Hand Sanitization, Wearing Face Masks, Social

Distancing, and Thermal Screening for Fever Detection:

Why Accuracy is Worth the Investment

Authors:
Susan Sly, RadiusAI
Dan Dietrich, Jogan Thermal Checkpoint

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 TABLE OF CONTENTS

Introduction ................................................................................................................................................. 2
Proven Monitored Basics………………………………………………………………………………………………………………………… 3

Fever Detection Accuracy ............................................................................................................................ 4

Your Process Depends on Accurate Data ..................................................................................................... 5
System ROI Depends on Accuracy ................................................................................................................ 6
Lack of Accuracy Creates Potential Liability ................................................................................................. 7
Employee Satisfaction and Marketing Advantages ...................................................................................... 8
Conclusion .................................................................................................................................................... 8
Key Takeaways ............................................................................................................................................. 9

INTRODUCTION
As the COVID-19 pandemic continues to impact our global society, businesses are being forced to discover
new ways to operate while ensuring the safety of staff and customers. Many groups are exploring a
variety of individual solutions to promote wearing surgical style masks, hand sanitization compliance, and
social distancing. Solutions range from a variety of signs that are posted to hopefully encourage
compliance to hiring, or utilizing existing staff members, to ensure that other employees, or customers,
comply while also using handheld “fever screening” solutions. These measures are only somewhat
effective because they rely on individual voluntary compliance and potentially put employees, or
customers, at risk of becoming infected.

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Commencing with febrile detection, the market is awash in thermal detection systems, many previously
marketed for industrial machine monitoring, now being touted as capable of determining Elevated Body
Temperature (EBT). Wild and unproven claims on these system capabilities defy our body of knowledge
on thermodynamics and physics in general. These claims combined with a wide price range and limited
supply availability create a complicated economic decision model which buyers must navigate. David
Yaffe-Bellany summed it up best in his NY Times article published on February 14th, 2020, “thermometer
guns on Coronavirus’ front lines are notoriously not accurate.”
https://www.nytimes.com/2020/02/14/business/coronavirus-temperature-sensor-guns.html

The proven methods of prevention of viral spread include effective hand sanitization, wearing masks,
and social distancing. Stacy Gillan, Director of the Center for Human Dignity and Bioethics, writes of
COVID-19, ‘The best way to protect the future is to remember the past, and in order to do that we must
act now.” From our history with any flu epidemic and viruses such as H1N1, it is understood that viruses
spread on surfaces, through the air, and via human contact. Sanitizing hands, preventing the spread of
airborne illness with masks, and social distancing, can help to dramatically reduce the rapid, costly
spread of viruses.

This paper serves to provide insight into why a seemingly “expensive” solution may, in fact, be the most
economical.

PROVEN MONITORED BASICS ARE THE MOST EFFECTIVE

FIRST LINE OF DEFENSE
It is widely understood that proper hand sanitization methods can help to prevent the spread of viruses
and bacteria. Unfortunately, many techniques are grossly ineffective. If the individual fails to wash their
hands for a long enough period of time or uses a hand sanitizing solution that is under 60% alcohol, the
effect is inadequate. Research, such as a study published in the journal Food and Environmental
Virology, found that alcohol-based hand sanitization is highly effective in preventing the spread of
viruses. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032461/

COVID-19 is believed to be primarily spread through airborne droplets from coughing and sneezing.
People cough and sneeze into their hands, they touch their faces, and they touch others. This also
increases the spread of the virus. The CDC recommends that people wear surgical style masks in order to
prevent the spread of the virus through airborne transmission. Unfortunately, allocating staff to enforce
mask detection for employees and visitors is not only unrealistic, it can cause undue additional stress for
personnel who are trying to maintain a safe distance from other people.

To further complicate the matter, a significant percentage of COVID-19 carriers may not have symptoms.
Dr. Robert Redfield, Director of the CDC is cited as stating that ‘25% of infected people may be
asymptomatic.’ Furthermore, people with COVID-19 might have the virus for up to two weeks before

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displaying the most common symptoms of fever, coughing, and respiratory distress. The only known,
proven methods of prevention are hand sanitization, social distancing, and wearing surgical style masks.

