Feverish preps for bird flu

Way back when this crap first started Revere I told my wife to get a pair each of the old mercury rectal and oral thermometers. Couldnt find them.. (mercury being the key issue),

Finally settled on a pistol type radiation thermometer that had a laser pointer on it. You can find an exposed piece of skin, (generally the forehead) and from ten feet a way zap them and get a temp thats accurate to one tenth of a degree. Aint bad and you dont have to be in the proximity of them.

Except you aren't measuring body core temp. Forehead is usually a degree or so cooler than core temp and is sensitive to environmental temperature. That's why rectal temps were the standard (although they are usually a bit above core temps because of heat generated by microbial metabolism). The ones you stick in the ear are measuring tympanic membrane (ear drum) temps via infrared radiation as this is probably a pretty good reflection of body core temp, although a number of things can interfere with this measurement. In addition I wonder about the laser locator version you have. You might point it at an MRK-type with a concealed weapon who thinks you are targeting them with a gun, not a thermometer.

Revere, I can understand your irritation with us lay folks, but give us a break. People don't even remember how to make jelly anymore, let alone the differences between a cold and a fever. Honestly, I am very worried. People are so used to relying on a doctor. They are NOT going to know that fluids might save their loved one. So maybe the thermometer is not all that important, but it sure helps knowing when things are really bad like at 104 and what to do then with no hospital, ambulance or doctor in the list of options. What does one do?

revere,

Health care workers have thermometers. They are not in short supply and they are not going to be the choke point. If not every household has one I don't think that's going to be the problem if there's a pandemic with an influenza virus even a tenth as virulent as the current H5N1.

Do you mean to say HCWs are not in short supply? Or thermometers are not in short supply?

Either way, I'm surprised that you don't think they (whatever the 'they' is) are not going to be the choke point. I was a family physician for over a decade and an ER doc for a year, and I would say that well over half of those who walks into either one of these places saying they have a fever don't.

In a pandemic, one of the greatest choke points will be where people first go to seek treatment, whether it is primary care physicians or hospitals. And one of the most useful objective signs for triage, as you rightly pointed out, is the presence or absence of fever. IF every or most households have thermometers and know how to use them, then frequent PSAs and/or phone hotlines telling people NOT to go and seek treatment if they don't have a temperature will IMO serve to alleviate a lot of the pressure.

It will at the very least remove from the mayhem a large number of the 'worried well'. The experience from SARS is that many of those prone to such worries were also worried about getting infected IF they go and see a doc. Helping them to make a sensible decision by using temperature as a criterion is IMO one of the best ways of keeping them at home.

phyto: It's not an irritation with lay folks. On the contrary, I think it is a misplaced reliance on a medicalized measurement. You don't need either a doctor or a thermometer to realize someone has a temp of 101. Of all things that should be stockpiled, thermometers are low on the list and making a point of this is potentially confusing and worrying to people. As I said, the choke point in a pandemic is not going to be a shortage of thermometers and implying that it is I think is silly. Let's keep our eye on the ball (which we may differ about but I don't think thermometer shortages is one of them).

SusanC, good point and well worth adding to a local city plan in educating the public. I'm very glad there are lots of sites for information on how to treat influenza at home. And, as long as the Internet stays up, people will suddenly rush to download these directions. But I have little hope that will happen. One of the best things the local public health can do is offer lectures on how to treat at home; and companies requiring employees to attend these lectures! I can see the posters on the corner telephone polls now with short directions on how to treat a fever at home.

Thermometers are not going to be a choking point in my estimation either. Every mother has placed her hand on the forehead of a sick family member. We can tell if junior is really sick or gold-bricking. Those that head to the doctor's office with the idea they are sporting a fever, when they aren't, have other issues. Those people would go to the doctor in any case, fever or not. The fever thing is just an excuse.

What puzzles me is who and why someone felt this would be an important issue to raise? Someone who sells or has connections to manufacturers of thermometers perhaps? Is this a bait and switch? May we expect something a little more substantive the next time this group speaks? Because the bottom line here is, if you have bf you aren't going to have a low grade fever, but one that would be obvious to all but the most incompetent caregiver.

Something else we might bear in mind is that the Aussies have already stated all households need to have a 90 day food and water supply on hand. Perhaps at this point they are just looking for tiny chinks in their armor. If that is the case, well, more power to them. Too bad we aren't working on minutia now as well.

FWIW, for those who can tell accurately whether someone has a fever or not in any other way than using a thermometer, good for you.

