Screening nearly 1 million patients, visitors, and healthcare workers at the entrance of a large hospital for COVID-19 symptoms, exposures, or travel was of limited benefit at considerable cost, finds a Yale study published yesterday in JAMA Internal Medicine.
Researchers tracked rates of failed COVID-19 screenings (ie, temperature of 100.4°F or higher, exposure or symptom suggestive of COVID-19, positive test result in the preceding 2 weeks, or recent travel to high-risk areas) at 10 entrances to Yale New Haven Hospital from Mar 17, 2020, to May 8, 2021.
High COVID-19 community incidence was defined as more than, and low incidence as fewer than, an average of 10 cases per 100,000 people per month.
Less than 0.1% failed screenings
Of 951,033 screenings performed, 0.07% were failures. The failure rate varied widely, peaking at 2.64% in March 2020 and then falling thereafter. In the first wave of the pandemic, 0.69% of screenings failed but then were consistent across times of high (0.04%) and low (0.03%) community COVID-19 incidence.
Entrance screeners also assessed face-covering use and gave masks to those who didn't have one or wore one that the hospital deemed unacceptable (eg, cloth mask, bandana). A total of 62,009 patients and visitors (6.84% of people screened) and 7,742 healthcare workers were given a mask due to inadequate or absent masking.
To maintain a 24-hour screening schedule, 29.5 full-time staff were paid a total of $1,288,560 in annual compensation (using a minimum wage of $15 per hour for Connecticut plus benefits estimated at 40%). That estimate excludes managerial staff pay and the cost of supplies such as gloves, masks, and thermometers. Thus, the estimated minimum cost to identify one screening failure was $223.58 during the first wave and $2,350.96 over the entire study.
Enabling sick workers to stay home
"The failure rate was substantially higher in the beginning of the pandemic, possibly because of greater adherence to screening protocols and enhanced symptom and exposure vigilance," the researchers wrote. "It is also possible that patient education and increased communication may have meant patients and visitors stayed home with exposures or symptoms or that people were not truthful on subsequent visits."
Whether having an entrance screener served as a deterrent, keeping ill people from trying to enter the hospital, is unknown, as was the true incidence of COVID-19 among those screened, the authors said.
The researchers noted that a high proportion of patients and visitors arrived with inadequate face coverings. "Given the effectiveness of masks and need for source control of asymptomatic contagious persons, this service represents an additional value of screeners in mitigating COVID-19 spread," they wrote.
In a related editor's note, Eric Ward, MD, of the University of California at San Francisco, and Mitchell Katz, MD, of NYC Health + Hospitals, noted that screening is expensive for healthcare systems and cumbersome for employees.
"The authors suggest that screening may have maximum utility during the early phase of a public health crisis," they wrote. "Nonetheless, self-reported symptoms have a low sensitivity for true infection with COVID-19, so it remains unclear the degree to which screening measures are truly effective in reducing the spread of COVID-19."
There is, of course, value in keeping all ill workers and visitors with infectious diseases from entering the hospital, Ward and Katz said. "It is known that some health care workers come to work under virtually any personal health circumstance due to tacit pressure," they wrote. "COVID-19 surveillance screening has enabled workers to appropriately stay home when they are ill."