Study: COVID-19 Hospital Entrance Screening Might Not Be Worth It

COVID-19 symptom and exposure screening at hospital entrances turned away fewer than 0.1% of patients, visitors, and health workers, according to a single center's experience screening nearly 1 million people, raising doubts about its utility.

At a cost of more than $1.3 million (over $2,000 for each of the 631 people denied entry), catching those few potential risks might not have been worth it, reported Scott C. Roberts, MD, MS, of Yale New Haven Hospital in Connecticut, and colleagues.

However, they noted in their JAMA Internal Medicine research letter, "we do not know whether having an entrance screener served as a deterrent, keeping sick persons from attempting to enter the hospital."

A previous study of screening at Yale's outpatient facilities likewise turned up a low 0.1% rate of turning people away due to COVID-19 screen failure.

The screening measures, which are required by the U.S. Department of Labor, rely on self-reported factors such as symptoms or exposure history, which have low sensitivity for true COVID-19 infection, added Eric Ward, MD, of the University of California San Francisco, and Mitchell H. Katz, MD, of NYC Health and Hospitals in New York City, in an accompanying editor's note.

Hospital entrance surveillance screening is also expensive and "a daily annoyance for those who work there," they wrote.

Even so, the editorialists concluded: "Certainly there is value in keeping all symptomatically ill workers and visitors out of the hospital -- not merely those who are infected with COVID-19. It is known that some health care workers come to work under virtually any personal health circumstance due to tacit pressure. COVID-19 surveillance screening has enabled workers to appropriately stay home when they are ill."

Another upside to the screening was impact on masking. Yale's surveillance data revealed that some 6.84% of patients and visitors presented at the hospital with no or inadequate masks, such as cloth or bandana face coverings. As a result, 62,009 masks were given to them before entering the hospital.

In addition, there were 7,742 hospital staff that needed a mask before they entered. "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," Roberts and colleagues said.

The study encompassed surveillance screening at the 1,541-bed academic medical center with 10 entrances across two campuses from March 2020 to May 2021. A positive screen, which meant being turned away, could be due to body temperature of 38°C (100.4°F) or greater, an exposure to or symptoms suggestive of COVID-19, a positive SARS-CoV-2 test result in the preceding 2 weeks, or recent travel to a high-risk area.

Out of 951,033 individuals screened, 631 (0.066%) patients and visitors were turned away from the Yale New Haven Hospital in Connecticut due to possible COVID-19.

Nearly half of the positive screening tests occurred during the first wave of the pandemic, from March to May 2020, at a rate of 0.69% (308 of 44,370 people screened). That yield dropped substantially to 0.036% (202 of 555,611) in subsequent high-incidence waves (October 2020 to April 2021) and during periods when the community infection rate was low (June to September 2020 and May 2021), at 0.034% (121 of 351,052 people screened).

"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," Roberts and co-authors said. "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."

When breaking down the cost of having 24-hour staffing for screening surveillance at 10 hospital entrances, the researchers calculated $1,288,560 in total annual salaries (paying 29.5 full-time equivalent staff a minimum wage of $15 an hour). When adding benefits for those workers (estimated at 40%), the researchers estimated a cost of $223.58 to identify one positive screening during the first wave of the pandemic and a cost of $2,350.96 when calculating the entire study period.

Those estimates were likely conservative, as they did not include equipment or disposables like gloves, masks, and thermometers or management staff for the surveillance workers.

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