The point is, a large proportion of the public don't. Again this is speaking from my own experience, which may not be representative. But still, we cannot make plans based on assumptions of good judgment from the public unless we have means of verifying those assumptions.

Apparently Revere it takes that into account. I used an ear type and the laser and the difference was the exact one tenth advertised.

And you are right, it might give someone pause if you aimed it at them in the night if they broke in. Nasty thing about laser sights. It goes right where you aim it.

Hey Shannon.... Is that 90 day supply in the Australian Pandemic plan or is that something like a public service announcement that they make there?

Here is my little rub. The US puts out the NPFP... everyone ignores it. Yesterday there were 88 stories on the web that I could pull about BF.... The US? One in the NYT......

The US is going to need a lot more than thermometers for panflu if it comes. Its just another tool. If it cranks up I doubt that the diagnosis will be in question. The prognosis will for sure. Personally, I wouldnt get near someone that had it without a suit, full mask and a decon facility out back.

In particular I think the US and developed countries will by percentage suffer more than the underdeveloped ones in relation to life style. If they had thermometers in say Pakistan, or Somlia...Would they know how to use them? On the other hand, we might know how to use them but they wouldnt be available along with the Aussie 90 day supply of food and supplies because they dont take it seriously.

Batesville Casket Co. Revere. Publicly traded..........

More of a public service announcement. See here.

See issue 12, December '07.

or here
http://opac.library.usyd.edu.au/search?/tMedical+journal+of+Australia+%…

Correction, meant to place this one first.

http://opac.library.usyd.edu.au/search?/tMedical+journal+of+Australia+%…

see issue December 12, 2007

Specifics here.

http://www.mja.com.au/public/issues/187_11_031207/hau10357_fm.html#intro

Susan: Thermometers was the reference, not HCW. When I say "fever" I am talking over 100 or 101. Maybe some people can't tell, neither of us know how many people that is or what their response is (call a doc or whatever). But we are arguing on the margins. Thermometers isn't a big problem (IMO) and this article made it sound like it was.

Susan: Forgot to add: the question isn't "accurate" determination of a fever. It is, as Shannon says, can you tell if your kid is hot as a pistol. Most of us can. Maybe some can't. I don't know. But you don't have to get to the nearest tenth of a degree.

Susan: Forgot to add: the question isn't "accurate" determination of a fever. It is, as Shannon says, can you tell if your kid is hot as a pistol. Most of us can. Maybe some can't. I don't know. But you don't have to get to the nearest tenth of a degree.

Yes, I did understand what you were saying, and it wasn't about getting to the nearest tenth of a degree. ;-) And I AM also talking about temperatures over 100 or 101.

I'm just saying, you'll be surprised at the number of people who can't tell if their kid is hot as a pistol. Particularly if they are worried their kid is having a fever, but in fact is not. ie false positives are much more common than false negatives, you know, and these will be useful to filter/triage out in a pandemic, right out of the gate.

Also, I agree that thermometers aren't a big problem in the grand scheme of things, in a pandemic. But they are a cheap harmless solution that is easy to implement.

There must be some study somewhere about the incidence of ER or physician office attendance where the patient was suspected to have fever but in fact did not. It will be a very useful bit of information to know.

Revere, I too agree with your assessement that there's fever, then there's high fever, and most moms know the difference by a simple kiss on the forehead.

Once a determination has been made, by whatever method, though, that a kid is "really sick," what will be the next step? Where will they go if we are talking about the second week of a pandemic and onward? Homecare, I would assume, would be the option for most as primary care centers and hospitals become overwhelmed.

For those who truly must venture out to seek medical care and who cannot be treated at home, the more pressing question would seem to be whether HCW's will have enough PPE to treat patients once they show up. Thermometers will be the least of our problems in keeping the system operational at that point, while adequate amounts of proper PPE will be vital. For a publication with the words "Communicable Diseases" in its title, you'd think they'd be better advised to place the emphasis there.

I own a laser IR thermometer.

Its utility for taking a body temperature is not high. I have empirically noted that skin surface temps vary considerably. A contact or insertable thermometer is vastly more reliable.

In the context of pandemic prep, the first thought would be that it would allow a temperature assessment to be made of a possibly ill/infectious person from a safe distance away.

That first thought would be wrong. These sensors have a cone-shaped field of view. The further from the sensor head, the wider the field of view. There is actually an illustration of this embossed on the plastic case. Yes, there is a sighting dot from the laser, but that dot is just in the center of what can be a *large* circle.

