Thanks everyone (below) who was concerned about whether the 42degrees figure was too high. A doctor on the team confirmed that figure was on purpose, but for peculiar reasons, and was kind enough to offer a few pages of explanation which I'll do my best to summarise. Any errors below are mine, not theirs.
The purpose of the program is to watch a large population of COVID patients who are not sick enough to warrant being in hospital. Miserable no doubt, but OK. The purpose of the monitoring is to identify those who are getting sicker before they have become very sick.
The goal is not to have the system calling ambulances. It can (and has) but we should be spotting degradation and reacting before it comes to that. To that end we measure three vitals (temperature, heart rate and oxygen saturation). They are not each equal predictors of the sickness we wish to spot. They are also not linear indicators of sickness.
We have three levels of response to patient vitals. There are some automated suggestions for patient comfort at the bottom end. There is the metcall at the top end. But the most important is the Clinical Review in the middle. Clinical Review connects the patient with a clinician by phone so that we can dig into their situation.
Temperature it turns out is not an especially good marker of the sickness we need to find in the group of people we are monitoring. "[with temperature] there is a U shape association with mortality, but the error bars at any point a super wide". It has some correlation, but high temperatures are not a good enough predictor of what we're trying to spot. Oxygen Saturation is good because of what COVID can cause in the lungs. That can happen without the patient being aware of it so it's critical to what we must spot.
Infection alone wont bring someone up to a temperature that high (we're monitoring people with covid, not amphetamines overdoses or desert marathons). So COVID monitoring is not dependant on spotting patient temperatures that high, and if it was that high it would not be on account of the virus. For those patients this isn't the only healthcare the patient is involved with.
So why do we bother to give the patient a thermometer? It's easy to measure. The devices are cheap and readily available. It's useful at the slightly-elevated end and helps us recommend paracetamol if/when appropriate. Tracking a patient temperature over their monitoring period feeds data back into the ongoing analysis of the virus. We ask a number of supplementary questions of the patients each day. Hopefully there will be trends.
So finally, why is there a temperature threshold at 42 degrees? More an accident of the project history. We'd built the multi-step thresholds for each of the measurements, but it turned out the highest temperature one really isn't applicable in our project. The patient hits Clinical Review well before they get up to those temperatures. It may come out completely in a newer version.
Also they added "Whilst not completely analogous, we draw your attention to the NEWS2 illness scoring system used by the National Health Service (UK)
(https://www.mdcalc.com/national-early-warning-score-news-2). The system uses various parameters to calculate a score of 'how sick they are'. Whilst many measurements have a 3+ (add 3 to the score) threshold values, the NHS does not have a temperature threshold value 'worthy' of contributing 3 points to your illness score."
The purpose of the program is to watch a large population of COVID patients who are not sick enough to warrant being in hospital. Miserable no doubt, but OK. The purpose of the monitoring is to identify those who are getting sicker before they have become very sick.
The goal is not to have the system calling ambulances. It can (and has) but we should be spotting degradation and reacting before it comes to that. To that end we measure three vitals (temperature, heart rate and oxygen saturation). They are not each equal predictors of the sickness we wish to spot. They are also not linear indicators of sickness.
We have three levels of response to patient vitals. There are some automated suggestions for patient comfort at the bottom end. There is the metcall at the top end. But the most important is the Clinical Review in the middle. Clinical Review connects the patient with a clinician by phone so that we can dig into their situation.
Temperature it turns out is not an especially good marker of the sickness we need to find in the group of people we are monitoring. "[with temperature] there is a U shape association with mortality, but the error bars at any point a super wide". It has some correlation, but high temperatures are not a good enough predictor of what we're trying to spot. Oxygen Saturation is good because of what COVID can cause in the lungs. That can happen without the patient being aware of it so it's critical to what we must spot.
Infection alone wont bring someone up to a temperature that high (we're monitoring people with covid, not amphetamines overdoses or desert marathons). So COVID monitoring is not dependant on spotting patient temperatures that high, and if it was that high it would not be on account of the virus. For those patients this isn't the only healthcare the patient is involved with.
So why do we bother to give the patient a thermometer? It's easy to measure. The devices are cheap and readily available. It's useful at the slightly-elevated end and helps us recommend paracetamol if/when appropriate. Tracking a patient temperature over their monitoring period feeds data back into the ongoing analysis of the virus. We ask a number of supplementary questions of the patients each day. Hopefully there will be trends.
So finally, why is there a temperature threshold at 42 degrees? More an accident of the project history. We'd built the multi-step thresholds for each of the measurements, but it turned out the highest temperature one really isn't applicable in our project. The patient hits Clinical Review well before they get up to those temperatures. It may come out completely in a newer version.
Also they added "Whilst not completely analogous, we draw your attention to the NEWS2 illness scoring system used by the National Health Service (UK) (https://www.mdcalc.com/national-early-warning-score-news-2). The system uses various parameters to calculate a score of 'how sick they are'. Whilst many measurements have a 3+ (add 3 to the score) threshold values, the NHS does not have a temperature threshold value 'worthy' of contributing 3 points to your illness score."