key: cord-0957383-aoc61qy5 authors: Markowitz, Kenneth; Strickland, Maxine; Huang, Ai title: Fever and other clinical indicators may fail to detect COVID-19 infected individuals date: 2020-09-22 journal: J Evid Based Dent Pract DOI: 10.1016/j.jebdp.2020.101499 sha: 2c48e75b7d6b26f4cf511a3ec531295d5ff11059 doc_id: 957383 cord_uid: aoc61qy5 ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19). Nishiura H, Kobayashi T, Miyama T, et al.Int J Infect Dis 2020;94:154-155. https://doi.org/10.1016/j.ijid.2020.03.020. SOURCE OF FUNDING Self-funded. TYPE OF STUDY/DESIGN Cross-sectional population study. populations. Instead, the authors examined a sample of people at risk for COVID-19 infection, a group of Japanese nationals evacuated from Wuhan, China, to Japan. 565 Japanese nationals evacuated from Wuhan, China, to Japan. All 565 evacuees were assessed for symptoms including fever determined by temperature screening, and interviews to collect information concerning cough and other non-specific symptoms that are consistent with COVID-19 infection. COVID-19 reverse transcription polymerase chain reaction (RT-PCR) was also performed on all evacuees. The authors used Bayes theorem to determine the asymptomatic ratio within this population. Among 565 passengers that were evacuated from China, 63 (11.2%) were symptomatic. RT-PCR testing revealed that there were 4 asymptomatic and 9 symptomatic people who tested positive for COVID-19. The sensitivity of symptoms-based screening was 69.23% and specificity was 90.3%. Probability was determined that 30.8% (95% confidence interval 7.7-53.8%) of infected individuals are asymptomatic. Asymptomatic infections cannot be determined if they are not confirmed by being tested with RT-PCR, and symptomatic cases may not be detected if they do not seek medical attention. These results indicate that symptom-based screening of COVID-19 is likely to fail to detect many infected individuals. When the severity of the COVID-19 pandemic was recognized in March 2020, in-office dental treatment came to a virtual halt. At our dental school, only emergency services were available during this shut down period. These services were supplemented by teledentistry, which acted as a gateway to in-person dental intervention. At that time, education switched from live classes to online instruction, and few faculty, staff, students, or patients entered the facility. During this J o u r n a l P r e -p r o o f period, ingress to the dental school was restricted to an entrance where all persons entering underwent questioning concerning flu-like symptoms and body temperature checks. The rationale behind COVID-19 screening by assessing temperature and self-reported flu-like symptoms is to identify individuals who are likely to be infected. Similar screening programs take place at airports and other public facilities. Before the COVID-19 pandemic, fever and symptom screening were employed to contain other communicable diseases such as Ebola and severe acute respiratory syndrome (SARS), which like COVID-19, is a coronavirus-caused illness. 1 Since many dental procedures result in aerosols, COVID-19 infected patients pose an infection risk to staff and other patients even with infection control practices. As dental care resumes during the summer of 2020, it is important to detect infected individuals. Access to COVID-19 testing is still limited. At our school, COVID-19 testing of personnel is available, but patients are not tested by the school. In the coming weeks, the number of individuals screened daily by symptom checking will increase. The goal of this commentary is to describe the limitations of symptom-based screening. Although commonly conducted in dental facilities, using body temperature measurements and a person's self-report of symptoms can fail to identify COVID-19 infected individuals. In areas where the rate of infection is increasing, the number of asymptomatic and infected individuals will increase, further eroding the effectiveness of symptom-based screening. We recommend that symptom-based screening continue and improve in dental facilities. The evidence does however indicate that symptom-based screening of patients and staff for COVID-19 should not be relied on to protect the dental environment from this virus. Coronavirus disease-2019: is fever an adequate screening for the returning travelers? Estimation of the asymptomatic ratio of novel coronavirus infections (COVID-19) Temperature screening has negligible value for control of COVID-19 Characteristics of 1573 healthcare workers who underwent nasopharyngeal swab testing for SARS-CoV-2 in Milan COVID-19 symptoms predictive of healthcare workers' SARS-CoV-2 PCR results CMMID nCoV working group. Effectiveness of airport screening at detecting travellers infected with novel coronavirus (2019-nCoV)