The unit cannot be focused down to, say, cover a face-sized field at ten meters.

You can move in closer to get greater specificity in terms of what the sensor sees. But to narrow it down to a face-sized field would require coming in to about a two meter distance from the individual being tested. That is cough and sneeze territory.

It may perhaps be possible to design and build such units with the intention of making them of utility for this purpose. The one I own is useless for that.

Note also that when taking a temp reading from the face with such a unit, there is a certain level of risk of retinal damage from the sighting laser, if you are testing someone who will not reliably keep their eyes closed while being illuminated (such as a kid).

The laser is low-powered, pretty much a laser pointer, but you are not supposed to look into the beam aperture of one of those, either.

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From the most common of people here, what Im reading into this is that alot of homes do not have thermometers and those that do may not even know how to take a temperature. It does make good sense that this would be a good tool to have in your home in the case of when the bird flu makes it here. If people were educated a little on the use of a thermometer etc..maybe there would be less trips to hospitals, doctors offices for people that have just relied for so long on the doctor just to tell them yes or no you are sick. I think it stands to reason that wshtf, the poor and the people that have relied on the government for so long will be the ones that panic. I say we should start now by educating in the most basic ways to these people, who knows it may just help. Believe it or not the simple phrase...Keep it simple stupid...that is the way to train people..regular people that dont understand chain reactions and the other scientific jargon are the ones that need some simple tips to preparation and planning for when.

I should mention: for body temperature measurements, our household owns and uses two, both of them solid state thermocouple devices. One of them is an oral unit, the other an aural.

In keeping with our wonderful modern age of planned obsolescence and deliberate waste, these are both consumer grade devices, which means that they run on a watch battery physically sealed inside the case. You're supposed to toss the whole unit in the landfill when the battery dies.

Investing in professional grade equipment may make sense.

I have seen and used skin contact thermometers. These are typically made of flexible plastic film, and change color to provide an indication. They will not give you a reading accurate to within a tenth of a degree Fahrenheit, but they need not do so for most household purposes. Useful for a fussy small child. Unbreakable. No power requirement.

I should also note that they are cheap, and flat, and could be made by the millions and simply mailed out to households as part of a pandemic awareness package.

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I dunno, Revere... I once had 102.2 degree fever I was unaware of having. (I'd gone in because I had a cough and sore neck, and there'd been a meningitis warning at my uni.) Granted, maybe a friend could have told I had a fever... and I was more out of it than I knew at the time, but I didn't think to ask. Besides, lots of people live alone, and as my case shows, you can have a fever and not know it.

And they still didn't say I had the flu -- it was an "upper respiratory infection." I still think it was the flu, but like you've said repeatedly, there are other ILIs out there.

Levygoddess: We wouldn't want to distribute mercury thermometers and others are more expensive and don't always give the right readings if not used properly (same for mercury therms, BTW). Most need to have fresh batteries, as marquer notes. I've used the flexible strips and I think they are worthless. I can do much better with my cheek or hand on the person's forehead. Note, I am suggesting this for family members, not HCWs. They must use a thermometer.

Levygoddess -- I'd dispute your assertion that it is poor people who stream into the doctor's office when they are sick. I know people without health insurance, and they are the ones who put off going to the doctor because a simple visit is a major expense, and/or they can't afford to miss work. Nor do I think the freaking out will be limited by socioeconomic class. (I don't call it panic, because as Sandman (and Lanard?) note, true panic is irrational, destructive, dangerous... and extremely rare.)

If anything, the existence of so many people without health insurance is risky for the rest of us because their delays in seeking care could well delay our notice that a panflu has arrived in a given place.

caia: But if you didn't feel feverish what are the chances you would have taken your temp? (did you have a thermometer?). Remember, too, that body temps vary between people. You can have people seeking medical care for slight elevations in temp that wouldn't otherwise. But remember the main point of the post: of all problems with pandemic preparedness, this is second or third level, if that. The commentary elevated it to what I consider a silly level, which is about all I said (despite the fevered reaction to the post).

Aussies are basing their pandemic plan on quarantine rather than hospital admittance. It is a given there will not be enough beds, health care workers or vents. Instead of concentrating the sick in one place, family will care for them at home. The plan is to phone a health care worker when you have a temperature. A medical worker then visits and makes the call as to whether or not you need to quarantine. Based on that assumption, the need for a thermometer is required.