Mark Lipsitch, professor of epidemiology at the Harvard Chan School and director of the Center for
Communicable Disease Dynamics said, with regard to COVID-19, “all those measures, small as some of
they may be, help to slow the epidemic. There is a real coalescence between individually self-protective
measures and measures that will benefit the community. Basic hygiene and self-protection measures
are in fact socially beneficial.”

Using artificial intelligence, it is possible to now monitor employees, patients, and guests, for effective
hand sanitization compliance, mask detection, and social distancing, at facilities without compromising
any personally, identifiable information. The same technology can be used to detect avoiders and send
real-time alerts to encourage compliance to anyone who is not following the guidelines. This
technology, combined with accurate fever detection, allows for employers to have a solution that assists
with adhering to the suggested guidelines to prevent the spread of illness and detection of those who
might have it. The objective is to help bring people back to work and create safer environments.

ACCURATE FEVER DETECTION HELPS INTERCEPT INFECTED

INDIVIDUALS
Currently, there are many poor methods of fever detection and unfortunately the vast majority are grossly
inaccurate. Dr. James Lawler, from the University of Nebraska’s Global Center for Health Security says,
“these devices are notoriously not accurate and reliable. Some of it is quite frankly for show.”

The Jogan Thermal Checkpoint® is an enterprise level, full-stack, out-of-the box, hand sanitization and
mask detection compliance, people counting, social distancing nudging, and thermal temperature
scanning kiosk using precision thermal cameras and high-definition cameras in a proprietary enclosure
calibrated to meet federal FDA guidelines and global ISO and IEC standards on thermal screening of
humans to attain accuracy in real world settings. The camera stabilization and calibration design separates
Jogan from others who are affected by heat variances from open doors, drafts, A/C ducts, and other
environmental factors.

The US made thermal camera uses either a 320 X 240 or 640 x 480 resolution precision grade thermal core
(camera) manufactured and optimized to deliver precision readings of the human body, specifically the
tear ducts of the eyes (the Canthus) which is the most accurate area of the face with regards to
temperature. Each camera is calibrated and packaged in a stabilized enclosure designed to closely emulate
test laboratory conditions in the field. Coupled with a laboratory grade calibration device specifically
engineered to calibrate cameras for human body temperature readings (a “Blackbody”) in the
background, this system ensures the Jogan Thermal Checkpoint is configured to provide the most accurate
temperature readings at plus or minus .3 degrees C.

Most systems currently on the market measure Elevated Skin Temperature (EST). This is significant as the
skin temperature is highly influenced by external factors such as outside ambient temperature, direct sun

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exposure, wind, humidity, exhalation around masks and perspiration. Many manufacturers claim to use
an algorithm to create a temperature average and then adjust their thermal imager results to compensate
for these factors. This is often up to a 3 C degree difference from the camera’s actual reading. By focusing
only on the tear ducts or interior canthus as the sole accepted method cited in both the federal and global
standards, the Jogan Thermal Checkpoint eliminates this guesswork and simply provides the most
accurate body temperature measurement available from a thermal camera.

Systems measuring skin temperatures are often the exact same thermal sensor products which were
being sold to manufacturers to measure the operating temperatures of their factory machines just a few
weeks ago. The only change has been in the marketing… which drives unsupported claims. On the 17th
of April 2020, the United States FDA published its recommendation on thermal screening accuracy
(https://www.fda.gov/media/137079/download). It concluded that accuracy can only be achieved by:

• Measuring body temperature instead of skin temperature (EBT versus EST)

• The only accurate body temperature screening point is the Canthus (tear ducts)
• The thermal sensor must be environmentally stabilized for an accurate reading
• The system must include an accurate black body temperature reference source

EST systems are naturally less expensive than EBT-capable systems, sometimes by half the cost. This
factor can drive decision makers to forgo accuracy to save budget. However, as they do with other
corporate expenditure decisions, leaders need to understand the “other” financial impacts to their
business.

