Schools Are Doing COVID-19 Temperature Checks: Do They Really Help?

The Centers for Disease Control and Prevention doesn’t recommend schools use them. Dr. Anthony Fauci, the nation’s top infectious-disease expert, called them “notoriously inaccurate.” And they can be expensive and time-consuming.

Yet more than half of U.S. district leaders say their schools are conducting or plan to do temperature checks for students and employees for in-person instruction as a means of screening for coronavirus infection, according to a nationally representative Education Week Research Center survey conducted last month.

What accounts for this discrepancy?

Without consistent national guidance from the federal government to help schools reopen safely, district leaders have turned to local public health officials and their peers when deciding which measures may help keep their communities safe. Temperature checks were a recommended strategy in many places.

A handful of states require temperature checks for students and school staff, while many more recommend them or leave the decision to individual districts based on the spread of COVID-19 in the area, according to a policy analysis by Future Ed and The 74.

Some temperature checks can be effective and worthwhile, experts say. Handled poorly, though, temperature checks can violate students’ privacy, squeeze school budgets, and pose logistical challenges.

Public health experts also have expressed a range of views on the efficacy of temperature checks in schools during the pandemic.

Ashish K. Jha, dean of Brown University’s School of Public Health, told Education Week this week that temperature checks are “useless” and that schools should instead be provided with the resources to conduct random on-site COVID-19 testing in buildings.

Others see them as useful, if limited. Ali Mokdad, a professor at the Institute for Health Metrics and Evaluation at the University of Washington, thinks temperature checks can be used alongside other measures like mask wearing and social distancing. They don’t detect COVID-19 infection, but they can highlight a possible symptom of viral infection, and they can be less invasive and painful, especially for younger students, than a nasal swab.

He said schools should consider conducting random temperature checks of a portion of the student population. “Out of 100, if 10 have a temperature, it makes me wonder what’s happening in the community,” he said.

Perhaps the best way to think about a measure like temperature checks, according to James Lawler, an associate professor of medicine at the University of Nebraska Medical Center’s Division of Infectious Diseases, is to imagine each preventative strategy against COVID-19 as a layer of Swiss cheese. “They all have big holes in them. But you start stacking them on top of each other and they create a level of impermeability.”

Understanding the Limitations

The Laramie County school district in Wyoming has been conducting daily temperature checks for all students and staff since school buildings reopened in August. They occur after parents and students have filled a daily symptom screening survey accessed via a QR code on their smartphones.

The district has invested federal CARES Act funds in hand-held temperature scanners for some schools and stationary thermal detectors that students walk through as they enter the building. The hand-held scanners require a “huge increase in staff time,” said Dave Bartlett, the district’s assistant superintendent of support operations.

Early on, schools were sending “a lot of kids home,” including many who simply had seasonal allergies, but “we’ve matured in our decision-making,” with help from local health officials, Bartlett said. Yet even now, multiple students are being sent home each day, he said.

So far, the district hasn’t sent home any students with apparent elevated temperatures who later tested positive for COVID-19, Barrett said.

School nurses can help separate potential COVID-19 cases from more mundane illnesses if temperature checks detect evidence of a fever, said Laurie Combe, president of the National Association of School Nurses. But a quarter of U.S. public schools don’t employ a school nurse, and another third share a part-time nurse with other schools, according to the association’s 2016 workforce report.

“If you don’t have access to that expertise, you’re going to be sending more kids home,” Combe said.

The Laramie district is still weighing whether to continue on-site temperature checks, but in the meantime, it has refined the processes for the at-home survey. Each teacher has a unique QR code for their students, rather than relying on a secretary to keep track of hundreds of kids’ daily results.

“It really has been an all-hands-on-deck mentality,” Bartlett said.

Combe said some schools have moved their temperature checks indoors to prevent inaccurate readings due to the increasingly cold weather.

Efforts to check temperatures don’t come cheap. Some districts have spent up to half a million dollars on devices that take temperatures.

