A single temperature screening is unlikely to accurately detect COVID-19 in nursing facility residents, according to a new Veterans Administration study. 

Investigators analyzed more than 7,000 residents’ temperature readings before and after universal COVID-19 screening was implemented in VA eldercare facilities. While federal screening guidance includes a fever threshold of 38˚C (100.4˚F), only 26% of residents who tested positive for the virus met that threshold during the survey period. 

In addition, while most residents with confirmed COVID-19 experienced two or more 0.5°C elevations above their baseline temperatures, 20% had temperature readings that never deviated more than 0.5°C from baseline, reported first author James Rudolph, M.D., from the Providence Veterans Administration Medical Center, Rhode Island, and Brown University.

“Most older nursing home residents do have temperature elevations when infected with SARS-CoV-2, but this elevation infrequently meets a fever threshold of 38°C,” the researchers wrote.

The results suggest that the current fever threshold for COVID-19 screening should be reconsidered, Rudolph and colleagues contend. And multiple temperature checks may be needed to help control the spread of the virus in eldercare communities.

“Repeated temperature measurement with a patient-derived baseline can increase sensitivity,” they concluded.

The study abstract has been published online prior to publication in JAMDA.