Temperature screening, mask and H1N1 in Singapore

Yesterday there is an article written by Dr. Lee Wei Ling, Director of National Neuroscience Institute in Singapore, daughter of Lee Kuan Yew. She called temperature screening as herd mentality. She argued that temperature screening is carried out since everyone else is doing it, not really because true belief that it will works. She is a knowledgeable person and quite right to quote research saying that asymptomatic person with H1N1 can be infectious. In fact, Singapore acknowledges that 1/3 of people infected with H1N1 can be infectious and this is a clear group of people which temperature screening will definitely miss.

Today I visited a clinic in CCK and notice first hand how I think temperature screening can really create more cases than prevent it. The clinic has employed a girl who is her teenage years. She wore a disposable blue gown, N95 mask and used ear thermometer. The N95 mask clearly looks too big for her, with the lower strap dangling loosely at the back of her neck. The N95 mask she wore is from 3M and it is actually for occupational use where respiratory fit testing is required and the mask must fit the face. The guidance document on mask clearly specify N95 mask is not designed for small faces.
Worse is the way she touched and adjusted the mask and then use the same finger to:
1. Touch her eyes
2. Play with her handphone which was on the table
3. Write using a pen which is also used by the multiple visitors + patients
4. She has no gloves. Not that it's wrong, but she has to perform personal hygiene to do it right.
And despite having a hand sanitizer on the desk, she never used it.

The girl is a clear example that putting PPE and temperature screening may create more havoc. The chance of cross infection from her action especially through the pen is enormous. The false sense of security by the patient and visitor that temperature screening will prevent H1N1 infection is something that should not be maintained. Inexperienced personnel handling supposedly first line defence like temperature screening is really an error that should be easily fixed.

Temperature screening is indeed helping to screen 2/3 of cases but the false sense of security and simple mistakes in screening activities may simply create more cases from the missed 1/3. The fact that a lady actually asked her daugther to wear surgical mask only because of fever is another example of wrong knowledge. Educating the population to be vigilant, appropirate use of PPE, keeping themselves away from people sneezing and coughing while being responsible to lock themselves up if they suspect themselves having flu will probably go a long way further than screening by inexperienced personnel.