The 420-student Sebastopol Union school system in California has spent $2,500 on thermometers, or roughly $6 per student, according to Linda Irving, the district’s superintendent. They haven’t been used yet because school buildings haven’t opened to students so far this school year.

Still, “if it works, I would pay any price,” Irving said. “There’s also a comfort level for parents and the community that this is being done. Is that worth it? Yeah, I think it is.”

Rising Data Privacy Concerns

Schools should also consider privacy concerns when weighing the merits of temperature checks.

If students waiting in line for temperature checks get moved to a separate area if they seem to have a fever, they might be stigmatized or mocked by other students, Combe said.

But temperature scanning devices are much “more sophisticated than what people understand,” said Sara Jordan, policy counsel for artificial intelligence and ethics for the Future of Privacy Forum.

When temperature scanners are integrated into schools’ broader technology systems, they can increase a school’s risk for being targeted by hackers, Jordan said.

Some of these tools also contain facial recognition or other software that can perpetuate bias, according to a report from the Future of Privacy Forum. Fayette Schools in Georgia, for instance, recently spent $525,000 for 75 cameras that use facial recognition and thermal imaging to flag students with high temperatures, reported The Citizen.

Distance infrared scanners, the cameras that have cropped up at airports since the pandemic, also tend to be less reliable than more simple digital thermometers, Lawler said.

The fewer people who have access to data from temperature checks and health screenings, the better, said Linnette Attai, president of PlayWell, a privacy compliance consulting firm with education clients. Similarly, schools need to balance having accurate data that can inform decision-making and ensuring that students and families aren’t required to share more than they need to.

For instance, if a student is sent home with a temperature, “one might keep a record that student A will be learning from home for the next two weeks,” rather than specifying that the student had a high temperature on a particular day, Attai said.

Teachers who can access students’ health data should be trained on how to handle sensitive information, including knowing who has a right to know which pieces of information at which times, Attai said.

The devices themselves can be sources of privacy concerns, particularly if they’re connected to the internet. The same processes schools use to vet classroom technology should be employed for temperature devices as well, Attai said, including asking questions like:

• What data do you need to collect?
• Who needs to see it?
• Who will share it?
• How is it being protected?

She also recommends schools consult with nearby employers who may have a head start on implementing temperature checks in their buildings. “Companies have more resources to have explored more options,” she said.

Taking an Alternative Approach

Temperature checks don’t need to involve scanners with students standing in long lines on campus. In the North Shore school district in Illinois, parents log in each day to the app CrisisGo, where they answer a brief survey about their child’s symptoms and any suspected exposure to COVID-19. If any of their answers pose red flags, an assistant superintendent receives a notification and contacts that family to follow up.

Mike Lubelfeld, the district’s superintendent, spent the first couple weeks of the school year imploring families to participate. By mid-September, 100 percent of the district’s 3,700 families were filling out the survey each day.

The district was open for seven weeks of in-person instruction before reverting to full-time remote learning as COVID-19 cases rose in the surrounding community. During in-person instruction, only five students and staff members were known to have tested positive for the virus, according to Lubelfeld. “The schools were not spreading locations,” he said.

Lubelfeld and his team had previously considered universal temperature checks as students entered the building, but decided they were too expensive. Plus, Lubelfeld said, the time it would take to get temperature readings might be better spent getting students and parents to report a wider range of updates about their health and recent activity.

Some parents have told Lubelfeld the daily surveys have encouraged them to think more carefully about where they’ve been and how they and their children are feeling.

“Requiring parents to screen children for symptoms each day can be complicated too. The Portland district in Maine plans to stop requiring daily at-home symptom checks after getting reports from only 50 to 60 percent of students each day. Following up was taking too much of nurses’ valuable time, a district spokesperson told the Press-Herald. The district plans to instead focus on urging families to keep sick kids home.”

Lubelfeld has been taking advice from other superintendents, state and local health departments, and the District Management Group, a consulting firm he hired to help with school reopening decisions. For schools that haven’t reopened buildings yet, he recommends embracing the idea that the best decisions might not always be obvious.

“We’re not going to know if we were right for a couple years,” Lubelfeld said. “Do the best you can.”