Schools turn to temperature screenings, but will they really keep kids safe?
As most Wisconsin schools welcome students and staff back, they’re armed with an arsenal of tools to fight the coronavirus. For hundreds of school districts, that arsenal includes infrared thermometers, which clock a person’s temperature from a distance and which districts hope will play a role in preventing outbreaks.
More than 4,200 thermometers have been sent to public, charter and private schools around Wisconsin under a partnership of the State Emergency Operations Center and Department of Public Instruction. Bigger districts, like Milwaukee Public Schools or Madison Metropolitan School District, will receive more than 100, and smaller districts will get just a handful.
The thermometers, along with millions of cloth face masks, were provided by the Federal Emergency Management Agency.
They’re seen as a simple front-line defense in preventing infected people from entering schools. But there’s an ongoing debate about how they can be used most effectively.
Temperature checks and symptom screenings aren’t universally recommended by the Centers for Disease Control and Prevention to manage outbreaks in K-12 schools. And health experts say if used alone, they’ll miss some cases, which might give schools a false sense of confidence that their students and staff aren’t infectious.
Fever has been the most frequently reported symptom of COVID-19 among children, according to a July 23 CDC report on screening K-12 students for symptoms.
Yet temperature screenings will miss an infection in a person who is asymptomatic, which the CDC now estimates could be up to 40% of cases nationwide.
“Especially in the school-aged population, their symptoms may not include a fever and often don’t,” said Kurt Eggebrecht, health officer for the City of Appleton. “If you’re using (temperature screenings) as your sentinel indicator, that might give you a false sense of security.”
Even if someone does eventually develop symptoms, scientists believe it’s likely that the person was infectious and could have spread the virus two to three days before the symptoms appeared.
And some people who fall ill never develop a fever at all — the virus instead shows itself through any of the other symptoms of COVID-19, which include difficulty breathing, fatigue, aches, cough, headache, loss of taste or smell, sore throat and gastrointestinal issues. For others, a fever could signify another ailment that’s not COVID-19.
So how helpful will the thermometers be for schools?
A temperature check is simply one strategy for sussing out whether a child might be sick, which is information that can’t hurt, said Dr. Nasia Safdar, medical director of infection control at UW Health in Madison.
“It’s not a perfect system, but it would allow you to capture some people (who are infected),” Safdar said.
Patients and visitors at UW Health undergo a no-touch temperature screening upon entry, in line with federal guidelines from the Centers for Medicare and Medicaid Services on how to safely provide non-COVID health care.
Several districts’ reopening plans note that parents should screen children for symptoms, including taking their temperature, before they go to school each day. The Stevens Point Area Public School District, for example, where most students will be attending school in-person at least two days a week, has asked families to monitor for symptoms including a fever of over 100.4 degrees.
Eggebrecht said he’s a fan of that approach, rather than queuing students up to get a thermometer pointed at their foreheads after they arrive at school, which could cause them to group together in close proximity.
“If you have a line of students and
you’re doing temperature checks, you’re creating a scenario where you’re having little mass gatherings. You may be creating a worse environment than not checking,” he said.
How can fever screenings be most effective?
In an ideal world, Safdar said, we’d adjust to a routine where children are screened at home every day, before coming to school and potentially exposing others to the virus.
But given the busy mornings families often have, coupled with pandemic-related stress, the most thorough way to be certain that a child doesn’t have a fever is to screen them right at school, she said.
Some districts do plan to tackle it this way. At Fox Valley Lutheran High School in Appleton, for example, parents are asked to screen their child before school, but kids will also have their temperatures checked daily before they enter their building.
Last Wednesday marked the first day back for the roughly 600 students who chose in-person school this year, said Fox Valley Lutheran President Jeff Loberger. Each student and staff member had their temperature checked using one of three facial recognition scanners stationed at the building’s entrances, which Loberger estimated cost about $2,000 apiece.
The process takes about two seconds per student, Loberger said: They step up, the scanner reads their temperature, a green light flashes if a fever is not detected, and they move through. Each temperature reading then uploads to a database.
“We got everybody through in a pretty timely fashion this morning,” Loberger said last Wednesday. “There were moments, when a bus would drop off, that we had a short line,” he said, but he predicts things will move more smoothly as kids get used to the process.
The most recent federal guidelines do not recommend universal temperature checks of K-12 children at school, nor do state health department guidelines released last week. The CDC cited asymptomatic cases, infected people who do not develop fevers and the fact that a child could have a fever, cough or other symptoms but not COVID-19 in its reasoning.
“Symptom screenings have the potential to exclude some students from school repeatedly even though they do not have COVID-19 or any contagious illness.
This in turn may worsen disparities in students who already miss school frequently because of chronic medical conditions,” the report says.
Temperature checks and other screenings will not prevent an outbreak unless coupled with other mitigation strategies, it says, like wearing masks, physical distancing and hand-washing.
The CDC recommendation against daily in-school screenings likely stems from the knowledge that lots of districts are dealing with constrained resources, Safdar said.
“It’s hard to deny that (temperature screenings) do take time and effort and manpower. It’s not like there are oodles of resources that have suddenly come about in response to this,” she said. “There will be a tradeoff.”
The fact that such screenings won’t catch everyone who might be infected is why Fox Valley Lutheran is also relying on parents to vigilantly look for other symptoms, Loberger said, and students who present with other symptoms during the day will be sent home. The school bought the screening software early, before the CDC had released its guidance, but officials have decided that it will help with more than just COVID-19.
“The biggest thing for us, our number one concern, is safety of kids,” he said. “COVID aside, (the screenings are) still going to be a good thing for any fever of any sort. We don’t want sick students in our building.”
He said he hopes the desire of students and families to have in-person school continues throughout the year and will serve as motivation to pay close attention to symptoms and keep kids home if they’re not feeling well.