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KAPATOS AND SPOONEMORE
The main limitation of this study is the small sample
size, which also consisted exclusively of incarcerated
males from a single institution, that limits generalization
of these findings. Females are known to have higher
SpO2 levels than males (97.7% [SD 1.4%] vs. 97.2%
[SD 1.6%]; p< .001; Vold et al., 2012) and so different
cut-off scores for females and males will have to be
used if adding pulse oximetry to screening.
Our population of infected individuals included many
housed in a mental health unit with a high prevalence of
mental illness. Although it is reasonable to suspect that
ourfindingof61%asymptomatic infectionsmaybe inflated
due to the high prevalence ofmental illness, thismay not be
the case as only two (6%)ofACtookOTC antipyreticmedications
compared to seven (32%) ofSC who did so. Additionally,
the SC group had a higher prevalence of mental
illness (41%) compared to the AC group (20%).
Another limitation of this study is that the results seen
with these screening algorithms required that screening be
performed at least three times daily; thus, the algorithms
will be less sensitive if applied to once-daily screening.
Also, to be effective, pulse oximetry must be performed
carefully with high quality pulse oximeters as these devices
have a number of pitfalls (Luks & Swenson, 2020).
Knowledge of how varying cut-off scores and disease
prevalence rates affect the positive and negative predictive
value of screening is also critical for balancing
screening sensitivity and false positive rates. The various
algorithms may not be effective when used by nonmedical
screeners who lack this knowledge and training.
In this study, individuals with COVID-19 had vital
signs measured three times per day compared to once
per day for those under COVID-19 quarantine; thus, a
component of error may arise from individuals with
COVID-19 having a lower SpO2 because they received
more measurements. However, that alone could not explain
the M duration of SpO2£95% of 3.9 days (SD
3.1, range 1-10 days).
Another weakness is the validity of the reference test
used to define true cases and true controls. There has
been some discussion on the accuracy of the Abbott
Rapid ID Now device, with one study done in New
York City reporting a false negative rate of 46% (Basu
et al., 2020). However, subsequent studies report significantly
better results (Harrington et al., 2020; Mitchell &
St. George, 2020; Tu et al., 2021). In our population, two
obvious false negative Abbott Rapid ID Now tests were
found, which lends confidence that our control group accurately
represents a true control group.
Conclusion
In our small sample, there was a subtle yet high prevalence
of abnormal SpO2 and temperature vitals measurements
among people with asymptomatic COVID-19
infections who did not experience an overt fever.
A screening algorithm that uses both of these measures
was superior to the traditional screening algorithm by
detecting many people with asymptomatic infections
who had low-grade fevers or mild hypoxemia.
Although our small and selective sample limits generalization
of the results to broader populations, the findings
warrant further study of COVID-19 screening
procedures to better understand how effective they are
in detecting infected individuals, especially those who
are asymptomatic. One study expounded on the mechanisms
of anosmia, reported on the prevalence of anosmia
in asymptomatic infections, and called for the use of anosmia
in daily screening (Butowt & von Bartheld, 2021).
A large, multicentered study investigating low-grade fevers,
hypoxemia, and anosmia as potential targets for
rapid and cost-effective COVID-19 screening may help
mitigate the spread of the virus.
Acknowledgment
The authors would like to acknowledge Lesianelle King,
DPT, PT, for her assistance in gathering background information
presented in the Method section and in the
preparing of this manuscript.
Authors' Note
The conclusions are the authors' personal opinions and
do not reflect any official position of the Federal Bureau
of Prisons, Indian Health Services, U.S. Public Health
Service, or the U.S. Department of Health and Human
Services.
Authors' Contributions
P.D.K. contributed to this study by developing the methods,
collecting the data, assisting in the statistical analysis,
and writing the manuscript. S.L.S. contributed to this
study by assisting with developing the methods, determining
what data to collect, performance of the statistical
analysis, writing the results section, and overall input on
the writing of the body of the manuscript.
Author Disclosure Statement
The authors disclosed no conflicts of interest with respect
to the research, authorship, or publication of this article.
Funding Information
The authors received no financial support for the research,
authorship, or publication of this article.
References
Basu, A., Zinger, T., Inglima, K., Woo, K. M., Atie, O., Yurasits, L., See, B., &
Aguero-Rosenfeld, M. E. (2020). Performance of abbott id now covid-19
rapid nucleic acid amplification test using nasopharyngeal swabs transported
in viral transport media and dry nasal swabs in a New York City
academic institution. Journal of Clinical Microbiology, 58(8), e01136-20.
https://doi.org/10.1128/JCM.01136-20
https://www.doi.org/10.1128/JCM.01136-20
Journal of Correctional Health Care - April 2023

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