How fever is defined in COVID-19 publications: A disturbing lack of precision

A. Grünebaum
F. A. Chervenak, Zucker School of Medicine at Hofstra/Northwell
L. B. McCullough
J. W. Dudenhausen
E. Bornstein, Zucker School of Medicine at Hofstra/Northwell
P. A. MacKowiak

Abstract

© 2020 Fever is the single most frequently reported manifestation of COVID-19 and is a critical element of screening persons for COVID-19. The meaning of "fever"varies depending on the cutoff temperature used, the type of thermometer, the time of the day, the site of measurements, and the person's gender and race. The absence of a universally accepted definition for fever has been especially problematic during the current COVID-19 pandemic. This investigation determined the extent to which fever is defined in COVID-19 publications, with special attention to those associated with pregnancy. Of 53 publications identified in which "fever"is reported as a manifestation of COVID-19 illness, none described the method used to measure patient's temperatures. Only 10 (19%) publications specified the minimum temperature used to define a fever with values that varied from a 37.3 °C (99.1 °F) to 38.1 °C (100.6 °F). There is a disturbing lack of precision in defining fever in COVID-19 publications. Given the many factors influencing temperature measurements in humans, there can never be a single, universally accepted temperature cut-off defining a fever. This clinical reality should not prevent precision in reporting fever. To achieve the precision and improve scientific and clinical communication, when fever is reported in clinical investigations, at a minimum the cut-off temperature used in determining the presence of fever, the anatomical site at which temperatures are taken, and the instrument used to measure temperatures should each be described. In the absence of such information, what is meant by the term "fever"is uncertain.