The Seven Truths behind the Worldwide Failure of the Temperature Measurement Protocols during the COVID-19 Pandemic.

On February 16th, 2020, there were 51,857 infections of COVID-19 with 98.68% of all lab-confirmed cases located in the country of China [1].?Two months later, on April 16th, 2020, John Hopkins University reported on its trusted mapping monitoring system a staggering 2,188,194 infections in 185 countries.?By May 16th, 2020, the same platform indicates 4,425,485 infections in 188 countries.?With a toll of 302,059 victims across the planet [2].??

In comparison, the September 11 attacks of 2001 had 2,977 victims [3].

How could such a disastrous event happen with such incredible diligence and dire consequences ?

On February 28th, 2020, The World Health Organization and China published a joint mission COVID-19 report [4] with these four major objectives: 1. to enhance the understanding of the evolving outbreak in China and the nature and impact of the ongoing containment measures; 2. to share knowledge on COVID-19 response and preparedness measures being implemented in countries affected by or at risk of importations of COVID-19; 3. to generate recommendations for adjusting COVID-19 containment and response measures in China and internationally; and 4. to establish priorities for a collaborative programme of work, research and development to address critical gaps in knowledge and response and readiness tools and activities.

In this first-of-its-kind report about the virus, the symptoms of COVID-19 were analyzed across 55,924 lab-confirmed infections.?It was concluded that 87.9% of patients had Fever as their primary early symptom of the virus and, as we have all witnessed, the implementation of temperature checks with infrared touchless thermometers became the global standard methodology to screen infected individuals at all border crossings, airports and other points of human travel [5].?In some of the wealthiest countries or well-funded organizations, thermal imaging cameras were even installed in hope of catching infected invaders across flocks of innocent commuters [6, 7, 8, 9] yet to no avail COVID-19 still managed to getting from one country to anchoring itself in 95.92% of all countries in the World as of the time of this writing [10].

So why did this drastic failure happen ?

First, there have been indications that some of the individuals infected with the coronavirus were asymptomatic.?In other words, you might be carrying the virus right now and transmitting it to others yet you are not exhibiting any symptoms of the disease [11].

Observations in various populations suggested that 18% to 50.5% of people with positive results were asymptomatic at testing, and epidemiologic modelling has been suggesting that asymptomatic cases may be responsible for potentially significant transmission, with a wide range of estimates from 0% to 44% [12]. However, this is statistically in conflict from WHO-based epidemiologic findings from the initial epidemic in China and elsewhere which do not suggest that asymptomatic transmission is a major driver for the COVID19 epidemic [13].

Dr. Maria Van Kerkhove, the head of the emerging diseases and zoonoses unit at the World Health Organization, indicated in April 2020 that many cases may have actually been misclassified as asymptomatic when in fact they were -- presymptomatic -- with no apparent symptoms at first but then went on to develop symptoms [14, 15].

In other words, the individuals who have passed right through national borders after being temperature-checked could have been asymptomatic and they could have been a potentially significant transmission source of the virus or possibly not... depending on which scientific conclusion you are reading.

Now this could certainly seem confusing at first yet I believe there are seven truths to this current debacle.

First, there is no question that fever is and remains the main symptom of COVID-19.??

What was concluded at that level by the WHO and China in their Joint-Mission Report of February 2020 [4] has not been taken back and further expert monitoring reviews and official governmental directives have confirmed the same as of the time of this writing [16, 17, 18].

Second, contactless infrared thermometers and thermal imaging cameras in the fight against COVID-19 are used to determine individuals’ temperatures at around or near 38°C or above.??

If an individual hits that mark, recommendations for immediate isolation and actual viral testing are put in place and that individual most likely does not step into that flight back home, crosses a border or even enters into your neighborhood’s food processing plant or supermarket [19, 20, 21, 22].

That’s great… besides the fact that contactless infrared thermometers and thermal imaging cameras have scientifically demonstrated significant variance in accuracy, specificity and sensitivity of up to 2°C.?In a multitude of settings, extensive studies have demonstrated that they are in fact unreliable due to environmental factors (such as ambient temperature, humidity or even airflow), a complete lack of a proven, required and lengthy (15 minutes up to 30 minutes) controlled acclimatization period for each individual prior to temperature measurement due to blood flow variations, the presence or not of cosmetics on an individual’s skin and various operator-based and/or device-based errors (inconsistent distances from targeted areas, constantly-changing angles, focal lengths, striping, vignetting, narcissus and motion artifacts and/or drifts of performed scans, improper calibrations, lack of sensor and imager uniformity,?and more).?In some cases, infrared devices have been unable to detect up to 75% of fever in measurements outside of stable laboratory settings [23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33].

Now this is where this gets interesting.

COVID-19 seems to generate a complex fever pattern.?At first, COVID-19 seems to be possibly presenting in its early form a low-grade intermittent fever which eventually becomes a more persistent fever.?The evolution of this persistent fever can last over several days up to several weeks and eventually decreases.?Patients admitted to ICU have demonstrated significantly longer duration of this continuous fever which could be explained by the disease progression and uncontrolled viral replication with a median duration of 31 days of fever versus 9 for Non-ICU patients after onset of symptoms [34].?

However, it would seem that the fever pattern of COVID-19 has not yet been understood. In fact, in some critical instances, it has been wrongly studied and reported.?

