J Hosp Infect
                J. Hosp. Infect
                The Journal of Hospital Infection
                The Healthcare Infection Society. Published by Elsevier Ltd.
                0195-6701
                1532-2939
                21 February 2020
                21 February 2020
                :
                Affiliations
                [1]Frontier Medical Group, Singapore
                Author notes
                []Address: 163 Ang Mo Kio Avenue 4 #01-426, 560163, Singapore. Tel.: +65 64532571. med00114@ 123456yahoo.com
                Article
                S0195-6701(20)30058-X
                10.1016/j.jhin.2020.02.010
                7134396
                32092368
                337b0cb5-e285-48dd-9e13-0a0a5e12f1fc
                © 2020 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 11 February 2020
                : 17 February 2020
                Categories
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                Infectious disease & Microbiology
                Infectious disease & Microbiology

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