Katherine*, 42, became concerned when she first heard that stores and restaurants in China were taking patrons’ temperatures before letting them inside. Talking with family members over the phone about US businesses following the same protocol, Katherine broke down in tears. She wasn’t sure how she’d go about her life in Charleston, where she lives alone.
“Will I be able to go get groceries?” she recalls worrying. “Will I be able to get errands done? Will my social life be over even if I stay healthy and [don’t get] COVID?”
Katherine has Hashimoto’s disease, a condition in which the immune system attacks the thyroid. Because of this and chronic active Epstein-Barr virus (CAEBV), her temperature can reach 100.9 degrees in the late afternoon. Businesses conducting temperature checks won’t admit people who register above 100.4 degrees, and healthcare clinics can refuse entry to those with a temperature above 100 degrees. These rules are meant to keep us safe, since fever is one of the most common COVID symptoms. But at the same time, for people who run above-average temperatures due to health conditions or medications, routine temp checks can cause anxiety and depression, interfere with daily life, and even restrict access to necessary healthcare.
“We don’t have that extra time”
Ann*, 39, also lives in Charleston. She and Katherine are part of the same online community for people living with chronic illness. In 2009, Ann went from working out six days a week to being too sick to work. After three years of seeing one doctor after another, during which time she lost her career and many relationships, she was finally diagnosed with Lyme disease. Though Ann successfully recovered from Lyme, she contracted Epstein-Barr virus (EPV) and a staph infection earlier this year, putting her at an increased risk of getting severely ill from the coronavirus.
“It’s been one of the most difficult things I’ve ever had to deal with in my life,” Ann says, through tears. “I can easily compartmentalize things, but it’s something different when your doctor tells you, ‘If you get the coronavirus and go into the hospital, you are not coming back home.’”
When she first heard that businesses were conducting temperature checks, she thought nothing of it. After taking the antibiotic doxycycline for a month and a half to fight the EPV and staph, she realized her temperature was spiking every day. According to her digital thermometer, readings of up to 101 degrees were a regular occurrence. “I scheduled all of my doctor’s appointments starting a week after I would be off of doxycycline, hoping my temperature would be back to normal,” she says. In the meantime, she crossed her fingers that she wouldn’t need medical attention until then, because she didn’t think doctors would admit her due to her temperature.
Her anxiety surged in the days leading up to her first follow-up appointment, in early August, for her infection and EPV. “I was sort of petrified and got really hot and flustered” walking up to the office, she says, which only made her worry more about having a fever.
During the height of the pandemic, most healthcare clinics transitioned all non-urgent visits to telehealth. As they reopen, some are facing a backlog of in-person appointments, leading to longer waiting periods for non-urgent care. “Knowing you’re not going to get your medication refill, knowing you’re not going to get your lab work done for two or three months because you didn’t pass a temperature check,” says Ann. “For people with chronic illnesses, we don’t have that extra time. That’s really scary.”
For Katherine, a “good day” is when her afternoon temperature only reaches 100.3. She first encountered a temperature screening at a hair salon, which she chose for the safety protocols listed on its website. Still, her mind raced and her body shook as she walked into the salon. “I knew most of the staff, and that increased my anxiety,” she says. “What would happen if my temperature was 100.5? Would I get banned from the salon? I was afraid of people seeing my condition. I work really hard to make it appear like nothing is wrong.”
Although Katherine passed the temp check, “it’s not really a relief,” she says, because there’s always a looming threat of failing the next check. “Although I have a system in place where if I have an appointment, I have it in the morning [when my temperature is lower], it’s still really stressful.”
Security or just security theater?
Both Katherine and Ann say they’re grateful for the various safety measures businesses have implemented. “It’s helping the general population, but for people with underlying conditions or on medication, a lot of us have put our lives on hold,” says Ann, who works in financial management and worries about losing business if clients of hers, such as airline executives, require screenings for in-person meetings.
Katherine says temperature screenings make her angry and frustrated for a number of reasons, including the fact that there’s no standardized screening process. Also, she adds, temp checks aren’t a reliable way to catch all coronavirus carriers.
“Not only can COVID-19 present with no symptoms at all, but people who do have symptoms often do not have fever, especially early in the disease,” says Dr. Shira Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center in Boston. In a study of 5,700 patients hospitalized with COVID-19 in New York City, only 30 percent had a fever. Similarly, an Australian study found that less than one-quarter of patients who tested positive for the virus also had a fever. Even Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has cast doubt on the efficacy of routine temp checks. “We have found at the NIH,” he said at an event in August, “that it is much much better to just question people when they come in and save the time, because the temperatures are notoriously inaccurate.”
“Temperature screening is quite useless,” says Biswadev Mitra, lead author of the Australian study. “When we combine [his study results] with a known fact that fever may be due to many other causes, to screen for SARS-Cov-2, places of business would be better off tossing a coin.” While these checks can catch some cases, they may miss more than 50 percent of COVID-infected people, the FDA reports. Some journalists and psychologists have used the term “security theater” to suggest that checks make people feel secure but don’t provide any real protection from infection.
Additionally, there are privacy concerns, like Katherine’s worry about a database of “failed” names. “It is essential that organizations treat all data with utmost care and develop policies on how such data would be handled,” Mitra says. “I see no value in temperature data to individual organizations and would consider use of such data to be against privacy laws.” The ACLU expressed similar concerns in a statement in May: “This crisis threatens to normalize such physiological surveillance, with the result that even after a vaccine is distributed and COVID-19 retreats as a public health threat, new infrastructures for the routine and suspicion-less collection of such data will remain.”
All of this uncertainty causes anxiety for many people, and perhaps more so for those who have a condition, or are on medication, that causes them to run a higher temperature. All any of us can do is protect ourselves the best we can. For those with chronic conditions, that means adjusting their schedules, both to avoid crowds and work with the modulations of their body temperatures if they know they’ll need to be checked. So Katherine continues to limit trips outside her apartments to one weekly errand run, while Ann only goes outside to walk her dog or drive to the beach during off hours.
“It’s tough,” Ann says. “We don’t have the luxury to go outside with masks and have a little bit of normal life. We are suffering at a different fear level and have so much more at stake medically, emotionally and psychologically than people who are healthy and cognizant of the coronavirus.”
*Katherine and Ann asked us not to use their real names. Due to Ann’s involvement in a lawsuit, she also asked that we leave out certain details about her health.