Of more importance is if the citizens in Australia are going to comply? It means the government will have to actively prepare it's citizens, in advance, for a worst case scenario. How adult. How honest. How non-elitist. How many are ready to care for the sick at home here? Especially given the severity of bf and the lack of treatment options. Interesting question because eventually we are also going to be treating sick at home. Where, as Revere stated, a thermometer may be the least of our worries.

Revere -- of course you're right, thermometers aren't at the top of the list in pandemic preparedness. I was just discussing the concept that a fever is necessarily obvious. Because, while I wasn't aware of "feeling feverish," I was out of it enough to have a friend drive me... and forgot both to bring my health card and who my insurance carrier was once I was there. I definitely knew it later when the fever broke, I was just too out of it to notice how feverish I felt.

FWIW, my normal body temperature was/is usually on the low side, almost always below 98.6, so 102.2 is definitely a fever. And I assume anything over 100 counts as a fever no matter who you are, right?

revere,

I had a quick look around for papers about fever, parental perceptions, ER visits, after-hours calls etc. It was very interesting. While I did not find anything on how accurate parents can determine whether a child has a fever without the use of thermometers, (ie it didn't directly address the question that I was interested in) there is a surprisingly large amount of research on 'fever phobia', parental anxieties around fever, parental and more intriguingly healthcare professionals' misconceptions about fever, including beliefs that fever causes cerebral damage, etc.

I know this isn't quite what you are talking about here, but I thought I might as well post a few of the most interesting papers here. Enjoy. ;-)
Fever Phobia Revisited: Have Parental Misconceptions About Fever Changed in 20 Years?

Parental and health care provider understanding of childhood fever: a Canadian perspective

When Fever, Paracetamol? Theory and Practice in a Paediatric Outpatient Clinic

Thanks, Susan (as always). Pretty interesting.

Everytime I had the flu, there was no doubt. I never needed a thermometer, the first signs for me usually are chills, aches, headache, and then wham, the fever kicks in big time. There are many reasons for a fever, not all of them are flu related, so temperature checks would yield false positives. Those with the flu know it, it is not difficult to diagnose flu from a typical URI. Besides, with influenza, you are infectious BEFORE symptoms are felt, like fever. And when the flu hits, you are too sick to want to go out, so quarantine measures seem absurd for influenza, people may go to work with a cold, not the flu once it has kicked in.

As you recover from the flu, having no temperature is an indicator you are recovered, but my understanding is that you are not very infectious at this point even with a mild fever. If I am wrong, then having a thermometer may be useful to determine when you can safely go public.

But Big Brother wants to exercise their police powers, and get you used to being dominated, even if it does nothing of value and may even make things worse.

I wonder how many tents and nurses/doctors (nurses actually more important than doctors in a pandemic) they have signed up to volunteer to treat patients who show up at hospitals whose beds are full in the event of a pandemicc This was the biggest issue in 1918. Has it been addressed? Not everyone needs to go to hospital when they have the flu, even a pandemic flu, but treating those who do in an isolated setting is paramount, especially since other diseases do not simply go away (getting the flu at hospital while being treated for heart attack is not beneficial).

In 1918 people eventually realized it was best to stay home and fend for themselves, come what may. Seems little in our planning gives any hope that we will do any better this time.

Uh, please note that this was just a letter to the editor. Some folk in a fairly obscure area clearly just wanted to add their 2 cents to a report on a preparedness excercise by contributing the only datapoint they had from their own work that was even remotely relevant. Lots of people do this sort of thing (who here is guilty of it?) and are rightly ignored. I really don't see that anyone in a position to actually spend money would take this suggestion seriously.

Preparedness mailout, sure, worth doing. Adding "thermometer" to list of items to keep in preparedness pack, so the TV can tell people what a fever is? No problem - it gives people something to do, some way of feeling like they're doing something, if only diagnosis.

Stockpiling them? It'd never happen.

One of the rare moments where I disagree at least partially with the reveres. At least in Germany we do expect that HCWs will be absolutely overwhelmed with demand. Nothing goes, sort off. So on the humorous side the recommendations to docs, aside from many other recommendations was buying larger mobile phone batteries. Because they will be constantly and mainly on the road visiting patients or groups of patients. Triage will be done via mobile communication with the doc or support personell for most of outpatient area. Which, by sheer scarcity for hospital beds or surrogates for that, will be a considerable, if not the biggest part of any healthcare assistance available.
Assuming that at least some phone/mobile communication still works, being able to tell before driving to anyones home wether the patient indeed has a fever (and that somewhat more objectively measured with a thermometer) might save time and effort for the benefit of other patients and if only in the order of visits.
Temperature (fast and high raising) is one of the two telltale signs, the other most reliable being the sudden onset (that truck that hit you) all others might be there or not in the very beginning. So for any triage it is essential, at least in all situations where initial triage is done via distant communication.