This next portion of the paper focuses on:

• How a businesses’ thoughtful screening process depends on accurate data

• The Return on Investment from ancillary impacts
• The liability considerations for thermal screening
• How accurate screening can be used for customer service marketing and employee satisfaction

Your Screening Process Depends on Accurate Data

To combat the spread of COVID-19 in the workplace, businesses are spending critical time and effort to
create a thoughtful screening process for customers and employees. Using “If This Then That” (ITTT)
methodology and metric-driven goals, virtually every action in that process is dependent on two factors:

• The individual Elevated Body Temperature (EBT) screening results

• The screening throughput rate (which is a function of the EBT screening results)

Thermal screening can have three possible outcomes:

• An accurate EBT reading

• A false positive (individuals without a high EBT are mistakenly reported as having a fever)
• A false negative (individuals with a fever are reported as having a normal body temperature)

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The truly thoughtful process will consider the risks associated with anything other than an accurate EBT
reading. A viable screening process must plan for the handling of subjects which present a high EBT
through initial isolation, rescreening via a secondary medical screening as outlined by the latest FDA
recommendations, and, if necessary, denying access to the workplace. Inaccurate high temperature data
will decrease throughput rates by requiring rescreening and multiple process points where key decisions
must be made by lower-level employees monitoring the entrances.

With systems measuring EST (skin temperatures), these false positives may be created by a worker
walking from their car to the lobby on a hot and humid day. Any situation which causes perspiration can
be a culprit driving bad data. A hot and humid day may dramatically slow throughput. Isolation areas
where subjects requiring re-screening wait their turn, or wait for their skin temperature to decrease, must
be large enough to account for social distancing requirements. Using an EST system will require a
considerably larger isolation area than by using the Jogan solution.

Conversely, a cold and windy day in that same parking lot is likely to generate a lower EST, creating a false
negative. A subject who actually has a fever, will be allowed to enter the workplace due to the inaccurate
data. This negates the company’s thoughtful process and allows contamination of the workplace and
transmission of any virus or illness to co-workers.

The Return on Investment for the Screening System is

Dependent on Accuracy

As mentioned above, inaccurate data introduced into the company’s screening system will have adverse
effects which have a calculable financial cost. In the case of false positive reports:

• Lost productivity of individuals waiting to be initially screened. The Jogan solution can screen
subjects in 1-3 seconds.
• Lost productivity of individuals waiting to “cool down” for rescreening
• Lost productivity of workers refused entrance to the facility – mistakenly sent home for the day
• If vendors screen positive, there will be lost productivity of workers who must perform tasks which
are normally done by those vendors… unloading delivery trucks, etc.
• If screening customers, the lost revenue from their transactions. Is a potential customer going to
stay and wait for re-screening? Will they continue to return to that business and face the hassle
and perceived embarrassment of another false positive?

The financial impact of a false negative (failing to identify a subject with a fever) may be exponentially
higher. The lost productivity of the worker themselves will be small compared to transmission to co-
workers, creating mass absence. Additionally, decontaminating workspaces, elevators, break rooms,
bathrooms used by an employee (or vendor, or customer) who has the virus can be very expensive and
must be timely. It’s exactly this situation that every company is seeking to prevent.

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Lack of Accurate and Compliant Systems Will Create a
Potential Liability

Returning to the company’s thoughtful screening process, the simple fact the process exists creates the
legal concept that it is indeed a requirement. If not necessary, the company wouldn’t conduct the
screening. Any form of screening, therefore, creates a liability. Inaccurate data dramatically increases
that liability. Without quoting the myriad of federal, state and local law, employers are compelled to
provide a safe workplace for their employees. In our litigious culture, lawsuits must be expected.

According to the National Safety Council, The average cost for all worker safety claims combined in
2016-2017 was $40,000 (https://injuryfacts.nsc.org/work/costs/workers-compensation-costs/). With
the uniqueness of the Covid-related claims, this may likely be much greater.

Employees who are denied entrance to the workplace may lose wages as well as suffer the perceived
embarrassment of being singled out as “contaminated”. These employees, who are proven to not have
any virus or illness may sue for those wages and damages.

Some customers who are denied entrance to a place of business will similarly be offended and seek
monetary compensation, as they would if they “slipped and fell” in a store.

A creative lawyer will likely build the lawsuit by demonstrating that there were relevant screening
standards which should have been met, if screening was being conducted at all. Both the US FDA, global
standards entities ISO and the IEC have published standards for “Fever Screening Technology”.