On March 5, 2020, The New England Journal of Medicine publishes an investigation done on the ‘First Case of 2019 Novel Coronavirus in the United States’ by a small army of medical experts [35]. This instrumental case report for the United States indicates that the patient’s vital signs remained largely stable on days 2 through 5 of hospitalization (days 6 though 9 of illness) apart from the development of -- intermittent -- fevers.

An Intermittent Fever is a type or pattern of fever in which there is an interval where temperature is elevated for several hours followed by an interval when the temperature actually drops back to normal [36].

Comparatively, a Continuous Fever does not fluctuate more than about 1°C, increases in a step ladder pattern and does not return to normal during a 24-hour period.?Further, a Remittent Fever is a fever which increases typically by 1.1°C or more, has a peak-and-valley pattern over time and does not return to normal within a 24-hour period [37].

When reviewing the data presented in The New England Journal of Medicine, one can discover the patient’s temperature measurements according to Day of Illness and Day of Hospitalization from January 16 to January 30, 2020 [38]. If one plots these temperatures over time, one can see that this first patient of the United States did not show an Intermittent Fever as it is reported.?It shows a Remittent Fever pattern.?In other words, an increase of temperature by 1.1°C or more above baseline with a peak-and-valley pattern which does not return to normal within a 24-hour period and this over multiple days.

This important distinction is also appearing in another set of COVID-19 patients: Children.

Children seem to be showing with COVID-19 similar pathophysiologies to the known Kawasaki Disease.?One of the key symptoms of the Kawasaki Disease which can affect children of all races is defined by a Remittent Fever pattern rather than an Intermittent Fever pattern [39, 40].

A third truth may now be defined.?COVID-19 might be presenting an actual fever pattern over time which could be considered for both early screening (prior to an actual diagnostic test) and for post-disease monitoring (in the case of possible recurrence).?Such pattern being completely invisible to the temperature measurement methodologies currently in practice.

As such, if your path is crossing a contactless infrared thermometer or a thermal imaging camera on your way to your plane, your grocery store, your customs and border control agent or your newly reopened business building, you are probably going to do this current temperature measurement -- once -- and at a -- specific -- point in time.?In other words, the concept of you having a progressive fever increasing over time (regardless of its pattern) may or may not be determined by that measurement check from the infrared contactless thermometer or thermal imaging camera.?By logistically taking a single measurement across millions of travellers, this globally-adopted approach has proven to have fundamentally failed.?The fourth truth is defined by this fact that a single temperature measurement of any individual crossing a border or entering into a building at a single specific point in time is simply not enough and will not stop the spread of this particular virus [41].

Further, and this is the kicker… A significant study of 243,506 temperature measurements in a diverse cohort of 35,488 patients indicated that 99% of the tests had a body baseline temperature between 35.3°C and 37.7°C with several demographic factors linked to each individual’s level of body baseline temperature [42].?This fifth truth tells you that a sought-after temperature detection of 38°C or above for COVID-19 is technically incorrect by simply ignoring human physiology.?If your normal body baseline temperature is anywhere between 35.3°C and 36.8°C, a progressively-increasing continuous low-grade fever or even a remittent fever is not going to put you through the detection threshold and you are going to be on your merry way.?On the other side of the spectrum, if your normal body baseline temperature is more elevated, then good luck as you are most likely going to be stopped at every thermometer crossing, especially if you are in a rush getting to work because a bit of physical exercise will make your body temperature temporarily increase as well [43, 44] to a point where you will be measured as a false positive by these devices and will most likely not get on that plane or get to work on-time.

The sixth truth is defined by another important physiological aspect of the human body.?The nadir of human body temperature is in early morning, at around 4am, and its peak is at about 6pm [45].?In other words, when that infrared contactless thermometer or thermal imaging camera is measuring your temperature on your happy way to your professional occupation, it might be getting a much lower normal body temperature and, as such, you will, once again, pass right through the measures that were supposed to protect all of us.?Even with a rising remittent fever, you might still be low enough in the degrees’ red flag range, especially at the start of your day, and you will get to your co-workers and the general public without knowing for certain that you are a virus carrier, ready to infect plenty of other clueless individuals [46, 47].

Last but not least, outside of internal coronary arteries measurements, the seventh truth might be somewhat uncomfortable but your rectum is the most accurate and scientifically-speaking the best “non-invasive” way of measuring your body temperature [48].

Now I doubt all of us are going to put our pants down at every single temperature measurement crossing.?Luckily, the forehead has been determined to be one of the very best next options when it comes to temperature accuracy so technically we do not have to rush to our next door tanning salons anytime soon and the forehead will probably do.?However, and based on the six other truths and the undeniable and tragic numerical rise of cases across the World, the infrared contactless thermometers and thermal imaging cameras are failing us… and the decision-makers who have thought this was the way to protect humanity have simply made a devastating mistake, spreading a virus from patient 0 to almost 4.5 million souls with a human and economic toll that we have yet to fully understand.

Nota Bene: As of June 16th, 2020, one month after the completion of this research paper, the toll has now reached 8 million infections. Perhaps it is time for a slightly better approach... Stay tuned.

As of August 9th, 2021, we have now passed the 200 million infection mark... and I still see these thermometers being used at the entrance of hospitals, airports and more.

As of April 9th, 2022, the World has now reached 500 million infections with more than 6 million deaths and despite crucial vaccines now in place... I am still seeing these thermometers being utilized, especially at the entrance of hospitals, doctors' offices and more.

Unbelievable. On all points.

References

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