The ability to diagnose fever? Possibly you are a little biased there because of your excellent skills. I am not confident to be able to guess any more precisely than fever or very high fever and that is a little too inaccurate for my liking, plus the issue of knowing before-hand (in a double meaning)/via a distance.

There is at least one analog thermometer out there without batteries and without mercury, about the same precision/problems as the glass mercury ones. But with the advantage that it will work even if forgotten and unused for years.

Agreed, the overall pandemic battle will not be won with or without thermometers. But I can imagine enough situations where it does make a difference on an individual level wether a scarce resource in a pandemic, that is a doc here, all kinds of HCWs elsewhere, goes to help patient A or patient B first because of the tiny tidbit of information about fever/no fever known upfront. Just as with any phone consultation where treatment directives could depend on at least some rough but more objective idea about the level of temperature.

Not sure if this was covered in the other comments (as there were quite a few) but this so called common sense surely assumes the person assessing the temp. of a patient is not also suffering from a temperature which I am sure would affect your ability to detect. They are not expensive or in short supply (at the moment) so why not just get one if you don't already. No it probably won't save your life but to assume a call for them to be purchased is some sort of corporate conspiracy to sell thermometers is as crazy as the argument to not have one.

All: Look, I'm not arguing against having a thermometer. They are a useful thing to have in the house (we don't have one but I've urged my daughter to get one for her family). But of all the things to focus on, this seems to me misplaced and frankly silly. ST has a point when he says it was just a Letter and shouldn't be taken too seriously. By the same token, this was just a blog post. I will say this: the reaction to it and conversation have been interesting and illuminating and generally thoughtful.

With all due respect to the Aussies, Shannon's post surprised me. I can't imagine why it would be necessary to have HCWs check out all reports of fever with a home visit to decide if the ill person should be isolated (quarantine is for well, exposed people).

The message to the public in a pandemic should be, if you're ill, stay home!

Why would we use scarce HCW resources and unnecessarily expose them to PI for this purpose?

by the time you realize your infected it will be to late.the hospitals will send you to an area with h5n1 people,they will have no respirators to keep you alive.the medical people will be protected by the military,state workers will be held in protection to keep things moving.all the bodys will be burned.70 percent of the infected will perish.this bug is a protein which means cold winter air will not kill it.this virus can live in the ground and re appear at anytime.the only protection you have is yourself and your family.this virus has mutated to now live in your nose throat and lungs,it has not become airborn at this time,it needs one more mutation to achieve this.once this happens it will take about 3 weaks to be global,the second wave will come 6 to 9 months later.they are down playing this as to not create a panic.i am on the emergency board for the county.travel will not happen. countys and towns will be locked down and martial law will be inforced with deadly force,electrity telephone and internet will not last long, neither will the food or public services,if you want to survive you need at least one year worth of food and water,dont panic until you the spread into europe,human to human,then you have maybe 2 weaks,i didnt post this to scare people i posted this because anybody who knows anything wont.sorry to be the bearer of bad news but my guess is this virus will mutate in the heat of the middle east this year.if you would like to email me about this topic please do,chance favors the prepaired.hitekrednek65@hotmail.com

For what it's worth, and while we're at it, here's a piece of news (July 2007):

http://www.cbc.ca/health/story/2007/07/11/mercury-ban.html

The European Union has banned the use of mercury in thermometers and other devices as a part of a larger strategy to end the use of the highly toxic substance across the continent.

The European Parliament approved on Tuesday a ban on the sale of new mercury fever thermometers, manometers and other measurement devices, citing its toxic effects on humans, ecosystems and wildlife. The new legislation should become national law in the EU's 27 member countries by spring 2009.

More info at http://en.wikipedia.org/wiki/Mercury_(element)

Now, if battery-dependent thermometers are the way to go, then that's one more reason to have generic crank charging devices, at least one in every home and one in each car. Phone companies could easily get that going (with their customers' money). Couple that with this and there'd be some higher degree of "first world resilience" (the kind you might have with air-bags for speedy cars).

Some things can be done. And minor things don't add up: they multiply up. So it's a matter of choosing what to do, exactly; and then doing it.

lugon: "Now, if battery-dependent thermometers are the way to go,"

Not really. As I posted there is at least one analog, without batteries. A quick google search will reveal the name without me advertizing it here.