The IEC (International Electrotechnical Commission) has the following standards for these products:

IEC 80601-2-59:2017 Medical electrical equipment — Part 2-59: Particular

requirements for the basic safety and essential performance of screening
thermographs for human febrile temperature screening

ISO/TR 13154:2017 Medical electrical equipment — Deployment,

implementation and operational guidelines for identifying febrile humans
using a screening thermograph

ISO 80601-2-56:2017 Medical electrical equipment — Part 2-56: Particular

The IEC standards stated among other findings that it is critical to focus on interior canthus (tear ducts)
for accurate measurements… as all other areas are "unreliable"

The US Food and Drug Administration has traditionally regulated any device purported to determine body
temperature as a medical device. Gaining that FDA certification for a product may take years. In light of
the COVID pandemic, the FDA issued a statement saying they were not going to enforce the need for
certification on thermal screening devices at this time but left open the option that they would in the
future (https://www.fda.gov/media/136698/download). Instead, they issued their recommendations (as

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cited above) including the need for measurements at the inner eye and the necessity for a stabilized
camera environment to prevent temperature “drift” reducing accuracy.

The patent pending Jogan Thermal Checkpoint solution, though not currently 510K certified by the FDA
since it is not a medical device, meets all of the IEC, ISO and FDA recommendations. Jogan expects FDA
510K certification in the near future.

Companies which chose a solution that does not meet those standards could be at a disadvantage in any
potential lawsuit relating to the screening process. The “Profits Over Safety” argument will be prevalent.

Additionally, when the FDA acts on their statement to begin enforcing their existing medical device
regulations in the future, companies which purchased non-standard compliant thermal screening systems
may have to cease using them and replace with a compliant system. A company’s entire investment is at
real risk and simply having to change systems may be additional proof of liability for additional lawsuits.

Using a More Accurate System Has Employee Satisfaction

and Marketing Advantages

As part of a company’s process to thoroughly screen their employees, one objective is to instill a sense of
security and safety in the staff. They need to feel comfortable that the company leaders are taking every
step to ensure a safe environment. The purchase of screening systems that were chosen by cost over
accuracy sends a clear statement to the team about their value to the company. In fact, the high quality
of the system may be used as a communication point to the employees, conveying that their safety is
paramount.

Additionally, this same type of marketing may be used externally to inform shareholders and customers
of the value placed upon safety in the workplace. For companies where customers enter the workplace,
this may be the topic for an advertising campaign to bring them back into the stores. Some Jogan
customers are closely involving their marketing teams in the decision and focusing on efforts to maximize
the ROI for the checkpoints through advertising, including using marketing budget to pay for the
unplanned screening costs.

To further monetize the solution, Jogan Thermal Checkpoint kiosks may be “wrapped” in the company’s
logo and brand colors.

CONCLUSION
As we respond to the Covid-19 pandemic with processes to ensure hand sanitization compliance, wearing
masks, social distancing nudging, and screen employees and customers for fever, the accuracy of the
process has value implications far beyond base cost price.

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KEY TAKEAWAYS
• Thoroughly proven prevention methods of viral spread such as hand sanitization compliance,
wearing surgical style masks, and social distancing, are the most effective in combating the spread
of COVID-19 or other viruses such as influenza.
• The thoughtful screening process is very dependent on accurate Elevated Body Temperature
readings to drive throughput and reduce both false positive and false negative results.
• Lower quality screening systems with less accuracy can quickly cost far more with lost productivity
and contamination of the workplace.
• The screening process has innate legal and financial liabilities. Selecting a less accurate tool may
contribute to increased lawsuits. Failure for a company’s chosen monitoring system to be
compliant with ISCO, IEC and FDA recommendations may open up culpability and thus damages.
• The quality of the screening system can affect employee perception of the leadership’s
commitment to their health and safety.
• The investment to purchase a high-quality screening system may be partially offset through
internal and external advertising demonstrating the company’s compassion and commitment
during the pandemic.
• The Jogan Thermal Checkpoint full-stack, AI-driven solution is the ideal solution to create a safer
environment for employees and visitors.