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Brain thermal kinetics at brain-eyelid thermal tunnels overcoming COVID-19 thermometry limitations for automated asymptomatic infection detection in concert with physical and biological principles
  • +9
  • M Marc Abreu,
  • Ricardo L Smith,
  • Trevor M Banack,
  • Alexander C Arroyo,
  • Robert F Gochman,
  • Anna L Clebone,
  • Feng Dai,
  • Michael F Bergeron,
  • Ala S Haddadin,
  • Tyler J Silverman,
  • Adriano F Da Silva,
  • David G Silverman
M Marc Abreu
Department of Ophthalmology and Visual Science, Yale University School of Medicine, Department of Anesthesiology, Yale University School of Medicine
Ricardo L Smith
Department of Morphology and Genetics, Paulista School of Medicine, Federal University of São Paulo
Trevor M Banack
Department of Anesthesiology, Yale University School of Medicine
Alexander C Arroyo
Department of Pediatric Emergency Medicine, North Shore - Long Island Jewish Medical Center
Robert F Gochman
Department of Pediatric Emergency Medicine, North Shore - Long Island Jewish Medical Center,
Anna L Clebone
Department of Anesthesiology, Yale University School of Medicine
Feng Dai
Yale Center for Analytical Sciences, Yale School of Public Health, Yale University
Michael F Bergeron
Department of Physical Therapy, Augusta University Medical Center, Medical College of Georgia, Augusta University
Ala S Haddadin
Department of Anesthesiology, Yale University School of Medicine
Tyler J Silverman
Department of Anesthesiology, Yale University School of Medicine
Adriano F Da Silva
Department of Radiology, Heart Institute, University of São Paulo Medical School
David G Silverman
John B. Pierce Foundation Laboratory, Yale University, Department of Anesthesiology, Yale University School of Medicine


For centuries, temperature measurement deficiencies attributable to biological barriers and low thermo-conductivity (k) have precluded accurate surface-based fever assessment. At this stage of the pandemic, infection detection in children (who due to immature immune system may not effectively respond to vaccines) is critical because children can be readily infected and also become a large mutation reservoir. We reveal hitherto-unrecognized worldwide body temperature measurements (T°), in children and adults, over tissue typified by low-k similar to wood that may reach 6.8°C in thermal variability, hampering thereby COVID-19 control. Brain-eyelid thermal tunnels’ (BTT) integration of low-k and high-k regions creating a thermal pathway for undisturbed heat transmission from hypothalamus to high-k skin eliminates current shortcomings and makes the brain indispensable for defeating COVID-19 given that brain thermoregulatory signals are not limited by mutations. Anatomo-histologic, emissive, physiologic, and thermometric bench-to-bedside studies characterized and overcome biophysical limitations of thermometry through high-k eyelid-enabled brain temperature measurements in children and adults. BTT eyelid features fat-free skin (~900 µm) and unique light emission through a blood/fat configuration in the underlying tunnel. Contrarily, forehead features variable and thick dermis (2000–2500 µm) and variable fat layers (1100–2800 µm) resulting in variable low-k as well as temperatures 1.97 °C lower than BTT temperature (BTT°). Highest emission present in only ~3.1% of forehead averaged 1.08±0.49 °C (mean±SD) less than BTT° (p=0.008). Environmental and biological impacts during fanning revealed thermal imaging limitations for COVID-19 screening. Comparison of paired measurements for 100 pediatric patients showed that in the children subgroup above 37°C, BTT° exceeded body core temperature (Core°) in 60/72 patients; the average difference in the 72 patients was 0.62±0.7°C  (p<0.001 by unpaired t-test); and in the subgroup beyond 37.5°C, BTT° exceeded Core° in 30/32 patients. Delineating hypothalamic activity in children facilitates early infection detection, which is essential because children’s immunogenicity prevents effective vaccination and causes accelerated viral evolution. Capturing hypothalamic thermal signals from BTT was further supported by brain thermal kinetics via BTT using wearables during anesthesia, sedation, sleep, brain injury, exercise, and asymptomatic infection, which revealed brain/core discordance and enabled automated noninvasive afebrile infection detection for interrupting asymptomatic human-to-human transmission. BTT-based spot-check thermometry can be harmlessly implemented for children worldwide without undue burden and costs; meanwhile, continuous brain-eyelid T° in concert with biological and physical principles affords a new dimension for combating pandemics. The “detection–vaccination” pair solution presented is required to mitigate COVID-19 from spreading indefinitely through mutations and vaccine evasion while opening a viable path for eradicating COVID-19.