Are Airline Temperature Checks Effective for Avoiding Coronavirus Spread or Just False Comfort? Frontier Airlines announced that it would start temperature checks for all passengers and employees effective June 1, 2020, and Air Canada advised it would start temperature checks starting May 15, 2020. Frontier will prevent passengers and staff with temperatures 100.4 degrees or higher from flying, while Air Canada's cutoff temperature will be 99.7 degrees and higher.
U.S. airline group Airlines for America, which represents major airlines such as United Airlines, American Airlines, Delta Air Lines and Southwest, is calling for the TSA to check the temperatures of passengers and airport employees, and JetBlue is also calling for the government to mandate temperature checks, so that it becomes a standard across the industry.
Airlines, which have been bleeding cash, need passengers to start flying again. And while most passengers, if flying economy, don't want to be seated next to another passenger and would like middle seats blocked, airlines have varying policies on this and have faced complaints from passengers about the lack of social distancing measures on flights that is likely to be exacerbated as demand starts to increase and flights fly fuller. Temperature checks are likely to be as much about reassuring passengers, without taking a corresponding revenue hit.
False Sense of Security
But how effective are temperature checks for the stated aim of preventing coronavirus infection? Iceland, which tested about 13.5% of its population, found that at the time of testing, about half of those testing positive were asymptomatic. Even if the exact percentage of asymptomatics varies from population to population, the underlying message is that a temperature check is likely to be highly under-inclusive, allowing many people to fly who are infected, but have no symptoms, or at least not a high temperature that will result in them being barred from flying.
And those who are asymptomatic, even if they're not sneezing or coughing, can easily transmit the virus whenever they talk, eat or exhale. Passengers are now being required to wear face masks, but these can be makeshift ones from scarfs or the link, and they are not required when eating, so there will be ample opportunities for asymptomatic infected passengers to transmit the virus on board.
There's also the matter of passengers who have a fever but take medication to reduce their fever in order to pass the temperature check. But as noted above, even if there are no passengers trying to game the system, unwitting asymptomatic passengers could easily thwart the goal of preventing virus transmission.
Are There Alternatives?
Emirates administered coronavirus antibody blood tests to passengers, with results provided in 10 minutes, on a flight to Tunisia. One of the most accurate coronavirus antibody tests, with sensitivity of 100% (successful identification of all those with antibodies) and specificity greater than 99.8% (successful identification of those without antibodies). These antibody tests only test for antibodies and not for active infections, so while they would be helpful in identifying passengers and crew who are safe to fly, other measures would be needed to help prevent infected passengers and crew from flying.
Another type of test that the U.S. FDA has granted Emergency Use Authorization (EUA) for is COVID-19 antigen testing, made by Quidel. This test takes about 15 minutes and is faster in returning results than PCR tests, but also less accurate, with many more false negatives, although positive results tend to be accurate.
Crucially, at time of writing, test capacity still has to be ramped up to allow the general public to be tested, not just healthcare and frontline workers. Until that happens, more accurate testing (of those who are either currently infected with coronavirus or were in the past and have coronavirus antibodies) is unrealistic.
Naturally, both blood tests and swab tests are far more invasive for passengers and take more time than a contactless temperature reading, which is why temperature checks have become so widespread across Asia, despite the fact that they miss so many asymptomatic cases. Temperature checks are a poor proxy, but more precise and invasive alternatives at the scale we need them aren't available yet.
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